HB 1941

1	A bill to be entitled
2	An act relating to the licensure of health care providers;
3	creating pts. I, II, III, and IV of ch. 408, F.S.;
4	creating s. 408.801, F.S.; providing a popular name;
5	providing legislative findings and purpose; creating s.
6	408.802, F.S.; providing applicability; creating s.
7	408.803, F.S.; providing definitions; creating s. 408.804,
8	F.S.; requiring providers to have and display a license;
9	providing limitations; creating s. 408.805, F.S.;
10	establishing license fees; providing a method for
11	calculating annual adjustment of fees; creating s.
12	408.806, F.S.; providing a license application process;
13	requiring specified information to be included on the
14	application; requiring payment of late fees under certain
15	circumstances; requiring inspections; providing an
16	exception; authorizing the Agency for Health Care
17	Administration to establish procedures and rules for
18	electronic transmission of required information; creating
19	s. 408.807, F.S.; providing procedures for change of
20	ownership; requiring the transferor to notify the agency
21	in writing within a specified time period; providing for
22	duties and liability of the transferor; providing for
23	maintenance of records; creating s. 408.808, F.S.;
24	providing license categories and requirements therefor;
25	creating s. 408.809, F.S.; requiring background screening
26	of specified employees; providing for submission of proof
27	of compliance, under certain circumstances; providing
28	conditions for granting provisional and standard licenses;
29	providing an exception to screening requirements; creating
30	s. 408.810, F.S.; providing minimum licensure
31	requirements; providing procedures for discontinuance of
32	operation and surrender of license; requiring forwarding
33	of client records; requiring publication of a notice of
34	discontinuance of operation of a provider; providing
35	penalties; providing for statewide toll-free telephone
36	numbers for reporting complaints and abusive, neglectful,
37	and exploitative practices; requiring proof of legal right
38	to occupy property, proof of insurance, and proof of
39	financial viability, under certain circumstances;
40	requiring disclosure of information relating to financial
41	instability; providing a penalty; prohibiting the agency
42	from licensing a health care provider that does not have a
43	certificate of need or an exemption; creating s. 408.811,
44	F.S.; providing for inspections and investigations to
45	determine compliance; providing that inspection reports
46	are public records; requiring retention of records for a
47	specified period of time; creating s. 408.812, F.S.;
48	prohibiting certain unlicensed activity by a provider;
49	requiring unlicensed providers to cease activity;
50	providing penalties; requiring reporting of unlicensed
51	providers; creating s. 408.813, F.S.; authorizing the
52	agency to impose administrative fines; creating s.
53	408.814, F.S.; providing conditions for the agency to
54	impose a moratorium or emergency suspension on a provider;
55	requiring notice; creating s. 408.815, F.S.; providing
56	grounds for denial or revocation of a license or change-
57	of-ownership application; providing conditions to continue
58	operation; exempting renewal applications from provisions
59	requiring the agency to approve or deny an application
60	within a specified period of time, under certain
61	circumstances; creating s. 408.816, F.S.; authorizing the
62	agency to institute injunction proceedings, under certain
63	circumstances; creating s. 408.817, F.S.; providing basis
64	for review of administrative proceedings challenging
65	agency licensure enforcement action; creating s. 408.818,
66	F.S.; requiring fees and fines related to health care
67	licensing to be deposited into the Health Care Trust Fund;
68	creating s. 408.819, F.S.; authorizing the agency to adopt
69	rules; providing a timeframe for compliance; amending s.
70	112.0455, F.S.; providing applicability of licensure
71	requirements under pt. II of ch. 408, F.S., to drug-
72	testing laboratories; establishing fees for license
73	applications; amending ss. 381.0303 and 381.78, F.S.;
74	conforming cross references; amending ss. 383.301,
75	383.305, and 383.309, F.S.; providing applicability of
76	licensure requirements under pt. II of ch. 408, F.S., to
77	birth centers; repealing s. 383.304, F.S., relating to
78	licensure requirement for birth centers; amending s.
79	383.315, F.S.; revising a provision relating to birth
80	center consultation agreements; repealing s. 383.332,
81	F.S., relating to establishing, managing, or operating a
82	birth center without a license and penalties therefor;
83	amending s. 383.324, F.S.; conforming provisions relating
84	to inspections and investigations of birth centers to
85	changes made by the act; repealing s.. 383.325, F.S.,
86	relating to inspection reports; amending s. 383.33, F.S.,
87	relating to administrative fines, penalties, emergency
88	orders , and moratoriums on admissions; conforming
89	provisions to changes made by the act; repealing s.
90	383.331, F.S., relating to injunctive relief; amending s.
91	383.335, F.S., relating to partial exemptions; conforming
92	provisions to changes made by the act; amending s. 383.50,
93	F.S.; conforming a cross reference; amending s. 390.011,
94	F.S.; revising a definition; amending s. 390.012, F.S.,
95	relating to rulemaking power of the agency; conforming
96	provisions to changes made by the act; repealing s.
97	390.013, F.S., relating to effective date of rules
98	governing abortion clinics; amending s. 390.014, F.S.;
99	providing applicability of licensure requirements under
100	pt. II of ch. 408, F.S., to abortion clinics; increasing
101	fees for licensing of abortion clinics; repealing s.
102	390.015, F.S., relating to application for license to
103	operate an abortion clinic; repealing s. 390.016, F.S.,
104	relating to expiration and renewal of license; repealing
105	s. 390.017, F.S., relating to grounds for suspension or
106	revocation of license; amending s. 390.018, F.S.;
107	providing applicability of pt. II of ch. 408, F.S., to
108	administrative fines; repealing s. 390.019, F.S., relating
109	to inspections and investigations of abortion clinics;
110	repealing s. 390.021, F.S., relating to injunctive relief;
111	amending s. 393.501, F.S.; revising provisions relating to
112	rulemaking; amending s. 394.455, F.S.; revising a
113	definition; amending s. 394.4787, F.S.; conforming a cross
114	reference; amending s. 394.67, F.S.; deleting and revising
115	and providing definitions; conforming cross references;
116	amending ss. 394.74 and 394.82, F.S.; conforming cross
117	references; amending s. 394.875, F.S.; providing purpose
118	of short-term residential treatment facilities; providing
119	applicability of licensure requirements under pt. II of
120	ch. 408, F.S., to crisis stabilization units, short-term
121	residential treatment facilities, residential treatment
122	facilities, and residential treatment centers for children
123	and adolescents; providing an exemption from licensure
124	requirements for hospitals licensed under ch. 395, F.S.,
125	and certain programs operated therein; repealing s.
126	394.876, F.S., relating to license applications; amending
127	s. 394.877, F.S.; providing applicability of pt. II of ch.
128	408, F.S., to license fees; amending s. 394.878, F.S.,
129	relating to issuance and renewal of licenses; conforming
130	provisions to changes made by the act; amending s.
131	394.879, F.S.; providing for rulemaking authority;
132	conforming provisions to changes made by the act; amending
133	s. 394.90, F.S.; conforming provisions relating to
134	inspections of crisis stabilization units and residential
135	treatment facilities to changes made by the act; repealing
136	s. 394.902, F.S., relating to denial, suspension, and
137	revocation of licenses of certain mental health
138	facilities; amending s. 394.907, F.S., relating to access
139	to records of community mental health centers; providing
140	for the department to determine licensee compliance with
141	quality assurance programs; amending s. 395.002, F.S.;
142	deleting a definition; conforming cross references;
143	amending ss. 395.003, 395.004, and 395.0161, F.S.;
144	providing applicability of licensure requirements under
145	pt. II of ch. 408, F.S., to hospitals, ambulatory surgical
146	centers, and mobile surgical facilities; repealing s.
147	395.0055, F.S., relating to background screening;
148	repealing s. 395.0162, F.S., relating to inspection
149	reports; amending s. 395.0163, F.S.; revising provisions
150	relating to deposit of fees; conforming provisions to
151	changes made by the act; providing an exception to Florida
152	Building Code requirements for a licensed facility under
153	specified circumstances; amending s. 395.0191, F.S.;
154	requiring the presence of certain registered nurses in the
155	operating room of a facility licensed under ch. 395, F.S.,
156	during specified procedures; amending s. 395.0193, F.S.;
157	requiring that reports concerning disciplinary actions be
158	reported to the Department of Health and that final
159	disciplinary actions be reported to the Division of Health
160	Quality Assurance; conforming a cross reference; amending
161	s. 395.0197, F.S.; conforming a cross reference; amending
162	ss. 395.0199 and 395.1046, F.S.; providing applicability
163	of licensure requirements under pt. II of ch. 408, F.S.,
164	to health care utilization review and complaint
165	investigation procedures; amending s. 395.1055, F.S.;
166	providing applicability of licensure requirements under
167	pt. II of ch. 408, F.S., to adoption and enforcement of
168	rules; requiring the agency to enforce compliance with
169	provisions relating to specified immunizations; amending
170	ss. 395.1065, 395.10973, and 395.10974, F.S.; providing
171	applicability of licensure requirements under pt. II of
172	ch. 408, F.S., to administrative penalties and
173	injunctions, rulemaking, and health care risk managers;
174	amending ss. 395.602 and 395.701, F.S.; conforming cross
175	references; amending s. 400.021, F.S.; deleting
176	definitions; amending s. 400.022, F.S.; providing
177	applicability of licensure requirements under pt. II of
178	ch. 408, F.S., to grounds for action for a violation of
179	residents' rights; amending s. 400.051, F.S.; conforming a
180	cross reference; amending s. 400.062, F.S.; providing
181	applicability of licensure requirements under pt. II of
182	ch. 408, F.S., to nursing homes and related health care
183	facilities; revising provisions relating to license fees;
184	amending s. 400.063, F.S.; conforming a cross reference;
185	amending ss. 400.071 and 400.0712, F.S.; providing
186	applicability of licensure requirements under pt. II of
187	ch. 408, F.S., to license applications; amending s.
188	400.102, F.S.; providing applicability of licensure
189	requirements under pt. II of ch. 408, F.S., to grounds for
190	action by the agency against a licensee; amending s.
191	400.111, F.S.; providing applicability of licensure
192	requirements under pt. II of ch. 408, F.S.; requiring a
193	licensee to disclose certain holdings of a controlling
194	interest; amending s. 400.1183, F.S.; revising a provision
195	requiring facilities to report resident grievances to the
196	agency; amending s. 400.121, F.S., relating to denial,
197	suspension, and revocation of licenses and administrative
198	fines; conforming provisions to changes made by the act;
199	repealing s. 400.125, F.S., relating to injunction
200	proceedings; amending s. 400.141, F.S.; revising timeframe
201	for submission of information related to staffing
202	requirements and number of vacant beds in a facility;
203	conforming a cross reference; amending s. 400.162, F.S.;
204	providing for payment of a deceased resident's funeral
205	services under certain circumstances; amending s. 400.179,
206	F.S.; revising provisions relating to liability for
207	Medicaid underpayments and overpayments; conforming
208	provisions to changes made by the act; amending s. 400.18,
209	F.S.; revising provisions relating to the closing of a
210	nursing home facility; conforming provisions to changes
211	made by the act; amending s. 400.19, F.S.; providing
212	applicability of licensure requirements under pt. II of
213	ch. 408, F.S., to nursing home facility inspections;
214	revising a provision relating to a fine; amending s.
215	400.191, F.S.; authorizing the agency to provide
216	electronic access to inspection reports; requiring the
217	agency to publish the Nursing Home Guide in printed and
218	electronic formats and providing information to be
219	included therein; revising information to be included on
220	the agency Internet site; revising provisions relating to
221	availability of nursing home facility records; amending s.
222	400.20, F.S.; revising language relating to nursing home
223	administrators; amending s. 400.23, F.S.; providing
224	applicability of pt. II of ch. 408, F.S., to rulemaking
225	for nursing home facilities; providing an alternative to
226	nursing home room requirements under the Florida Building
227	Code; amending s. 400.241, F.S.; providing applicability
228	of licensure requirements under pt. II of ch. 408, F.S.,
229	to prohibited acts relating to establishment, operation,
230	or advertisement of nursing home facilities; amending s.
231	400.402, F.S.; revising and deleting definitions; amending
232	s. 400.407, F.S.; providing applicability of licensure
233	requirements under pt. II of ch. 408, F.S., to assisted
234	living facilities; conforming provisions to changes made
235	by the act; providing an exemption; amending s. 400.4075,
236	F.S.; providing applicability of licensure requirements
237	under pt. II of ch. 408, F.S., to limited mental health
238	licenses; amending s. 400.408, F.S., relating to penalties
239	imposed on unlicensed assisted living facilities;
240	conforming provisions to changes made by the act; amending
241	ss. 400.411, 400.412, 400.414, 400.417, and 400.4174,
242	F.S.; providing applicability of licensure requirements
243	under pt. II of ch. 408, F.S., to assisted living
244	facilities; conforming provisions to changes made by the
245	act; repealing s. 400.415, F.S., relating to a moratorium
246	on admissions and notice thereof; amending s. 400.4176,
247	F.S.; conforming provisions to changes made by the act;
248	amending s. 400.4178, F.S.; deleting provisions exempting
249	specified nursing home facilities from fees for training
250	and education programs relating to special care for
251	persons with Alzheimer's disease or other related
252	disorders; amending ss. 400.418 and 400.419, F.S.;
253	providing applicability of pt. II of ch. 408, F.S., to
254	provisions relating to disposition and imposition of fees
255	and fines collected under pt. III of ch. 400, F.S.;
256	conforming provisions to changes made by the act;
257	repealing s. 400.421, F.S., relating to injunctive
258	proceedings; amending s. 400.422, F.S.; conforming a cross
259	reference; amending s. 400.423, F.S.; transferring
260	rulemaking authority from the Department of Elderly
261	Affairs to the agency; amending s. 400.424, F.S.;
262	providing that fines on assisted living facilities for
263	failure to comply with certain refund provisions are not
264	subject to s. 400.419(3), F.S.; amending ss. 400.4255,
265	400.4256, 400.427, and 400.4275, F.S.; conforming
266	provisions to changes made by the act; amending s.
267	400.426, F.S.; conforming a cross reference; amending ss.
268	400.431 and 400.434, F.S.; providing applicability of
269	licensure requirements under pt. II of ch. 408, F.S., to
270	the closing of and right of entry and inspection of
271	assisted living facilities; amending s. 400.435, F.S.;
272	revising provisions relating to maintenance of records of
273	inspection reports for a specified period of time;
274	amending s. 400.441, F.S.; transferring rulemaking
275	authority from the Department of Elderly Affairs to the
276	agency; deleting provisions requiring submission of
277	proposed rules and a report to the Legislature; deleting a
278	fee for copies of rules and standards; conforming
279	provisions to changes made by the act; amending ss.
280	400.442 and 400.444, F.S.; conforming provisions to
281	changes made by the act; amending s. 400.447, F.S.;
282	providing applicability of licensure requirements under
283	pt. II of ch. 408, F.S., to prohibited acts and penalties
284	for violation of said requirements; repealing s. 400.451,
285	F.S., relating to compliance by existing facilities with
286	applicable rules and standards; amending ss. 400.452 and
287	400.454, F.S.; conforming provisions to changes made by
288	the act; amending ss. 400.464, 400.471, 400.474, and
289	400.484, F.S.; providing applicability of licensure
290	requirements under pt. II of ch. 408, F.S., to home health
291	agencies; amending s. 400.487, F.S.; revising contents of
292	home health service agreements; authorizing physician
293	assistants and advanced registered nurse practitioners to
294	establish treatment orders; amending s. 400.494, F.S.;
295	conforming provisions to changes made by the act; amending
296	ss. 400.495 and 400.497, F.S.; providing applicability of
297	licensure requirements under pt. II of ch. 408, F.S., to
298	the toll-free central abuse hotline and rules establishing
299	minimum standards for home health aides; amending s.
300	400.506, F.S.; providing applicability of licensure
301	requirements under pt. II of ch. 408, F.S., to nurse
302	registries; requiring a nurse registry to notify patients
303	or their families of the availability and costs of visits
304	by registered nurses; permitting physician assistants and
305	advanced registered nurse practitioners to sign a plan of
306	treatment; revising provisions relating to assessment of
307	costs related to certain investigations; amending s.
308	400.509, F.S.; providing applicability of pt. II of ch.
309	408, F.S., to the registration of companion or homemaker
310	service providers exempt from licensure; providing a fee
311	for registration; conforming provisions to changes made by
312	the act; amending s. 400.512, F.S.; conforming provisions
313	relating to the screening of home health agency, nurse
314	registry, companion, and homemaker personnel to changes
315	made by the act; repealing s. 400.515, F.S., relating to
316	injunction proceedings; amending s. 400.551, F.S.;
317	revising definitions; amending ss. 400.554, 400.555,
318	400.5565, 400.557, and 400.5572, F.S.; providing
319	applicability of licensure requirements under pt. II of
320	ch. 408, F.S., to adult day care centers; amending s.
321	400.556, F.S.; authorizing the agency to impose an
322	emergency action against an owner, operator, or employee
323	of an adult day care facility; revising grounds for action
324	by the agency against an owner, operator, or employee of
325	an adult day care facility; providing applicability of
326	licensure requirements under pt. II of ch. 408, F.S.;
327	repealing s. 400.5575, F.S., relating to disposition of
328	fees and fines; repealing s. 400.558, F.S., relating to
329	injunctive relief; amending ss. 400.559 and 400.56, F.S.;
330	providing applicability of licensure requirements under
331	pt. II of ch. 408, F.S., to the closing of and right of
332	entry and inspection of adult day care centers; amending
333	s. 400.562, F.S.; transferring rulemaking authority from
334	the Department of Elderly Affairs to the agency; deleting
335	a fee for copies of rules and standards; conforming
336	provisions to changes made by the act; repealing s.
337	400.564, F.S., relating to prohibited acts and penalties
338	therefor; amending ss. 400.602, 400.605, 400.606,
339	400.6065, and 400.607, F.S.; providing applicability of
340	licensure requirements under pt. II of ch. 408, F.S., to
341	hospices; conforming provisions to changes made by the
342	act; amending s. 400.6095, F.S.; conforming provisions
343	relating to rulemaking to changes made by the act;
344	amending ss. 400.617, 400.6211, and 400.625, F.S.;
345	conforming provisions relating to legislative intent and
346	purpose, rulemaking, training and education programs, and
347	residency agreements for adult family-care homes to
348	changes made by the act; amending ss. 400.619, 400.6194,
349	400.6196, and 400.621, F.S.; providing applicability of
350	licensure requirements under pt. II of ch. 408, F.S., to
351	adult family-care homes; repealing s. 400.622, F.S.,
352	relating to injunctive proceedings; amending s. 400.801,
353	F.S.; conforming provisions relating to homes for special
354	services to changes made by the act; providing a fee;
355	amending s. 400.805, F.S.; providing applicability of
356	licensure requirements under pt. II of ch. 408, F.S., to
357	transitional living facilities; providing a fee; amending
358	s. 400.902, F.S.; revising a definition; amending ss.
359	400.903, 400.905, 400.907, and 400.908, F.S.; providing
360	applicability of licensure requirements under pt. II of
361	ch. 408, F.S., to prescribed pediatric extended care
362	centers; repealing s. 400.906, F.S., relating to initial
363	application for a license; repealing s. 400.910, F.S.,
364	relating to expiration or renewal of a license and
365	conditional licenses; repealing s. 400.911, F.S., relating
366	to injunction proceedings; amending s. 400.912, F.S.;
367	conforming provisions relating to the closing of a
368	prescribed pediatric extended care center to changes made
369	by the act; repealing s. 400.913, F.S., relating to right
370	of entry and inspection; amending ss. 400.914 and 400.915,
371	F.S.; providing applicability of licensure requirements
372	under pt. II of ch. 408, F.S., to rules establishing
373	standards for and requirements for construction and
374	renovation of prescribed pediatric extended care centers;
375	repealing s. 400.916, F.S., relating to penalties for
376	prohibited acts; repealing s. 400.917, F.S., relating to
377	disposition of moneys from fines and fees; amending s.
378	400.925, F.S.; deleting and revising definitions; amending
379	ss. 400.93, 400.931, 400.932, 400.933, and 400.935, F.S.;
380	providing applicability of licensure requirements under
381	pt. II of ch. 408, F.S., to home medical equipment
382	providers; repealing s. 400.95, F.S., relating to notice
383	of toll-free telephone number for the central abuse
384	hotline; amending ss. 400.953 and 400.955, F.S.; revising
385	provisions relating to background screening of home
386	medical equipment provider personnel; repealing s.
387	400.956, F.S., relating to injunction proceedings;
388	amending s. 400.960, F.S.; deleting and revising
389	definitions; amending s. 400.962, F.S.; providing
390	applicability of licensure requirements under pt. II of
391	ch. 408, F.S., to intermediate care facilities for persons
392	with developmental disabilities; providing a fee;
393	repealing s. 400.963, F.S., relating to injunctive
394	proceedings; repealing s. 400.965, F.S., relating to
395	grounds for actions by the agency against the licensee;
396	amending s. 400.967, F.S.; providing applicability of
397	licensure requirements under pt. II of ch. 408, F.S., to
398	intermediate care facilities for persons with
399	developmental disabilities; requiring facilities to adhere
400	to the Bill of Rights of Persons Who are Developmentally
401	Disabled; amending s. 400.968, F.S.; conforming provisions
402	relating to injunctive proceedings and a moratorium on
403	admissions to changes made by the act; amending s.
404	400.9685, F.S.; conforming language to changes made by the
405	act; amending s. 400.969, F.S.; providing applicability of
406	pt. II of ch. 408, F.S., to penalties relating to
407	intermediate care facilities for persons with
408	developmental disabilities; amending s. 400.980, F.S.;
409	providing applicability of licensure requirements under
410	pt. II of ch. 408, F.S., to health care services pools;
411	amending ss. 400.991, 400.9915, 400.9925, 400.993, and
412	400.9935, F.S.; providing applicability of licensure
413	requirements under pt. II of ch. 408, F.S., to health care
414	clinics; providing a fee; repealing s. 400.992, F.S.,
415	relating to license renewal, transfer of ownership, and
416	provisional licenses; repealing s. 400.994, F.S., relating
417	to injunctive proceedings; repealing s. 400.9945, F.S.,
418	relating to agency actions; amending s. 400.995, F.S.;
419	conforming provisions relating to agency administrative
420	penalties to changes made by the act; amending s. 401.265,
421	F.S.; requiring license requirements for emergency medical
422	technicians and paramedics; amending s. 408.831, F.S.;
423	revising provisions relating to agency action to deny,
424	suspend, or revoke a license, registration, certificate,
425	or application; amending s. 440.102, F.S.; providing
426	applicability of licensure requirements under pt. II of
427	ch. 408, F.S., to drug testing standards for laboratories;
428	amending s. 464.015, F.S.; providing restrictions on the
429	use of the title "Certified Registered Nurse Anesthetist";
430	amending s. 464.016, F.S.; providing a penalty for misuse
431	of the title "Certified Registered Nurse Anesthetist";
432	amending ss. 483.035, 483.051, 483.061, 483.091, 483.101,
433	483.111, 483.172, 483.201, 483.221, and 483.23, F.S.;
434	providing applicability of licensure requirements under
435	pt. II of ch. 408, F.S., to clinical laboratories;
436	repealing s. 483.131, F.S., relating to the display of a
437	license; repealing s. 483.25, F.S., relating to injunctive
438	proceedings; amending ss. 483.291, 483.294, 483.30,
439	483.302, 483.317, 483.32, and 483.322, F.S.; providing
440	applicability of licensure requirements under pt. II of
441	ch. 408, F.S., to multiphasic health testing centers;
442	repealing s. 483.311, F.S., relating to the display of a
443	license; repealing s. 483.328, F.S., relating to
444	injunctive relief; amending s. 765.541, F.S.; conforming
445	provisions relating to cadaveric organ and tissue
446	procurement to changes made by the act; amending s.
447	765.542, F.S.; providing applicability of licensure
448	requirements under pt. II of ch. 408, F.S., to organ
449	procurement organizations and tissue and eye banks;
450	amending s. 765.544, F.S.; conforming provisions relating
451	to application fees from organizations and tissue and eye
452	banks to changes made by the act; amending ss. 402.164,
453	409.815, 409.905, 409.907, 468.505, 483.106, 766.118,
454	766.316, and 812.014, F.S.; conforming cross references;
455	providing for priority of application in case of conflict;
456	transferring rules adopted by the Department of Elderly
457	Affairs under pts. III, V, VI, and VII of ch. 400, F.S.,
458	to the agency; authorizing the agency to issue licenses
459	for less than a specified time period and providing
460	conditions therefor; providing an effective date.
461
462	Be It Enacted by the Legislature of the State of Florida:
463
464	Section 1.  Part I of chapter 408, Florida Statutes,
465	consisting of sections 408.031, 408.032, 408.033, 408.034,
466	408.035, 408.036, 408.0361, 408.037, 408.038, 408.039, 408.040,
467	408.041, 408.042, 408.043, 408.044, 408.045, 408.0455, 408.05,
468	408.061, 408.062, 408.063, 408.07, 408.08, 408.09, 408.10,
469	408.15, 408.16, 408.18, 408.185, 408.20, 408.301, 408.302,
470	408.40, 408.50, 408.70, 408.7056, 408.7057, and 408.7071,
471	Florida Statutes, is created and entitled "Health Facility and
472	Services Planning."
473	Section 2.  Part II of chapter 408, Florida Statutes,
474	consisting of sections 408.801, 408.802, 408.803, 408.804,
475	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
476	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
477	408.819, and 408.831, Florida Statutes, is created and entitled
478	"Health Care Licensing: General Provisions."
479	Section 3.  Part III of chapter 408, Florida Statutes,
480	consisting of sections 408.90, 408.901, 408.902, 408.903,
481	408.904, 408.905, 408.906, 408.907, 408.908, and 408.909,
482	Florida Statutes, is created and entitled "Health Insurance
483	Access."
484	Section 4.  Part IV of chapter 408, Florida Statutes,
485	consisting of sections 408.911, 408.913, 408.914, 408.915,
486	408.916, 408.917, and 408.918, Florida Statutes, is created and
487	entitled "Health and Human Services Eligibility Access System."
488	Section 5.  Sections 408.801, 408.802, 408.803, 408.804,
489	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
490	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
491	and 408.819, Florida Statutes, are created to read:
492	408.801  Popular name; purpose.--
493	(1)  This part may be cited as the "Health Care Licensing
494	Procedures Act."
495	(2)  The Legislature finds that there is unnecessary
496	duplication and variation in the requirements for licensure by
497	the Agency for Health Care Administration brought about by the
498	historical pattern of legislative action focused exclusively on
499	a single type of regulated provider. It is the intent of the
500	Legislature to provide a streamlined and consistent set of basic
501	licensing requirements for all such providers in order to
502	minimize confusion, standardize terminology, and include issues
503	that are otherwise not adequately addressed in the Florida
504	Statutes pertaining to specific providers.
505	408.802  Applicability.--The provisions of this part apply
506	to the provision of services that require licensure as defined
507	in this part and to the following entities licensed, registered,
508	or certified by the Agency for Health Care Administration, as
509	described in chapters 112, 383, 390, 394, 395, 400, 440, 483,
510	and 765:
511	(1)  Laboratories authorized to perform testing under the
512	Drug-Free Workplace Act, as provided under ss. 112.0455 and
513	440.102.
514	(2)  Birth centers, as provided under chapter 383.
515	(3)  Abortion clinics, as provided under chapter 390.
516	(4)  Crisis stabilization units, as provided under parts I
517	and IV of chapter 394.
518	(5)  Short-term residential treatment facilities, as
519	provided under parts I and IV of chapter 394.
520	(6)  Residential treatment facilities, as provided under
521	part IV of chapter 394.
522	(7)  Residential treatment centers for children and
523	adolescents, as provided under part IV of chapter 394.
524	(8)  Hospitals, as provided under part I of chapter 395.
525	(9)  Ambulatory surgical centers, as provided under part I
526	of chapter 395.
527	(10)  Mobile surgical facilities, as provided under part I
528	of chapter 395.
529	(11)  Private review agents, as provided under part I of
530	chapter 395.
531	(12)  Health care risk managers, as provided under part I
532	of chapter 395.
533	(13)  Nursing homes, as provided under part II of chapter
534	400.
535	(14)  Assisted living facilities, as provided under part
536	III of chapter 400.
537	(15)  Home health agencies, as provided under part IV of
538	chapter 400.
539	(16)  Nurse registries, as provided under part IV of
540	chapter 400.
541	(17)  Companion services or homemaker services providers,
542	as provided under part IV of chapter 400.
543	(18)  Adult day care centers, as provided under part V of
544	chapter 400.
545	(19)  Hospices, as provided under part VI of chapter 400.
546	(20)  Adult family-care homes, as provided under part VII
547	of chapter 400.
548	(21)  Homes for special services, as provided under part
549	VIII of chapter 400.
550	(22)  Transitional living facilities, as provided under
551	part VIII of chapter 400.
552	(23)  Prescribed pediatric extended care centers, as
553	provided under part IX of chapter 400.
554	(24)  Home medical equipment providers, as provided under
555	part X of chapter 400.
556	(25)  Intermediate care facilities for persons with
557	developmental disabilities, as provided under part XI of chapter
558	400.
559	(26)  Health care services pools, as provided under part
560	XII of chapter 400.
561	(27)  Health care clinics, as provided under part XIII of
562	chapter 400.
563	(28)  Clinical laboratories, as provided under part I of
564	chapter 483.
565	(29)  Multiphasic health testing centers, as provided under
566	part II of chapter 483.
567	(30)  Organ and tissue procurement agencies, as provided
568	under chapter 765.
569	408.803  Definitions.--As used in this part, the term:
570	(1)  "Agency" means the Agency for Health Care
571	Administration, which is the licensing agency under this part.
572	(2)  "Applicant" means an individual, corporation,
573	partnership, firm, association, or governmental entity that
574	submits an application to the agency for a license.
575	(3)  "Authorizing statute" means the statute authorizing
576	the licensed operation of a provider listed in s. 408.802,
577	including chapters 112, 383, 390, 394, 395, 400, 440, 483, and
578	765.
579	(4)  "Certification" means certification as a Medicare or
580	Medicaid provider of the services that require licensure or
581	certification pursuant to the federal Clinical Laboratory
582	Improvement Amendment (CLIA).
583	(5)  "Change in ownership" means an event in which the
584	licensee changes to a different legal entity or in which 45
585	percent or more of the ownership, voting shares, or interest in
586	a corporation whose shares are not publicly traded on a
587	recognized stock exchange is transferred or assigned, including
588	the final transfer or assignment of multiple transfers or
589	assignments over a 2-year period that cumulatively total 45
590	percent or greater. However, a change solely in the management
591	company is not a change of ownership.
592	(6)  "Client" means any person receiving services from a
593	provider listed in s. 408.802.
594	(7)  "Controlling interest" means:
595	(a)  The applicant or licensee;
596	(b)  A person or entity that serves as an officer of, is on
597	the board of directors of, or has a 5 percent or greater
598	ownership interest in the applicant or licensee; or
599	(c)  A person or entity that serves as an officer of, is on
600	the board of directors of, or has a 5 percent or greater
601	ownership interest in the management company or other entity,
602	related or unrelated, with which the applicant or licensee
603	contracts to manage the provider.
604
605	The term does not include a voluntary board member.
606	(8)  "License" means any permit, registration, certificate,
607	or license issued by the agency.
608	(9)  "Licensee" means an individual, corporation,
609	partnership, firm, association, or governmental entity that is
610	issued a permit, registration, certificate, or license by the
611	agency. The licensee is legally responsible for all aspects of
612	the provider operation.
613	(10)  "Moratorium" means a prohibition on the acceptance of
614	new clients.
615	(11)  "Provider" means any activity, service, agency, or
616	facility regulated by the agency and listed in s. 408.802.
617	(12)  "Services that require licensure" means those
618	services, including residential services, that require a valid
619	license before those services may be provided in accordance with
620	authorizing statutes and agency rules.
621	(13)  "Voluntary board member" means a board member of a
622	not-for-profit corporation or organization who serves solely in
623	a voluntary capacity, does not receive any remuneration for his
624	or her services on the board of directors, and has no financial
625	interest in the corporation or organization. The agency shall
626	recognize a person as a voluntary board member following
627	submission of a statement to the agency by the board member and
628	the not-for-profit corporation or organization that affirms that
629	the board member conforms to this definition. The statement
630	affirming the status of the board member must be submitted to
631	the agency on a form provided by the agency.
632	408.804  License required; display.--
633	(1)  It is unlawful to provide services that require
634	licensure, or operate or maintain a provider that offers or
635	provides services that require licensure, without first
636	obtaining from the agency a license authorizing the provision of
637	such services or the operation or maintenance of such provider.
638	(2)  A license must be displayed in a conspicuous place
639	readily visible to clients who enter at the address that appears
640	on the license and is valid only in the hands of the licensee to
641	whom it is issued and may not be sold, assigned, or otherwise
642	transferred, voluntarily or involuntarily. The license is valid
643	only for the licensee, provider, and location for which the
644	license is issued.
645	408.805  Fees required; adjustments.--Unless otherwise
646	limited by authorizing statutes, license fees must be reasonably
647	calculated by the agency to cover its costs in carrying out its
648	responsibilities under this part, authorizing statutes, and
649	applicable rules, including the cost of licensure, inspection,
650	and regulation of providers.
651	(1)  Licensure fees shall be adjusted to provide for
652	biennial licensure in agency rules.
653	(2)  The agency shall annually adjust licensure fees,
654	including fees paid per bed, by not more than the change in the
655	Consumer Price Index based on the 12 months immediately
656	preceding the increase.
657	(3)  The agency may, by rule, adjust licensure fees to
658	cover the cost of administering this part, authorizing statutes,
659	and applicable rules.
660	(4)  An inspection fee must be paid as required in
661	authorizing statutes.
662	(5)  Fees are nonrefundable.
663	(6)  When a change is reported that requires issuance of a
664	license, a fee may be assessed. The fee must be based on the
665	actual cost of processing and issuing the license.
666	(7)  A fee may be charged to a licensee requesting a
667	duplicate license. The fee may not exceed the actual cost of
668	duplication and postage.
669	(8)  Total fees collected may not exceed the cost of
670	administering this part, authorizing statutes, and applicable
671	rules.
672	408.806  License application process.--
673	(1)  An application for licensure must be made to the
674	agency on forms furnished by the agency, submitted under oath,
675	and accompanied by the appropriate fee in order to be accepted
676	and considered timely. The application must contain information
677	required by authorizing statutes and applicable rules and must
678	include:
679	(a)  The name, address, and social security number of the
680	applicant and each controlling interest if the applicant or
681	controlling interest is an individual.
682	(b)  The name, address, and federal employer identification
683	number or taxpayer identification number of the applicant and
684	each controlling interest if the applicant or controlling
685	interest is not an individual.
686	(c)  The name by which the provider is to be known.
687	(d)  The total number of beds or capacity requested, as
688	applicable.
689	(e)  The following information regarding the location of
690	the provider for which the application is made:
691	1.  A report or letter from the zoning authority indicating
692	that the location is zoned appropriately for its use. If the
693	provider is a community residential home under chapter 419, the
694	zoning requirement must be satisfied by proof of compliance with
695	chapter 419. The zoning report or letter is not required for a
696	renewal application if the provider location did not change
697	since the date on which the most recent license was issued.
698	2.  A satisfactory fire safety report from the local
699	authority having jurisdiction or the state fire marshal.
700	(f)  The name of the person or persons under whose
701	management or supervision the provider will be operated and the
702	name of the administrator, if required.
703	(g)  If the applicant offers continuing care agreements as
704	defined in chapter 651, proof shall be furnished that the
705	applicant has obtained a certificate of authority as required
706	for operation under chapter 651.
707	(h)  Other information, including satisfactory inspection
708	results, that the agency finds necessary to determine the
709	ability of the applicant to carry out its responsibilities under
710	this part, authorizing statutes, and applicable rules.
711	(2)(a)  The applicant for a renewal license must submit an
712	application that must be received by the agency at least 60 days
713	prior to the expiration of the current license.
714	(b)  The applicant for initial licensure due to a change of
715	ownership must submit an application that must be received by
716	the agency at least 60 days prior to the date of change of
717	ownership.
718	(c)  For any other application or request, the applicant
719	must submit an application or request that must be received by
720	the agency at least 60 days prior to the requested effective
721	date, unless otherwise specified in authorizing statutes or
722	rules.
723	(d)  The agency shall notify the licensee by mail or
724	electronically at least 90 days prior to the expiration of a
725	license that a renewal license is necessary to continue
726	operation. The failure to timely file an application and submit
727	a license fee shall result in a late fee charged to the licensee
728	by the agency in an amount equal to 50 percent of the licensure
729	fee but in no event shall the aggregate amount of the fine
730	exceed $5,000. If an application is received after the required
731	filing date and exhibits a hand-canceled postmark obtained from
732	a United States Post Office dated on or before the required
733	filing date, no fine will be levied.
734	(3)(a)  Upon receipt of an application for a license, the
735	agency shall examine the application and, within 30 days after
736	receipt, notify the applicant in writing of any apparent errors
737	or omissions and request any additional information required.
738	(b)  Requested information omitted from an application for
739	licensure, license renewal, or change of ownership, other than
740	an inspection, must be filed with the agency within 21 days
741	after the agency's request for omitted information or the
742	application shall be deemed incomplete and shall be withdrawn
743	from further consideration and the fees shall be forfeited.
744	(c)  Within 60 days after the receipt of a complete
745	application, the agency shall approve or deny the application.
746	(4)(a)  Licensees subject to the provisions of this part
747	shall be issued biennial licenses unless conditions of the
748	license category specify a shorter license period.
749	(b)  Each license issued shall indicate the name of the
750	licensee, the type of provider or service that the licensee is
751	required or authorized to operate or offer, the date the license
752	is effective, the expiration date of the license, the maximum
753	capacity of the licensed premises, if applicable, and any other
754	information required or deemed necessary by the agency.
755	(5)  In accordance with authorizing statutes and applicable
756	rules, proof of compliance with s. 408.810 must be submitted
757	with an application for licensure.
758	(6)  The agency may not issue an initial license to a
759	health care provider subject to the certificate-of-need
760	provisions in part I of this chapter if the licensee has not
761	been issued a certificate of need or certificate-of-need
762	exemption, when applicable. Failure to apply for the renewal of
763	a license prior to the expiration date renders the license null
764	and void and the former licensee may not be issued a new license
765	unless the licensee reapplies for an initial license and meets
766	all current qualifications for licensure, including construction
767	standards for facilities, where applicable, and complies with
768	certificate-of-need requirements if the applicant is subject to
769	the provisions of part I of this chapter.
770	(7)(a)  An applicant must demonstrate compliance with the
771	requirements in this part, authorizing statutes, and applicable
772	rules during an inspection pursuant to s. 408.811, as required
773	by authorizing statutes.
774	(b)  An initial inspection is not required for companion
775	services or homemaker services providers, as provided under part
776	IV of chapter 400, or for health care services pools, as
777	provided under part XII of chapter 400.
778	(c)  If an inspection is required by the authorizing
779	statute for a license application other than an initial
780	application, the inspection must be unannounced. This paragraph
781	does not apply to inspections required pursuant to ss. 383.324,
782	395.0161(4), and 483.061(2).
783	(d)  If a provider is not available when an inspection is
784	attempted, the application shall be denied.
785	(8)  The agency may establish procedures for the electronic
786	submission of required information, including, but not limited
787	to:
788	(a)  Licensure applications.
789	(b)  Required signatures.
790	(c)  Payment of fees.
791	(d)  Notarization of applications.
792
793	Requirements for electronic submission of any documents required
794	by this part or authorizing statutes may be established by rule.
795	408.807  Change of ownership.--Whenever a change of
796	ownership occurs:
797	(1)  The transferor shall notify the agency in writing at
798	least 60 days before the anticipated date of the change of
799	ownership.
800	(2)  The transferee shall make application to the agency
801	for a license within the timeframes required in s. 408.806.
802	(3)  The transferor shall be responsible and liable for:
803	(a)  The lawful operation of the provider and the welfare
804	of the clients served until the date the transferee is licensed
805	by the agency.
806	(b)  Any and all penalties imposed against the transferor
807	for violations occurring before the date of change of ownership.
808	(4)  Any restriction on licensure, including a conditional
809	license existing at the time of a change of ownership, shall
810	remain in effect until removed by the agency.
811	(5)  The transferee shall maintain records of the
812	transferor as required in this part, authorizing statutes, and
813	applicable rules, including:
814	(a)  All client records.
815	(b)  Inspection reports.
816	(c)  All records required to be maintained pursuant to s.
817	409.913, if applicable.
818	408.808  License categories.--
819	(1)  STANDARD LICENSE.--A standard license may be issued to
820	an applicant at the time of initial licensure, license renewal,
821	or change of ownership. A standard license shall be issued when
822	the applicant is in compliance with all statutory requirements
823	and agency rules. Unless sooner revoked, a standard license
824	expires 2 years after the date of issue.
825	(2)  PROVISIONAL LICENSE.--A provisional license may be
826	issued to an applicant pursuant to s. 408.809(3). An applicant
827	against whom a proceeding denying or revoking a license is
828	pending at the time of license renewal may be issued a
829	provisional license effective until final disposition by the
830	agency of the proceeding. If judicial relief is sought under
831	this section, the court having jurisdiction may issue such
832	orders regarding the issuance of a provisional license during
833	the pendency of the judicial proceeding.
834	(3)  INACTIVE LICENSE.--An inactive license may be issued
835	to a health care provider subject to the certificate-of-need
836	provisions in part I of this chapter when the provider is
837	currently licensed, does not have a provisional license, and
838	will be temporarily unable to provide services but is reasonably
839	expected to resume services within 12 months. Such designation
840	may be made for a period not to exceed 12 months but may be
841	renewed by the agency for up to 6 additional months upon
842	demonstration by the licensee of the provider's progress toward
843	reopening. A request by a licensee for an inactive license or to
844	extend the previously approved inactive period must be submitted
845	to the agency and include a written justification for the
846	inactive license with the beginning and ending dates of
847	inactivity specified, a plan for the transfer of any clients to
848	other providers, and the appropriate licensure fees. The agency
849	may not accept a request that is submitted after initiating
850	closure, after any suspension of service, or after notifying
851	clients of closure or suspension of service. Upon agency
852	approval, the provider shall notify clients of any necessary
853	discharge or transfer as required by authorizing statutes or
854	applicable rules. The beginning of the inactive license period
855	is the date the provider ceases operations. The end of the
856	inactive license period shall become the license expiration
857	date. All licensure fees must be current, must be paid in full,
858	and may be prorated. Reactivation of an inactive license
859	requires the approval of a renewal application, including
860	payment of licensure fees and agency inspections indicating
861	compliance with all requirements of this part, authorizing
862	statutes, and applicable rules.
863	(4)  OTHER LICENSES.--Other types of license categories may
864	be issued pursuant to authorizing statutes or applicable rules.
865	408.809  Background screening; prohibited offenses.--
866	(1)  Level 2 background screening pursuant to chapter 435
867	must be conducted through the agency on each of the following
868	persons, who shall be considered an employee for the purposes of
869	conducting screening under chapter 435:
870	(a)  The licensee, if an individual.
871	(b)  The administrator or a similarly titled person who is
872	responsible for the day-to-day operation of the provider.
873	(c)  The financial officer or similarly titled individual
874	who is responsible for the financial operation of the licensee
875	or provider.
876	(d)  Any person who is a controlling interest if the agency
877	has reason to believe that such person has been convicted of any
878	offense prohibited by s. 435.04. For each controlling interest
879	who has been convicted of any such offense, the licensee shall
880	submit to the agency a description and explanation of the
881	conviction at the time of license application.
882	(2)  Proof of compliance with level 2 screening standards
883	submitted within the previous 5 years to meet any provider or
884	professional licensure requirements of the agency, the
885	Department of Health, the Agency for Persons with Disabilities,
886	or the Department of Children and Family Services satisfies the
887	requirements of this section, provided that such proof is
888	accompanied, under penalty of perjury, by an affidavit of
889	compliance with the provisions of chapter 435 using forms
890	provided by the agency. Proof of compliance with the background
891	screening requirements of the Department of Financial Services
892	submitted within the previous 5 years for an applicant for a
893	certificate of authority to operate a continuing care retirement
894	community under chapter 651 satisfies the Department of Law
895	Enforcement and Federal Bureau of Investigation portions of a
896	level 2 background check.
897	(3)  A provisional license may be granted to an applicant
898	when each individual required by this section to undergo
899	background screening has met the standards for the Department of
900	Law Enforcement background check but the agency has not yet
901	received background screening results from the Federal Bureau of
902	Investigation. A standard license may be granted to the licensee
903	upon the agency's receipt of a report of the results of the
904	Federal Bureau of Investigation background screening for each
905	individual required by this section to undergo background
906	screening that confirms that all standards have been met or upon
907	the granting of an exemption from disqualification by the agency
908	as set forth in chapter 435.
909	(4)  When a change of any person required to be screened
910	under this section occurs, the licensee must notify the agency
911	of the change within the time period specified in the
912	authorizing statute or rules and must submit to the agency
913	information necessary to conduct level 2 screening or provide
914	evidence of compliance with background screening requirements of
915	this section. The person may serve in his or her capacity
916	pending the agency's receipt of the report from the Federal
917	Bureau of Investigation if he or she has met the standards for
918	the Department of Law Enforcement background check. However, the
919	person may not continue to serve if the report indicates any
920	violation of background screening standards unless an exemption
921	from disqualification has been granted by the agency as set
922	forth in chapter 435.
923	(5)  Background screening is not required to obtain a
924	certificate of exemption issued under s. 483.106.
925	408.810  Minimum licensure requirements.--In addition to
926	the licensure requirements specified in this part, authorizing
927	statutes, and applicable rules, each applicant and licensee must
928	comply with the requirements of this section in order to obtain
929	and maintain a license.
930	(1)  An applicant for licensure must comply with the
931	background screening requirements of s. 408.809.
932	(2)  An applicant for licensure must provide a description
933	and explanation of any exclusions, suspensions, or terminations
934	of the applicant from the Medicare, Medicaid, or federal
935	Clinical Laboratory Improvement Amendment (CLIA) programs.
936	(3)  Unless otherwise specified in this part, authorizing
937	statutes, or applicable rules, any information required to be
938	reported to the agency must be submitted within 21 calendar days
939	after the report period or effective date of the information.
940	(4)  Whenever a licensee discontinues operation of a
941	provider:
942	(a)  The licensee must inform the agency not less than 30
943	days prior to the discontinuance of operation and inform clients
944	of discharge as required by authorizing statutes. Immediately
945	upon discontinuance of operation of a provider, the licensee
946	shall surrender the license to the agency and the license shall
947	be canceled.
948	(b)  Upon closure of a provider, the licensee shall remain
949	responsible for retaining and appropriately distributing all
950	records within the timeframes prescribed in authorizing statutes
951	and applicable rules. In addition, the licensee or, in the event
952	of death or dissolution of a licensee, the estate or agent of
953	the licensee shall:
954	1.  Make arrangements to forward records for each client to
955	one of the following, based upon the client's choice: the client
956	or the client's legal representative, the client's attending
957	physician, or the health care provider where the client
958	currently receives services; or
959	2.  Cause a notice to be published in the newspaper of
960	greatest general circulation in the county where the provider
961	was located that advises clients of the discontinuance of the
962	provider operation. The notice must inform clients that they may
963	obtain copies of their records and specify the name, address,
964	and telephone number of the person from whom the copies of
965	records may be obtained. The notice must appear at least once a
966	week for 4 consecutive weeks. Failure to comply with this
967	paragraph is a misdemeanor of the second degree, punishable as
968	provided in s. 775.082 or s. 775.083.
969	(5)(a)  On or before the first day services are provided to
970	a client, a licensee must inform the client and his or her
971	immediate family or representative, if appropriate, of the right
972	to report:
973	1.  Complaints. The statewide toll-free telephone number
974	for reporting complaints to the agency must be provided to
975	clients in a manner that is clearly legible and must include the
976	words: "To report a complaint regarding the services you
977	receive, please call toll-free (phone number)."
978	2.  Abusive, neglectful, or exploitative practices. The
979	statewide toll-free telephone number for the central abuse
980	hotline must be provided to clients in a manner that is clearly
981	legible and must include the words: "To report abuse, neglect,
982	or exploitation, please call toll-free (phone number)." The
983	agency shall publish a minimum of a 90-day advance notice of a
984	change in the toll-free telephone numbers.
985	(b)  Each licensee shall establish appropriate policies and
986	procedures for providing such notice to clients.
987	(6)  An applicant must provide the agency with proof of the
988	applicant's legal right to occupy the property before a license
989	may be issued. Proof may include, but need not be limited to,
990	copies of warranty deeds, lease or rental agreements, contracts
991	for deeds, quitclaim deeds, or other such documentation.
992	(7)  If proof of insurance is required by the authorizing
993	statute, that insurance must be in compliance with chapter 624,
994	chapter 626, chapter 627, or chapter 628 and with agency rules.
995	(8)  Upon application for initial licensure or change-of-
996	ownership licensure, the applicant shall furnish satisfactory
997	proof of the applicant's financial ability to operate in
998	accordance with the requirements of this part, authorizing
999	statutes, and applicable rules. The agency shall establish
1000	standards for this purpose, including information concerning the
1001	applicant's controlling interests. The agency shall also
1002	establish documentation requirements, to be completed by each
1003	applicant, that show anticipated provider revenues and
1004	expenditures, the basis for financing the anticipated cash-flow
1005	requirements of the provider, and an applicant's access to
1006	contingency financing. A current certificate of authority,
1007	pursuant to chapter 651, may be provided as proof of financial
1008	ability to operate. The agency may require a licensee to provide
1009	proof of financial ability to operate at any time if there is
1010	evidence of financial instability, including, but not limited
1011	to, unpaid expenses necessary for the basic operations of the
1012	provider.
1013	(9)  A controlling interest may not withhold from the
1014	agency any evidence of financial instability of a licensed
1015	provider, including, but not limited to, checks returned due to
1016	insufficient funds, delinquent accounts, nonpayment of
1017	withholding taxes, unpaid utility expenses, nonpayment for
1018	essential services, or adverse court action concerning the
1019	financial viability of the provider or any other provider
1020	licensed under this part that is under the control of the
1021	controlling interest. Any person who violates this subsection
1022	commits a misdemeanor of the second degree, punishable as
1023	provided in s. 775.082 or s. 775.083. Each day of continuing
1024	violation is a separate offense.
1025	(10)  The agency may not issue a license to a health care
1026	provider subject to the certificate-of-need provisions in part I
1027	of this chapter if the health care provider has not been issued
1028	a certificate of need or an exemption. Upon initial licensure of
1029	any such provider, the authorization contained in the
1030	certificate of need shall be considered fully implemented and
1031	merged into the license and shall have no force and effect upon
1032	termination of the license for any reason.
1033	408.811  Right of inspection; copies; inspection reports.--
1034	(1)  An authorized officer or employee of the agency may
1035	make or cause to be made any inspection or investigation deemed
1036	necessary by the agency to determine the state of compliance
1037	with this part, authorizing statutes, and applicable rules. The
1038	right of inspection extends to any business that the agency has
1039	reason to believe is being operated as a provider without a
1040	license, but inspection of any business suspected of being
1041	operated without the appropriate license may not be made without
1042	the permission of the owner or person in charge unless a warrant
1043	is first obtained from a circuit court. Any application for a
1044	license issued under this part, authorizing statutes, or
1045	applicable rules constitutes permission for an appropriate
1046	inspection to verify the information submitted on or in
1047	connection with the application.
1048	(a)  All inspections shall be unannounced, except as
1049	specified in s. 408.806.
1050	(b)  Inspections for relicensure shall be conducted
1051	biennially unless otherwise specified by authorizing statutes or
1052	applicable rules.
1053	(2)  Inspections conducted in conjunction with
1054	certification may be accepted in lieu of a complete licensure
1055	inspection.  However, a licensure inspection may also be
1056	conducted to review any licensure requirements that are not also
1057	requirements for certification.
1058	(3)  The agency shall have access to and the licensee shall
1059	provide copies of all provider records required during an
1060	inspection at no cost to the agency.
1061	(4)(a)  Each licensee shall maintain as public information,
1062	available upon request, records of all inspection reports
1063	pertaining to that provider that have been filed by the agency
1064	unless those reports are exempt from or contain information that
1065	is exempt from s. 119.07(1) or is otherwise made confidential by
1066	law. Effective October 1, 2005, copies of such reports shall be
1067	retained in the records of the provider for at least 3 years
1068	following the date the reports are filed and issued, regardless
1069	of a change of ownership.
1070	(b)  A licensee shall, upon the request of any person who
1071	has completed a written application with intent to be admitted
1072	by such provider, any person who is a client of such provider,
1073	or any relative, spouse, or guardian of any such person, furnish
1074	to the requester a copy of the last inspection report pertaining
1075	to the licensed provider that was issued by the agency or by an
1076	accrediting organization if such report is used in lieu of a
1077	licensure inspection.
1078	408.812  Unlicensed activity.--
1079	(1)  A person or entity may not offer or advertise services
1080	that require licensure as defined by this part, authorizing
1081	statutes, or applicable rules to the public without obtaining a
1082	valid license from the agency. A licenseholder may not advertise
1083	or hold out to the public that he or she holds a license for
1084	other than that for which he or she actually holds the license.
1085	(2)  The operation or maintenance of an unlicensed provider
1086	or the performance of any services that require licensure
1087	without proper licensure is a violation of this part and
1088	authorizing statutes. Unlicensed activity constitutes harm that
1089	materially affects the health, safety, and welfare of clients.
1090	The agency or any state attorney may, in addition to other
1091	remedies provided in this part, bring an action for an
1092	injunction to restrain such violation or to enjoin the future
1093	operation or maintenance of any such provider or the provision
1094	of services that require licensure in violation of this part and
1095	authorizing statutes until compliance with this part,
1096	authorizing statutes, and agency rules has been demonstrated to
1097	the satisfaction of the agency.
1098	(3)  Any person or entity that owns, operates, or maintains
1099	an unlicensed provider and that, after receiving notification
1100	from the agency, fails to cease operation and apply for a
1101	license under this part and authorizing statutes commits a
1102	felony of the third degree, punishable as provided in s.
1103	775.082, s. 775.083, or s. 775.084. Each day of continued
1104	operation is a separate offense.
1105	(4)  Any person or entity found who violates subsection (3)
1106	a second or subsequent time commits a felony of the second
1107	degree, punishable as provided in s. 775.082, s. 775.083, or s.
1108	775.084. Each day of continued operation is a separate offense.
1109	(5)  Any person or entity that fails to cease operation
1110	after agency notification may be fined $1,000 for each day of
1111	noncompliance.
1112	(6)  When a controlling interest or licensee has an
1113	interest in more than one provider and fails to license a
1114	provider rendering services that require licensure, the agency
1115	may revoke all licenses, impose actions under s. 408.814, and
1116	impose a fine of $1,000 per day unless otherwise specified by
1117	authorizing statutes against each licensee until such time as
1118	the appropriate license is obtained for the unlicensed
1119	operation.
1120	(7)  In addition to granting injunctive relief pursuant to
1121	subsection (2), if the agency determines that a person or entity
1122	is operating or maintaining a provider without obtaining a
1123	license and determines that a condition exists that poses a
1124	threat to the health, safety, or welfare of a client of the
1125	provider, the person or entity is subject to the same actions
1126	and fines imposed against a licensee as specified in this part,
1127	authorizing statutes, and agency rules.
1128	(8)  Any person aware of the operation of an unlicensed
1129	provider must report that provider to the agency.
1130	408.813  Administrative fines.--As a penalty for any
1131	violation of this part, authorizing statutes, or applicable
1132	rules, the agency may impose an administrative fine. Unless the
1133	amount of the fine is prescribed by authorizing statutes or
1134	applicable rules, the agency may establish criteria by rule for
1135	the amount of administrative fines applicable to this part,
1136	authorizing statutes, and applicable rules. Each day of
1137	violation constitutes a separate violation and is subject to a
1138	separate fine. For fines imposed by final order of the agency
1139	and not subject to further appeal, the violator shall pay the
1140	fine plus interest at the rate specified in s. 55.03 for each
1141	day beyond the date set by the agency for payment of the fine.
1142	408.814  Moratoriums; emergency suspensions.--
1143	(1)  The agency may impose an immediate moratorium or
1144	emergency suspension as defined in s. 120.60 on any provider if
1145	the agency determines that any condition related to the provider
1146	or licensee presents a threat to the health, safety, or welfare
1147	of a client.
1148	(2)  A provider or licensee, the license of which is denied
1149	or revoked, may be subject to immediate imposition of a
1150	moratorium or emergency suspension to run concurrently with
1151	licensure denial, revocation, or injunction.
1152	(3)  A moratorium or emergency suspension remains in effect
1153	after a change of ownership, unless the agency has determined
1154	that the conditions that created the moratorium, emergency
1155	suspension, or denial of licensure have been corrected.
1156	(4)  When a moratorium or emergency suspension is placed on
1157	a provider or licensee, notice of the action shall be posted and
1158	visible to the public at the location of the provider until the
1159	action is lifted.
1160	408.815  License or application denial; revocation.--
1161	(1)  In addition to the grounds provided in authorizing
1162	statutes, grounds that may be used by the agency for denying and
1163	revoking a license or change-of-ownership application include
1164	any of the following actions by a controlling interest:
1165	(a)  False representation of a material fact in the license
1166	application or intentional omission of any material fact from
1167	the application.
1168	(b)  An intentional or negligent act materially affecting
1169	the health or safety of a client of the provider.
1170	(c)  A violation of this part, authorizing statutes, or
1171	applicable rules.
1172	(d)  A demonstrated pattern of deficient performance.
1173	(e)  The applicant, licensee, or controlling interest has
1174	been or is currently excluded, suspended, terminated from
1175	participation in the state Medicaid program, the Medicaid
1176	program of any other state, or the Medicare program.
1177	(2)  If a licensee lawfully continues to operate while a
1178	denial or revocation is pending in litigation, the licensee must
1179	continue to meet all other requirements of this part,
1180	authorizing statutes, and applicable rules and must file
1181	subsequent renewal applications for licensure and pay all
1182	licensure fees. The provisions of ss. 120.60(1) and
1183	408.806(3)(c) shall not apply to renewal applications filed
1184	during the time period in which the litigation of the denial or
1185	revocation is pending until that litigation is final.
1186	(3)  An action under s. 408.814 or denial of the license of
1187	the transferor may be grounds for denial of a change-of-
1188	ownership application of the transferee.
1189	408.816  Injunctions.--
1190	(1)  In addition to the other powers provided by this part
1191	and authorizing statutes, the agency may institute injunction
1192	proceedings in a court of competent jurisdiction to:
1193	(a)  Restrain or prevent the establishment or operation of
1194	a provider that does not have a license or is in violation of
1195	any provision of this part, authorizing statutes, or applicable
1196	rules. The agency may also institute injunction proceedings in a
1197	court of competent jurisdiction when a violation of this part,
1198	authorizing statutes, or applicable rules constitutes an
1199	emergency affecting the immediate health and safety of a client.
1200	(b)  Enforce the provisions of this part, authorizing
1201	statutes, or any minimum standard, rule, or order issued or
1202	entered into pursuant thereto when the attempt by the agency to
1203	correct a violation through administrative sanctions has failed
1204	or when the violation materially affects the health, safety, or
1205	welfare of clients or involves any operation of an unlicensed
1206	provider.
1207	(c)  Terminate the operation of a provider when a violation
1208	of any provision of this part, authorizing statutes, or any
1209	standard or rule adopted pursuant thereto exists that materially
1210	affects the health, safety, or welfare of clients.
1211
1212	Such injunctive relief may be temporary or permanent.
1213	(2)  If action is necessary to protect clients of providers
1214	from immediate, life-threatening situations, the court may allow
1215	a temporary injunction without bond upon proper proof being
1216	made. If it appears by competent evidence or a sworn,
1217	substantiated affidavit that a temporary injunction should be
1218	issued, the court, pending the determination on final hearing,
1219	shall enjoin the operation of the provider.
1220	408.817  Administrative proceedings.--Administrative
1221	proceedings challenging agency licensure enforcement action
1222	shall be reviewed on the basis of the facts and conditions that
1223	resulted in the agency action.
1224	408.818  Health Care Trust Fund.--Unless otherwise
1225	prescribed by authorizing statutes, all fees and fines collected
1226	under this part, authorizing statutes, and applicable rules
1227	shall be deposited into the Health Care Trust Fund, created in
1228	s. 408.16, and used to pay the costs of the agency in
1229	administering the provider program paying the fees or fines.
1230	408.819  Rules.--The agency is authorized to adopt rules as
1231	necessary to administer this part. Any licensed provider that is
1232	in operation at the time of adoption of any applicable rule
1233	under this part or authorizing statutes shall be given a
1234	reasonable time under the particular circumstances, not to
1235	exceed 6 months after the date of such adoption, within which to
1236	comply with such rule, unless otherwise specified by rule.
1237	Section 6.  Subsections (12) and (17) and paragraph (a) of
1238	subsection (13) of section 112.0455, Florida Statutes, are
1239	amended to read:
1240	112.0455  Drug-Free Workplace Act.--
1241	(12)  DRUG-TESTING STANDARDS; LABORATORIES.--
1242	(a)  The requirements of part II of chapter 408 shall apply
1243	to the provision of services that require licensure pursuant to
1244	this section and part II of chapter 408 and to entities licensed
1245	by or applying for such licensure from the Agency for Health
1246	Care Administration pursuant to this section.
1247	(b)(a)  A laboratory may analyze initial or confirmation
1248	drug specimens only if:
1249	1.  The laboratory is licensed and approved by the Agency
1250	for Health Care Administration using criteria established by the
1251	United States Department of Health and Human Services as general
1252	guidelines for modeling the state drug testing program and in
1253	accordance with part II of chapter 408. Each applicant for
1254	licensure and licensee must comply with all requirements of part
1255	II of chapter 408 except s. 408.810(5)-(10). the following
1256	requirements:
1257	a.  Upon receipt of a completed, signed, and dated
1258	application, the agency shall require background screening, in
1259	accordance with the level 2 standards for screening set forth in
1260	chapter 435, of the managing employee, or other similarly titled
1261	individual responsible for the daily operation of the
1262	laboratory, and of the financial officer, or other similarly
1263	titled individual who is responsible for the financial operation
1264	of the laboratory, including billings for services. The
1265	applicant must comply with the procedures for level 2 background
1266	screening as set forth in chapter 435, as well as the
1267	requirements of s. 435.03(3).
1268	b.  The agency may require background screening of any
1269	other individual who is an applicant if the agency has probable
1270	cause to believe that he or she has been convicted of an offense
1271	prohibited under the level 2 standards for screening set forth
1272	in chapter 435.
1273	c.  Proof of compliance with the level 2 background
1274	screening requirements of chapter 435 which has been submitted
1275	within the previous 5 years in compliance with any other health
1276	care licensure requirements of this state is acceptable in
1277	fulfillment of screening requirements.
1278	d.  A provisional license may be granted to an applicant
1279	when each individual required by this section to undergo
1280	background screening has met the standards for the Department of
1281	Law Enforcement background check, but the agency has not yet
1282	received background screening results from the Federal Bureau of
1283	Investigation, or a request for a disqualification exemption has
1284	been submitted to the agency as set forth in chapter 435, but a
1285	response has not yet been issued. A license may be granted to
1286	the applicant upon the agency's receipt of a report of the
1287	results of the Federal Bureau of Investigation background
1288	screening for each individual required by this section to
1289	undergo background screening which confirms that all standards
1290	have been met, or upon the granting of a disqualification
1291	exemption by the agency as set forth in chapter 435. Any other
1292	person who is required to undergo level 2 background screening
1293	may serve in his or her capacity pending the agency's receipt of
1294	the report from the Federal Bureau of Investigation. However,
1295	the person may not continue to serve if the report indicates any
1296	violation of background screening standards and a
1297	disqualification exemption has not been requested of and granted
1298	by the agency as set forth in chapter 435.
1299	e.  Each applicant must submit to the agency, with its
1300	application, a description and explanation of any exclusions,
1301	permanent suspensions, or terminations of the applicant from the
1302	Medicare or Medicaid programs. Proof of compliance with the
1303	requirements for disclosure of ownership and control interests
1304	under the Medicaid or Medicare programs shall be accepted in
1305	lieu of this submission.
1306	f.  Each applicant must submit to the agency a description
1307	and explanation of any conviction of an offense prohibited under
1308	the level 2 standards of chapter 435 by a member of the board of
1309	directors of the applicant, its officers, or any individual
1310	owning 5 percent or more of the applicant. This requirement does
1311	not apply to a director of a not-for-profit corporation or
1312	organization if the director serves solely in a voluntary
1313	capacity for the corporation or organization, does not regularly
1314	take part in the day-to-day operational decisions of the
1315	corporation or organization, receives no remuneration for his or
1316	her services on the corporation or organization's board of
1317	directors, and has no financial interest and has no family
1318	members with a financial interest in the corporation or
1319	organization, provided that the director and the not-for-profit
1320	corporation or organization include in the application a
1321	statement affirming that the director's relationship to the
1322	corporation satisfies the requirements of this sub-subparagraph.
1323	g.  A license may not be granted to any applicant if the
1324	applicant or managing employee has been found guilty of,
1325	regardless of adjudication, or has entered a plea of nolo
1326	contendere or guilty to, any offense prohibited under the level
1327	2 standards for screening set forth in chapter 435, unless an
1328	exemption from disqualification has been granted by the agency
1329	as set forth in chapter 435.
1330	h.  The agency may deny or revoke licensure if the
1331	applicant:
1332	(I)  Has falsely represented a material fact in the
1333	application required by sub-subparagraph e. or sub-subparagraph
1334	f., or has omitted any material fact from the application
1335	required by sub-subparagraph e. or sub-subparagraph f.; or
1336	(II)  Has had prior action taken against the applicant
1337	under the Medicaid or Medicare program as set forth in sub-
1338	subparagraph e.
1339	i.  An application for license renewal must contain the
1340	information required under sub-subparagraphs e. and f.
1341	2.  The laboratory has written procedures to ensure chain
1342	of custody.
1343	3.  The laboratory follows proper quality control
1344	procedures, including, but not limited to:
1345	a.  The use of internal quality controls including the use
1346	of samples of known concentrations which are used to check the
1347	performance and calibration of testing equipment, and periodic
1348	use of blind samples for overall accuracy.
1349	b.  An internal review and certification process for drug
1350	test results, conducted by a person qualified to perform that
1351	function in the testing laboratory.
1352	c.  Security measures implemented by the testing laboratory
1353	to preclude adulteration of specimens and drug test results.
1354	d.  Other necessary and proper actions taken to ensure
1355	reliable and accurate drug test results.
1356	(c)(b)  A laboratory shall disclose to the employer a
1357	written test result report within 7 working days after receipt
1358	of the sample. All laboratory reports of a drug test result
1359	shall, at a minimum, state:
1360	1.  The name and address of the laboratory which performed
1361	the test and the positive identification of the person tested.
1362	2.  Positive results on confirmation tests only, or
1363	negative results, as applicable.
1364	3.  A list of the drugs for which the drug analyses were
1365	conducted.
1366	4.  The type of tests conducted for both initial and
1367	confirmation tests and the minimum cutoff levels of the tests.
1368	5.  Any correlation between medication reported by the
1369	employee or job applicant pursuant to subparagraph (8)(b)2. and
1370	a positive confirmed drug test result.
1371
1372	No report shall disclose the presence or absence of any drug
1373	other than a specific drug and its metabolites listed pursuant
1374	to this section.
1375	(d)(c)  The laboratory shall submit to the Agency for
1376	Health Care Administration a monthly report with statistical
1377	information regarding the testing of employees and job
1378	applicants. The reports shall include information on the methods
1379	of analyses conducted, the drugs tested for, the number of
1380	positive and negative results for both initial and confirmation
1381	tests, and any other information deemed appropriate by the
1382	Agency for Health Care Administration. No monthly report shall
1383	identify specific employees or job applicants.
1384	(e)(d)  Laboratories shall provide technical assistance to
1385	the employer, employee, or job applicant for the purpose of
1386	interpreting any positive confirmed test results which could
1387	have been caused by prescription or nonprescription medication
1388	taken by the employee or job applicant.
1389	(13)  RULES.--
1390	(a)  The Agency for Health Care Administration may adopt
1391	additional rules to support this law and part II of chapter 408,
1392	using criteria established by the United States Department of
1393	Health and Human Services as general guidelines for modeling
1394	drug-free workplace laboratories the state drug-testing program,
1395	concerning, but not limited to:
1396	1.  Standards for drug-testing laboratory licensing and
1397	denial, suspension, and revocation of a license.
1398	2.  Urine, hair, blood, and other body specimens and
1399	minimum specimen amounts which are appropriate for drug testing,
1400	not inconsistent with other provisions established by law.
1401	3.  Methods of analysis and procedures to ensure reliable
1402	drug-testing results, including standards for initial tests and
1403	confirmation tests, not inconsistent with other provisions
1404	established by law.
1405	4.  Minimum cutoff detection levels for drugs or their
1406	metabolites for the purposes of determining a positive test
1407	result, not inconsistent with other provisions established by
1408	law.
1409	5.  Chain-of-custody procedures to ensure proper
1410	identification, labeling, and handling of specimens being
1411	tested, not inconsistent with other provisions established by
1412	law.
1413	6.  Retention, storage, and transportation procedures to
1414	ensure reliable results on confirmation tests and retests.
1415	7.  A list of the most common medications by brand name or
1416	common name, as applicable, as well as by chemical name, which
1417	may alter or affect a drug test.
1418
1419	This section shall not be construed to eliminate the bargainable
1420	rights as provided in the collective bargaining process where
1421	applicable.
1422	(17)  LICENSE FEE.--Fees from licensure of drug-testing
1423	laboratories shall be sufficient to carry out the
1424	responsibilities of the Agency for Health Care Administration
1425	for the regulation of drug-testing laboratories. In accordance
1426	with s. 408.805, applicants and licensees shall pay a fee for
1427	each license application submitted under this part, part II of
1428	chapter 408, and applicable rules. The fee shall be not less
1429	than $16,000 or more than $20,000 per biennium and shall be
1430	established by rule. The Agency for Health Care Administration
1431	shall collect fees for all licenses issued under this part. Each
1432	nonrefundable fee shall be due at the time of application and
1433	shall be payable to the Agency for Health Care Administration to
1434	be deposited in a trust fund administered by the Agency for
1435	Health Care Administration and used only for the purposes of
1436	this section. The fee schedule is as follows: For licensure as a
1437	drug-testing laboratory, an annual fee of not less than $8,000
1438	or more than $10,000 per fiscal year; for late filing of an
1439	application for renewal, an additional fee of $500 per day shall
1440	be charged.
1441	Section 7.  Subsection (7) of section 381.0303, Florida
1442	Statutes, is amended to read:
1443	381.0303  Health practitioner recruitment for special needs
1444	shelters.--
1445	(7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
1446	of emergency management plans to county health departments by
1447	home health agencies pursuant to s. 400.497(8)(c) and (d) and by
1448	nurse registries pursuant to s. 400.506(11)(16)(e) and by
1449	hospice programs pursuant to s. 400.610(1)(b) is conditional
1450	upon the receipt of an appropriation by the department to
1451	establish medical services disaster coordinator positions in
1452	county health departments unless the secretary of the department
1453	and a local county commission jointly determine to require such
1454	plans to be submitted based on a determination that there is a
1455	special need to protect public health in the local area during
1456	an emergency.
1457	Section 8.  Paragraph (b) of subsection (4) of section
1458	381.78, Florida Statutes, is amended to read:
1459	381.78  Advisory council on brain and spinal cord
1460	injuries.--
1461	(4)  The council shall:
1462	(b)  Annually appoint a five-member committee composed of
1463	one individual who has a brain injury or has a family member
1464	with a brain injury, one individual who has a spinal cord injury
1465	or has a family member with a spinal cord injury, and three
1466	members who shall be chosen from among these representative
1467	groups: physicians, other allied health professionals,
1468	administrators of brain and spinal cord injury programs, and
1469	representatives from support groups with expertise in areas
1470	related to the rehabilitation of individuals who have brain or
1471	spinal cord injuries, except that one and only one member of the
1472	committee shall be an administrator of a transitional living
1473	facility. Membership on the council is not a prerequisite for
1474	membership on this committee.
1475	1.  The committee shall perform onsite visits to those
1476	transitional living facilities identified by the Agency for
1477	Health Care Administration as being in possible violation of the
1478	statutes and rules regulating such facilities. The committee
1479	members have the same rights of entry and inspection granted
1480	under s. 400.805(4)(8) to designated representatives of the
1481	agency.
1482	2.  Factual findings of the committee resulting from an
1483	onsite investigation of a facility pursuant to subparagraph 1.
1484	shall be adopted by the agency in developing its administrative
1485	response regarding enforcement of statutes and rules regulating
1486	the operation of the facility.
1487	3.  Onsite investigations by the committee shall be funded
1488	by the Health Care Trust Fund.
1489	4.  Travel expenses for committee members shall be
1490	reimbursed in accordance with s. 112.061.
1491	5.  Members of the committee shall recuse themselves from
1492	participating in any investigation that would create a conflict
1493	of interest under state law, and the council shall replace the
1494	member, either temporarily or permanently.
1495	Section 9.  Section 383.301, Florida Statutes, is amended
1496	to read:
1497	383.301  Licensure and regulation of birth centers;
1498	legislative intent.--It is the intent of the Legislature to
1499	provide for the protection of public health and safety in the
1500	establishment, maintenance, and operation of birth centers by
1501	providing for licensure of birth centers and for the
1502	development, establishment, and enforcement of minimum standards
1503	with respect to birth centers. The requirements of part II of
1504	chapter 408 shall apply to the provision of services that
1505	require licensure pursuant to ss. 383.30-383.335 and part II of
1506	chapter 408 and to entities licensed by or applying for such
1507	licensure from the Agency for Health Care Administration
1508	pursuant to ss. 383.30-383.335.
1509	Section 10.  Section 383.304, Florida Statutes, is
1510	repealed.
1511	Section 11.  Section 383.305, Florida Statutes, is amended
1512	to read:
1513	383.305  Licensure; issuance, renewal, denial, suspension,
1514	revocation; fees; background screening.--
1515	(1)(a)  In accordance with s. 408.805, an applicant or a
1516	licensee shall pay a fee for each license application submitted
1517	under ss. 383.30-383.335 and part II of chapter 408. The amount
1518	of the fee shall be established by rule. Upon receipt of an
1519	application for a license and the license fee, the agency shall
1520	issue a license if the applicant and facility have received all
1521	approvals required by law and meet the requirements established
1522	under ss. 383.30-383.335 and by rules promulgated hereunder.
1523	(b)  A provisional license may be issued to any birth
1524	center that is in substantial compliance with ss. 383.30-383.335
1525	and with the rules of the agency. A provisional license may be
1526	granted for a period of no more than 1 year from the effective
1527	date of rules adopted by the agency, shall expire automatically
1528	at the end of its term, and may not be renewed.
1529	(c)  A license, unless sooner suspended or revoked,
1530	automatically expires 1 year from its date of issuance and is
1531	renewable upon application for renewal and payment of the fee
1532	prescribed, provided the applicant and the birth center meet the
1533	requirements established under ss. 383.30-383.335 and by rules
1534	promulgated hereunder. A complete application for renewal of a
1535	license shall be made 90 days prior to expiration of the license
1536	on forms provided by the agency.
1537	(2)  An application for a license, or renewal thereof,
1538	shall be made to the agency upon forms provided by it and shall
1539	contain such information as the agency reasonably requires,
1540	which may include affirmative evidence of ability to comply with
1541	applicable laws and rules.
1542	(3)(a)  Each application for a birth center license, or
1543	renewal thereof, shall be accompanied by a license fee. Fees
1544	shall be established by rule of the agency. Such fees are
1545	payable to the agency and shall be deposited in a trust fund
1546	administered by the agency, to be used for the sole purpose of
1547	carrying out the provisions of ss. 383.30-383.335.
1548	(b)  The fees established pursuant to ss. 383.30-383.335
1549	shall be based on actual costs incurred by the agency in the
1550	administration of its duties under such sections.
1551	(4)  Each license is valid only for the person or
1552	governmental unit to whom or which it is issued; is not subject
1553	to sale, assignment, or other transfer, voluntary or
1554	involuntary; and is not valid for any premises other than those
1555	for which it was originally issued.
1556	(5)  Each license shall be posted in a conspicuous place on
1557	the licensed premises.
1558	(6)  Whenever the agency finds that there has been a
1559	substantial failure to comply with the requirements established
1560	under ss. 383.30-383.335 or in rules adopted under those
1561	sections, it is authorized to deny, suspend, or revoke a
1562	license.
1563	(2)(7)  Each applicant for licensure and each licensee must
1564	comply with the following requirements of part II of chapter 408
1565	except s. 408.810(7)-(10).:
1566	(a)  Upon receipt of a completed, signed, and dated
1567	application, the agency shall require background screening, in
1568	accordance with the level 2 standards for screening set forth in
1569	chapter 435, of the managing employee, or other similarly titled
1570	individual who is responsible for the daily operation of the
1571	center, and of the financial officer, or other similarly titled
1572	individual who is responsible for the financial operation of the
1573	center, including billings for patient care and services. The
1574	applicant must comply with the procedures for level 2 background
1575	screening as set forth in chapter 435 as well as the
1576	requirements of s. 435.03(3).
1577	(b)  The agency may require background screening of any
1578	other individual who is an applicant if the agency has probable
1579	cause to believe that he or she has been convicted of a crime or
1580	has committed any other offense prohibited under the level 2
1581	standards for screening set forth in chapter 435.
1582	(c)  Proof of compliance with the level 2 background
1583	screening requirements of chapter 435 which has been submitted
1584	within the previous 5 years in compliance with any other health
1585	care licensure requirements of this state is acceptable in
1586	fulfillment of the requirements of paragraph (a).
1587	(d)  A provisional license may be granted to an applicant
1588	when each individual required by this section to undergo
1589	background screening has met the standards for the Department of
1590	Law Enforcement background check, but the agency has not yet
1591	received background screening results from the Federal Bureau of
1592	Investigation, or a request for a disqualification exemption has
1593	been submitted to the agency as set forth in chapter 435 but a
1594	response has not yet been issued. A standard license may be
1595	granted to the applicant upon the agency's receipt of a report
1596	of the results of the Federal Bureau of Investigation background
1597	screening for each individual required by this section to
1598	undergo background screening which confirms that all standards
1599	have been met, or upon the granting of a disqualification
1600	exemption by the agency as set forth in chapter 435. Any other
1601	person who is required to undergo level 2 background screening
1602	may serve in his or her capacity pending the agency's receipt of
1603	the report from the Federal Bureau of Investigation. However,
1604	the person may not continue to serve if the report indicates any
1605	violation of background screening standards and a
1606	disqualification exemption has not been requested of and granted
1607	by the agency as set forth in chapter 435.
1608	(e)  Each applicant must submit to the agency, with its
1609	application, a description and explanation of any exclusions,
1610	permanent suspensions, or terminations of the applicant from the
1611	Medicare or Medicaid programs. Proof of compliance with the
1612	requirements for disclosure of ownership and control interests
1613	under the Medicaid or Medicare programs shall be accepted in
1614	lieu of this submission.
1615	(f)  Each applicant must submit to the agency a description
1616	and explanation of any conviction of an offense prohibited under
1617	the level 2 standards of chapter 435 by a member of the board of
1618	directors of the applicant, its officers, or any individual
1619	owning 5 percent or more of the applicant. This requirement does
1620	not apply to a director of a not-for-profit corporation or
1621	organization if the director serves solely in a voluntary
1622	capacity for the corporation or organization, does not regularly
1623	take part in the day-to-day operational decisions of the
1624	corporation or organization, receives no remuneration for his or
1625	her services on the corporation or organization's board of
1626	directors, and has no financial interest and has no family
1627	members with a financial interest in the corporation or
1628	organization, provided that the director and the not-for-profit
1629	corporation or organization include in the application a
1630	statement affirming that the director's relationship to the
1631	corporation satisfies the requirements of this paragraph.
1632	(g)  A license may not be granted to an applicant if the
1633	applicant or managing employee has been found guilty of,
1634	regardless of adjudication, or has entered a plea of nolo
1635	contendere or guilty to, any offense prohibited under the level
1636	2 standards for screening set forth in chapter 435, unless an
1637	exemption from disqualification has been granted by the agency
1638	as set forth in chapter 435.
1639	(h)  The agency may deny or revoke licensure if the
1640	applicant:
1641	1.  Has falsely represented a material fact in the
1642	application required by paragraph (e) or paragraph (f), or has
1643	omitted any material fact from the application required by
1644	paragraph (e) or paragraph (f); or
1645	2.  Has had prior action taken against the applicant under
1646	the Medicaid or Medicare program as set forth in paragraph (e).
1647	(i)  An application for license renewal must contain the
1648	information required under paragraphs (e) and (f).
1649	Section 12.  Section 383.309, Florida Statutes, is amended
1650	to read:
1651	383.309  Minimum standards for birth centers; rules and
1652	enforcement.--
1653	(1)  The agency shall adopt and enforce rules to administer
1654	ss. 383.30-383.335 and part II of chapter 408, which rules shall
1655	include, but are not limited to, reasonable and fair minimum
1656	standards for ensuring that:
1657	(a)  Sufficient numbers and qualified types of personnel
1658	and occupational disciplines are available at all times to
1659	provide necessary and adequate patient care and safety.
1660	(b)  Infection control, housekeeping, sanitary conditions,
1661	disaster plan, and medical record procedures that will
1662	adequately protect patient care and provide safety are
1663	established and implemented.
1664	(c)  Licensed facilities are established, organized, and
1665	operated consistent with established programmatic standards.
1666	(2)  Any licensed facility that is in operation at the time
1667	of adoption of any applicable rule under ss. 383.30-383.335
1668	shall be given a reasonable time under the particular
1669	circumstances, not to exceed 1 year after the date of such
1670	adoption, within which to comply with such rule.
1671	(2)(3)  The agency may not establish any rule governing the
1672	design, construction, erection, alteration, modification,
1673	repair, or demolition of birth centers. It is the intent of the
1674	Legislature to preempt that function to the Florida Building
1675	Commission and the State Fire Marshal through adoption and
1676	maintenance of the Florida Building Code and the Florida Fire
1677	Prevention Code. However, the agency shall provide technical
1678	assistance to the commission and the State Fire Marshal in
1679	updating the construction standards of the Florida Building Code
1680	and the Florida Fire Prevention Code which govern birth centers.
1681	In addition, the agency may enforce the special-occupancy
1682	provisions of the Florida Building Code and the Florida Fire
1683	Prevention Code which apply to birth centers in conducting any
1684	inspection authorized under this chapter.
1685	Section 13.  Subsection (1) of section 383.315, Florida
1686	Statutes, is amended to read:
1687	383.315  Agreements with consultants for advice or
1688	services; maintenance.--
1689	(1)  A birth center shall maintain in writing a
1690	consultation agreement, signed within the current license period
1691	year, with each consultant who has agreed to provide advice and
1692	services to the birth center as requested.
1693	Section 14.  Section 383.324, Florida Statutes, is amended
1694	to read:
1695	383.324  Inspections and investigations; Inspection fees.--
1696	(1)  The agency shall make or cause to be made such
1697	inspections and investigations as it deems necessary.
1698	(2)  Each facility licensed under s. 383.305 shall pay to
1699	the agency, at the time of inspection, an inspection fee
1700	established by rule of the agency.
1701	(3)  The agency shall coordinate all periodic inspections
1702	for licensure made by the agency to ensure that the cost to the
1703	facility of such inspections and the disruption of services by
1704	such inspections is minimized.
1705	Section 15.  Section 383.325, Florida Statutes, is
1706	repealed.
1707	Section 16.  Section 383.33, Florida Statutes, is amended
1708	to read:
1709	383.33  Administrative fines penalties; emergency orders;
1710	moratorium on admissions.--
1711	(1)(a)  In addition to the requirements of part II of
1712	chapter 408, the agency may deny, revoke, or suspend a license,
1713	or impose an administrative fine not to exceed $500 per
1714	violation per day, for the violation of any provision of ss.
1715	383.30-383.335, part II of chapter 408, or applicable rules or
1716	any rule adopted under ss. 383.30-383.335. Each day of violation
1717	constitutes a separate violation and is subject to a separate
1718	fine.
1719	(2)(b)  In determining the amount of the fine to be levied
1720	for a violation, as provided in subsection (1) paragraph (a),
1721	the following factors shall be considered:
1722	(a)1.  The severity of the violation, including the
1723	probability that death or serious harm to the health or safety
1724	of any person will result or has resulted; the severity of the
1725	actual or potential harm; and the extent to which the provisions
1726	of ss. 383.30-383.335, part II of chapter 408, or applicable
1727	rules were violated.
1728	(b)2.  Actions taken by the licensee to correct the
1729	violations or to remedy complaints.
1730	(c)3.  Any previous violations by the licensee.
1731	(c)  All amounts collected pursuant to this section shall
1732	be deposited into a trust fund administered by the agency to be
1733	used for the sole purpose of carrying out the provisions of ss.
1734	383.30-383.335.
1735	(2)  The agency may issue an emergency order immediately
1736	suspending or revoking a license when it determines that any
1737	condition in the licensed facility presents a clear and present
1738	danger to the public health and safety.
1739	(3)  The agency may impose an immediate moratorium on
1740	elective admissions to any licensed facility, building or
1741	portion thereof, or service when the agency determines that any
1742	condition in the facility presents a threat to the public health
1743	or safety.
1744	Section 17.  Section 383.331, Florida Statutes, is
1745	repealed.
1746	Section 18.  Section 383.332, Florida Statutes, is
1747	repealed.
1748	Section 19.  Subsection (1) of section 383.335, Florida
1749	Statutes, is amended to read:
1750	383.335  Partial exemptions.--
1751	(1)  Any facility that which was providing obstetrical and
1752	gynecological surgical services and was owned and operated by a
1753	board-certified obstetrician on June 15, 1984, and that which is
1754	otherwise subject to licensure under ss. 383.30-383.335 as a
1755	birth center, is exempt from the provisions of ss. 383.30-
1756	383.335 and part II of chapter 408 which restrict the provision
1757	of surgical services and outlet forceps delivery and the
1758	administration of anesthesia at birth centers. The agency shall
1759	adopt rules specifically related to the performance of such
1760	services and the administration of anesthesia at such
1761	facilities.
1762	Section 20.  Subsection (4) of section 383.50, Florida
1763	Statutes, is amended to read:
1764	383.50  Treatment of abandoned newborn infant.--
1765	(4)  Each hospital of this state subject to s. 395.1041
1766	shall, and any other hospital may, admit and provide all
1767	necessary emergency services and care, as defined in s.
1768	395.002(9)(10), to any newborn infant left with the hospital in
1769	accordance with this section. The hospital or any of its
1770	licensed health care professionals shall consider these actions
1771	as implied consent for treatment, and a hospital accepting
1772	physical custody of a newborn infant has implied consent to
1773	perform all necessary emergency services and care. The hospital
1774	or any of its licensed health care professionals is immune from
1775	criminal or civil liability for acting in good faith in
1776	accordance with this section. Nothing in this subsection limits
1777	liability for negligence.
1778	Section 21.  Subsection (5) of section 390.011, Florida
1779	Statutes, is amended to read:
1780	390.011  Definitions.--As used in this chapter, the term:
1781	(5)  "Hospital" means a facility as defined in s. 395.002
1782	and licensed under chapter 395.
1783	Section 22.  Subsection (1) of section 390.012, Florida
1784	Statutes, is amended to read:
1785	390.012  Powers of agency; rules; disposal of fetal
1786	remains.--
1787	(1)  The agency may shall have the authority to develop and
1788	enforce rules pursuant to ss. 390.001-390.018 and part II of
1789	chapter 408 for the health, care, and treatment of persons in
1790	abortion clinics and for the safe operation of such clinics.
1791	These rules shall be comparable to rules which apply to all
1792	surgical procedures requiring approximately the same degree of
1793	skill and care as the performance of first trimester abortions.
1794	The rules shall be reasonably related to the preservation of
1795	maternal health of the clients. The rules shall not impose a
1796	legally significant burden on a woman's freedom to decide
1797	whether to terminate her pregnancy. The rules shall provide for:
1798	(a)  The performance of pregnancy termination procedures
1799	only by a licensed physician.
1800	(b)  The making, protection, and preservation of patient
1801	records, which shall be treated as medical records under chapter
1802	458.
1803	Section 23.  Section 390.013, Florida Statutes, is
1804	repealed.
1805	Section 24.  Section 390.014, Florida Statutes, is amended
1806	to read:
1807	390.014  Licenses; fees, display, etc.--
1808	(1)  The requirements of part II of chapter 408 shall apply
1809	to the provision of services that require licensure pursuant to
1810	ss. 390.011-390.018 and part II of chapter 408 and to entities
1811	licensed by or applying for such licensure from the Agency for
1812	Health Care Administration pursuant to ss. 390.011-390.018.
1813	However, each applicant for licensure and each licensee is
1814	exempt from s. 408.810(7)-(10). No abortion clinic shall operate
1815	in this state without a currently effective license issued by
1816	the agency.
1817	(2)  A separate license shall be required for each clinic
1818	maintained on separate premises, even though it is operated by
1819	the same management as another clinic; but a separate license
1820	shall not be required for separate buildings on the same
1821	premises.
1822	(3)  In accordance with s. 408.805, an applicant or
1823	licensee shall pay a fee for each license application submitted
1824	under this part and part II of chapter 408. The amount of the
1825	fee shall be established by rule and The annual license fee
1826	required for a clinic shall be nonrefundable and shall be
1827	reasonably calculated to cover the cost of regulation under this
1828	chapter, but may not be less than $70 or $35 nor more than $500
1829	per biennium $250.
1830	(4)  Counties and municipalities applying for licenses
1831	under this act shall be exempt from the payment of the license
1832	fees.
1833	(5)  The license shall be displayed in a conspicuous place
1834	inside the clinic.
1835	(6)  A license shall be valid only for the clinic to which
1836	it is issued, and it shall not be subject to sale, assignment,
1837	or other transfer, voluntary or involuntary. No license shall be
1838	valid for any premises other than those for which it was
1839	originally issued.
1840	Section 25.  Section 390.015, Florida Statutes, is
1841	repealed.
1842	Section 26.  Section 390.016, Florida Statutes, is
1843	repealed.
1844	Section 27.  Section 390.017, Florida Statutes, is
1845	repealed.
1846	Section 28.  Section 390.018, Florida Statutes, is amended
1847	to read:
1848	390.018  Administrative fine penalty in lieu of revocation
1849	or suspension.--In addition to the requirements of part II of
1850	chapter 408 If the agency finds that one or more grounds exist
1851	for the revocation or suspension of a license issued to an
1852	abortion clinic, the agency may, in lieu of such suspension or
1853	revocation, impose a fine upon the clinic in an amount not to
1854	exceed $1,000 for each violation of any provision this part,
1855	part II of chapter 408, or applicable rules. The fine shall be
1856	paid to the agency within 60 days from the date of entry of the
1857	administrative order. If the licensee fails to pay the fine in
1858	its entirety to the agency within the period allowed, the
1859	license of the licensee shall stand suspended, revoked, or
1860	renewal or continuation may be refused, as the case may be, upon
1861	expiration of such period and without any further administrative
1862	or judicial proceedings.
1863	Section 29.  Section 390.019, Florida Statutes, is
1864	repealed.
1865	Section 30.  Section 390.021, Florida Statutes, is
1866	repealed.
1867	Section 31.  Subsection (13) of section 394.455, Florida
1868	Statutes, is amended to read:
1869	394.455  Definitions.--As used in this part, unless the
1870	context clearly requires otherwise, the term:
1871	(13)  "Hospital" means a facility as defined in s. 395.002
1872	and licensed under chapter 395.
1873	Section 32.  Subsection (7) of section 394.4787, Florida
1874	Statutes, is amended to read:
1875	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
1876	and 394.4789.--As used in this section and ss. 394.4786,
1877	394.4788, and 394.4789:
1878	(7)  "Specialty psychiatric hospital" means a hospital
1879	licensed by the agency pursuant to s. 395.002(28)(29) as a
1880	specialty psychiatric hospital.
1881	Section 33.  Subsections (3) through (23) of section
1882	394.67, Florida Statutes, are renumbered as subsections (2)
1883	through (22), respectively, present subsections (2) and (4) are
1884	amended, and a new subsection (23) is added to said section, to
1885	read:
1886	394.67  Definitions.--As used in this part, the term:
1887	(2)  "Applicant" means an individual applicant, or any
1888	officer, director, agent, managing employee, or affiliated
1889	person, or any partner or shareholder having an ownership
1890	interest equal to a 5-percent or greater interest in the
1891	corporation, partnership, or other business entity.
1892	(3)(4)  "Crisis services" means short-term evaluation,
1893	stabilization, and brief intervention services provided to a
1894	person who is experiencing an acute mental or emotional crisis,
1895	as defined in subsection (17) (18), or an acute substance abuse
1896	crisis, as defined in subsection (18) (19), to prevent further
1897	deterioration of the person's mental health. Crisis services are
1898	provided in settings such as a crisis stabilization unit, an
1899	inpatient unit, a short-term residential treatment program, a
1900	detoxification facility, or an addictions receiving facility; at
1901	the site of the crisis by a mobile crisis response team; or at a
1902	hospital on an outpatient basis.
1903	(23)  "Short-term residential treatment facility" means a
1904	facility that provides an alternative to inpatient
1905	hospitalization and that provides brief, intensive services 24
1906	hours a day, 7 days a week for mentally ill individuals who are
1907	temporarily in need of a 24-hour-a-day structured therapeutic
1908	setting as a less restrictive but longer-term alternative to
1909	hospitalization.
1910	Section 34.  Paragraph (a) of subsection (3) of section
1911	394.74, Florida Statutes, is amended to read:
1912	394.74  Contracts for provision of local substance abuse
1913	and mental health programs.--
1914	(3)  Contracts shall include, but are not limited to:
1915	(a)  A provision that, within the limits of available
1916	resources, substance abuse and mental health crisis services, as
1917	defined in s. 394.67(3)(4), shall be available to any individual
1918	residing or employed within the service area, regardless of
1919	ability to pay for such services, current or past health
1920	condition, or any other factor;
1921	Section 35.  Subsections (1) and (5) of section 394.82,
1922	Florida Statutes, are amended to read:
1923	394.82  Funding of expanded services.--
1924	(1)  Pursuant to the General Appropriations Acts for the
1925	2001-2002 and 2002-2003 fiscal years, funds appropriated to the
1926	Department of Children and Family Services for the purpose of
1927	expanding community mental health services must be used to
1928	implement programs that emphasize crisis services as defined in
1929	s. 394.67(3)(4) and treatment services, rehabilitative services,
1930	support services, and case management services, as defined in s.
1931	394.67(15)(16). Following the 2002-2003 fiscal year, the
1932	Department of Children and Family Services must continue to
1933	expand the provision of these community mental health services.
1934	(5)  By January 1, 2004, the crisis services defined in s.
1935	394.67(3)(4) shall be implemented, as appropriate, in the
1936	state's public community mental health system to serve children
1937	and adults who are experiencing an acute mental or emotional
1938	crisis, as defined in s. 394.67(17)(18). By January 1, 2006, the
1939	mental health services defined in s. 394.67(15)(16) shall be
1940	implemented, as appropriate, in the state's public community
1941	mental health system to serve adults and older adults who have a
1942	severe and persistent mental illness and to serve children who
1943	have a serious emotional disturbance or mental illness, as
1944	defined in s. 394.492(6).
1945	Section 36.  Section 394.875, Florida Statutes, is amended
1946	to read:
1947	394.875  Crisis stabilization units, short-term residential
1948	treatment facilities, residential treatment facilities, and
1949	residential treatment centers for children and adolescents;
1950	authorized services; license required; penalties.--
1951	(1)(a)  The purpose of a crisis stabilization unit is to
1952	stabilize and redirect a client to the most appropriate and
1953	least restrictive community setting available, consistent with
1954	the client's needs. Crisis stabilization units may screen,
1955	assess, and admit for stabilization persons who present
1956	themselves to the unit and persons who are brought to the unit
1957	under s. 394.463. Clients may be provided 24-hour observation,
1958	medication prescribed by a physician or psychiatrist, and other
1959	appropriate services. Crisis stabilization units shall provide
1960	services regardless of the client's ability to pay and shall be
1961	limited in size to a maximum of 30 beds.
1962	(b)  The purpose of a short-term residential treatment
1963	facility is to provide intensive services in a 24-hour-a-day
1964	structured therapeutic setting as a less restrictive but longer-
1965	term alternative to hospitalization.
1966	(c)(b)  The purpose of a residential treatment facility is
1967	to be a part of a comprehensive treatment program for mentally
1968	ill individuals in a community-based residential setting.
1969	(d)(c)  The purpose of a residential treatment center for
1970	children and adolescents is to provide mental health assessment
1971	and treatment services pursuant to ss. 394.491, 394.495, and
1972	394.496 to children and adolescents who meet the target
1973	population criteria specified in s. 394.493(1)(a), (b), or (c).
1974	(2)  The requirements of part II of chapter 408 shall apply
1975	to the provision of services that require licensure under ss.
1976	394.455-394.904 and part II of chapter 408 and to entities
1977	licensed by or applying for such licensure from the Agency for
1978	Health Care Administration pursuant to ss. 394.455-394.904.
1979	However, each applicant for licensure and each licensee is
1980	exempt from the provisions of s. 408.810(8)?(10). It is unlawful
1981	for any entity to hold itself out as a crisis stabilization
1982	unit, a residential treatment facility, or a residential
1983	treatment center for children and adolescents, or to act as a
1984	crisis stabilization unit, a residential treatment facility, or
1985	a residential treatment center for children and adolescents,
1986	unless it is licensed by the agency pursuant to this chapter.
1987	(3)  Any person who violates subsection (2) is guilty of a
1988	misdemeanor of the first degree, punishable as provided in s.
1989	775.082 or s. 775.083.
1990	(4)  The agency may maintain an action in circuit court to
1991	enjoin the unlawful operation of a crisis stabilization unit, a
1992	residential treatment facility, or a residential treatment
1993	center for children and adolescents if the agency first gives
1994	the violator 14 days' notice of its intention to maintain such
1995	action and if the violator fails to apply for licensure within
1996	such 14-day period.
1997	(3)(5)  The following are exempt from licensure as required
1998	in ss. 394.455-394.904 Subsection (2) does not apply to:
1999	(a)  Hospitals licensed pursuant to chapter 395 or programs
2000	operated within such hospitals. Homes for special services
2001	licensed under chapter 400; or
2002	(b)  Nursing homes licensed under chapter 400.
2003	(c)  Comprehensive transitional education programs licensed
2004	under s. 393.067.
2005	(4)(6)  The department, in consultation with the agency,
2006	may establish multiple license classifications for residential
2007	treatment facilities.
2008	(5)(7)  The agency may not issue a license to a crisis
2009	stabilization unit unless the unit receives state mental health
2010	funds and is affiliated with a designated public receiving
2011	facility.
2012	(6)(8)  The agency may issue a license for a crisis
2013	stabilization unit or short-term residential treatment facility,
2014	certifying the number of authorized beds for such facility as
2015	indicated by existing need and available appropriations. The
2016	agency may disapprove an application for such a license if it
2017	determines that a facility should not be licensed pursuant to
2018	the provisions of this chapter. Any facility operating beds in
2019	excess of those authorized by the agency shall, upon demand of
2020	the agency, reduce the number of beds to the authorized number,
2021	forfeit its license, or provide evidence of a license issued
2022	pursuant to chapter 395 for the excess beds.
2023	(7)(9)  A children's crisis stabilization unit which does
2024	not exceed 20 licensed beds and which provides separate
2025	facilities or a distinct part of a facility, separate staffing,
2026	and treatment exclusively for minors may be located on the same
2027	premises as a crisis stabilization unit serving adults. The
2028	department, in consultation with the agency, shall adopt rules
2029	governing facility construction, staffing and licensure
2030	requirements, and the operation of such units for minors.
2031	(8)(10)  The department, in consultation with the agency,
2032	must adopt rules governing a residential treatment center for
2033	children and adolescents which specify licensure standards for:
2034	admission; length of stay; program and staffing; discharge and
2035	discharge planning; treatment planning; seclusion, restraints,
2036	and time-out; rights of patients under s. 394.459; use of
2037	psychotropic medications; and standards for the operation of
2038	such centers.
2039	(9)(11)  Notwithstanding the provisions of subsection (8),
2040	crisis stabilization units may not exceed their licensed
2041	capacity by more than 10 percent, nor may they exceed their
2042	licensed capacity for more than 3 consecutive working days or
2043	for more than 7 days in 1 month.
2044	(10)(12)  Notwithstanding the other provisions of this
2045	section, any facility licensed under former chapter 396 and
2046	chapter 397 for detoxification, residential level I care, and
2047	outpatient treatment may elect to license concurrently all of
2048	the beds at such facility both for that purpose and as a long-
2049	term residential treatment facility pursuant to this section, if
2050	all of the following conditions are met:
2051	(a)  The licensure application is received by the
2052	department prior to January 1, 1993.
2053	(b)  On January 1, 1993, the facility was licensed under
2054	former chapter 396 and chapter 397 as a facility for
2055	detoxification, residential level I care, and outpatient
2056	treatment of substance abuse.
2057	(c)  The facility restricted its practice to the treatment
2058	of law enforcement personnel for a period of at least 12 months
2059	beginning after January 1, 1992.
2060	(d)  The number of beds to be licensed under this chapter
2061	is equal to or less than the number of beds licensed under
2062	former chapter 396 and chapter 397 as of January 1, 1993.
2063	(e)  The licensee agrees in writing to a condition placed
2064	upon the license that the facility will limit its treatment
2065	exclusively to law enforcement personnel and their immediate
2066	families who are seeking admission on a voluntary basis and who
2067	are exhibiting symptoms of posttraumatic stress disorder or
2068	other mental health problems, including drug or alcohol abuse,
2069	which are directly related to law enforcement work and which are
2070	amenable to verbal treatment therapies; the licensee agrees to
2071	coordinate the provision of appropriate postresidential care for
2072	discharged individuals; and the licensee further agrees in
2073	writing that a failure to meet any condition specified in this
2074	paragraph shall constitute grounds for a revocation of the
2075	facility's license as a residential treatment facility.
2076	(f)  The licensee agrees that the facility will meet all
2077	licensure requirements for a residential treatment facility,
2078	including minimum standards for compliance with lifesafety
2079	requirements, except those licensure requirements which are in
2080	express conflict with the conditions and other provisions
2081	specified in this subsection.
2082	(g)  The licensee agrees that the conditions stated in this
2083	subsection must be agreed to in writing by any person acquiring
2084	the facility by any means.
2085
2086	Any facility licensed under this subsection is not required to
2087	provide any services to any persons except those included in the
2088	specified conditions of licensure, and is exempt from any
2089	requirements related to the 60-day or greater average length of
2090	stay imposed on community-based residential treatment facilities
2091	otherwise licensed under this chapter.
2092	(13)  Each applicant for licensure must comply with the
2093	following requirements:
2094	(a)  Upon receipt of a completed, signed, and dated
2095	application, the agency shall require background screening, in
2096	accordance with the level 2 standards for screening set forth in
2097	chapter 435, of the managing employee and financial officer, or
2098	other similarly titled individual who is responsible for the
2099	financial operation of the facility, including billings for
2100	client care and services. The applicant must comply with the
2101	procedures for level 2 background screening as set forth in
2102	chapter 435, as well as the requirements of s. 435.03(3).
2103	(b)  The agency may require background screening of any
2104	other individual who is an applicant if the agency has probable
2105	cause to believe that he or she has been convicted of a crime or
2106	has committed any other offense prohibited under the level 2
2107	standards for screening set forth in chapter 435.
2108	(c)  Proof of compliance with the level 2 background
2109	screening requirements of chapter 435 which has been submitted
2110	within the previous 5 years in compliance with any other health
2111	care licensure requirements of this state is acceptable in
2112	fulfillment of the requirements of paragraph (a).
2113	(d)  A provisional license may be granted to an applicant
2114	when each individual required by this section to undergo
2115	background screening has met the standards for the Department of
2116	Law Enforcement background check, but the agency has not yet
2117	received background screening results from the Federal Bureau of
2118	Investigation, or a request for a disqualification exemption has
2119	been submitted to the agency as set forth in chapter 435, but a
2120	response has not yet been issued. A standard license may be
2121	granted to the applicant upon the agency's receipt of a report
2122	of the results of the Federal Bureau of Investigation background
2123	screening for each individual required by this section to
2124	undergo background screening which confirms that all standards
2125	have been met, or upon the granting of a disqualification
2126	exemption by the agency as set forth in chapter 435. Any other
2127	person who is required to undergo level 2 background screening
2128	may serve in his or her capacity pending the agency's receipt of
2129	the report from the Federal Bureau of Investigation. However,
2130	the person may not continue to serve if the report indicates any
2131	violation of background screening standards and a
2132	disqualification exemption has not been requested of and granted
2133	by the agency as set forth in chapter 435.
2134	(e)  Each applicant must submit to the agency, with its
2135	application, a description and explanation of any exclusions,
2136	permanent suspensions, or terminations of the applicant from the
2137	Medicare or Medicaid programs. Proof of compliance with the
2138	requirements for disclosure of ownership and control interests
2139	under the Medicaid or Medicare programs shall be accepted in
2140	lieu of this submission.
2141	(f)  Each applicant must submit to the agency a description
2142	and explanation of any conviction of an offense prohibited under
2143	the level 2 standards of chapter 435 by a member of the board of
2144	directors of the applicant, its officers, or any individual
2145	owning 5 percent or more of the applicant. This requirement does
2146	not apply to a director of a not-for-profit corporation or
2147	organization if the director serves solely in a voluntary
2148	capacity for the corporation or organization, does not regularly
2149	take part in the day-to-day operational decisions of the
2150	corporation or organization, receives no remuneration for his or
2151	her services on the corporation or organization's board of
2152	directors, and has no financial interest and has no family
2153	members with a financial interest in the corporation or
2154	organization, provided that the director and the not-for-profit
2155	corporation or organization include in the application a
2156	statement affirming that the director's relationship to the
2157	corporation satisfies the requirements of this paragraph.
2158	(g)  A license may not be granted to an applicant if the
2159	applicant or managing employee has been found guilty of,
2160	regardless of adjudication, or has entered a plea of nolo
2161	contendere or guilty to, any offense prohibited under the level
2162	2 standards for screening set forth in chapter 435, unless an
2163	exemption from disqualification has been granted by the agency
2164	as set forth in chapter 435.
2165	(h)  The agency may deny or revoke licensure if the
2166	applicant:
2167	1.  Has falsely represented a material fact in the
2168	application required by paragraph (e) or paragraph (f), or has
2169	omitted any material fact from the application required by
2170	paragraph (e) or paragraph (f); or
2171	2.  Has had prior action taken against the applicant under
2172	the Medicaid or Medicare program as set forth in paragraph (e).
2173	(i)  An application for license renewal must contain the
2174	information required under paragraphs (e) and (f).
2175	Section 37.  Section 394.876, Florida Statutes, is
2176	repealed.
2177	Section 38.  Section 394.877, Florida Statutes, is amended
2178	to read:
2179	394.877  Fees.--
2180	(1)  In accordance with s. 408.805, an applicant or
2181	licensee shall pay a fee for each license application submitted
2182	under this part, part II of chapter 408, and applicable rules.
2183	The amount of the fee shall be established by rule. Each
2184	application for licensure or renewal must be accompanied by a
2185	fee set by the department, in consultation with the agency, by
2186	rule. Such fees shall be reasonably calculated to cover only the
2187	cost of regulation under this chapter.
2188	(2)  All fees collected under this section shall be
2189	deposited in the Health Care Trust Fund.
2190	Section 39.  Section 394.878, Florida Statutes, is amended
2191	to read:
2192	394.878  Issuance and renewal of licenses.--
2193	(1)  Upon review of the application for licensure and
2194	receipt of appropriate fees, the agency shall issue an original
2195	or renewal license to any applicant that meets the requirements
2196	of this chapter.
2197	(2)  A license is valid for a period of 1 year. An
2198	applicant for renewal of a license shall apply to the agency no
2199	later than 90 days before expiration of the current license.
2200	(3)  A license may not be transferred from one entity to
2201	another and is valid only for the premises for which it was
2202	originally issued. For the purposes of this subsection,
2203	"transfer" includes, but is not limited to, transfer of a
2204	majority of the ownership interests in a licensee or transfer of
2205	responsibilities under the license to another entity by
2206	contractual arrangement.
2207	(4)  Each license shall state the services which the
2208	licensee is required or authorized to perform and the maximum
2209	residential capacity of the licensed premises.
2210	(1)(5)  The agency may issue a probationary license to an
2211	applicant that has completed the application requirements of
2212	this chapter but has not, at the time of the application,
2213	developed an operational crisis stabilization unit or
2214	residential treatment facility. The probationary license shall
2215	expire 90 days after issuance and may once be renewed for an
2216	additional 90-day period. The agency may cancel a probationary
2217	license at any time.
2218	(2)(6)  The agency may issue an interim license to an
2219	applicant that has substantially completed all application
2220	requirements and has initiated action to fully meet such
2221	requirements. The interim license shall expire 90 days after
2222	issuance and, in cases of extreme hardship, may once be renewed
2223	for an additional 90-day period.
2224	(7)  Any applicant which fails to file an application for
2225	license renewal during the 90-day relicensure period shall be
2226	considered unlicensed and subject to penalties pursuant to s.
2227	394.875.
2228	Section 40.  Subsections (1), (3), and (4) of section
2229	394.879, Florida Statutes, are amended to read:
2230	394.879  Rules; enforcement.--
2231	(1)  The agency, in consultation with the department, may
2232	adopt rules to implement the requirements of part II of chapter
2233	408. The department, in consultation with the agency, shall
2234	adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
2235	the provisions of this chapter, including, at a minimum, rules
2236	providing standards to ensure that:
2237	(a)  Sufficient numbers and types of qualified personnel
2238	are on duty and available at all times to provide necessary and
2239	adequate client safety and care.
2240	(b)  Adequate space is provided each client of a licensed
2241	facility.
2242	(c)  Licensed facilities are limited to an appropriate
2243	number of beds.
2244	(d)  Each licensee establishes and implements adequate
2245	infection control, housekeeping, sanitation, disaster planning,
2246	and medical recordkeeping.
2247	(e)  Licensed facilities are established, organized, and
2248	operated in accordance with programmatic standards of the
2249	department.
2250	(f)  The operation and purposes of these facilities assure
2251	individuals' health, safety, and welfare.
2252	(3)  The department, in consultation with the agency, shall
2253	allow any licensed facility in operation at the time of adoption
2254	of any rule a reasonable period, not to exceed 1 year, to bring
2255	itself into compliance with department rules such rule.
2256	(4)  In accordance with part II of chapter 408, the agency
2257	may impose an administrative penalty of no more than $500 per
2258	day against any licensee that violates any rule adopted pursuant
2259	to this section and may suspend and or revoke the license and or
2260	deny the renewal application of such licensee. In imposing such
2261	penalty, the agency shall consider the severity of the
2262	violation, actions taken by the licensee to correct the
2263	violation, and previous violations by the licensee. Fines
2264	collected under this subsection shall be deposited in the Mental
2265	Health Facility Licensing Trust Fund.
2266	Section 41.  Paragraph (a) of subsection (1) of section
2267	394.90, Florida Statutes, is amended to read:
2268	394.90  Inspection; right of entry; records.--
2269	(1)(a)  The department and the agency, in accordance with
2270	s. 408.811, may enter and inspect at any time a licensed
2271	facility to determine whether the facility is in compliance with
2272	this chapter and the applicable rules of the department.
2273	Section 42.  Section 394.902, Florida Statutes, is
2274	repealed.
2275	Section 43.  Subsection (7) of section 394.907, Florida
2276	Statutes, is amended to read:
2277	394.907  Community mental health centers; quality assurance
2278	programs.--
2279	(7)  The department shall have access to all records
2280	necessary to determine licensee agency compliance with the
2281	provisions of this section. The records of quality assurance
2282	programs which relate solely to actions taken in carrying out
2283	the provisions of this section, and records obtained by the
2284	department to determine licensee agency compliance with this
2285	section, are confidential and exempt from s. 119.07(1). Such
2286	records are not admissible in any civil or administrative
2287	action, except in disciplinary proceedings by the Department of
2288	Business and Professional Regulation and the appropriate
2289	regulatory board, nor shall such records be available to the
2290	public as part of the record of investigation for, and
2291	prosecution in disciplinary proceedings made available to the
2292	public by the Department of Business and Professional Regulation
2293	or the appropriate regulatory board. Meetings or portions of
2294	meetings of quality assurance program committees that relate
2295	solely to actions taken pursuant to this section are exempt from
2296	s. 286.011.
2297	Section 44.  Subsections (5) through (33) of section
2298	395.002, Florida Statutes, are renumbered as subsections (4)
2299	through (32), respectively, and present subsections (4), (11),
2300	and (29) of said section are amended to read:
2301	395.002  Definitions.--As used in this chapter:
2302	(4)  "Applicant" means an individual applicant, or any
2303	officer, director, or agent, or any partner or shareholder
2304	having an ownership interest equal to a 5-percent or greater
2305	interest in the corporation, partnership, or other business
2306	entity.
2307	(10)(11)  "General hospital" means any facility which meets
2308	the provisions of subsection (12) (13) and which regularly makes
2309	its facilities and services available to the general population.
2310	(28)(29)  "Specialty hospital" means any facility which
2311	meets the provisions of subsection (12) (13), and which
2312	regularly makes available either:
2313	(a)  The range of medical services offered by general
2314	hospitals, but restricted to a defined age or gender group of
2315	the population;
2316	(b)  A restricted range of services appropriate to the
2317	diagnosis, care, and treatment of patients with specific
2318	categories of medical or psychiatric illnesses or disorders; or
2319	(c)  Intensive residential treatment programs for children
2320	and adolescents as defined in subsection (15) (16).
2321	Section 45.  Section 395.003, Florida Statutes, is amended
2322	to read:
2323	395.003  Licensure; issuance, renewal, denial,
2324	modification, suspension, and revocation.--
2325	(1)(a)  The requirements of part II of chapter 408 shall
2326	apply to the provision of services that require licensure
2327	pursuant to ss. 395.001-395.1065 and part II of chapter 408 and
2328	to entities licensed by or applying for such licensure from the
2329	Agency for Health Care Administration pursuant to ss. 395.001-
2330	395.1065. However, each applicant for licensure and each
2331	licensee is exempt from s. 408.810(7)-(9). Ambulatory surgical
2332	center and mobile surgical facility licensees and applicants for
2333	such licensure are also exempt from s. 408.810(10). A person may
2334	not establish, conduct, or maintain a hospital, ambulatory
2335	surgical center, or mobile surgical facility in this state
2336	without first obtaining a license under this part.
2337	(b)1.  It is unlawful for a person to use or advertise to
2338	the public, in any way or by any medium whatsoever, any facility
2339	as a "hospital," "ambulatory surgical center," or "mobile
2340	surgical facility" unless such facility has first secured a
2341	license under the provisions of this part.
2342	2.  This part does not apply to veterinary hospitals or to
2343	commercial business establishments using the word "hospital,"
2344	"ambulatory surgical center," or "mobile surgical facility" as a
2345	part of a trade name if no treatment of human beings is
2346	performed on the premises of such establishments.
2347	(c)3.  By December 31, 2004, the agency shall submit a
2348	report to the President of the Senate and the Speaker of the
2349	House of Representatives recommending whether it is in the
2350	public interest to allow a hospital to license or operate an
2351	emergency department located off the premises of the hospital.
2352	If the agency finds it to be in the public interest, the report
2353	shall also recommend licensure criteria for such medical
2354	facilities, including criteria related to quality of care and,
2355	if deemed necessary, the elimination of the possibility of
2356	confusion related to the service capabilities of such facility
2357	in comparison to the service capabilities of an emergency
2358	department located on the premises of the hospital. Until July
2359	1, 2005, additional emergency departments located off the
2360	premises of licensed hospitals may not be authorized by the
2361	agency.
2362	(2)(a)  Upon the receipt of an application for a license
2363	and the license fee, the agency shall issue a license if the
2364	applicant and facility have received all approvals required by
2365	law and meet the requirements established under this part and in
2366	rules. Such license shall include all beds and services located
2367	on the premises of the facility.
2368	(b)  A provisional license may be issued to a new facility
2369	or a facility that is in substantial compliance with this part
2370	and with the rules of the agency. A provisional license shall be
2371	granted for a period of no more than 1 year and shall expire
2372	automatically at the end of its term. A provisional license may
2373	not be renewed.
2374	(c)  A license, unless sooner suspended or revoked, shall
2375	automatically expire 2 years from the date of issuance and shall
2376	be renewable biennially upon application for renewal and payment
2377	of the fee prescribed by s. 395.004(2), provided the applicant
2378	and licensed facility meet the requirements established under
2379	this part and in rules. An application for renewal of a license
2380	shall be made 90 days prior to expiration of the license, on
2381	forms provided by the agency.
2382	(a)(d)  The agency shall, at the request of a licensee,
2383	issue a single license to a licensee for facilities located on
2384	separate premises. Such a license shall specifically state the
2385	location of the facilities, the services, and the licensed beds
2386	available on each separate premises. If a licensee requests a
2387	single license, the licensee shall designate which facility or
2388	office is responsible for receipt of information, payment of
2389	fees, service of process, and all other activities necessary for
2390	the agency to carry out the provisions of this part.
2391	(b)(e)  The agency shall, at the request of a licensee that
2392	is a teaching hospital as defined in s. 408.07(44), issue a
2393	single license to a licensee for facilities that have been
2394	previously licensed as separate premises, provided such
2395	separately licensed facilities, taken together, constitute the
2396	same premises as defined in s. 395.002(23)(24). Such license for
2397	the single premises shall include all of the beds, services, and
2398	programs that were previously included on the licenses for the
2399	separate premises. The granting of a single license under this
2400	paragraph shall not in any manner reduce the number of beds,
2401	services, or programs operated by the licensee.
2402	(c)(f)  Intensive residential treatment programs for
2403	children and adolescents which have received accreditation from
2404	the Joint Commission on Accreditation of Healthcare
2405	Organizations and which meet the minimum standards developed by
2406	rule of the agency for such programs shall be licensed by the
2407	agency under this part.
2408	(3)(a)  Each license shall be valid only for the person to
2409	whom it is issued and shall not be sold, assigned, or otherwise
2410	transferred, voluntarily or involuntarily. A license is only
2411	valid for the premises for which it was originally issued.
2412	(b)1.  An application for a new license is required if
2413	ownership, a majority of the ownership, or controlling interest
2414	of a licensed facility is transferred or assigned and when a
2415	lessee agrees to undertake or provide services to the extent
2416	that legal liability for operation of the facility rests with
2417	the lessee. The application for a new license showing such
2418	change shall be made at least 60 days prior to the date of the
2419	sale, transfer, assignment, or lease.
2420	(3)2.  After a change of ownership has occurred, the
2421	transferee shall be liable for any liability to the state,
2422	regardless of when identified, resulting from changes to
2423	allowable costs affecting provider reimbursement for Medicaid
2424	participation or Public Medical Assistance Trust Fund
2425	Assessments, and related administrative fines. The transferee,
2426	simultaneously with the transfer of ownership, shall pay or make
2427	arrangements to pay to the agency or the department any amount
2428	owed to the agency or the department; payment assurances may be
2429	in the form of an irrevocable credit instrument or payment bond
2430	acceptable to the agency or the department provided by or on
2431	behalf of the transferor. The issuance of a license to the
2432	transferee shall be delayed pending payment or until arrangement
2433	for payment acceptable to the agency or the department is made.
2434	(4)  The agency shall issue a license which specifies the
2435	service categories and the number of hospital beds in each bed
2436	category for which a license is received. Such information shall
2437	be listed on the face of the license. All beds which are not
2438	covered by any specialty-bed-need methodology shall be specified
2439	as general beds. A licensed facility shall not operate a number
2440	of hospital beds greater than the number indicated by the agency
2441	on the face of the license without approval from the agency
2442	under conditions established by rule.
2443	(5)(a)  Adherence to patient rights, standards of care, and
2444	examination and placement procedures provided under part I of
2445	chapter 394 shall be a condition of licensure for hospitals
2446	providing voluntary or involuntary medical or psychiatric
2447	observation, evaluation, diagnosis, or treatment.
2448	(b)  Any hospital that provides psychiatric treatment to
2449	persons under 18 years of age who have emotional disturbances
2450	shall comply with the procedures pertaining to the rights of
2451	patients prescribed in part I of chapter 394.
2452	(6)  No specialty hospital shall provide any service or
2453	regularly serve any population group beyond those services or
2454	groups specified in its license.
2455	(7)  Licenses shall be posted in a conspicuous place on
2456	each of the licensed premises.
2457	(7)(8)  In addition to the requirements of part II of
2458	chapter 408, whenever the agency finds that there has been a
2459	substantial failure to comply with the requirements established
2460	under this part or in rules, the agency is authorized to deny,
2461	modify, suspend, and or revoke:
2462	(a)  A license;
2463	(b)  That part of a license which is limited to a separate
2464	premises, as designated on the license; or
2465	(c)  Licensure approval limited to a facility, building, or
2466	portion thereof, or a service, within a given premises.
2467	(8)(9)  A hospital may not be licensed or relicensed if:
2468	(a)  The diagnosis-related groups for 65 percent or more of
2469	the discharges from the hospital, in the most recent year for
2470	which data is available to the Agency for Health Care
2471	Administration pursuant to s. 408.061, are for diagnosis, care,
2472	and treatment of patients who have:
2473	1.  Cardiac-related diseases and disorders classified as
2474	diagnosis-related groups 103-145, 478-479, 514-518, or 525-527;
2475	2.  Orthopedic-related diseases and disorders classified as
2476	diagnosis-related groups 209-256, 471, 491, 496-503, or 519-520;
2477	3.  Cancer-related diseases and disorders classified as
2478	diagnosis-related groups 64, 82, 172, 173, 199, 200, 203, 257-
2479	260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363,
2480	366, 367, 400-414, 473, or 492; or
2481	4.  Any combination of the above discharges.
2482	(b)  The hospital restricts its medical and surgical
2483	services to primarily or exclusively cardiac, orthopedic,
2484	surgical, or oncology specialties.
2485	(9)(10)  A hospital licensed as of June 1, 2004, shall be
2486	exempt from subsection (8) (9) as long as the hospital maintains
2487	the same ownership, facility street address, and range of
2488	services that were in existence on June 1, 2004. Any transfer of
2489	beds, or other agreements that result in the establishment of a
2490	hospital or hospital services within the intent of this section,
2491	shall be subject to subsection (8) (9). Unless the hospital is
2492	otherwise exempt under subsection (8) (9), the agency shall deny
2493	or revoke the license of a hospital that violates any of the
2494	criteria set forth in that subsection.
2495	(10)(11)  The agency may adopt rules implementing the
2496	licensure requirements set forth in subsection (8) (9). Within
2497	14 days after rendering its decision on a license application or
2498	revocation, the agency shall publish its proposed decision in
2499	the Florida Administrative Weekly. Within 21 days after
2500	publication of the agency's decision, any authorized person may
2501	file a request for an administrative hearing. In administrative
2502	proceedings challenging the approval, denial, or revocation of a
2503	license pursuant to subsection (8) (9), the hearing must be
2504	based on the facts and law existing at the time of the agency's
2505	proposed agency action. Existing hospitals may initiate or
2506	intervene in an administrative hearing to approve, deny, or
2507	revoke licensure under subsection (8) (9) based upon a showing
2508	that an established program will be substantially affected by
2509	the issuance or renewal of a license to a hospital within the
2510	same district or service area.
2511	Section 46.  Section 395.004, Florida Statutes, is amended
2512	to read:
2513	395.004  Application for license, fees; expenses.--
2514	(1)  In accordance with s. 408.805, an applicant or
2515	licensee shall pay a fee for each license application submitted
2516	under this part, part II of chapter 408, and applicable rules.
2517	The amount of the fee shall be established by rule. An
2518	application for a license or renewal thereof shall be made under
2519	oath to the agency, upon forms provided by it, and shall contain
2520	such information as the agency reasonably requires, which may
2521	include affirmative evidence of ability to comply with
2522	applicable laws and rules.
2523	(2)  Each application for a general hospital license,
2524	specialty hospital license, ambulatory surgical center license,
2525	or mobile surgical facility license, or renewal thereof, shall
2526	be accompanied by a license fee, in accordance with the
2527	following schedule:
2528	(a)  The biennial license, provisional license, and license
2529	renewal fee required of a facility licensed under this part
2530	shall be reasonably calculated to cover the cost of regulation
2531	under this part and shall be established by rule at the rate of
2532	not less than $9.50 per hospital bed, nor more than $30 per
2533	hospital bed, except that the minimum license fee shall be
2534	$1,500 and the total fees collected from all licensed facilities
2535	may not exceed the cost of properly carrying out the provisions
2536	of this part.
2537	(b)  Such fees shall be paid to the agency and shall be
2538	deposited in the Planning and Regulation Trust Fund of the
2539	agency, which is hereby created, for the sole purpose of
2540	carrying out the provisions of this part.
2541	Section 47.  Section 395.0055, Florida Statutes, is
2542	repealed.
2543	Section 48.  Section 395.0161, Florida Statutes, is amended
2544	to read:
2545	395.0161  Licensure inspection.--
2546	(1)  In accordance with s. 408.811, the agency shall make
2547	or cause to be made such inspections and investigations as it
2548	deems necessary, including:
2549	(a)  Inspections directed by the Health Care Financing
2550	Administration.
2551	(b)  Validation inspections.
2552	(c)  Lifesafety inspections.
2553	(d)  Licensure complaint investigations, including full
2554	licensure investigations with a review of all licensure
2555	standards as outlined in the administrative rules. Complaints
2556	received by the agency from individuals, organizations, or other
2557	sources are subject to review and investigation by the agency.
2558	(e)  Emergency access complaint investigations.
2559	(f)  inspections of mobile surgical facilities at each time
2560	a facility establishes a new location, prior to the admission of
2561	patients. However, such inspections shall not be required when a
2562	mobile surgical facility is moved temporarily to a location
2563	where medical treatment will not be provided.
2564	(2)  The agency shall accept, in lieu of its own periodic
2565	inspections for licensure, the survey or inspection of an
2566	accrediting organization, provided the accreditation of the
2567	licensed facility is not provisional and provided the licensed
2568	facility authorizes release of, and the agency receives the
2569	report of, the accrediting organization. The agency shall
2570	develop, and adopt by rule, criteria for accepting survey
2571	reports of accrediting organizations in lieu of conducting a
2572	state licensure inspection.
2573	(3)  In accordance with s. 408.805, an applicant or
2574	licensee shall pay a fee for each license application submitted
2575	under this part, part II of chapter 408, and applicable rules.
2576	With the exception of state-operated licensed facilities, each
2577	facility licensed under this part shall pay to the agency, at
2578	the time of inspection, the following fees:
2579	(a)  Inspection for licensure.--A fee shall be paid which
2580	is not less than $8 per hospital bed, nor more than $12 per
2581	hospital bed, except that the minimum fee shall be $400 per
2582	facility.
2583	(b)  Inspection for lifesafety only.--A fee shall be paid
2584	which is not less than 75 cents per hospital bed, nor more than
2585	$1.50 per hospital bed, except that the minimum fee shall be $40
2586	per facility.
2587	(4)  The agency shall coordinate all periodic inspections
2588	for licensure made by the agency to ensure that the cost to the
2589	facility of such inspections and the disruption of services by
2590	such inspections is minimized.
2591	Section 49.  Section 395.0162, Florida Statutes, is
2592	repealed.
2593	Section 50.  A licensee that failed to renew its ambulatory
2594	surgical center license may meet requirements of the Florida
2595	Building Code that were in effect at the time of original
2596	licensure for the purposes of an initial application if:
2597	(a)  The license expired between July 1, 2004, and December
2598	31, 2004.
2599	(b)  The initial license application was filed within 30
2600	days after the license expiration.
2601	(c)  The ambulatory surgical center is in compliance with
2602	regulatory requirements based upon agency inspection.
2603
2604	This section only applies to the initial application for
2605	licensure and does not circumvent any requirement to meet
2606	current Florida Building Code requirements for renovations or
2607	other modifications.
2608	Section 51.  Subsections (2) and (3) of section 395.0163,
2609	Florida Statutes, are amended to read:
2610	395.0163  Construction inspections; plan submission and
2611	approval; fees.--
2612	(2)(a)  The agency is authorized to charge an initial fee
2613	of $2,000 for review of plans and construction on all projects,
2614	no part of which is refundable. The agency may also collect a
2615	fee, not to exceed 1 percent of the estimated construction cost
2616	or the actual cost of review, whichever is less, for the portion
2617	of the review which encompasses initial review through the
2618	initial revised construction document review. The agency is
2619	further authorized to collect its actual costs on all subsequent
2620	portions of the review and construction inspections. The initial
2621	fee payment shall accompany the initial submission of plans and
2622	specifications. Any subsequent payment that is due is payable
2623	upon receipt of the invoice from the agency.
2624	(b)  Notwithstanding any other provisions of law to the
2625	contrary, all moneys received by the agency pursuant to the
2626	provisions of this section shall be deposited in the Planning
2627	and Regulation Trust Fund, as created by s. 395.004, to be held
2628	and applied solely for the operations required under this
2629	section.
2630	(3)  In accordance with s. 408.811, the agency shall
2631	inspect a mobile surgical facility at initial licensure and at
2632	each time the facility establishes a new location, prior to
2633	admission of patients. However, such inspections shall not be
2634	required when a mobile surgical facility is moved temporarily to
2635	a location where medical treatment will not be provided.
2636	Section 52.  Paragraph (c) of subsection (2) of section
2637	395.0191, Florida Statutes, is redesignated as paragraph (d),
2638	and a new paragraph (c) is added to said subsection, to read:
2639	395.0191  Staff membership and clinical privileges.--
2640	(2)
2641	(c)  A registered nurse licensed under part I of chapter
2642	464 and qualified by training and experience in perioperative
2643	nursing as defined in s. 464.027(2)(a) shall be present in the
2644	operating room and function as the circulating nurse during all
2645	operative, surgical, or invasive procedures.
2646	Section 53.  Subsections (4) and (6) of section 395.0193,
2647	Florida Statutes, are amended to read:
2648	395.0193  Licensed facilities; peer review; disciplinary
2649	powers; agency or partnership with physicians.--
2650	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
2651	actions taken under subsection (3) shall be reported in writing
2652	to the Department of Health Division of Health Quality Assurance
2653	of the agency within 30 working days after its initial
2654	occurrence, regardless of the pendency of appeals to the
2655	governing board of the hospital. The notification shall identify
2656	the disciplined practitioner, the action taken, and the reason
2657	for such action. All final disciplinary actions taken under
2658	subsection (3), if different from those which were reported to
2659	the department agency within 30 days after the initial
2660	occurrence, shall be reported within 10 working days to the
2661	Department of Health Division of Health Quality Assurance of the
2662	agency in writing and shall specify the disciplinary action
2663	taken and the specific grounds therefor. Final disciplinary
2664	actions shall be reported monthly to the Division of Health
2665	Quality Assurance of the agency. The division shall review each
2666	report and determine whether it potentially involved conduct by
2667	the licensee that is subject to disciplinary action, in which
2668	case s. 456.073 shall apply. The reports are not subject to
2669	inspection under s. 119.07(1) even if the division's
2670	investigation results in a finding of probable cause.
2671	(6)  For a single incident or series of isolated incidents
2672	that are nonwillful violations of the reporting requirements of
2673	this section, the agency shall first seek to obtain corrective
2674	action by the facility. If correction is not demonstrated within
2675	the timeframe established by the agency or if there is a pattern
2676	of nonwillful violations of this section, the agency may impose
2677	an administrative fine, not to exceed $5,000 for any violation
2678	of the reporting requirements of this section. The
2679	administrative fine for repeated nonwillful violations shall not
2680	exceed $10,000 for any violation. The administrative fine for
2681	each intentional and willful violation may not exceed $25,000
2682	per violation, per day. The fine for an intentional and willful
2683	violation of this section may not exceed $250,000. In
2684	determining the amount of fine to be levied, the agency shall be
2685	guided by s. 395.1065(1)(2)(b).
2686	Section 54.  Subsection (12) of section 395.0197, Florida
2687	Statutes, is amended to read:
2688	395.0197  Internal risk management program.--
2689	(12)  In addition to any penalty imposed pursuant to this
2690	section, the agency shall require a written plan of correction
2691	from the facility. For a single incident or series of isolated
2692	incidents that are nonwillful violations of the reporting
2693	requirements of this section, the agency shall first seek to
2694	obtain corrective action by the facility. If the correction is
2695	not demonstrated within the timeframe established by the agency
2696	or if there is a pattern of nonwillful violations of this
2697	section, the agency may impose an administrative fine, not to
2698	exceed $5,000 for any violation of the reporting requirements of
2699	this section. The administrative fine for repeated nonwillful
2700	violations shall not exceed $10,000 for any violation. The
2701	administrative fine for each intentional and willful violation
2702	may not exceed $25,000 per violation, per day. The fine for an
2703	intentional and willful violation of this section may not exceed
2704	$250,000. In determining the amount of fine to be levied, the
2705	agency shall be guided by s. 395.1065(1)(2)(b).
2706	Section 55.  Section 395.0199, Florida Statutes, is amended
2707	to read:
2708	395.0199  Private utilization review.--
2709	(1)  The purpose of this section is to:
2710	(a)  Promote the delivery of quality health care in a cost-
2711	effective manner.
2712	(b)  Foster greater coordination between providers and
2713	health insurers performing utilization review.
2714	(c)  Protect patients and insurance providers by ensuring
2715	that private review agents are qualified to perform utilization
2716	review activities and to make informed decisions on the
2717	appropriateness of medical care.
2718	(d)  This section does not regulate the activities of
2719	private review agents, health insurers, health maintenance
2720	organizations, or hospitals, except as expressly provided
2721	herein, or authorize regulation or intervention as to the
2722	correctness of utilization review decisions of insurers or
2723	private review agents.
2724	(2)  The requirements of part II of chapter 408 shall apply
2725	to the provision of services that require registration or
2726	licensure pursuant to this section and part II of chapter 408
2727	and to persons registered by or applying for such registration
2728	from the Agency for Health Care Administration pursuant to this
2729	section. However, each applicant for registration and registrant
2730	is exempt from the provisions of ss. 408.806(1)(e)2.,
2731	408.810(5)-(10), and 408.811. A private review agent conducting
2732	utilization review as to health care services performed or
2733	proposed to be performed in this state shall register with the
2734	agency in accordance with this section.
2735	(3)  In accordance with s. 408.805, an applicant for
2736	registration or registrant shall pay a fee for each registration
2737	application submitted under this section, part II of chapter
2738	408, and applicable rules. The amount of the fee shall be
2739	established by rule Registration shall be made annually with the
2740	agency on forms furnished by the agency and shall be accompanied
2741	by the appropriate registration fee as set by the agency. The
2742	fee and shall be sufficient to pay for the administrative costs
2743	of registering the agent, but shall not exceed $250. The agency
2744	may also charge reasonable fees, reflecting actual costs, to
2745	persons requesting copies of registration.
2746	(4)  Each applicant for registration must comply with the
2747	following requirements:
2748	(a)  Upon receipt of a completed, signed, and dated
2749	application, the agency shall require background screening, in
2750	accordance with the level 2 standards for screening set forth in
2751	chapter 435, of the managing employee or other similarly titled
2752	individual who is responsible for the operation of the entity.
2753	The applicant must comply with the procedures for level 2
2754	background screening as set forth in chapter 435, as well as the
2755	requirements of s. 435.03(3).
2756	(b)  The agency may require background screening of any
2757	other individual who is an applicant, if the agency has probable
2758	cause to believe that he or she has been convicted of a crime or
2759	has committed any other offense prohibited under the level 2
2760	standards for screening set forth in chapter 435.
2761	(c)  Proof of compliance with the level 2 background
2762	screening requirements of chapter 435 which has been submitted
2763	within the previous 5 years in compliance with any other health
2764	care licensure requirements of this state is acceptable in
2765	fulfillment of the requirements of paragraph (a).
2766	(d)  A provisional registration may be granted to an
2767	applicant when each individual required by this section to
2768	undergo background screening has met the standards for the
2769	Department of Law Enforcement background check, but the agency
2770	has not yet received background screening results from the
2771	Federal Bureau of Investigation, or a request for a
2772	disqualification exemption has been submitted to the agency as
2773	set forth in chapter 435 but a response has not yet been issued.
2774	A standard registration may be granted to the applicant upon the
2775	agency's receipt of a report of the results of the Federal
2776	Bureau of Investigation background screening for each individual
2777	required by this section to undergo background screening which
2778	confirms that all standards have been met, or upon the granting
2779	of a disqualification exemption by the agency as set forth in
2780	chapter 435. Any other person who is required to undergo level 2
2781	background screening may serve in his or her capacity pending
2782	the agency's receipt of the report from the Federal Bureau of
2783	Investigation. However, the person may not continue to serve if
2784	the report indicates any violation of background screening
2785	standards and a disqualification exemption has not been
2786	requested of and granted by the agency as set forth in chapter
2787	435.
2788	(e)  Each applicant must submit to the agency, with its
2789	application, a description and explanation of any exclusions,
2790	permanent suspensions, or terminations of the applicant from the
2791	Medicare or Medicaid programs. Proof of compliance with the
2792	requirements for disclosure of ownership and control interests
2793	under the Medicaid or Medicare programs shall be accepted in
2794	lieu of this submission.
2795	(f)  Each applicant must submit to the agency a description
2796	and explanation of any conviction of an offense prohibited under
2797	the level 2 standards of chapter 435 by a member of the board of
2798	directors of the applicant, its officers, or any individual
2799	owning 5 percent or more of the applicant. This requirement does
2800	not apply to a director of a not-for-profit corporation or
2801	organization if the director serves solely in a voluntary
2802	capacity for the corporation or organization, does not regularly
2803	take part in the day-to-day operational decisions of the
2804	corporation or organization, receives no remuneration for his or
2805	her services on the corporation or organization's board of
2806	directors, and has no financial interest and has no family
2807	members with a financial interest in the corporation or
2808	organization, provided that the director and the not-for-profit
2809	corporation or organization include in the application a
2810	statement affirming that the director's relationship to the
2811	corporation satisfies the requirements of this paragraph.
2812	(g)  A registration may not be granted to an applicant if
2813	the applicant or managing employee has been found guilty of,
2814	regardless of adjudication, or has entered a plea of nolo
2815	contendere or guilty to, any offense prohibited under the level
2816	2 standards for screening set forth in chapter 435, unless an
2817	exemption from disqualification has been granted by the agency
2818	as set forth in chapter 435.
2819	(h)  The agency may deny or revoke the registration if any
2820	applicant:
2821	1.  Has falsely represented a material fact in the
2822	application required by paragraph (e) or paragraph (f), or has
2823	omitted any material fact from the application required by
2824	paragraph (e) or paragraph (f); or
2825	2.  Has had prior action taken against the applicant under
2826	the Medicaid or Medicare program as set forth in paragraph (e).
2827	(i)  An application for registration renewal must contain
2828	the information required under paragraphs (e) and (f).
2829	(4)(5)  Registration shall include the following:
2830	(a)  A description of the review policies and procedures to
2831	be used in evaluating proposed or delivered hospital care.
2832	(b)  The name, address, and telephone number of the
2833	utilization review agent performing utilization review, who
2834	shall be at least:
2835	1.  A licensed practical nurse or licensed registered
2836	nurse, or other similarly qualified medical records or health
2837	care professionals, for performing initial review when
2838	information is necessary from the physician or hospital to
2839	determine the medical necessity or appropriateness of hospital
2840	services; or
2841	2.  A licensed physician, or a licensed physician
2842	practicing in the field of psychiatry for review of mental
2843	health services, for an initial denial determination prior to a
2844	final denial determination by the health insurer and which shall
2845	include the written evaluation and findings of the reviewing
2846	physician.
2847	(c)  A description of an appeal procedure for patients or
2848	health care providers whose services are under review, who may
2849	appeal an initial denial determination prior to a final
2850	determination by the health insurer with whom the private review
2851	agent has contracted. The appeal procedure shall provide for
2852	review by a licensed physician, or by a licensed physician
2853	practicing in the field of psychiatry for review of mental
2854	health services, and shall include the written evaluation and
2855	findings of the reviewing physician.
2856	(d)  A designation of the times when the staff of the
2857	utilization review agent will be available by toll-free
2858	telephone, which shall include at least 40 hours per week during
2859	the normal business hours of the agent.
2860	(e)  An acknowledgment and agreement that any private
2861	review agent which, as a general business practice, fails to
2862	adhere to the policies, procedures, and representations made in
2863	its application for registration shall have its registration
2864	revoked.
2865	(f)  Disclosure of any incentive payment provision or quota
2866	provision which is contained in the agent's contract with a
2867	health insurer and is based on reduction or denial of services,
2868	reduction of length of stay, or selection of treatment setting.
2869	(g)  Updates of any material changes to review policies or
2870	procedures.
2871	(6)  The agency may impose fines or suspend or revoke the
2872	registration of any private review agent in violation of this
2873	section. Any private review agent failing to register or update
2874	registration as required by this section shall be deemed to be
2875	within the jurisdiction of the agency and subject to an
2876	administrative penalty not to exceed $1,000. The agency may
2877	bring actions to enjoin activities of private review agents in
2878	violation of this section.
2879	(5)(7)  No insurer shall knowingly contract with or utilize
2880	a private review agent which has failed to register as required
2881	by this section or which has had a registration revoked by the
2882	agency.
2883	(6)(8)  A private review agent which operates under
2884	contract with the federal or state government for utilization
2885	review of patients eligible for hospital or other services under
2886	Title XVIII or Title XIX of the Social Security Act is exempt
2887	from the provisions of this section for services provided under
2888	such contract. A private review agent which provides utilization
2889	review services to the federal or state government and a private
2890	insurer shall not be exempt for services provided to
2891	nonfederally funded patients. This section shall not apply to
2892	persons who perform utilization review services for medically
2893	necessary hospital services provided to injured workers pursuant
2894	to chapter 440 and shall not apply to self-insurance funds or
2895	service companies authorized pursuant to chapter 440 or part VII
2896	of chapter 626.
2897	(7)(9)  Facilities licensed under this chapter shall
2898	promptly comply with the requests of utilization review agents
2899	or insurers which are reasonably necessary to facilitate prompt
2900	accomplishment of utilization review activities.
2901	(8)(10)  The agency shall adopt rules to implement the
2902	provisions of this section.
2903	Section 56.  Section 395.1046, Florida Statutes, is amended
2904	to read:
2905	395.1046  Complaint investigation procedures.--
2906	(1)  In accordance with s. 408.811, the agency shall
2907	investigate any complaint against a hospital for any violation
2908	of s. 395.1041 that the agency reasonably believes to be legally
2909	sufficient. A complaint is legally sufficient if it contains
2910	ultimate facts that which show that a violation of this section
2911	chapter, or any rule adopted under this chapter by the agency
2912	under this section, has occurred. The agency may investigate, or
2913	continue to investigate, and may take appropriate final action
2914	on a complaint, even though the original complainant withdraws
2915	his or her complaint or otherwise indicates his or her desire
2916	not to cause it to be investigated to completion. When an
2917	investigation of any person or facility is undertaken, the
2918	agency shall notify such person in writing of the investigation
2919	and inform the person or facility in writing of the substance,
2920	the facts which show that a violation has occurred, and the
2921	source of any complaint filed against him or her. The agency may
2922	conduct an investigation without notification to any person if
2923	the act under investigation is a criminal offense. The agency
2924	shall have access to all records necessary for the investigation
2925	of the complaint.
2926	(2)  The agency or its agent shall expeditiously
2927	investigate each complaint against a hospital for a violation of
2928	s. 395.1041. When its investigation is complete, the agency
2929	shall prepare an investigative report. The report shall contain
2930	the investigative findings and the recommendations of the agency
2931	concerning the existence of probable cause.
2932	(3)  The complaint and all information obtained by the
2933	agency during an investigation conducted pursuant to this
2934	section are exempt from the provisions of s. 119.07(1) and s.
2935	24(a), Art. I of the State Constitution until 10 days after the
2936	facility has been determined by the agency to be out of
2937	compliance with regulatory requirements probable cause has been
2938	found to exist by the agency, or until the person who is the
2939	subject of the investigation waives his or her privilege of
2940	confidentiality, whichever occurs first. In cases where the
2941	agency finds that the complaint is either not legally sufficient
2942	or does not demonstrate the facility's noncompliance with
2943	regulatory requirements when the agency determines that no
2944	probable cause exists, all records pertaining thereto are
2945	confidential and exempt from the provisions of s. 119.07(1) and
2946	s. 24(a), Art. I of the State Constitution. However, the
2947	complaint and a summary of the agency's findings shall be
2948	available, although information therein identifying an
2949	individual shall not be disclosed.
2950	Section 57.  Subsections (1) and (7) of section 395.1055,
2951	Florida Statutes, are amended to read:
2952	395.1055  Rules and enforcement.--
2953	(1)  The agency shall adopt rules pursuant to ss.
2954	120.536(1) and 120.54 to implement the provisions of this part
2955	and part II of chapter 408, which shall include reasonable and
2956	fair minimum standards for ensuring that:
2957	(a)  Sufficient numbers and qualified types of personnel
2958	and occupational disciplines are on duty and available at all
2959	times to provide necessary and adequate patient care and safety.
2960	(b)  Infection control, housekeeping, sanitary conditions,
2961	and medical record procedures that will adequately protect
2962	patient care and safety are established and implemented.
2963	(c)  A comprehensive emergency management plan is prepared
2964	and updated annually. Such standards must be included in the
2965	rules adopted by the agency after consulting with the Department
2966	of Community Affairs. At a minimum, the rules must provide for
2967	plan components that address emergency evacuation
2968	transportation; adequate sheltering arrangements; postdisaster
2969	activities, including emergency power, food, and water;
2970	postdisaster transportation; supplies; staffing; emergency
2971	equipment; individual identification of residents and transfer
2972	of records, and responding to family inquiries. The
2973	comprehensive emergency management plan is subject to review and
2974	approval by the local emergency management agency. During its
2975	review, the local emergency management agency shall ensure that
2976	the following agencies, at a minimum, are given the opportunity
2977	to review the plan: the Department of Elderly Affairs, the
2978	Department of Health, the Agency for Health Care Administration,
2979	and the Department of Community Affairs. Also, appropriate
2980	volunteer organizations must be given the opportunity to review
2981	the plan. The local emergency management agency shall complete
2982	its review within 60 days and either approve the plan or advise
2983	the facility of necessary revisions.
2984	(d)  Licensed facilities are established, organized, and
2985	operated consistent with established standards and rules.
2986	(e)  Licensed facility beds conform to minimum space,
2987	equipment, and furnishings standards as specified by the
2988	department.
2989	(f)  All hospitals submit such data as necessary to conduct
2990	certificate-of-need reviews required under part I of chapter 408
2991	ss. 408.031-408.045. Such data shall include, but shall not be
2992	limited to, patient origin data, hospital utilization data, type
2993	of service reporting, and facility staffing data. The agency
2994	shall not collect data that identifies or could disclose the
2995	identity of individual patients. The agency shall utilize
2996	existing uniform statewide data sources when available and shall
2997	minimize reporting costs to hospitals.
2998	(g)  Each hospital has a quality improvement program
2999	designed according to standards established by their current
3000	accrediting organization. This program will enhance quality of
3001	care and emphasize quality patient outcomes, corrective action
3002	for problems, governing board review, and reporting to the
3003	agency of standardized data elements necessary to analyze
3004	quality of care outcomes. The agency shall use existing data,
3005	when available, and shall not duplicate the efforts of other
3006	state agencies in order to obtain such data.
3007	(h)  Licensed facilities make available on their Internet
3008	websites, no later than October 1, 2004, and in a hard copy
3009	format upon request, a description of and a link to the patient
3010	charge and performance outcome data collected from licensed
3011	facilities pursuant to s. 408.061.
3012	(7)  The agency shall enforce compliance with the
3013	provisions of s. 381.005(2) and rules adopted thereunder with
3014	respect to immunizations against the influenza virus and
3015	pneumococcal bacteria. Any licensed facility which is in
3016	operation at the time of promulgation of any applicable rules
3017	under this part shall be given a reasonable time, under the
3018	particular circumstances, but not to exceed 1 year from the date
3019	of such promulgation, within which to comply with such rules.
3020	Section 58.  Section 395.1065, Florida Statutes, is amended
3021	to read:
3022	395.1065  Criminal and Administrative penalties;
3023	injunctions; emergency orders; moratorium.--
3024	(1)  Any person establishing, conducting, managing, or
3025	operating any facility without a license under this part is
3026	guilty of a misdemeanor and, upon conviction, shall be fined not
3027	more than $500 for the first offense and not more than $1,000
3028	for each subsequent offense, and each day of continuing
3029	violation after conviction shall be considered a separate
3030	offense.
3031	(1)(2)(a)  The agency may deny, revoke, or suspend a
3032	license or impose an administrative fine, not to exceed $1,000
3033	per violation, per day, for the violation of any provision of
3034	this part, part II of chapter 408, or applicable rules adopted
3035	under this part. Each day of violation constitutes a separate
3036	violation and is subject to a separate fine.
3037	(b)  In determining the amount of fine to be levied for a
3038	violation, as provided in paragraph (a), the following factors
3039	shall be considered:
3040	1.  The severity of the violation, including the
3041	probability that death or serious harm to the health or safety
3042	of any person will result or has resulted, the severity of the
3043	actual or potential harm, and the extent to which the provisions
3044	of this part were violated.
3045	2.  Actions taken by the licensee to correct the violations
3046	or to remedy complaints.
3047	3.  Any previous violations of the licensee.
3048	(c)  All amounts collected pursuant to this section shall
3049	be deposited into the Planning and Regulation Trust Fund, as
3050	created by s. 395.004.
3051	(c)(d)  The agency may impose an administrative fine for
3052	the violation of s. 641.3154 or, if sufficient claims due to a
3053	provider from a health maintenance organization do not exist to
3054	enable the take-back of an overpayment, as provided under s.
3055	641.3155(5), for the violation of s. 641.3155(5). The
3056	administrative fine for a violation cited in this paragraph
3057	shall be in the amounts specified in s. 641.52(5), and the
3058	provisions of paragraph (a) do not apply.
3059	(2)(3)  Notwithstanding the existence or pursuit of any
3060	other remedy, the agency may maintain an action in the name of
3061	the state for injunction or other process to enforce the
3062	provisions of this part, part II of chapter 408, and applicable
3063	rules promulgated hereunder.
3064	(4)  The agency may issue an emergency order immediately
3065	suspending or revoking a license when it determines that any
3066	condition in the licensed facility presents a clear and present
3067	danger to public health and safety.
3068	(5)  The agency may impose an immediate moratorium on
3069	elective admissions to any licensed facility, building, or
3070	portion thereof, or service, when the agency determines that any
3071	condition in the facility presents a threat to public health or
3072	safety.
3073	(3)(6)  In seeking to impose penalties against a facility
3074	as defined in s. 394.455 for a violation of part I of chapter
3075	394, the agency is authorized to rely on the investigation and
3076	findings by the Department of Health in lieu of conducting its
3077	own investigation.
3078	(4)(7)  The agency shall impose a fine of $500 for each
3079	instance of the facility's failure to provide the information
3080	required by rules adopted pursuant to s. 395.1055(1)(h).
3081	Section 59.  Subsection (1) of section 395.10973, Florida
3082	Statutes, is amended to read:
3083	395.10973  Powers and duties of the agency.--It is the
3084	function of the agency to:
3085	(1)  Adopt rules pursuant to ss. 120.536(1) and 120.54 to
3086	implement the provisions of this part and part II of chapter 408
3087	conferring duties upon it.
3088	Section 60.  Section 395.10974, Florida Statutes, is
3089	amended to read:
3090	395.10974  Health care risk managers; qualifications,
3091	licensure, fees.--
3092	(1)  The requirements of part II of chapter 408 shall apply
3093	to the provision of services that require licensure pursuant to
3094	ss. 395.10971?395.10976 and part II of chapter 408 and to
3095	entities licensed by or applying for such licensure from the
3096	Agency for Health Care Administration pursuant to ss. 395.10971?
3097	395.10976. Any person desiring to be licensed as a health care
3098	risk manager shall submit an application on a form provided by
3099	the agency. In order to qualify for licensure, the applicant
3100	shall submit evidence satisfactory to the agency that which
3101	demonstrates the applicant's competence, by education or
3102	experience, in the following areas:
3103	(a)  Applicable standards of health care risk management.
3104	(b)  Applicable federal, state, and local health and safety
3105	laws and rules.
3106	(c)  General risk management administration.
3107	(d)  Patient care.
3108	(e)  Medical care.
3109	(f)  Personal and social care.
3110	(g)  Accident prevention.
3111	(h)  Departmental organization and management.
3112	(i)  Community interrelationships.
3113	(j)  Medical terminology.
3114
3115	Each applicant for licensure and licensee must comply with all
3116	provisions of part II of chapter 408 except ss. 408.806(1)(e)2.,
3117	408.810, and 408.811. The agency may require such additional
3118	information, from the applicant or any other person, as may be
3119	reasonably required to verify the information contained in the
3120	application.
3121	(2)  The agency shall not grant or issue a license as a
3122	health care risk manager to any individual unless from the
3123	application it affirmatively appears that the applicant:
3124	(a)  Is 18 years of age or over;
3125	(b)  Is a high school graduate or equivalent; and
3126	(c)1.  Has fulfilled the requirements of a 1-year program
3127	or its equivalent in health care risk management training which
3128	may be developed or approved by the agency;
3129	2.  Has completed 2 years of college-level studies which
3130	would prepare the applicant for health care risk management, to
3131	be further defined by rule; or
3132	3.  Has obtained 1 year of practical experience in health
3133	care risk management.
3134	(3)  The agency shall issue a license to practice health
3135	care risk management to any applicant who qualifies under this
3136	section. In accordance with s. 408.805, an applicant or licensee
3137	shall pay a fee for each license application submitted under
3138	this part, part II of chapter 408, and applicable rules. The
3139	amount of the fee shall be established by rule as follows: and
3140	submits an application fee of not more than $75, a background
3141	screening fingerprinting fee of not more than $75, and a license
3142	fee of not more than $100. The agency shall by rule establish
3143	fees and procedures for the issuance and cancellation of
3144	licenses.
3145	(4)  The agency shall renew a health care risk manager
3146	license upon receipt of a biennial renewal application and fees.
3147	The agency shall by rule establish a procedure for the biennial
3148	renewal of licenses.
3149	Section 61.  Subsections (6) through (19) of section
3150	400.021, Florida Statutes, are renumbered as subsections (5)
3151	through (18), respectively, and present subsections (5) and (20)
3152	of said section are amended to read:
3153	400.021  Definitions.--When used in this part, unless the
3154	context otherwise requires, the term:
3155	(5)  "Controlling interest" means:
3156	(a)  The applicant for licensure or a licensee;
3157	(b)  A person or entity that serves as an officer of, is on
3158	the board of directors of, or has a 5 percent or greater
3159	ownership interest in the management company or other entity,
3160	related or unrelated, which the applicant or licensee may
3161	contract with to operate the facility; or
3162	(c)  A person or entity that serves as an officer of, is on
3163	the board of directors of, or has a 5 percent or greater
3164	ownership interest in the applicant or licensee.
3165
3166	The term does not include a voluntary board member.
3167	(20)  "Voluntary board member" means a director of a not-
3168	for-profit corporation or organization who serves solely in a
3169	voluntary capacity for the corporation or organization, does not
3170	receive any remuneration for his or her services on the board of
3171	directors, and has no financial interest in the corporation or
3172	organization. The agency shall recognize a person as a voluntary
3173	board member following submission of a statement to the agency
3174	by the director and the not-for-profit corporation or
3175	organization which affirms that the director conforms to this
3176	definition. The statement affirming the status of the director
3177	must be submitted to the agency on a form provided by the
3178	agency.
3179	Section 62.  Paragraph (c) of subsection (2) of section
3180	395.602, Florida Statutes, is amended to read:
3181	395.602  Rural hospitals.--
3182	(2)  DEFINITIONS.--As used in this part:
3183	(c)  "Inactive rural hospital bed" means a licensed acute
3184	care hospital bed, as defined in s. 395.002(13)(14), that is
3185	inactive in that it cannot be occupied by acute care inpatients.
3186	Section 63.  Paragraph (c) of subsection (1) of section
3187	395.701, Florida Statutes, is amended to read:
3188	395.701  Annual assessments on net operating revenues for
3189	inpatient and outpatient services to fund public medical
3190	assistance; administrative fines for failure to pay assessments
3191	when due; exemption.--
3192	(1)  For the purposes of this section, the term:
3193	(c)  "Hospital" means a health care institution as defined
3194	in s. 395.002(12)(13), but does not include any hospital
3195	operated by the agency or the Department of Corrections.
3196	Section 64.  Subsection (3) of section 400.022, Florida
3197	Statutes, is amended to read:
3198	400.022  Residents' rights.--
3199	(3)  Any violation of the resident's rights set forth in
3200	this section shall constitute grounds for action by the agency
3201	under the provisions of s. 400.102, s. 400.121, or part II of
3202	chapter 408. In order to determine whether the licensee is
3203	adequately protecting residents' rights, the licensure annual
3204	inspection of the facility shall include private informal
3205	conversations with a sample of residents to discuss residents'
3206	experiences within the facility with respect to rights specified
3207	in this section and general compliance with standards, and
3208	consultation with the ombudsman council in the local planning
3209	and service area of the Department of Elderly Affairs in which
3210	the nursing home is located.
3211	Section 65.  Paragraph (b) of subsection (1) of section
3212	400.051, Florida Statutes, is amended to read:
3213	400.051  Homes or institutions exempt from the provisions
3214	of this part.--
3215	(1)  The following shall be exempt from the provisions of
3216	this part:
3217	(b)  Any hospital, as defined in s. 395.002(11), that is
3218	licensed under chapter 395.
3219	Section 66.  Section 400.062, Florida Statutes, is amended
3220	to read:
3221	400.062  License required; fee; disposition; display;
3222	transfer.--
3223	(1)  The requirements of part II of chapter 408 shall apply
3224	to the provision of services that require licensure pursuant to
3225	this part and part II of chapter 408 and to entities licensed by
3226	or applying for such licensure from the Agency for Health Care
3227	Administration pursuant to this part. However, each applicant
3228	for licensure and each licensee is exempt from s. 408.810(7). It
3229	is unlawful to operate or maintain a facility without first
3230	obtaining from the agency a license authorizing such operation.
3231	(2)  Separate licenses shall be required for facilities
3232	maintained in separate premises, even though operated under the
3233	same management. However, a separate license shall not be
3234	required for separate buildings on the same grounds.
3235	(3)  In accordance with s. 408.805, an applicant or
3236	licensee shall pay a fee for each license application submitted
3237	under this part, part II of chapter 408, and applicable rules.
3238	The annual license fee required for each license issued under
3239	this part shall be comprised of two parts. Part I of the license
3240	fee shall be the basic license fee. The rate per bed for the
3241	basic license fee shall be established biennially annually and
3242	shall be $100 $50 per bed unless modified by rule. The agency
3243	may adjust the per bed licensure fees by the Consumer Price
3244	Index based on the 12 months immediately preceding the increase
3245	to cover the cost of regulation under this part. Part II of the
3246	license fee shall be the resident protection fee, which shall be
3247	at the rate of not less than 50 25 cents per bed. The rate per
3248	bed shall be the minimum rate per bed, and such rate shall
3249	remain in effect until the effective date of a rate per bed
3250	adopted by rule by the agency pursuant to this part. At such
3251	time as the amount on deposit in the Resident Protection Trust
3252	Fund is less than $1 million, the agency may adopt rules to
3253	establish a rate which may not exceed $20 $10 per bed. The rate
3254	per bed shall revert back to the minimum rate per bed when the
3255	amount on deposit in the Resident Protection Trust Fund reaches
3256	$1 million, except that any rate established by rule shall
3257	remain in effect until such time as the rate has been equally
3258	required for each license issued under this part. Any amount in
3259	the fund in excess of $2 million shall revert to the Health Care
3260	Trust Fund and may not be expended without prior approval of the
3261	Legislature. The agency may prorate the biennial annual license
3262	fee for those licenses which it issues under this part for less
3263	than 2 years 1 year. Funds generated by license fees collected
3264	in accordance with this section shall be deposited in the
3265	following manner:
3266	(a)  The basic license fee collected shall be deposited in
3267	the Health Care Trust Fund, established for the sole purpose of
3268	carrying out this part. When the balance of the account
3269	established in the Health Care Trust Fund for the deposit of
3270	fees collected as authorized under this section exceeds one-
3271	third of the annual cost of regulation under this part, the
3272	excess shall be used to reduce the licensure fees in the next
3273	year.
3274	(b)  The resident protection fee collected shall be
3275	deposited in the Resident Protection Trust Fund for the sole
3276	purpose of paying, in accordance with the provisions of s.
3277	400.063, for the appropriate alternate placement, care, and
3278	treatment of a resident removed from a nursing home facility on
3279	a temporary, emergency basis or for the maintenance and care of
3280	residents in a nursing home facility pending removal and
3281	alternate placement.
3282	(4)  Counties or municipalities applying for licenses under
3283	this part are exempt from license fees authorized under this
3284	section.
3285	(5)  The license shall be displayed in a conspicuous place
3286	inside the facility.
3287	(6)  A license shall be valid only in the hands of the
3288	individual, firm, partnership, association, or corporation to
3289	whom it is issued and shall not be subject to sale, assignment,
3290	or other transfer, voluntary or involuntary, nor shall a license
3291	be valid for any premises other than those for which originally
3292	issued.
3293	Section 67.  Subsection (1) of section 400.063, Florida
3294	Statutes, is amended to read:
3295	400.063  Resident Protection Trust Fund.--
3296	(1)  A Resident Protection Trust Fund shall be established
3297	for the purpose of collecting and disbursing funds generated
3298	from the license fees and administrative fines as provided for
3299	in ss. 393.0673(2), 400.062(3)(b), 400.111(1), 400.121(2), and
3300	400.23(8). Such funds shall be for the sole purpose of paying
3301	for the appropriate alternate placement, care, and treatment of
3302	residents who are removed from a facility licensed under this
3303	part or a facility specified in s. 393.0678(1) in which the
3304	agency determines that existing conditions or practices
3305	constitute an immediate danger to the health, safety, or
3306	security of the residents. If the agency determines that it is
3307	in the best interest of the health, safety, or security of the
3308	residents to provide for an orderly removal of the residents
3309	from the facility, the agency may utilize such funds to maintain
3310	and care for the residents in the facility pending removal and
3311	alternative placement. The maintenance and care of the residents
3312	shall be under the direction and control of a receiver appointed
3313	pursuant to s. 393.0678(1) or s. 400.126(1). However, funds may
3314	be expended in an emergency upon a filing of a petition for a
3315	receiver, upon the declaration of a state of local emergency
3316	pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
3317	order of evacuation of a facility by emergency personnel to
3318	protect the health and safety of the residents.
3319	Section 68.  Section 400.071, Florida Statutes, is amended
3320	to read:
3321	400.071  Application for license.--
3322	(1)  An application for a license as required by s. 400.062
3323	shall be made to the agency on forms furnished by it and shall
3324	be accompanied by the appropriate license fee.
3325	(1)(2)  The application for a license shall be under oath
3326	and shall contain the following:
3327	(a)  The name, address, and social security number of the
3328	applicant if an individual; if the applicant is a firm,
3329	partnership, or association, its name, address, and employer
3330	identification number (EIN), and the name and address of any
3331	controlling interest; and the name by which the facility is to
3332	be known.
3333	(b)  The name of any person whose name is required on the
3334	application under the provisions of paragraph (a) and who owns
3335	at least a 10-percent interest in any professional service,
3336	firm, association, partnership, or corporation providing goods,
3337	leases, or services to the facility for which the application is
3338	made, and the name and address of the professional service,
3339	firm, association, partnership, or corporation in which such
3340	interest is held.
3341	(c)  The location of the facility for which a license is
3342	sought and an indication, as in the original application, that
3343	such location conforms to the local zoning ordinances.
3344	(d)  The name of the person or persons under whose
3345	management or supervision the facility will be conducted and the
3346	name of the administrator.
3347	(a)(e)  A signed affidavit disclosing any financial or
3348	ownership interest that a controlling interest as defined in
3349	part II of chapter 408 person or entity described in paragraph
3350	(a) or paragraph (d) has held in the last 5 years in any entity
3351	licensed by this state or any other state to provide health or
3352	residential care which has closed voluntarily or involuntarily;
3353	has filed for bankruptcy; has had a receiver appointed; has had
3354	a license denied, suspended, or revoked; or has had an
3355	injunction issued against it which was initiated by a regulatory
3356	agency. The affidavit must disclose the reason any such entity
3357	was closed, whether voluntarily or involuntarily.
3358	(b)(f)  The total number of beds and the total number of
3359	Medicare and Medicaid certified beds.
3360	(c)(g)  Information relating to the number, experience, and
3361	training of the employees of the facility and of the moral
3362	character of the applicant and employees that which the agency
3363	requires by rule, including the name and address of any nursing
3364	home with which the applicant or employees have been affiliated
3365	through ownership or employment within 5 years of the date of
3366	the application for a license and the record of any criminal
3367	convictions involving the applicant and any criminal convictions
3368	involving an employee if known by the applicant after inquiring
3369	of the employee. The applicant must demonstrate that sufficient
3370	numbers of qualified staff, by training or experience, will be
3371	employed to properly care for the type and number of residents
3372	who will reside in the facility.
3373	(d)(h)  Copies of any civil verdict or judgment involving
3374	the applicant rendered within the 10 years preceding the
3375	application, relating to medical negligence, violation of
3376	residents' rights, or wrongful death. As a condition of
3377	licensure, the licensee agrees to provide to the agency copies
3378	of any new verdict or judgment involving the applicant, relating
3379	to such matters, within 30 days after filing with the clerk of
3380	the court. The information required in this paragraph shall be
3381	maintained in the facility's licensure file and in an agency
3382	database which is available as a public record.
3383	(3)  The applicant shall submit evidence which establishes
3384	the good moral character of the applicant, manager, supervisor,
3385	and administrator. No applicant, if the applicant is an
3386	individual; no member of a board of directors or officer of an
3387	applicant, if the applicant is a firm, partnership, association,
3388	or corporation; and no licensed nursing home administrator shall
3389	have been convicted, or found guilty, regardless of
3390	adjudication, of a crime in any jurisdiction which affects or
3391	may potentially affect residents in the facility.
3392	(4)  Each applicant for licensure must comply with the
3393	following requirements:
3394	(a)  Upon receipt of a completed, signed, and dated
3395	application, the agency shall require background screening of
3396	the applicant, in accordance with the level 2 standards for
3397	screening set forth in chapter 435. As used in this subsection,
3398	the term "applicant" means the facility administrator, or
3399	similarly titled individual who is responsible for the day-to-
3400	day operation of the licensed facility, and the facility
3401	financial officer, or similarly titled individual who is
3402	responsible for the financial operation of the licensed
3403	facility.
3404	(b)  The agency may require background screening for a
3405	member of the board of directors of the licensee or an officer
3406	or an individual owning 5 percent or more of the licensee if the
3407	agency has probable cause to believe that such individual has
3408	been convicted of an offense prohibited under the level 2
3409	standards for screening set forth in chapter 435.
3410	(c)  Proof of compliance with the level 2 background
3411	screening requirements of chapter 435 which has been submitted
3412	within the previous 5 years in compliance with any other health
3413	care or assisted living licensure requirements of this state is
3414	acceptable in fulfillment of paragraph (a). Proof of compliance
3415	with background screening which has been submitted within the
3416	previous 5 years to fulfill the requirements of the Financial
3417	Services Commission and the Office of Insurance Regulation
3418	pursuant to chapter 651 as part of an application for a
3419	certificate of authority to operate a continuing care retirement
3420	community is acceptable in fulfillment of the Department of Law
3421	Enforcement and Federal Bureau of Investigation background
3422	check.
3423	(d)  A provisional license may be granted to an applicant
3424	when each individual required by this section to undergo
3425	background screening has met the standards for the Department of
3426	Law Enforcement background check, but the agency has not yet
3427	received background screening results from the Federal Bureau of
3428	Investigation, or a request for a disqualification exemption has
3429	been submitted to the agency as set forth in chapter 435, but a
3430	response has not yet been issued. A license may be granted to
3431	the applicant upon the agency's receipt of a report of the
3432	results of the Federal Bureau of Investigation background
3433	screening for each individual required by this section to
3434	undergo background screening which confirms that all standards
3435	have been met, or upon the granting of a disqualification
3436	exemption by the agency as set forth in chapter 435. Any other
3437	person who is required to undergo level 2 background screening
3438	may serve in his or her capacity pending the agency's receipt of
3439	the report from the Federal Bureau of Investigation; however,
3440	the person may not continue to serve if the report indicates any
3441	violation of background screening standards and a
3442	disqualification exemption has not been requested of and granted
3443	by the agency as set forth in chapter 435.
3444	(e)  Each applicant must submit to the agency, with its
3445	application, a description and explanation of any exclusions,
3446	permanent suspensions, or terminations of the applicant from the
3447	Medicare or Medicaid programs. Proof of compliance with
3448	disclosure of ownership and control interest requirements of the
3449	Medicaid or Medicare programs shall be accepted in lieu of this
3450	submission.
3451	(f)  Each applicant must submit to the agency a description
3452	and explanation of any conviction of an offense prohibited under
3453	the level 2 standards of chapter 435 by a member of the board of
3454	directors of the applicant, its officers, or any individual
3455	owning 5 percent or more of the applicant. This requirement
3456	shall not apply to a director of a not-for-profit corporation or
3457	organization if the director serves solely in a voluntary
3458	capacity for the corporation or organization, does not regularly
3459	take part in the day-to-day operational decisions of the
3460	corporation or organization, receives no remuneration for his or
3461	her services on the corporation or organization's board of
3462	directors, and has no financial interest and has no family
3463	members with a financial interest in the corporation or
3464	organization, provided that the director and the not-for-profit
3465	corporation or organization include in the application a
3466	statement affirming that the director's relationship to the
3467	corporation satisfies the requirements of this paragraph.
3468	(g)  An application for license renewal must contain the
3469	information required under paragraphs (e) and (f).
3470	(5)  The applicant shall furnish satisfactory proof of
3471	financial ability to operate and conduct the nursing home in
3472	accordance with the requirements of this part and all rules
3473	adopted under this part, and the agency shall establish
3474	standards for this purpose, including information reported under
3475	paragraph (2)(e). The agency also shall establish documentation
3476	requirements, to be completed by each applicant, that show
3477	anticipated facility revenues and expenditures, the basis for
3478	financing the anticipated cash-flow requirements of the
3479	facility, and an applicant's access to contingency financing.
3480	(6)  If the applicant offers continuing care agreements as
3481	defined in chapter 651, proof shall be furnished that such
3482	applicant has obtained a certificate of authority as required
3483	for operation under that chapter.
3484	(2)(7)  As a condition of licensure, each licensee, except
3485	one offering continuing care agreements as defined in chapter
3486	651, must agree to accept recipients of Title XIX of the Social
3487	Security Act on a temporary, emergency basis. The persons whom
3488	the agency may require such licensees to accept are those
3489	recipients of Title XIX of the Social Security Act who are
3490	residing in a facility in which existing conditions constitute
3491	an immediate danger to the health, safety, or security of the
3492	residents of the facility.
3493	(3)(8)  The agency may not issue a license to a nursing
3494	home that fails to receive a certificate of need under the
3495	provisions of ss. 408.031-408.045. It is the intent of the
3496	Legislature that, in reviewing a certificate-of-need application
3497	to add beds to an existing nursing home facility, preference be
3498	given to the application of a licensee who has been awarded a
3499	Gold Seal as provided for in s. 400.235, if the applicant
3500	otherwise meets the review criteria specified in s. 408.035.
3501	(4)(9)  The agency may develop an abbreviated survey for
3502	licensure renewal applicable to a licensee that has continuously
3503	operated as a nursing facility since 1991 or earlier, has
3504	operated under the same management for at least the preceding 30
3505	months, and has had during the preceding 30 months no class I or
3506	class II deficiencies.
3507	(5)(10)  As a condition of licensure, each facility must
3508	establish and submit with its application a plan for quality
3509	assurance and for conducting risk management.
3510	(11)  The applicant must provide the agency with proof of a
3511	legal right to occupy the property before a license may be
3512	issued. Proof may include, but is not limited to, copies of
3513	warranty deeds, lease or rental agreements, contracts for deeds,
3514	or quitclaim deeds.
3515	Section 69.  Subsection (4) of section 400.0712, Florida
3516	Statutes, is renumbered as subsection (3) and present subsection
3517	(3) of said section is amended to read:
3518	400.0712  Application for inactive license.--
3519	(3)  The agency may issue an inactive license to a nursing
3520	home that will be temporarily unable to provide services but is
3521	reasonably expected to resume services.
3522	(a)  An inactive license issued under this subsection may
3523	be issued for a period not to exceed 12 months and may be
3524	renewed by the agency for an additional 6 months upon
3525	demonstration of progress toward reopening.
3526	(b)  All licensure fees must be current and paid in full,
3527	and may be prorated as provided by agency rule, before the
3528	inactive license is issued.
3529	(c)  Reactivation of an inactive license requires that the
3530	applicant pay all licensure fees and be inspected by the agency
3531	to confirm that all of the requirements of this part and
3532	applicable rules are met.
3533	Section 70.  Section 400.102, Florida Statutes, is amended
3534	to read:
3535	400.102  Action by agency against licensee; grounds.--
3536	(1)  In addition to the grounds listed in part II of
3537	chapter 408, any of the following conditions shall be grounds
3538	for action by the agency against a licensee:
3539	(1)(a)  An intentional or negligent act materially
3540	affecting the health or safety of residents of the facility;
3541	(2)(b)  Misappropriation or conversion of the property of a
3542	resident of the facility;
3543	(3)(c)  Failure to follow the criteria and procedures
3544	provided under part I of chapter 394 relating to the
3545	transportation, voluntary admission, and involuntary examination
3546	of a nursing home resident; or
3547	(d)  Violation of provisions of this part or rules adopted
3548	under this part;
3549	(4)(e)  Fraudulent altering, defacing, or falsifying any
3550	medical or nursing home records, or causing or procuring any of
3551	these offenses to be committed.; or
3552	(f)  Any act constituting a ground upon which application
3553	for a license may be denied.
3554	(2)  If the agency has reasonable belief that any of such
3555	conditions exist, it shall take the following action:
3556	(a)  In the case of an applicant for original licensure,
3557	denial action as provided in s. 400.121.
3558	(b)  In the case of an applicant for relicensure or a
3559	current licensee, administrative action as provided in s.
3560	400.121 or injunctive action as authorized by s. 400.125.
3561	(c)  In the case of a facility operating without a license,
3562	injunctive action as authorized in s. 400.125.
3563	Section 71.  Section 400.111, Florida Statutes, is amended
3564	to read:
3565	400.111  Disclosure of controlling interest Expiration of
3566	license; renewal.--
3567	(1)  A license issued for the operation of a facility,
3568	unless sooner suspended or revoked, shall expire on the date set
3569	forth by the agency on the face of the license or 1 year from
3570	the date of issuance, whichever occurs first. Ninety days prior
3571	to the expiration date, an application for renewal shall be
3572	submitted to the agency. A license shall be renewed upon the
3573	filing of an application on forms furnished by the agency if the
3574	applicant has first met the requirements established under this
3575	part and all rules adopted under this part. The failure to file
3576	an application within the period established in this subsection
3577	shall result in a late fee charged to the licensee by the agency
3578	in an amount equal to 50 percent of the fee in effect on the
3579	last preceding regular renewal date. A late fee shall be levied
3580	for each and every day the filing of the license application is
3581	delayed, but in no event shall such fine aggregate more than
3582	$5,000. If an application is received after the required filing
3583	date and exhibits a hand-canceled postmark obtained from a
3584	United States Post Office dated on or before the required filing
3585	date, no fine will be levied.
3586	(2)  A licensee against whom a revocation or suspension
3587	proceeding, or any judicial proceeding instituted by the agency
3588	under this part, is pending at the time of license renewal may
3589	be issued a temporary license effective until final disposition
3590	by the agency of such proceeding. If judicial relief is sought
3591	from the aforesaid administrative order, the court having
3592	jurisdiction may issue such orders regarding the issuance of a
3593	temporary permit during the pendency of the judicial proceeding.
3594	(3)  The agency may not renew a license if the applicant
3595	has failed to pay any fines assessed by final order of the
3596	agency or final order of the Health Care Financing
3597	Administration under requirements for federal certification. The
3598	agency may renew the license of an applicant following the
3599	assessment of a fine by final order if such fine has been paid
3600	into an escrow account pending an appeal of a final order.
3601	(4)  In addition to the requirements of part II of chapter
3602	408, the licensee shall submit a signed affidavit disclosing any
3603	financial or ownership interest that a controlling interest
3604	licensee has held within the last 5 years in any entity licensed
3605	by the state or any other state to provide health or residential
3606	care which entity has closed voluntarily or involuntarily; has
3607	filed for bankruptcy; has had a receiver appointed; has had a
3608	license denied, suspended, or revoked; or has had an injunction
3609	issued against it which was initiated by a regulatory agency.
3610	The affidavit must disclose the reason such entity was closed,
3611	whether voluntarily or involuntarily.
3612	Section 72.  Subsections (2) and (5) of section 400.1183,
3613	Florida Statutes, are amended to read:
3614	400.1183  Resident grievance procedures.--
3615	(2)  Each facility shall maintain records of all grievances
3616	and shall report annually to the agency at the time of
3617	relicensure the total number of grievances handled during the
3618	prior licensure period, a categorization of the cases underlying
3619	the grievances, and the final disposition of the grievances.
3620	(5)  The agency may impose an administrative fine, in
3621	accordance with s. 400.121, against a nursing home facility for
3622	noncompliance with this section.
3623	Section 73.  Section 400.121, Florida Statutes, is amended
3624	to read:
3625	400.121  Denial, suspension, revocation of license;
3626	moratorium on admissions; administrative fines; procedure; order
3627	to increase staffing.--
3628	(1)  The agency may deny an application, revoke or suspend
3629	a license, and or impose an administrative fine, not to exceed
3630	$500 per violation per day for the violation of any provision of
3631	this part, part II of chapter 408, or applicable rules, against
3632	any applicant or licensee for the following violations by the
3633	applicant, licensee, or other controlling interest:
3634	(a)  A violation of any provision of this part, part II of
3635	chapter 408, or applicable rules s. 400.102(1); or
3636	(b)  A demonstrated pattern of deficient practice;
3637	(c)  Failure to pay any outstanding fines assessed by final
3638	order of the agency or final order of the Health Care Financing
3639	Administration pursuant to requirements for federal
3640	certification. The agency may renew or approve the license of an
3641	applicant following the assessment of a fine by final order if
3642	such fine has been paid into an escrow account pending an appeal
3643	of a final order;
3644	(d)  Exclusion from the Medicare or Medicaid program; or
3645	(b)(e)  An adverse action by a regulatory agency against
3646	any other licensed facility that has a common controlling
3647	interest with the licensee or applicant against whom the action
3648	under this section is being brought. If the adverse action
3649	involves solely the management company, the applicant or
3650	licensee shall be given 30 days to remedy before final action is
3651	taken. If the adverse action is based solely upon actions by a
3652	controlling interest, the applicant or licensee may present
3653	factors in mitigation of any proposed penalty based upon a
3654	showing that such penalty is inappropriate under the
3655	circumstances.
3656
3657	All hearings shall be held within the county in which the
3658	licensee or applicant operates or applies for a license to
3659	operate a facility as defined herein.
3660	(2)  Except as provided in s. 400.23(8), a $500 fine shall
3661	be imposed for each violation. Each day a violation of this part
3662	occurs constitutes a separate violation and is subject to a
3663	separate fine, but in no event may any fine aggregate more than
3664	$5,000. A fine may be levied pursuant to this section in lieu of
3665	and notwithstanding the provisions of s. 400.23. Fines paid
3666	shall be deposited in the Resident Protection Trust Fund and
3667	expended as provided in s. 400.063.
3668	(3)  The agency shall revoke or deny a nursing home license
3669	if the licensee or controlling interest operates a facility in
3670	this state that:
3671	(a)  Has had two moratoria imposed by final order for
3672	substandard quality of care, as defined by 42 C.F.R. part 483,
3673	within any 30-month period;
3674	(b)  Is conditionally licensed for 180 or more continuous
3675	days;
3676	(c)  Is cited for two class I deficiencies arising from
3677	unrelated circumstances during the same survey or investigation;
3678	or
3679	(d)  Is cited for two class I deficiencies arising from
3680	separate surveys or investigations within a 30-month period.
3681
3682	The licensee may present factors in mitigation of revocation,
3683	and the agency may make a determination not to revoke a license
3684	based upon a showing that revocation is inappropriate under the
3685	circumstances.
3686	(4)  The agency may issue an order immediately suspending
3687	or revoking a license when it determines that any condition in
3688	the facility presents a danger to the health, safety, or welfare
3689	of the residents in the facility.
3690	(5)(a)  The agency may impose an immediate moratorium on
3691	admissions to any facility when the agency determines that any
3692	condition in the facility presents a threat to the health,
3693	safety, or welfare of the residents in the facility.
3694	(4)(b)  Where the agency has placed a moratorium on
3695	admissions on any facility two times within a 7-year period, the
3696	agency may suspend the nursing home license of the nursing home
3697	and the facility's management company, if any. During the
3698	suspension, the agency shall take the facility into receivership
3699	and shall operate the facility.
3700	(5)(6)  An action taken by the agency to deny, suspend, or
3701	revoke a facility's license under this part shall be heard by
3702	the Division of Administrative Hearings of the Department of
3703	Management Services within 60 days after the assignment of an
3704	administrative law judge, unless the time limitation is waived
3705	by both parties. The administrative law judge must render a
3706	decision within 30 days after receipt of a proposed recommended
3707	order.
3708	(6)(7)  The agency is authorized to require a facility to
3709	increase staffing beyond the minimum required by law, if the
3710	agency has taken administrative action against the facility for
3711	care-related deficiencies directly attributable to insufficient
3712	staff. Under such circumstances, the facility may request an
3713	expedited interim rate increase. The agency shall process the
3714	request within 10 days after receipt of all required
3715	documentation from the facility. A facility that fails to
3716	maintain the required increased staffing is subject to a fine of
3717	$500 per day for each day the staffing is below the level
3718	required by the agency.
3719	(8)  An administrative proceeding challenging an action
3720	taken by the agency pursuant to this section shall be reviewed
3721	on the basis of the facts and conditions that resulted in such
3722	agency action.
3723	(7)(9)  Notwithstanding any other provision of law to the
3724	contrary, agency action in an administrative proceeding under
3725	this section may be overcome by the licensee upon a showing by a
3726	preponderance of the evidence to the contrary.
3727	(8)(10)  In addition to any other sanction imposed under
3728	this part, in any final order that imposes sanctions, the agency
3729	may assess costs related to the investigation and prosecution of
3730	the case. Payment of agency costs shall be deposited into the
3731	Health Care Trust Fund.
3732	Section 74.  Section 400.125, Florida Statutes, is
3733	repealed.
3734	Section 75.  Subsections (14), (15), and (16) of section
3735	400.141, Florida Statutes, are amended to read:
3736	400.141  Administration and management of nursing home
3737	facilities.--Every licensed facility shall comply with all
3738	applicable standards and rules of the agency and shall:
3739	(14)  Submit to the agency the information specified in s.
3740	400.071(1)(a)(2)(e) for a management company within 30 days
3741	after the effective date of the management agreement.
3742	(15)(a)  By the 15th calendar day of the month following
3743	the end of each calendar quarter, submit semiannually to the
3744	agency, or more frequently if requested by the agency,
3745	information regarding facility staff-to-resident ratios, staff
3746	turnover, and staff stability, including information regarding
3747	certified nursing assistants, licensed nurses, the director of
3748	nursing, and the facility administrator. For purposes of this
3749	reporting:
3750	1.(a)  Staff-to-resident ratios must be reported in the
3751	categories specified in s. 400.23(3)(a) and applicable rules.
3752	The ratio must be reported as an average for the most recent
3753	calendar quarter.
3754	2.(b)  Staff turnover must be reported for the most recent
3755	12-month period ending on the last workday of the most recent
3756	calendar quarter prior to the date the information is submitted.
3757	The turnover rate must be computed quarterly, with the annual
3758	rate being the cumulative sum of the quarterly rates. The
3759	turnover rate is the total number of terminations or separations
3760	experienced during the quarter, excluding any employee
3761	terminated during a probationary period of 3 months or less,
3762	divided by the total number of staff employed at the end of the
3763	period for which the rate is computed, and expressed as a
3764	percentage.
3765	3.(c)  The formula for determining staff stability is the
3766	total number of employees that have been employed for more than
3767	12 months, divided by the total number of employees employed at
3768	the end of the most recent calendar quarter, and expressed as a
3769	percentage.
3770	(b)(d)  A nursing facility that has failed to comply with
3771	state minimum-staffing requirements for 2 consecutive days is
3772	prohibited from accepting new admissions until the facility has
3773	achieved the minimum-staffing requirements for a period of 6
3774	consecutive days. For the purposes of this paragraph, any person
3775	who was a resident of the facility and was absent from the
3776	facility for the purpose of receiving medical care at a separate
3777	location or was on a leave of absence is not considered a new
3778	admission. Failure to impose such an admissions moratorium
3779	constitutes a class II deficiency.
3780	(c)(e)  A nursing facility that which does not have a
3781	conditional license may be cited for failure to comply with the
3782	standards in s. 400.23(3)(a) only if it has failed to meet those
3783	standards on 2 consecutive days or if it has failed to meet at
3784	least 97 percent of those standards on any one day.
3785	(d)(f)  A facility that which has a conditional license
3786	must be in compliance with the standards in s. 400.23(3)(a) at
3787	all times from the effective date of the conditional license
3788	until the effective date of a subsequent standard license.
3789
3790	Nothing in this subsection section shall limit the agency's
3791	ability to impose a deficiency or take other actions if a
3792	facility does not have enough staff to meet the residents'
3793	needs.
3794	(16)  Report by the 10th calendar day of each month monthly
3795	the number of vacant beds in the facility that which are
3796	available for resident occupancy on the last day of the month
3797	information is reported.
3798
3799	Facilities that have been awarded a Gold Seal under the program
3800	established in s. 400.235 may develop a plan to provide
3801	certified nursing assistant training as prescribed by federal
3802	regulations and state rules and may apply to the agency for
3803	approval of their program.
3804	Section 76.  Subsection (6) of section 400.162, Florida
3805	Statutes, is amended to read:
3806	400.162  Property and personal affairs of residents.--
3807	(6)  In the event of the death of a resident, a licensee
3808	shall return all refunds and funds held in trust to the
3809	resident's personal representative, if one has been appointed at
3810	the time the nursing home disburses such funds, and if not, to
3811	the resident's spouse or adult next of kin named in a
3812	beneficiary designation form provided by the nursing home to the
3813	resident. In the event the resident has not completed the
3814	beneficiary designation form or the resident's designated spouse
3815	or adult next of kin is deceased or cannot be located and no
3816	personal representative has been appointed, the nursing home may
3817	release funds to the funeral home that is handling the deceased
3818	resident's remains for the funeral home's actual charges for the
3819	services performed. In all other situations no spouse or adult
3820	next of kin or such person cannot be located, funds due to the
3821	resident shall be placed in an interest-bearing account in a
3822	bank, savings association, trust company, or credit union
3823	located in this state and, if possible, located within the same
3824	district in which the facility is located, which funds shall not
3825	be represented as part of the assets of the facility on a
3826	financial statement, and the licensee shall maintain such
3827	account until such time as the trust funds are disbursed
3828	pursuant to the provisions of the Florida Probate Code. All
3829	other property of a deceased resident being held in trust by the
3830	licensee shall be returned to the resident's personal
3831	representative, if one has been appointed at the time the
3832	nursing home disburses such property, and if not, to the
3833	resident's spouse or adult next of kin named in a beneficiary
3834	designation form provided by the nursing home to the resident.
3835	In the event the resident has no spouse or adult next of kin or
3836	such person cannot be located, property being held in trust
3837	shall be safeguarded until such time as the property is
3838	disbursed pursuant to the provisions of the Florida Probate
3839	Code. The trust funds and property of deceased residents shall
3840	be kept separate from the funds and the property of the licensee
3841	and from the funds and property of the residents of the
3842	facility. The nursing home needs to maintain only one account in
3843	which the trust funds amounting to less than $100 of deceased
3844	residents are placed. However, it shall be the obligation of the
3845	nursing home to maintain adequate records to permit compilation
3846	of interest due each individual resident's account. Separate
3847	accounts shall be maintained with respect to trust funds of
3848	deceased residents equal to or in excess of $100. In the event
3849	the trust funds of the deceased resident are not disbursed
3850	pursuant to the provisions of the Florida Probate Code within 2
3851	years of the death of the resident, the trust funds shall be
3852	deposited in the Resident Protection Trust Fund and expended as
3853	provided for in s. 400.063, notwithstanding the provisions of
3854	any other law of this state. Any other property of a deceased
3855	resident held in trust by a licensee which is not disbursed in
3856	accordance with the provisions of the Florida Probate Code shall
3857	escheat to the state as provided by law.
3858	Section 77.  Section 400.179, Florida Statutes, is amended
3859	to read:
3860	400.179  Sale or transfer of ownership of a nursing
3861	facility; Liability for Medicaid underpayments and
3862	overpayments.--
3863	(1)  It is the intent of the Legislature to protect the
3864	rights of nursing home residents and the security of public
3865	funds when a nursing facility is sold or the ownership is
3866	transferred.
3867	(2)  Whenever a nursing facility is sold or the ownership
3868	is transferred, including leasing, the transferee shall make
3869	application to the agency for a new license at least 90 days
3870	prior to the date of transfer of ownership.
3871	(3)  The transferor shall notify the agency in writing at
3872	least 90 days prior to the date of transfer of ownership. The
3873	transferor shall be responsible and liable for the lawful
3874	operation of the nursing facility and the welfare of the
3875	residents domiciled in the facility until the date the
3876	transferee is licensed by the agency. The transferor shall be
3877	liable for any and all penalties imposed against the facility
3878	for violations occurring prior to the date of transfer of
3879	ownership.
3880	(4)  The transferor shall, prior to transfer of ownership,
3881	repay or make arrangements to repay to the agency or the
3882	Department of Children and Family Services any amounts owed to
3883	the agency or the department. Should the transferor fail to
3884	repay or make arrangements to repay the amounts owed to the
3885	agency or the department prior to the transfer of ownership, the
3886	issuance of a license to the transferee shall be delayed until
3887	repayment or until arrangements for repayment are made.
3888	(2)(5)  Because any transfer of a nursing facility may
3889	expose the fact that Medicaid may have underpaid or overpaid the
3890	transferor, and because in most instances, any such underpayment
3891	or overpayment can only be determined following a formal field
3892	audit, the liabilities for any such underpayments or
3893	overpayments shall be as follows:
3894	(a)  The Medicaid program shall be liable to the transferor
3895	for any underpayments owed during the transferor's period of
3896	operation of the facility.
3897	(b)  Without regard to whether the transferor had leased or
3898	owned the nursing facility, the transferor shall remain liable
3899	to the Medicaid program for all Medicaid overpayments received
3900	during the transferor's period of operation of the facility,
3901	regardless of when determined.
3902	(c)  Where the facility transfer takes any form of a sale
3903	of assets, in addition to the transferor's continuing liability
3904	for any such overpayments, if the transferor fails to meet these
3905	obligations, the transferee shall be liable for all liabilities
3906	that can be readily identifiable 90 days in advance of the
3907	transfer. Such liability shall continue in succession until the
3908	debt is ultimately paid or otherwise resolved. It shall be the
3909	burden of the transferee to determine the amount of all such
3910	readily identifiable overpayments from the Agency for Health
3911	Care Administration, and the agency shall cooperate in every way
3912	with the identification of such amounts. Readily identifiable
3913	overpayments shall include overpayments that will result from,
3914	but not be limited to:
3915	1.  Medicaid rate changes or adjustments;
3916	2.  Any depreciation recapture;
3917	3.  Any recapture of fair rental value system indexing; or
3918	4.  Audits completed by the agency.
3919
3920	The transferor shall remain liable for any such Medicaid
3921	overpayments that were not readily identifiable 90 days in
3922	advance of the nursing facility transfer.
3923	(d)  Where the transfer involves a facility that has been
3924	leased by the transferor:
3925	1.  The transferee shall, as a condition to being issued a
3926	license by the agency, acquire, maintain, and provide proof to
3927	the agency of a bond with a term of 30 months, renewable
3928	annually, in an amount not less than the total of 3 months
3929	Medicaid payments to the facility computed on the basis of the
3930	preceding 12-month average Medicaid payments to the facility.
3931	2.  A leasehold licensee may meet the requirements of
3932	subparagraph 1. by payment of a nonrefundable fee, paid at
3933	initial licensure, paid at the time of any subsequent change of
3934	ownership, and paid annually thereafter at the time of any
3935	subsequent annual license renewal, in the amount of 2 percent of
3936	the total of 3 months' Medicaid payments to the facility
3937	computed on the basis of the preceding 12-month average Medicaid
3938	payments to the facility. If a preceding 12-month average is not
3939	available, projected Medicaid payments may be used. The fee
3940	shall be deposited into the Health Care Trust Fund and shall be
3941	accounted for separately as a Medicaid nursing home overpayment
3942	account. These fees shall be used at the sole discretion of the
3943	agency to repay nursing home Medicaid overpayments. Payment of
3944	this fee shall not release the licensee from any liability for
3945	any Medicaid overpayments, nor shall payment bar the agency from
3946	seeking to recoup overpayments from the licensee and any other
3947	liable party. As a condition of exercising this lease bond
3948	alternative, licensees paying this fee must maintain an existing
3949	lease bond through the end of the 30-month term period of that
3950	bond. The agency is herein granted specific authority to
3951	promulgate all rules pertaining to the administration and
3952	management of this account, including withdrawals from the
3953	account, subject to federal review and approval. This provision
3954	shall take effect upon becoming law and shall apply to any
3955	leasehold license application.
3956	a.  The financial viability of the Medicaid nursing home
3957	overpayment account shall be determined by the agency through
3958	annual review of the account balance and the amount of total
3959	outstanding, unpaid Medicaid overpayments owing from leasehold
3960	licensees to the agency as determined by final agency audits.
3961	b.  The agency, in consultation with the Florida Health
3962	Care Association and the Florida Association of Homes for the
3963	Aging, shall study and make recommendations on the minimum
3964	amount to be held in reserve to protect against Medicaid
3965	overpayments to leasehold licensees and on the issue of
3966	successor liability for Medicaid overpayments upon sale or
3967	transfer of ownership of a nursing facility. The agency shall
3968	submit the findings and recommendations of the study to the
3969	Governor, the President of the Senate, and the Speaker of the
3970	House of Representatives by January 1, 2003.
3971	3.  The leasehold licensee may meet the bond requirement
3972	through other arrangements acceptable to the agency. The agency
3973	is herein granted specific authority to promulgate rules
3974	pertaining to lease bond arrangements.
3975	4.  All existing nursing facility licensees, operating the
3976	facility as a leasehold, shall acquire, maintain, and provide
3977	proof to the agency of the 30-month bond required in
3978	subparagraph 1., above, on and after July 1, 1993, for each
3979	license renewal.
3980	5.  It shall be the responsibility of all nursing facility
3981	operators, operating the facility as a leasehold, to renew the
3982	30-month bond and to provide proof of such renewal to the agency
3983	annually at the time of application for license renewal.
3984	6.  Any failure of the nursing facility operator to
3985	acquire, maintain, renew annually, or provide proof to the
3986	agency shall be grounds for the agency to deny, cancel, revoke,
3987	and or suspend the facility license to operate such facility and
3988	to take any further action, including, but not limited to,
3989	enjoining the facility, asserting a moratorium pursuant to part
3990	II of chapter 408, or applying for a receiver, deemed necessary
3991	to ensure compliance with this section and to safeguard and
3992	protect the health, safety, and welfare of the facility's
3993	residents. A lease agreement required as a condition of bond
3994	financing or refinancing under s. 154.213 by a health facilities
3995	authority or required under s. 159.30 by a county or
3996	municipality is not a leasehold for purposes of this paragraph
3997	and is not subject to the bond requirement of this paragraph.
3998	Section 78.  Subsections (1) and (4) of section 400.18,
3999	Florida Statutes, are amended to read:
4000	400.18  Closing of nursing facility.--
4001	(1)  In addition to the requirements of part II of chapter
4002	408, Whenever a licensee voluntarily discontinues operation, and
4003	during the period when it is preparing for such discontinuance,
4004	it shall inform the agency not less than 90 days prior to the
4005	discontinuance of operation. the licensee also shall inform each
4006	the resident or the next of kin, legal representative, or agency
4007	acting on behalf of the resident of the fact, and the proposed
4008	time, of such discontinuance of operation and give at least 90
4009	days' notice so that suitable arrangements may be made for the
4010	transfer and care of the resident. In the event any resident has
4011	no such person to represent him or her, the licensee shall be
4012	responsible for securing a suitable transfer of the resident
4013	before the discontinuance of operation. The agency shall be
4014	responsible for arranging for the transfer of those residents
4015	requiring transfer who are receiving assistance under the
4016	Medicaid program.
4017	(4)  Immediately upon discontinuance of operation of a
4018	facility, the licensee shall surrender the license therefor to
4019	the agency, and the license shall be canceled.
4020	Section 79.  Subsections (1), (2), and (3) of section
4021	400.19, Florida Statutes, are amended to read:
4022	400.19  Right of entry and inspection.--
4023	(1)  In accordance with part II of chapter 408, the agency
4024	and any duly designated officer or employee thereof or a member
4025	of the State Long-Term Care Ombudsman Council or the local long-
4026	term care ombudsman council shall have the right to enter upon
4027	and into the premises of any facility licensed pursuant to this
4028	part, or any distinct nursing home unit of a hospital licensed
4029	under chapter 395 or any freestanding facility licensed under
4030	chapter 395 that provides extended care or other long-term care
4031	services, at any reasonable time in order to determine the state
4032	of compliance with the provisions of this part and rules in
4033	force pursuant thereto. The right of entry and inspection shall
4034	also extend to any premises which the agency has reason to
4035	believe is being operated or maintained as a facility without a
4036	license, but no such entry or inspection of any premises shall
4037	be made without the permission of the owner or person in charge
4038	thereof, unless a warrant is first obtained from the circuit
4039	court authorizing same. Any application for a facility license
4040	or renewal thereof, made pursuant to this part, shall constitute
4041	permission for and complete acquiescence in any entry or
4042	inspection of the premises for which the license is sought, in
4043	order to facilitate verification of the information submitted on
4044	or in connection with the application; to discover, investigate,
4045	and determine the existence of abuse or neglect; or to elicit,
4046	receive, respond to, and resolve complaints. The agency shall,
4047	within 60 days after receipt of a complaint made by a resident
4048	or resident's representative, complete its investigation and
4049	provide to the complainant its findings and resolution.
4050	(2)  The agency shall coordinate nursing home facility
4051	licensing activities and responsibilities of any duly designated
4052	officer or employee involved in nursing home facility inspection
4053	to assure necessary, equitable, and consistent supervision of
4054	inspection personnel without unnecessary duplication of
4055	inspections, consultation services, or complaint investigations.
4056	To facilitate such coordination, all rules promulgated by the
4057	agency pursuant to this part shall be distributed to nursing
4058	homes licensed under s. 400.062 30 days prior to implementation.
4059	This requirement does not apply to emergency rules.
4060	(3)  The agency shall every 15 months conduct at least one
4061	unannounced inspection to determine compliance by the licensee
4062	with statutes, and with rules promulgated under the provisions
4063	of those statutes, governing minimum standards of construction,
4064	quality and adequacy of care, and rights of residents. The
4065	survey shall be conducted every 6 months for the next 2-year
4066	period if the facility has been cited for a class I deficiency,
4067	has been cited for two or more class II deficiencies arising
4068	from separate surveys or investigations within a 60-day period,
4069	or has had three or more substantiated complaints within a 6-
4070	month period, each resulting in at least one class I or class II
4071	deficiency. In addition to any other fees or fines in this part,
4072	the agency shall assess a fine for each facility that is subject
4073	to the 6-month survey cycle. The fine for the 2-year period
4074	shall be $6,000, one-half to be paid at the completion of each
4075	survey. The agency may adjust this fine by the change in the
4076	Consumer Price Index, based on the 12 months immediately
4077	preceding the increase, to cover the cost of the additional
4078	surveys. The agency shall verify through subsequent inspection
4079	that any deficiency identified during the annual inspection is
4080	corrected. However, the agency may verify the correction of a
4081	class III or class IV deficiency unrelated to resident rights or
4082	resident care without reinspecting the facility if adequate
4083	written documentation has been received from the facility, which
4084	provides assurance that the deficiency has been corrected. The
4085	giving or causing to be given of advance notice of such
4086	unannounced inspections by an employee of the agency to any
4087	unauthorized person shall constitute cause for suspension of not
4088	fewer than 5 working days according to the provisions of chapter
4089	110.
4090	Section 80.  Section 400.191, Florida Statutes, is amended
4091	to read:
4092	400.191  Availability, distribution, and posting of reports
4093	and records.--
4094	(1)  The agency shall provide information to the public
4095	about all of the licensed nursing home facilities operating in
4096	the state. The agency shall, within 60 days after an annual
4097	inspection visit or within 30 days after any interim visit to a
4098	facility, send copies of the inspection reports to the local
4099	long-term care ombudsman council, the agency's local office, and
4100	a public library or the county seat for the county in which the
4101	facility is located. The agency may provide electronic access to
4102	inspection reports as a substitute for sending copies.
4103	(2)  The agency shall publish the Nursing Home Guide
4104	provide additional information in consumer-friendly printed and
4105	electronic formats to assist consumers and their families in
4106	comparing and evaluating nursing home facilities.
4107	(a)  The agency shall provide an Internet site which shall
4108	include at least the following information either directly or
4109	indirectly through a link to another established site or sites
4110	of the agency's choosing:
4111	1.  A list by name and address of all nursing home
4112	facilities in this state, including any prior name a facility
4113	was known by during the previous 12-month period.
4114	2.  Whether such nursing home facilities are proprietary or
4115	nonproprietary.
4116	3.  The current owner of the facility's license and the
4117	year that that entity became the owner of the license.
4118	4.  The name of the owner or owners of each facility and
4119	whether the facility is affiliated with a company or other
4120	organization owning or managing more than one nursing facility
4121	in this state.
4122	5.  The total number of beds in each facility and the most
4123	recently available occupancy levels.
4124	6.  The number of private and semiprivate rooms in each
4125	facility.
4126	7.  The religious affiliation, if any, of each facility.
4127	8.  The languages spoken by the administrator and staff of
4128	each facility.
4129	9.  Whether or not each facility accepts Medicare or
4130	Medicaid recipients or insurance, health maintenance
4131	organization, Veterans Administration, CHAMPUS program, or
4132	workers' compensation coverage.
4133	10.  Recreational and other programs available at each
4134	facility.
4135	11.  Special care units or programs offered at each
4136	facility.
4137	12.  Whether the facility is a part of a retirement
4138	community that offers other services pursuant to part III, part
4139	IV, or part V.
4140	13.  Survey and deficiency information contained on the
4141	Online Survey Certification and Reporting (OSCAR) system of the
4142	federal Health Care Financing Administration, including all
4143	federal and state recertification, licensure annual survey,
4144	revisit, and complaint survey information, for each facility for
4145	the past 30 45 months. For noncertified nursing homes, state
4146	survey and deficiency information, including licensure annual
4147	survey, revisit, and complaint survey information for the past
4148	30 45 months shall be provided.
4149	14.  A summary of the deficiency Online Survey
4150	Certification and Reporting (OSCAR) data for each facility over
4151	the past 30 45 months. Such summary may include a score, rating,
4152	or comparison ranking with respect to other facilities based on
4153	the number of citations received by the facility on
4154	recertification, licensure of annual, revisit, and complaint
4155	surveys; the severity and scope of the citations; and the number
4156	of annual recertification surveys the facility has had during
4157	the past 30 45 months. The score, rating, or comparison ranking
4158	may be presented in either numeric or symbolic form for the
4159	intended consumer audience.
4160	(b)  The agency shall provide the following information in
4161	printed form:
4162	1.  A list by name and address of all nursing home
4163	facilities in this state.
4164	2.  Whether such nursing home facilities are proprietary or
4165	nonproprietary.
4166	3.  The current owner or owners of the facility's license
4167	and the year that entity became the owner of the license.
4168	4.  The total number of beds, and of private and
4169	semiprivate rooms, in each facility.
4170	5.  The religious affiliation, if any, of each facility.
4171	6.  The name of the owner of each facility and whether the
4172	facility is affiliated with a company or other organization
4173	owning or managing more than one nursing facility in this state.
4174	7.  The languages spoken by the administrator and staff of
4175	each facility.
4176	8.  Whether or not each facility accepts Medicare or
4177	Medicaid recipients or insurance, health maintenance
4178	organization, Veterans Administration, CHAMPUS program, or
4179	workers' compensation coverage.
4180	9.  Recreational programs, special care units, and other
4181	programs available at each facility.
4182	10.  The Internet address for the site where more detailed
4183	information can be seen.
4184	11.  A statement advising consumers that each facility will
4185	have its own policies and procedures related to protecting
4186	resident property.
4187	12.  A summary of the deficiency Online Survey
4188	Certification and Reporting (OSCAR) data for each facility over
4189	the past 45 months. Such summary may include a score, rating, or
4190	comparison ranking with respect to other facilities based on the
4191	number of citations received by the facility on recertification,
4192	licensure annual, revisit, and complaint surveys; the severity
4193	and scope of the citations; the number of citations; and the
4194	number of annual recertification surveys the facility has had
4195	during the past 30 45 months. The score, rating, or comparison
4196	ranking may be presented in either numeric or symbolic form for
4197	the intended consumer audience.
4198	(c)  For purposes of this subsection, references to the
4199	Online Survey Certification and Reporting (OSCAR) system shall
4200	refer to any future system that the Health Care Financing
4201	Administration develops to replace the current OSCAR system.
4202	(c)(d)  The agency may provide the following additional
4203	information on an Internet site or in printed form as the
4204	information becomes available:
4205	1.  The licensure status history of each facility.
4206	2.  The rating history of each facility.
4207	3.  The regulatory history of each facility, which may
4208	include federal sanctions, state sanctions, federal fines, state
4209	fines, and other actions.
4210	4.  Whether the facility currently possesses the Gold Seal
4211	designation awarded pursuant to s. 400.235.
4212	5.  Internet links to the Internet sites of the facilities
4213	or their affiliates.
4214	(3)  Each nursing home facility licensee shall maintain as
4215	public information, available upon request, records of all cost
4216	and inspection reports pertaining to that facility that have
4217	been filed with, or issued by, any governmental agency. Copies
4218	of such reports shall be retained in such records for not less
4219	than 5 years from the date the reports are filed or issued.
4220	(a)  The agency shall quarterly publish in the Nursing Home
4221	Guide a "Nursing Home Guide Watch List" to assist consumers in
4222	evaluating the quality of nursing home care in Florida. The
4223	watch list must identify each facility that met the criteria for
4224	a conditional licensure status to be noticed as specified in
4225	this section on any day within the quarter covered by the list
4226	and each facility that is was operating under bankruptcy
4227	protection on any day within the quarter. The watch list must
4228	include, but is not limited to, the facility's name, address,
4229	and ownership; the county in which the facility operates; the
4230	license expiration date; the number of licensed beds; a
4231	description of the deficiency causing the facility to be placed
4232	on the list; any corrective action taken; and the cumulative
4233	number of days and percentage of days times the facility had a
4234	conditional license in the past 30 months has been on a watch
4235	list. The watch list must include a brief description regarding
4236	how to choose a nursing home, the categories of licensure, the
4237	agency's inspection process, an explanation of terms used in the
4238	watch list, and the addresses and phone numbers of the agency's
4239	managed care and health quality assurance field area offices.
4240	(b)  Upon publication of each quarterly Nursing Home Guide
4241	watch list, the agency must post transmit a copy on its website
4242	by the 15th calendar day 2 months following the end of the
4243	calendar quarter. Each nursing home licensee must retrieve the
4244	most recent version of the Nursing Home Guide from of the watch
4245	list to each nursing home facility by mail and must make the
4246	watch list available on the agency's Internet website.
4247	(4)  Any records of a nursing home facility determined by
4248	the agency to be necessary and essential to establish lawful
4249	compliance with any rules or standards shall be made available
4250	to the agency on the premises of the facility and submitted to
4251	the agency. Each facility must submit this information
4252	electronically when electronic transmission to the agency is
4253	available.
4254	(5)  Every nursing home facility licensee shall:
4255	(a)  Post, in a sufficient number of prominent positions in
4256	the nursing home so as to be accessible to all residents and to
4257	the general public:
4258	1.  A concise summary of the last inspection report
4259	pertaining to the nursing home and issued by the agency, with
4260	references to the page numbers of the full reports, noting any
4261	deficiencies found by the agency and the actions taken by the
4262	licensee to rectify such deficiencies and indicating in such
4263	summaries where the full reports may be inspected in the nursing
4264	home.
4265	2.  A copy of all pages listing the facility from the most
4266	recent version of the Florida Nursing Home Guide Watch List.
4267	(b)  Upon request, provide to any person who has completed
4268	a written application with an intent to be admitted to, or to
4269	any resident of, such nursing home, or to any relative, spouse,
4270	or guardian of such person, a copy of the last inspection report
4271	pertaining to the nursing home and issued by the agency,
4272	provided the person requesting the report agrees to pay a
4273	reasonable charge to cover copying costs.
4274	(6)  The agency may adopt rules as necessary to administer
4275	this section.
4276	Section 81.  Section 400.20, Florida Statutes, is amended
4277	to read:
4278	400.20  Licensed nursing home administrator required.--A No
4279	nursing home may not shall operate except under the supervision
4280	of a licensed nursing home administrator, and a no person may
4281	not shall be a nursing home administrator unless he or she holds
4282	is the holder of a current license as provided in chapter 468.
4283	Section 82.  Subsections (2), (7), and (8) of section
4284	400.23, Florida Statutes, are amended to read:
4285	400.23  Rules; evaluation and deficiencies; licensure
4286	status.--
4287	(2)  Pursuant to the intention of the Legislature, the
4288	agency, in consultation with the Department of Health and the
4289	Department of Elderly Affairs, shall adopt and enforce rules to
4290	implement this part and part II of chapter 408, which shall
4291	include reasonable and fair criteria in relation to:
4292	(a)  The location of the facility and housing conditions
4293	that will ensure the health, safety, and comfort of residents,
4294	including an adequate call system. In making such rules, the
4295	agency shall be guided by criteria recommended by nationally
4296	recognized reputable professional groups and associations with
4297	knowledge of such subject matters. The agency shall update or
4298	revise such criteria as the need arises. The agency may require
4299	alterations to a building if it determines that an existing
4300	condition constitutes a distinct hazard to life, health, or
4301	safety. In performing any inspections of facilities authorized
4302	by this part, the agency may enforce the special-occupancy
4303	provisions of the Florida Building Code and the Florida Fire
4304	Prevention Code which apply to nursing homes. The agency is
4305	directed to provide assistance to the Florida Building
4306	Commission in updating the construction standards of the code
4307	relative to nursing homes. During the care planning process, a
4308	resident shall be able to choose the placement of the bed in his
4309	or her room, provided the requirements of the Florida Building
4310	Code are met through alternate methods or equivalencies and the
4311	request does not infringe on the resident's roommate or
4312	interfere with the resident's care needs as determined by the
4313	care planning team.
4314	(b)  The number and qualifications of all personnel,
4315	including management, medical, nursing, and other professional
4316	personnel, and nursing assistants, orderlies, and support
4317	personnel, having responsibility for any part of the care given
4318	residents.
4319	(c)  All sanitary conditions within the facility and its
4320	surroundings, including water supply, sewage disposal, food
4321	handling, and general hygiene which will ensure the health and
4322	comfort of residents.
4323	(d)  The equipment essential to the health and welfare of
4324	the residents.
4325	(e)  A uniform accounting system.
4326	(f)  The care, treatment, and maintenance of residents and
4327	measurement of the quality and adequacy thereof, based on rules
4328	developed under this chapter and the Omnibus Budget
4329	Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
4330	1987), Title IV (Medicare, Medicaid, and Other Health-Related
4331	Programs), Subtitle C (Nursing Home Reform), as amended.
4332	(g)  The preparation and annual update of a comprehensive
4333	emergency management plan. The agency shall adopt rules
4334	establishing minimum criteria for the plan after consultation
4335	with the Department of Community Affairs. At a minimum, the
4336	rules must provide for plan components that address emergency
4337	evacuation transportation; adequate sheltering arrangements;
4338	postdisaster activities, including emergency power, food, and
4339	water; postdisaster transportation; supplies; staffing;
4340	emergency equipment; individual identification of residents and
4341	transfer of records; and responding to family inquiries. The
4342	comprehensive emergency management plan is subject to review and
4343	approval by the local emergency management agency. During its
4344	review, the local emergency management agency shall ensure that
4345	the following agencies, at a minimum, are given the opportunity
4346	to review the plan: the Department of Elderly Affairs, the
4347	Department of Health, the Agency for Health Care Administration,
4348	and the Department of Community Affairs. Also, appropriate
4349	volunteer organizations must be given the opportunity to review
4350	the plan. The local emergency management agency shall complete
4351	its review within 60 days and either approve the plan or advise
4352	the facility of necessary revisions.
4353	(h)  The availability, distribution, and posting of reports
4354	and records pursuant to s. 400.191 and the Gold Seal Program
4355	pursuant to s. 400.235.
4356	(7)  The agency shall, at least every 15 months, evaluate
4357	all nursing home facilities and make a determination as to the
4358	degree of compliance by each licensee with the established rules
4359	adopted under this part as a basis for assigning a licensure
4360	status to that facility. The agency shall base its evaluation on
4361	the most recent inspection report, taking into consideration
4362	findings from other official reports, surveys, interviews,
4363	investigations, and inspections. The agency shall assign a
4364	licensure status of standard or conditional to each nursing
4365	home.
4366	(a)  A standard licensure status means that a facility has
4367	no class I or class II deficiencies and has corrected all class
4368	III deficiencies within the time established by the agency.
4369	(b)  A conditional licensure status means that a facility,
4370	due to the presence of one or more class I or class II
4371	deficiencies, or class III deficiencies not corrected within the
4372	time established by the agency, is not in substantial compliance
4373	at the time of the survey with criteria established under this
4374	part or with rules adopted by the agency. If the facility has no
4375	class I, class II, or class III deficiencies at the time of the
4376	followup survey, a standard licensure status may be assigned.
4377	(c)  In evaluating the overall quality of care and services
4378	and determining whether the facility will receive a conditional
4379	or standard license, the agency shall consider the needs and
4380	limitations of residents in the facility and the results of
4381	interviews and surveys of a representative sampling of
4382	residents, families of residents, ombudsman council members in
4383	the planning and service area in which the facility is located,
4384	guardians of residents, and staff of the nursing home facility.
4385	(d)  The current licensure status of each facility must be
4386	indicated in bold print on the face of the license. A list of
4387	the deficiencies of the facility shall be posted in a prominent
4388	place that is in clear and unobstructed public view at or near
4389	the place where residents are being admitted to that facility.
4390	Licensees receiving a conditional licensure status for a
4391	facility shall prepare, within 10 working days after receiving
4392	notice of deficiencies, a plan for correction of all
4393	deficiencies and shall submit the plan to the agency for
4394	approval.
4395	(e)  Each licensee shall post its license in a prominent
4396	place that is in clear and unobstructed public view at or near
4397	the place where residents are being admitted to the facility.
4398	(e)(f)  The agency shall adopt rules that:
4399	1.  Establish uniform procedures for the evaluation of
4400	facilities.
4401	2.  Provide criteria in the areas referenced in paragraph
4402	(c).
4403	3.  Address other areas necessary for carrying out the
4404	intent of this section.
4405	(8)  The agency shall adopt rules pursuant to this part and
4406	part II of chapter 408 to provide that, when the criteria
4407	established under subsection (2) are not met, such deficiencies
4408	shall be classified according to the nature and the scope of the
4409	deficiency. The scope shall be cited as isolated, patterned, or
4410	widespread. An isolated deficiency is a deficiency affecting one
4411	or a very limited number of residents, or involving one or a
4412	very limited number of staff, or a situation that occurred only
4413	occasionally or in a very limited number of locations. A
4414	patterned deficiency is a deficiency where more than a very
4415	limited number of residents are affected, or more than a very
4416	limited number of staff are involved, or the situation has
4417	occurred in several locations, or the same resident or residents
4418	have been affected by repeated occurrences of the same deficient
4419	practice but the effect of the deficient practice is not found
4420	to be pervasive throughout the facility. A widespread deficiency
4421	is a deficiency in which the problems causing the deficiency are
4422	pervasive in the facility or represent systemic failure that has
4423	affected or has the potential to affect a large portion of the
4424	facility's residents. The agency shall indicate the
4425	classification on the face of the notice of deficiencies as
4426	follows:
4427	(a)  A class I deficiency is a deficiency that the agency
4428	determines presents a situation in which immediate corrective
4429	action is necessary because the facility's noncompliance has
4430	caused, or is likely to cause, serious injury, harm, impairment,
4431	or death to a resident receiving care in a facility. The
4432	condition or practice constituting a class I violation shall be
4433	abated or eliminated immediately, unless a fixed period of time,
4434	as determined by the agency, is required for correction. A class
4435	I deficiency is subject to a civil penalty of $10,000 for an
4436	isolated deficiency, $12,500 for a patterned deficiency, and
4437	$15,000 for a widespread deficiency. The fine amount shall be
4438	doubled for each deficiency if the facility was previously cited
4439	for one or more class I or class II deficiencies during the last
4440	annual inspection or any inspection or complaint investigation
4441	since the last annual inspection. A fine must be levied
4442	notwithstanding the correction of the deficiency.
4443	(b)  A class II deficiency is a deficiency that the agency
4444	determines has compromised the resident's ability to maintain or
4445	reach his or her highest practicable physical, mental, and
4446	psychosocial well-being, as defined by an accurate and
4447	comprehensive resident assessment, plan of care, and provision
4448	of services. A class II deficiency is subject to a civil penalty
4449	of $2,500 for an isolated deficiency, $5,000 for a patterned
4450	deficiency, and $7,500 for a widespread deficiency. The fine
4451	amount shall be doubled for each deficiency if the facility was
4452	previously cited for one or more class I or class II
4453	deficiencies during the last licensure annual inspection or any
4454	inspection or complaint investigation since the last licensure
4455	annual inspection. A fine shall be levied notwithstanding the
4456	correction of the deficiency.
4457	(c)  A class III deficiency is a deficiency that the agency
4458	determines will result in no more than minimal physical, mental,
4459	or psychosocial discomfort to the resident or has the potential
4460	to compromise the resident's ability to maintain or reach his or
4461	her highest practical physical, mental, or psychosocial well-
4462	being, as defined by an accurate and comprehensive resident
4463	assessment, plan of care, and provision of services. A class III
4464	deficiency is subject to a civil penalty of $1,000 for an
4465	isolated deficiency, $2,000 for a patterned deficiency, and
4466	$3,000 for a widespread deficiency. The fine amount shall be
4467	doubled for each deficiency if the facility was previously cited
4468	for one or more class I or class II deficiencies during the last
4469	licensure annual inspection or any inspection or complaint
4470	investigation since the last annual inspection. A citation for a
4471	class III deficiency must specify the time within which the
4472	deficiency is required to be corrected. If a class III
4473	deficiency is corrected within the time specified, no civil
4474	penalty shall be imposed.
4475	(d)  A class IV deficiency is a deficiency that the agency
4476	determines has the potential for causing no more than a minor
4477	negative impact on the resident. If the class IV deficiency is
4478	isolated, no plan of correction is required.
4479	Section 83.  Subsections (3) and (4) of section 400.241,
4480	Florida Statutes, are renumbered as subsections (1) and (2),
4481	respectively, and present subsections (1) and (2) of said
4482	section are amended to read:
4483	400.241  Prohibited acts; penalties for violations.--
4484	(1)  It is unlawful for any person or public body to
4485	establish, conduct, manage, or operate a home as defined in this
4486	part without obtaining a valid current license.
4487	(2)  It is unlawful for any person or public body to offer
4488	or advertise to the public, in any way by any medium whatever,
4489	nursing home care or service or custodial services without
4490	obtaining a valid current license. It is unlawful for any holder
4491	of a license issued pursuant to the provisions of this part to
4492	advertise or hold out to the public that it holds a license for
4493	a facility other than that for which it actually holds a
4494	license.
4495	Section 84.  Subsections (6) through (27) of section
4496	400.402, Florida Statutes, are renumbered as subsections (5)
4497	through (26), respectively, and present subsections (5), (12),
4498	(14), (17), and (20) are amended to read:
4499	400.402  Definitions.--When used in this part, the term:
4500	(5)  "Applicant" means an individual owner, corporation,
4501	partnership, firm, association, or governmental entity that
4502	applies for a license.
4503	(11)(12)  "Extended congregate care" means acts beyond
4504	those authorized in subsection (16) (17) that may be performed
4505	pursuant to part I of chapter 464 by persons licensed thereunder
4506	while carrying out their professional duties, and other
4507	supportive services which may be specified by rule. The purpose
4508	of such services is to enable residents to age in place in a
4509	residential environment despite mental or physical limitations
4510	that might otherwise disqualify them from residency in a
4511	facility licensed under this part.
4512	(13)(14)  "Limited nursing services" means acts that may be
4513	performed pursuant to part I of chapter 464 by persons licensed
4514	thereunder while carrying out their professional duties but
4515	limited to those acts which the agency department specifies by
4516	rule. Acts which may be specified by rule as allowable limited
4517	nursing services shall be for persons who meet the admission
4518	criteria established by the agency department for assisted
4519	living facilities and shall not be complex enough to require 24-
4520	hour nursing supervision and may include such services as the
4521	application and care of routine dressings, and care of casts,
4522	braces, and splints.
4523	(16)(17)  "Personal services" means direct physical
4524	assistance with or supervision of the activities of daily living
4525	and the self-administration of medication and other similar
4526	services which the agency department may define by rule.
4527	"Personal services" shall not be construed to mean the provision
4528	of medical, nursing, dental, or mental health services.
4529	(19)(20)  "Resident" means a person 18 years of age or
4530	older, residing in and receiving care from a facility, including
4531	a person receiving services pursuant to s. 400.553(2).
4532	Section 85.  Section 400.407, Florida Statutes, is amended
4533	to read:
4534	400.407  License required; fee, display.--
4535	(1)  The requirements of part II of chapter 408 shall apply
4536	to the provision of services that require licensure pursuant
4537	this part and part II of chapter 408 and to entities licensed by
4538	or applying for such licensure from the agency pursuant to this
4539	part. However, each applicant for licensure and each licensee is
4540	exempt from s. 408.810(10). A license issued by the agency is
4541	required for an assisted living facility operating in this
4542	state.
4543	(2)  Separate licenses shall be required for facilities
4544	maintained in separate premises, even though operated under the
4545	same management. A separate license shall not be required for
4546	separate buildings on the same grounds.
4547	(3)  In addition to the requirements of 408.806, each Any
4548	license granted by the agency must state the maximum resident
4549	capacity of the facility, the type of care for which the license
4550	is granted, the date the license is issued, the expiration date
4551	of the license, and any other information deemed necessary by
4552	the agency. Licenses shall be issued for one or more of the
4553	following categories of care: standard, extended congregate
4554	care, limited nursing services, or limited mental health.
4555	(a)  A standard license shall be issued to facilities
4556	providing one or more of the personal services identified in s.
4557	400.402. Such facilities may also employ or contract with a
4558	person licensed under part I of chapter 464 to administer
4559	medications and perform other tasks as specified in s. 400.4255.
4560	(b)  An extended congregate care license shall be issued to
4561	facilities providing, directly or through contract, services
4562	beyond those authorized in paragraph (a), including acts
4563	performed pursuant to part I of chapter 464 by persons licensed
4564	thereunder, and supportive services defined by rule to persons
4565	who otherwise would be disqualified from continued residence in
4566	a facility licensed under this part.
4567	1.  In order for extended congregate care services to be
4568	provided in a facility licensed under this part, the agency must
4569	first determine that all requirements established in law and
4570	rule are met and must specifically designate, on the facility's
4571	license, that such services may be provided and whether the
4572	designation applies to all or part of a facility. Such
4573	designation may be made at the time of initial licensure or
4574	relicensure, or upon request in writing by a licensee under this
4575	part and part II of chapter 408. Notification of approval or
4576	denial of such request shall be made in accordance with part II
4577	of chapter 408 within 90 days after receipt of such request and
4578	all necessary documentation. Existing facilities qualifying to
4579	provide extended congregate care services must have maintained a
4580	standard license and may not have been subject to administrative
4581	sanctions during the previous 2 years, or since initial
4582	licensure if the facility has been licensed for less than 2
4583	years, for any of the following reasons:
4584	a.  A class I or class II violation;
4585	b.  Three or more repeat or recurring class III violations
4586	of identical or similar resident care standards as specified in
4587	rule from which a pattern of noncompliance is found by the
4588	agency;
4589	c.  Three or more class III violations that were not
4590	corrected in accordance with the corrective action plan approved
4591	by the agency;
4592	d.  Violation of resident care standards resulting in a
4593	requirement to employ the services of a consultant pharmacist or
4594	consultant dietitian;
4595	e.  Denial, suspension, or revocation of a license for
4596	another facility under this part in which the applicant for an
4597	extended congregate care license has at least 25 percent
4598	ownership interest; or
4599	f.  Imposition of a moratorium on admissions or initiation
4600	of injunctive proceedings.
4601	2.  Facilities that are licensed to provide extended
4602	congregate care services shall maintain a written progress
4603	report on each person who receives such services, which report
4604	describes the type, amount, duration, scope, and outcome of
4605	services that are rendered and the general status of the
4606	resident's health. A registered nurse, or appropriate designee,
4607	representing the agency shall visit such facilities at least
4608	quarterly to monitor residents who are receiving extended
4609	congregate care services and to determine if the facility is in
4610	compliance with this part, part II of chapter 408, and with
4611	rules that relate to extended congregate care. One of these
4612	visits may be in conjunction with the regular survey. The
4613	monitoring visits may be provided through contractual
4614	arrangements with appropriate community agencies. A registered
4615	nurse shall serve as part of the team that inspects such
4616	facility. The agency may waive one of the required yearly
4617	monitoring visits for a facility that has been licensed for at
4618	least 24 months to provide extended congregate care services,
4619	if, during the inspection, the registered nurse determines that
4620	extended congregate care services are being provided
4621	appropriately, and if the facility has no class I or class II
4622	violations and no uncorrected class III violations. Before such
4623	decision is made, the agency shall consult with the long-term
4624	care ombudsman council for the area in which the facility is
4625	located to determine if any complaints have been made and
4626	substantiated about the quality of services or care. The agency
4627	may not waive one of the required yearly monitoring visits if
4628	complaints have been made and substantiated.
4629	3.  Facilities that are licensed to provide extended
4630	congregate care services shall:
4631	a.  Demonstrate the capability to meet unanticipated
4632	resident service needs.
4633	b.  Offer a physical environment that promotes a homelike
4634	setting, provides for resident privacy, promotes resident
4635	independence, and allows sufficient congregate space as defined
4636	by rule.
4637	c.  Have sufficient staff available, taking into account
4638	the physical plant and firesafety features of the building, to
4639	assist with the evacuation of residents in an emergency, as
4640	necessary.
4641	d.  Adopt and follow policies and procedures that maximize
4642	resident independence, dignity, choice, and decisionmaking to
4643	permit residents to age in place to the extent possible, so that
4644	moves due to changes in functional status are minimized or
4645	avoided.
4646	e.  Allow residents or, if applicable, a resident's
4647	representative, designee, surrogate, guardian, or attorney in
4648	fact to make a variety of personal choices, participate in
4649	developing service plans, and share responsibility in
4650	decisionmaking.
4651	f.  Implement the concept of managed risk.
4652	g.  Provide, either directly or through contract, the
4653	services of a person licensed pursuant to part I of chapter 464.
4654	h.  In addition to the training mandated in s. 400.452,
4655	provide specialized training as defined by rule for facility
4656	staff.
4657	4.  Facilities licensed to provide extended congregate care
4658	services are exempt from the criteria for continued residency as
4659	set forth in rules adopted under s. 400.441. Facilities so
4660	licensed shall adopt their own requirements within guidelines
4661	for continued residency set forth by the department in rule.
4662	However, such facilities may not serve residents who require 24-
4663	hour nursing supervision. Facilities licensed to provide
4664	extended congregate care services shall provide each resident
4665	with a written copy of facility policies governing admission and
4666	retention.
4667	5.  The primary purpose of extended congregate care
4668	services is to allow residents, as they become more impaired,
4669	the option of remaining in a familiar setting from which they
4670	would otherwise be disqualified for continued residency. A
4671	facility licensed to provide extended congregate care services
4672	may also admit an individual who exceeds the admission criteria
4673	for a facility with a standard license, if the individual is
4674	determined appropriate for admission to the extended congregate
4675	care facility.
4676	6.  Before admission of an individual to a facility
4677	licensed to provide extended congregate care services, the
4678	individual must undergo a medical examination as provided in s.
4679	400.426(4) and the facility must develop a preliminary service
4680	plan for the individual.
4681	7.  When a facility can no longer provide or arrange for
4682	services in accordance with the resident's service plan and
4683	needs and the facility's policy, the facility shall make
4684	arrangements for relocating the person in accordance with s.
4685	400.428(1)(k).
4686	8.  Failure to provide extended congregate care services
4687	may result in denial of extended congregate care license
4688	renewal.
4689	9.  No later than January 1 of each year, the department,
4690	in consultation with the agency, shall prepare and submit to the
4691	Governor, the President of the Senate, the Speaker of the House
4692	of Representatives, and the chairs of appropriate legislative
4693	committees, a report on the status of, and recommendations
4694	related to, extended congregate care services. The status report
4695	must include, but need not be limited to, the following
4696	information:
4697	a.  A description of the facilities licensed to provide
4698	such services, including total number of beds licensed under
4699	this part.
4700	b.  The number and characteristics of residents receiving
4701	such services.
4702	c.  The types of services rendered that could not be
4703	provided through a standard license.
4704	d.  An analysis of deficiencies cited during licensure
4705	inspections.
4706	e.  The number of residents who required extended
4707	congregate care services at admission and the source of
4708	admission.
4709	f.  Recommendations for statutory or regulatory changes.
4710	g.  The availability of extended congregate care to state
4711	clients residing in facilities licensed under this part and in
4712	need of additional services, and recommendations for
4713	appropriations to subsidize extended congregate care services
4714	for such persons.
4715	h.  Such other information as the department considers
4716	appropriate.
4717	(c)  A limited nursing services license shall be issued to
4718	a facility that provides services beyond those authorized in
4719	paragraph (a) and as specified in this paragraph.
4720	1.  In order for limited nursing services to be provided in
4721	a facility licensed under this part, the agency must first
4722	determine that all requirements established in law and rule are
4723	met and must specifically designate, on the facility's license,
4724	that such services may be provided. Such designation may be made
4725	at the time of initial licensure or relicensure, or upon request
4726	in writing by a licensee under this part and part II of chapter
4727	408. Notification of approval or denial of such request shall be
4728	made in accordance with part II of chapter 408 within 90 days
4729	after receipt of such request and all necessary documentation.
4730	Existing facilities qualifying to provide limited nursing
4731	services shall have maintained a standard license and may not
4732	have been subject to administrative sanctions that affect the
4733	health, safety, and welfare of residents for the previous 2
4734	years or since initial licensure if the facility has been
4735	licensed for less than 2 years.
4736	2.  Facilities that are licensed to provide limited nursing
4737	services shall maintain a written progress report on each person
4738	who receives such nursing services, which report describes the
4739	type, amount, duration, scope, and outcome of services that are
4740	rendered and the general status of the resident's health. A
4741	registered nurse representing the agency shall visit such
4742	facilities at least twice a year to monitor residents who are
4743	receiving limited nursing services and to determine if the
4744	facility is in compliance with applicable provisions of this
4745	part, part II of chapter 408, and with related rules. The
4746	monitoring visits may be provided through contractual
4747	arrangements with appropriate community agencies. A registered
4748	nurse shall also serve as part of the team that inspects such
4749	facility.
4750	3.  A person who receives limited nursing services under
4751	this part must meet the admission criteria established by the
4752	agency for assisted living facilities. When a resident no longer
4753	meets the admission criteria for a facility licensed under this
4754	part, arrangements for relocating the person shall be made in
4755	accordance with s. 400.428(1)(k), unless the facility is
4756	licensed to provide extended congregate care services.
4757	(4)  In accordance with s. 408.805, an applicant or
4758	licensee shall pay a fee for each license application submitted
4759	under this part, part II of chapter 408, and applicable rules.
4760	The amount of the fee shall be established by rule.
4761	(a)  The biennial license fee required of a facility is
4762	$300 per license, with an additional fee of $50 per resident
4763	based on the total licensed resident capacity of the facility,
4764	except that no additional fee will be assessed for beds
4765	designated for recipients of optional state supplementation
4766	payments provided for in s. 409.212. The total fee may not
4767	exceed $10,000, no part of which shall be returned to the
4768	facility. The agency shall adjust the per bed license fee and
4769	the total licensure fee annually by not more than the change in
4770	the consumer price index based on the 12 months immediately
4771	preceding the increase.
4772	(b)  In addition to the total fee assessed under paragraph
4773	(a), the agency shall require facilities that are licensed to
4774	provide extended congregate care services under this part to pay
4775	an additional fee per licensed facility. The amount of the
4776	biennial fee shall be $400 per license, with an additional fee
4777	of $10 per resident based on the total licensed resident
4778	capacity of the facility. No part of this fee shall be returned
4779	to the facility. The agency may adjust the per bed license fee
4780	and the annual license fee once each year by not more than the
4781	average rate of inflation for the 12 months immediately
4782	preceding the increase.
4783	(c)  In addition to the total fee assessed under paragraph
4784	(a), the agency shall require facilities that are licensed to
4785	provide limited nursing services under this part to pay an
4786	additional fee per licensed facility. The amount of the biennial
4787	fee shall be $250 per license, with an additional fee of $10 per
4788	resident based on the total licensed resident capacity of the
4789	facility. No part of this fee shall be returned to the facility.
4790	The agency may adjust the per bed license fee and the biennial
4791	license fee once each year by not more than the average rate of
4792	inflation for the 12 months immediately preceding the increase.
4793	(5)  Counties or municipalities applying for licenses under
4794	this part are exempt from the payment of license fees.
4795	(6)  The license shall be displayed in a conspicuous place
4796	inside the facility.
4797	(7)  A license shall be valid only in the possession of the
4798	individual, firm, partnership, association, or corporation to
4799	which it is issued and shall not be subject to sale, assignment,
4800	or other transfer, voluntary or involuntary; nor shall a license
4801	be valid for any premises other than that for which originally
4802	issued.
4803	(8)  A fee may be charged to a facility requesting a
4804	duplicate license. The fee shall not exceed the actual cost of
4805	duplication and postage.
4806	Section 86.  Subsection (1) of section 400.4075, Florida
4807	Statutes, is amended to read:
4808	400.4075  Limited mental health license.--An assisted
4809	living facility that serves three or more mental health
4810	residents must obtain a limited mental health license.
4811	(1)  To obtain a limited mental health license, a facility
4812	must hold a standard license as an assisted living facility,
4813	must not have any current uncorrected deficiencies or
4814	violations, and must ensure that, within 6 months after
4815	receiving a limited mental health license, the facility
4816	administrator and the staff of the facility who are in direct
4817	contact with mental health residents must complete training of
4818	no less than 6 hours related to their duties. Such designation
4819	may be made at the time of initial licensure or relicensure or
4820	upon request in writing by a licensee under this part and part
4821	II of chapter 408. Notification of approval or denial of such
4822	request shall be made in accordance with this part, part II of
4823	chapter 408, and applicable rules. This training will be
4824	provided by or approved by the Department of Children and Family
4825	Services.
4826	Section 87.  Section 400.408, Florida Statutes, is amended
4827	to read:
4828	400.408  Unlicensed facilities; referral of person for
4829	residency to unlicensed facility; penalties; verification of
4830	licensure status.--
4831	(1)(a)  It is unlawful to own, operate, or maintain an
4832	assisted living facility without obtaining a license under this
4833	part.
4834	(b)  Except as provided under paragraph (d), any person who
4835	owns, operates, or maintains an unlicensed assisted living
4836	facility commits a felony of the third degree, punishable as
4837	provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
4838	continued operation is a separate offense.
4839	(c)  Any person found guilty of violating paragraph (a) a
4840	second or subsequent time commits a felony of the second degree,
4841	punishable as provided under s. 775.082, s. 775.083, or s.
4842	775.084. Each day of continued operation is a separate offense.
4843	(d)  Any person who owns, operates, or maintains an
4844	unlicensed assisted living facility due to a change in this part
4845	or a modification in department rule within 6 months after the
4846	effective date of such change and who, within 10 working days
4847	after receiving notification from the agency, fails to cease
4848	operation or apply for a license under this part commits a
4849	felony of the third degree, punishable as provided in s.
4850	775.082, s. 775.083, or s. 775.084. Each day of continued
4851	operation is a separate offense.
4852	(e)  Any facility that fails to cease operation after
4853	agency notification may be fined for each day of noncompliance
4854	pursuant to s. 400.419.
4855	(f)  When a licensee has an interest in more than one
4856	assisted living facility, and fails to license any one of these
4857	facilities, the agency may revoke the license, impose a
4858	moratorium, or impose a fine pursuant to s. 400.419, on any or
4859	all of the licensed facilities until such time as the unlicensed
4860	facility is licensed or ceases operation.
4861	(g)  If the agency determines that an owner is operating or
4862	maintaining an assisted living facility without obtaining a
4863	license and determines that a condition exists in the facility
4864	that poses a threat to the health, safety, or welfare of a
4865	resident of the facility, the owner is subject to the same
4866	actions and fines imposed against a licensed facility as
4867	specified in ss. 400.414 and 400.419.
4868	(h)  Any person aware of the operation of an unlicensed
4869	assisted living facility must report that facility to the
4870	agency. The agency shall provide to the department's elder
4871	information and referral providers a list, by county, of
4872	licensed assisted living facilities, to assist persons who are
4873	considering an assisted living facility placement in locating a
4874	licensed facility.
4875	(2)(i)  Each field office of the Agency for Health Care
4876	Administration shall establish a local coordinating workgroup
4877	which includes representatives of local law enforcement
4878	agencies, state attorneys, the Medicaid Fraud Control Unit of
4879	the Department of Legal Affairs, local fire authorities, the
4880	Department of Children and Family Services, the district long-
4881	term care ombudsman council, and the district human rights
4882	advocacy committee to assist in identifying the operation of
4883	unlicensed facilities and to develop and implement a plan to
4884	ensure effective enforcement of state laws relating to such
4885	facilities. The workgroup shall report its findings, actions,
4886	and recommendations semiannually to the Director of Health
4887	Facility Regulation of the agency.
4888	(3)(2)  It is unlawful to knowingly refer a person for
4889	residency to an unlicensed assisted living facility; to an
4890	assisted living facility the license of which is under denial or
4891	has been suspended or revoked; or to an assisted living facility
4892	that has a moratorium pursuant to part II of chapter 408, on
4893	admissions. Any person who violates this subsection commits a
4894	noncriminal violation, punishable by a fine not exceeding $500
4895	as provided in s. 775.083.
4896	(a)  Any health care practitioner, as defined in s.
4897	456.001, who is aware of the operation of an unlicensed facility
4898	shall report that facility to the agency. Failure to report a
4899	facility that the practitioner knows or has reasonable cause to
4900	suspect is unlicensed shall be reported to the practitioner's
4901	licensing board.
4902	(b)  Any hospital or community mental health center
4903	licensed under chapter 395 or chapter 394 which knowingly
4904	discharges a patient or client to an unlicensed facility is
4905	subject to sanction by the agency.
4906	(c)  Any employee of the agency or department, or the
4907	Department of Children and Family Services, who knowingly refers
4908	a person for residency to an unlicensed facility; to a facility
4909	the license of which is under denial or has been suspended or
4910	revoked; or to a facility that has a moratorium pursuant to part
4911	II of chapter 408 on admissions is subject to disciplinary
4912	action by the agency or department, or the Department of
4913	Children and Family Services.
4914	(d)  The employer of any person who is under contract with
4915	the agency or department, or the Department of Children and
4916	Family Services, and who knowingly refers a person for residency
4917	to an unlicensed facility; to a facility the license of which is
4918	under denial or has been suspended or revoked; or to a facility
4919	that has a moratorium pursuant to part II of chapter 408 on
4920	admissions shall be fined and required to prepare a corrective
4921	action plan designed to prevent such referrals.
4922	(e)  The agency shall provide the department and the
4923	Department of Children and Family Services with a list of
4924	licensed facilities within each county and shall update the list
4925	at least quarterly.
4926	(f)  At least annually, the agency shall notify, in
4927	appropriate trade publications, physicians licensed under
4928	chapter 458 or chapter 459, hospitals licensed under chapter
4929	395, nursing home facilities licensed under part II of this
4930	chapter, and employees of the agency or the department, or the
4931	Department of Children and Family Services, who are responsible
4932	for referring persons for residency, that it is unlawful to
4933	knowingly refer a person for residency to an unlicensed assisted
4934	living facility and shall notify them of the penalty for
4935	violating such prohibition. The department and the Department of
4936	Children and Family Services shall, in turn, notify service
4937	providers under contract to the respective departments who have
4938	responsibility for resident referrals to facilities. Further,
4939	the notice must direct each noticed facility and individual to
4940	contact the appropriate agency office in order to verify the
4941	licensure status of any facility prior to referring any person
4942	for residency. Each notice must include the name, telephone
4943	number, and mailing address of the appropriate office to
4944	contact.
4945	Section 88.  Section 400.411, Florida Statutes, is amended
4946	to read:
4947	400.411  Initial application for license; provisional
4948	license.--
4949	(1)  Each applicant for licensure must comply with all
4950	provisions of part II of chapter 408 and must: Application for a
4951	license shall be made to the agency on forms furnished by it and
4952	shall be accompanied by the appropriate license fee.
4953	(2)  The applicant may be an individual owner, a
4954	corporation, a partnership, a firm, an association, or a
4955	governmental entity.
4956	(3)  The application must be signed by the applicant under
4957	oath and must contain the following:
4958	(a)  The name, address, date of birth, and social security
4959	number of the applicant and the name by which the facility is to
4960	be known. If the applicant is a firm, partnership, or
4961	association, the application shall contain the name, address,
4962	date of birth, and social security number of every member
4963	thereof. If the applicant is a corporation, the application
4964	shall contain the corporation's name and address; the name,
4965	address, date of birth, and social security number of each of
4966	its directors and officers; and the name and address of each
4967	person having at least a 5-percent ownership interest in the
4968	corporation.
4969	(b)  The name and address of any professional service,
4970	firm, association, partnership, or corporation that is to
4971	provide goods, leases, or services to the facility if a 5-
4972	percent or greater ownership interest in the service, firm,
4973	association, partnership, or corporation is owned by a person
4974	whose name must be listed on the application under paragraph
4975	(a).
4976	(c)  The name and address of any long-term care facility
4977	with which the applicant, administrator, or financial officer
4978	has been affiliated through ownership or employment within 5
4979	years of the date of this license application; and a signed
4980	affidavit disclosing any financial or ownership interest that
4981	the applicant, or any person listed in paragraph (a), holds or
4982	has held within the last 5 years in any facility licensed under
4983	this part, or in any other entity licensed by this state or
4984	another state to provide health or residential care, which
4985	facility or entity closed or ceased to operate as a result of
4986	financial problems, or has had a receiver appointed or a license
4987	denied, suspended or revoked, or was subject to a moratorium on
4988	admissions, or has had an injunctive proceeding initiated
4989	against it.
4990	(d)  A description and explanation of any exclusions,
4991	permanent suspensions, or terminations of the applicant from the
4992	Medicare or Medicaid programs. Proof of compliance with
4993	disclosure of ownership and control interest requirements of the
4994	Medicaid or Medicare programs shall be accepted in lieu of this
4995	submission.
4996	(e)  The names and addresses of persons of whom the agency
4997	may inquire as to the character, reputation, and financial
4998	responsibility of the owner and, if different from the
4999	applicant, the administrator and financial officer.
5000	(a)(f)  Identify Identification of all other homes or
5001	facilities, including the addresses and the license or licenses
5002	under which they operate, if applicable, which are currently
5003	operated by the applicant or administrator and which provide
5004	housing, meals, and personal services to residents.
5005	(b)(g)  Provide the location of the facility for which a
5006	license is sought and documentation, signed by the appropriate
5007	local government official, which states that the applicant has
5008	met local zoning requirements.
5009	(c)(h)  Provide the name, address, date of birth, social
5010	security number, education, and experience of the administrator,
5011	if different from the applicant.
5012	(4)  The applicant shall furnish satisfactory proof of
5013	financial ability to operate and conduct the facility in
5014	accordance with the requirements of this part. A certificate of
5015	authority, pursuant to chapter 651, may be provided as proof of
5016	financial ability.
5017	(5)  If the applicant is a continuing care facility
5018	certified under chapter 651, a copy of the facility's
5019	certificate of authority must be provided.
5020	(2)(6)  In addition to the requirements of s. 408.810, the
5021	applicant shall provide proof of liability insurance as defined
5022	in s. 624.605.
5023	(7)  If the applicant is a community residential home, the
5024	applicant must provide proof that it has met the requirements
5025	specified in chapter 419.
5026	(8)  The applicant must provide the agency with proof of
5027	legal right to occupy the property.
5028	(3)(9)  The applicant must furnish proof that the facility
5029	has received a satisfactory firesafety inspection. The local
5030	authority having jurisdiction or the State Fire Marshal must
5031	conduct the inspection within 30 days after written request by
5032	the applicant.
5033	(4)(10)  The applicant must furnish documentation of a
5034	satisfactory sanitation inspection of the facility by the county
5035	health department.
5036	(11)  The applicant must furnish proof of compliance with
5037	level 2 background screening as required under s. 400.4174.
5038	(5)(12)  A provisional license may be issued to an
5039	applicant making initial application for licensure or making
5040	application for a change of ownership. A provisional license
5041	shall be limited in duration to a specific period of time not to
5042	exceed 6 months, as determined by the agency.
5043	(6)(13)  A county or municipality may not issue an
5044	occupational license that is being obtained for the purpose of
5045	operating a facility regulated under this part without first
5046	ascertaining that the applicant has been licensed to operate
5047	such facility at the specified location or locations by the
5048	agency. The agency shall furnish to local agencies responsible
5049	for issuing occupational licenses sufficient instruction for
5050	making such determinations.
5051	Section 89.  Section 400.412, Florida Statutes, is amended
5052	to read:
5053	400.412  Sale or transfer of ownership of a facility.--It
5054	is the intent of the Legislature to protect the rights of the
5055	residents of an assisted living facility when the facility is
5056	sold or the ownership thereof is transferred. Therefore, in
5057	addition to the requirements of part II of chapter 408, whenever
5058	a facility is sold or the ownership thereof is transferred,
5059	including leasing:
5060	(1)  The transferee shall make application to the agency
5061	for a new license at least 60 days before the date of transfer
5062	of ownership. The application must comply with the provisions of
5063	s. 400.411.
5064	(2)(a)  The transferor shall notify the agency in writing
5065	at least 60 days before the date of transfer of ownership.
5066	(1)(b)  The transferee new owner shall notify the
5067	residents, in writing, of the change transfer of ownership
5068	within 7 days after of his or her receipt of the new license.
5069	(3)  The transferor shall be responsible and liable for:
5070	(a)  The lawful operation of the facility and the welfare
5071	of the residents domiciled in the facility until the date the
5072	transferee is licensed by the agency.
5073	(b)  Any and all penalties imposed against the facility for
5074	violations occurring before the date of transfer of ownership
5075	unless the penalty imposed is a moratorium on admissions or
5076	denial of licensure. The moratorium on admissions or denial of
5077	licensure remains in effect after the transfer of ownership,
5078	unless the agency has approved the transferee's corrective
5079	action plan or the conditions which created the moratorium or
5080	denial have been corrected, and may be grounds for denial of
5081	license to the transferee in accordance with chapter 120.
5082	(c)  Any outstanding liability to the state, unless the
5083	transferee has agreed, as a condition of sale or transfer, to
5084	accept the outstanding liabilities and to guarantee payment
5085	therefor; except that, if the transferee fails to meet these
5086	obligations, the transferor shall remain liable for the
5087	outstanding liability.
5088	(2)(4)  The transferor of a facility the license of which
5089	is denied pending an administrative hearing shall, as a part of
5090	the written change of ownership transfer-of-ownership contract,
5091	advise the transferee that a plan of correction must be
5092	submitted by the transferee and approved by the agency at least
5093	7 days before the change transfer of ownership and that failure
5094	to correct the condition which resulted in the moratorium
5095	pursuant to part II of chapter 408 on admissions or denial of
5096	licensure is grounds for denial of the transferee's license.
5097	(5)  The transferee must provide the agency with proof of
5098	legal right to occupy the property before a license may be
5099	issued. Proof may include, but is not limited to, copies of
5100	warranty deeds, or copies of lease or rental agreements,
5101	contracts for deeds, quitclaim deeds, or other such
5102	documentation.
5103	Section 90.  Section 400.414, Florida Statutes, is amended
5104	to read:
5105	400.414  Denial, revocation, or suspension of license;
5106	moratorium; imposition of administrative fine; grounds.--
5107	(1)  The agency may deny, revoke, and or suspend any
5108	license issued under this part and, or impose a moratorium and
5109	an administrative fine in the manner provided in chapter 120 on
5110	an assisted living facility for a violation of any provision of
5111	this part, part II of chapter 408, or applicable rules, or for
5112	any of the following actions by an assisted living facility, for
5113	the actions of any person subject to level 2 background
5114	screening under s. 408.809 400.4174, or for the actions of any
5115	facility employee:
5116	(a)  An intentional or negligent act seriously affecting
5117	the health, safety, or welfare of a resident of the facility.
5118	(b)  The determination by the agency that the owner lacks
5119	the financial ability to provide continuing adequate care to
5120	residents.
5121	(c)  Misappropriation or conversion of the property of a
5122	resident of the facility.
5123	(d)  Failure to follow the criteria and procedures provided
5124	under part I of chapter 394 relating to the transportation,
5125	voluntary admission, and involuntary examination of a facility
5126	resident.
5127	(e)  A citation of any of the following deficiencies as
5128	defined in s. 400.419:
5129	1.  One or more cited class I deficiencies.
5130	2.  Three or more cited class II deficiencies.
5131	3.  Five or more cited class III deficiencies that have
5132	been cited on a single survey and have not been corrected within
5133	the times specified.
5134	(f)  A determination that a person subject to level 2
5135	background screening under s. 408.809 400.4174(1) does not meet
5136	the screening standards of s. 435.04 or that the facility is
5137	retaining an employee subject to level 1 background screening
5138	standards under s. 400.4174(2) who does not meet the screening
5139	standards of s. 435.03 and for whom exemptions from
5140	disqualification have not been provided by the agency.
5141	(g)  A determination that an employee, volunteer,
5142	administrator, or owner, or person who otherwise has access to
5143	the residents of a facility does not meet the criteria specified
5144	in s. 435.03(2), and the owner or administrator has not taken
5145	action to remove the person. Exemptions from disqualification
5146	may be granted as set forth in s. 435.07. No administrative
5147	action may be taken against the facility if the person is
5148	granted an exemption.
5149	(h)  Violation of a moratorium.
5150	(i)  Failure of the license applicant, the licensee during
5151	relicensure, or a licensee that holds a provisional license to
5152	meet the minimum license requirements of this part, or related
5153	rules, at the time of license application or renewal.
5154	(j)  A fraudulent statement or omission of any material
5155	fact on an application for a license or any other document
5156	required by the agency, including the submission of a license
5157	application that conceals the fact that any board member,
5158	officer, or person owning 5 percent or more of the facility may
5159	not meet the background screening requirements of s. 400.4174,
5160	or that the applicant has been excluded, permanently suspended,
5161	or terminated from the Medicaid or Medicare programs.
5162	(h)(k)  An intentional or negligent life-threatening act in
5163	violation of the uniform firesafety standards for assisted
5164	living facilities or other firesafety standards that threatens
5165	the health, safety, or welfare of a resident of a facility, as
5166	communicated to the agency by the local authority having
5167	jurisdiction or the State Fire Marshal.
5168	(l)  Exclusion, permanent suspension, or termination from
5169	the Medicare or Medicaid programs.
5170	(i)(m)  Knowingly operating any unlicensed facility or
5171	providing without a license any service that must be licensed
5172	under this chapter.
5173	(j)(n)  Any act constituting a ground upon which
5174	application for a license may be denied.
5175
5176	Administrative proceedings challenging agency action under this
5177	subsection shall be reviewed on the basis of the facts and
5178	conditions that resulted in the agency action.
5179	(2)  Upon notification by the local authority having
5180	jurisdiction or by the State Fire Marshal, the agency may deny
5181	or revoke the license of an assisted living facility that fails
5182	to correct cited fire code violations that affect or threaten
5183	the health, safety, or welfare of a resident of a facility.
5184	(3)  The agency may deny a license to any applicant or
5185	controlling interest as defined in part II of chapter 408 that
5186	to any officer or board member of an applicant who is a firm,
5187	corporation, partnership, or association or who owns 5 percent
5188	or more of the facility, if the applicant, officer, or board
5189	member has or had a 25-percent or greater financial or ownership
5190	interest in any other facility licensed under this part, or in
5191	any entity licensed by this state or another state to provide
5192	health or residential care, which facility or entity during the
5193	5 years prior to the application for a license closed due to
5194	financial inability to operate; had a receiver appointed or a
5195	license denied, suspended, or revoked; was subject to a
5196	moratorium pursuant to part II of chapter 408 on admissions; had
5197	an injunctive proceeding initiated against it; or has an
5198	outstanding fine assessed under this chapter.
5199	(4)  The agency shall deny or revoke the license of an
5200	assisted living facility that has two or more class I violations
5201	that are similar or identical to violations identified by the
5202	agency during a survey, inspection, monitoring visit, or
5203	complaint investigation occurring within the previous 2 years.
5204	(5)  An action taken by the agency to suspend, deny, or
5205	revoke a facility's license under this part, in which the agency
5206	claims that the facility owner or an employee of the facility
5207	has threatened the health, safety, or welfare of a resident of
5208	the facility be heard by the Division of Administrative Hearings
5209	of the Department of Management Services within 120 days after
5210	receipt of the facility's request for a hearing, unless that
5211	time limitation is waived by both parties. The administrative
5212	law judge must render a decision within 30 days after receipt of
5213	a proposed recommended order.
5214	(6)  The agency shall provide to the Division of Hotels and
5215	Restaurants of the Department of Business and Professional
5216	Regulation, on a monthly basis, a list of those assisted living
5217	facilities that have had their licenses denied, suspended, or
5218	revoked or that are involved in an appellate proceeding pursuant
5219	to s. 120.60 related to the denial, suspension, or revocation of
5220	a license.
5221	(7)  Agency notification of a license suspension or
5222	revocation, or denial of a license renewal, shall be posted and
5223	visible to the public at the facility.
5224	(8)  The agency may issue a temporary license pending final
5225	disposition of a proceeding involving the suspension or
5226	revocation of an assisted living facility license.
5227	Section 91.  Section 400.415, Florida Statutes, is
5228	repealed.
5229	Section 92.  Section 400.417, Florida Statutes, is amended
5230	to read:
5231	400.417  Expiration of license; renewal; conditional
5232	license.--
5233	(1)  Biennial licenses, unless sooner suspended or revoked,
5234	shall expire 2 years from the date of issuance. Limited nursing,
5235	extended congregate care, and limited mental health licenses
5236	shall expire at the same time as the facility's standard
5237	license, regardless of when issued. The agency shall notify the
5238	facility at least 120 days prior to expiration that a renewal
5239	license is necessary to continue operation. The notification
5240	must be provided electronically or by mail delivery. Ninety days
5241	prior to the expiration date, an application for renewal shall
5242	be submitted to the agency. Fees must be prorated. The failure
5243	to file a timely renewal application shall result in a late fee
5244	charged to the facility in an amount equal to 50 percent of the
5245	current fee.
5246	(2)  A license shall be renewed in accordance with part II
5247	of chapter 408 within 90 days upon the timely filing of an
5248	application on forms furnished by the agency and the provision
5249	of satisfactory proof of ability to operate and conduct the
5250	facility in accordance with the requirements of this part and
5251	adopted rules, including proof that the facility has received a
5252	satisfactory firesafety inspection, conducted by the local
5253	authority having jurisdiction or the State Fire Marshal, within
5254	the preceding 12 months and an affidavit of compliance with the
5255	background screening requirements of s. 400.4174.
5256	(3)  In addition to the requirements of part II of chapter
5257	408, An applicant for renewal of a license who has complied with
5258	the provisions of s. 400.411 with respect to proof of financial
5259	ability to operate shall not be required to provide further
5260	proof unless the facility or any other facility owned or
5261	operated in whole or in part by the same person has demonstrated
5262	financial instability as provided under s. 400.447(2) or unless
5263	the agency suspects that the facility is not financially stable
5264	as a result of the annual survey or complaints from the public
5265	or a report from the State Long-Term Care Ombudsman Council.
5266	each facility must report to the agency any adverse court action
5267	concerning the facility's financial viability, within 7 days
5268	after its occurrence. The agency shall have access to books,
5269	records, and any other financial documents maintained by the
5270	facility to the extent necessary to determine the facility's
5271	financial stability. A license for the operation of a facility
5272	shall not be renewed if the licensee has any outstanding fines
5273	assessed pursuant to this part which are in final order status.
5274	(4)  A licensee against whom a revocation or suspension
5275	proceeding is pending at the time of license renewal may be
5276	issued a conditional license effective until final disposition
5277	by the agency. If judicial relief is sought from the final
5278	disposition, the court having jurisdiction may issue a
5279	conditional license for the duration of the judicial proceeding.
5280	(4)(5)  A conditional license may be issued to an applicant
5281	for license renewal if the applicant fails to meet all standards
5282	and requirements for licensure. A conditional license issued
5283	under this subsection shall be limited in duration to a specific
5284	period of time not to exceed 6 months, as determined by the
5285	agency, and shall be accompanied by an agency-approved plan of
5286	correction.
5287	(5)(6)  When an extended care or limited nursing license is
5288	requested during a facility's biennial license period, the fee
5289	shall be prorated in order to permit the additional license to
5290	expire at the end of the biennial license period. The fee shall
5291	be calculated as of the date the additional license application
5292	is received by the agency.
5293	(6)(7)  The agency department may by rule establish renewal
5294	procedures, identify forms, and specify documentation necessary
5295	to administer this section and part II of chapter 408.
5296	Section 93.  Section 400.4174, Florida Statutes, is amended
5297	to read:
5298	400.4174  Background screening; exemptions.--
5299	(1)(a)  Level 2 background screening must be conducted on
5300	each of the following persons, who shall be considered employees
5301	for the purposes of conducting screening under chapter 435:
5302	1.  The facility owner if an individual, the administrator,
5303	and the financial officer.
5304	2.  An officer or board member if the facility owner is a
5305	firm, corporation, partnership, or association, or any person
5306	owning 5 percent or more of the facility if the agency has
5307	probable cause to believe that such person has been convicted of
5308	any offense prohibited by s. 435.04. For each officer, board
5309	member, or person owning 5 percent or more who has been
5310	convicted of any such offense, the facility shall submit to the
5311	agency a description and explanation of the conviction at the
5312	time of license application. This subparagraph does not apply to
5313	a board member of a not-for-profit corporation or organization
5314	if the board member serves solely in a voluntary capacity, does
5315	not regularly take part in the day-to-day operational decisions
5316	of the corporation or organization, receives no remuneration for
5317	his or her services, and has no financial interest and has no
5318	family members with a financial interest in the corporation or
5319	organization, provided that the board member and facility submit
5320	a statement affirming that the board member's relationship to
5321	the facility satisfies the requirements of this subparagraph.
5322	(b)  Proof of compliance with level 2 screening standards
5323	which has been submitted within the previous 5 years to meet any
5324	facility or professional licensure requirements of the agency or
5325	the Department of Health satisfies the requirements of this
5326	subsection, provided that such proof is accompanied, under
5327	penalty of perjury, by an affidavit of compliance with the
5328	provisions of chapter 435. Proof of compliance with the
5329	background screening requirements of the Financial Services
5330	Commission and the Office of Insurance Regulation for applicants
5331	for a certificate of authority to operate a continuing care
5332	retirement community under chapter 651, submitted within the
5333	last 5 years, satisfies the Department of Law Enforcement and
5334	Federal Bureau of Investigation portions of a level 2 background
5335	check.
5336	(c)  The agency may grant a provisional license to a
5337	facility applying for an initial license when each individual
5338	required by this subsection to undergo screening has completed
5339	the Department of Law Enforcement background checks, but has not
5340	yet received results from the Federal Bureau of Investigation,
5341	or when a request for an exemption from disqualification has
5342	been submitted to the agency pursuant to s. 435.07, but a
5343	response has not been issued.
5344	(2)  The owner or administrator of an assisted living
5345	facility must conduct level 1 background screening, as set forth
5346	in chapter 435, on all employees hired on or after October 1,
5347	1998, who perform personal services as defined in s.
5348	400.402(16)(17). The agency may exempt an individual from
5349	employment disqualification as set forth in chapter 435. Such
5350	persons shall be considered as having met this requirement if:
5351	(1)(a)  Proof of compliance with level 1 screening
5352	requirements obtained to meet any professional license
5353	requirements in this state is provided and accompanied, under
5354	penalty of perjury, by a copy of the person's current
5355	professional license and an affidavit of current compliance with
5356	the background screening requirements.
5357	(2)(b)  The person required to be screened has been
5358	continuously employed in the same type of occupation for which
5359	the person is seeking employment without a breach in service
5360	which exceeds 180 days, and proof of compliance with the level 1
5361	screening requirement which is no more than 2 years old is
5362	provided. Proof of compliance shall be provided directly from
5363	one employer or contractor to another, and not from the person
5364	screened. Upon request, a copy of screening results shall be
5365	provided by the employer retaining documentation of the
5366	screening to the person screened.
5367	(3)(c)  The person required to be screened is employed by a
5368	corporation or business entity or related corporation or
5369	business entity that owns, operates, or manages more than one
5370	facility or agency licensed under this chapter, and for whom a
5371	level 1 screening was conducted by the corporation or business
5372	entity as a condition of initial or continued employment.
5373	Section 94.  Section 400.4176, Florida Statutes, is amended
5374	to read:
5375	400.4176  Notice of change of administrator.--If, during
5376	the period for which a license is issued, the owner changes
5377	administrators, the owner must notify the agency of the change
5378	within 10 days and provide documentation within 90 days that the
5379	new administrator has completed the applicable core educational
5380	requirements under s. 400.452. Background screening shall be
5381	completed on any new administrator as specified in s. 400.4174.
5382	Section 95.  Subsection (8) of section 400.4178, Florida
5383	Statutes, is renumbered as subsection (7) and present subsection
5384	(7) of said section is amended to read:
5385	400.4178  Special care for persons with Alzheimer's disease
5386	or other related disorders.--
5387	(7)  Any facility more than 90 percent of whose residents
5388	receive monthly optional supplementation payments is not
5389	required to pay for the training and education programs required
5390	under this section. A facility that has one or more such
5391	residents shall pay a reduced fee that is proportional to the
5392	percentage of such residents in the facility. A facility that
5393	does not have any residents who receive monthly optional
5394	supplementation payments must pay a reasonable fee, as
5395	established by the department, for such training and education
5396	programs.
5397	Section 96.  Section 400.418, Florida Statutes, is amended
5398	to read:
5399	400.418  Disposition of fees and administrative fines.--
5400	(1)  Income from license fees, inspection fees, late fees,
5401	and administrative fines collected under this part generated
5402	pursuant to ss. 400.407, 400.408, 400.417, 400.419, and 400.431
5403	shall be deposited in the Health Care Trust Fund administered by
5404	the agency. Such funds shall be directed to and used by the
5405	agency for the following purposes:
5406	(1)(a)  Up to 50 percent of the trust funds accrued each
5407	fiscal year under this part may be used to offset the expenses
5408	of receivership, pursuant to s. 400.422, if the court determines
5409	that the income and assets of the facility are insufficient to
5410	provide for adequate management and operation.
5411	(2)(b)  An amount of $5,000 of the trust funds accrued each
5412	year under this part shall be allocated to pay for inspection-
5413	related physical and mental health examinations requested by the
5414	agency pursuant to s. 400.426 for residents who are either
5415	recipients of supplemental security income or have monthly
5416	incomes not in excess of the maximum combined federal and state
5417	cash subsidies available to supplemental security income
5418	recipients, as provided for in s. 409.212. Such funds shall only
5419	be used where the resident is ineligible for Medicaid.
5420	(3)(c)  Any trust funds accrued each year under this part
5421	and not used for the purposes specified in subsections (1) and
5422	(2) paragraphs (a) and (b) shall be used to offset the costs of
5423	the licensure program, including the costs of conducting
5424	background investigations, verifying information submitted,
5425	defraying the costs of processing the names of applicants, and
5426	conducting inspections and monitoring visits pursuant to this
5427	part and part II of chapter 408.
5428	(2)  Income from fees generated pursuant to s. 400.441(5)
5429	shall be deposited in the Health Care Trust Fund and used to
5430	offset the costs of printing and postage.
5431	Section 97.  Section 400.419, Florida Statutes, is amended
5432	to read:
5433	400.419  Violations; imposition of administrative fines;
5434	grounds.--
5435	(1)  The agency shall impose an administrative fine in the
5436	manner provided in chapter 120 for the violation of any
5437	provision of this part, part II of chapter 408, and applicable
5438	rules for any of the actions or violations as set forth within
5439	this section by an assisted living facility, for the actions of
5440	any person subject to level 2 background screening under s.
5441	400.4174, for the actions of any facility employee, or for an
5442	intentional or negligent act seriously affecting the health,
5443	safety, or welfare of a resident of the facility.
5444	(2)  Each violation of this part and adopted rules shall be
5445	classified according to the nature of the violation and the
5446	gravity of its probable effect on facility residents. The agency
5447	shall indicate the classification on the written notice of the
5448	violation as follows:
5449	(a)  Class "I" violations are those conditions or
5450	occurrences related to the operation and maintenance of a
5451	facility or to the personal care of residents which the agency
5452	determines present an imminent danger to the residents or guests
5453	of the facility or a substantial probability that death or
5454	serious physical or emotional harm would result therefrom. The
5455	condition or practice constituting a class I violation shall be
5456	abated or eliminated within 24 hours, unless a fixed period, as
5457	determined by the agency, is required for correction. The agency
5458	shall impose an administrative fine for a cited class I
5459	violation in an amount not less than $5,000 and not exceeding
5460	$10,000 for each violation. A fine may be levied notwithstanding
5461	the correction of the violation.
5462	(b)  Class "II" violations are those conditions or
5463	occurrences related to the operation and maintenance of a
5464	facility or to the personal care of residents which the agency
5465	determines directly threaten the physical or emotional health,
5466	safety, or security of the facility residents, other than class
5467	I violations. The agency shall impose an administrative fine for
5468	a cited class II violation in an amount not less than $1,000 and
5469	not exceeding $5,000 for each violation. A fine shall be levied
5470	notwithstanding the correction of the violation.
5471	(c)  Class "III" violations are those conditions or
5472	occurrences related to the operation and maintenance of a
5473	facility or to the personal care of residents which the agency
5474	determines indirectly or potentially threaten the physical or
5475	emotional health, safety, or security of facility residents,
5476	other than class I or class II violations. The agency shall
5477	impose an administrative fine for a cited class III violation in
5478	an amount not less than $500 and not exceeding $1,000 for each
5479	violation. A citation for a class III violation must specify the
5480	time within which the violation is required to be corrected. If
5481	a class III violation is corrected within the time specified, no
5482	fine may be imposed, unless it is a repeated offense.
5483	(d)  Class "IV" violations are those conditions or
5484	occurrences related to the operation and maintenance of a
5485	building or to required reports, forms, or documents that do not
5486	have the potential of negatively affecting residents. These
5487	violations are of a type that the agency determines do not
5488	threaten the health, safety, or security of residents of the
5489	facility. The agency shall impose an administrative fine for a
5490	cited class IV violation in an amount not less than $100 and not
5491	exceeding $200 for each violation. A citation for a class IV
5492	violation must specify the time within which the violation is
5493	required to be corrected. If a class IV violation is corrected
5494	within the time specified, no fine shall be imposed. Any class
5495	IV violation that is corrected during the time an agency survey
5496	is being conducted will be identified as an agency finding and
5497	not as a violation.
5498	(3)  For purposes of this section, in determining if a
5499	penalty is to be imposed and in fixing the amount of the fine,
5500	the agency shall consider the following factors:
5501	(a)  The gravity of the violation, including the
5502	probability that death or serious physical or emotional harm to
5503	a resident will result or has resulted, the severity of the
5504	action or potential harm, and the extent to which the provisions
5505	of the applicable laws or rules were violated.
5506	(b)  Actions taken by the owner or administrator to correct
5507	violations.
5508	(c)  Any previous violations.
5509	(d)  The financial benefit to the facility of committing or
5510	continuing the violation.
5511	(e)  The licensed capacity of the facility.
5512	(4)  Each day of continuing violation after the date fixed
5513	for termination of the violation, as ordered by the agency,
5514	constitutes an additional, separate, and distinct violation.
5515	(5)  Any action taken to correct a violation shall be
5516	documented in writing by the owner or administrator of the
5517	facility and verified through followup visits by agency
5518	personnel. The agency may impose a fine and, in the case of an
5519	owner-operated facility, revoke or deny a facility's license
5520	when a facility administrator fraudulently misrepresents action
5521	taken to correct a violation.
5522	(6)  For fines that are upheld following administrative or
5523	judicial review, the violator shall pay the fine, plus interest
5524	at the rate as specified in s. 55.03, for each day beyond the
5525	date set by the agency for payment of the fine.
5526	(7)  Any unlicensed facility that continues to operate
5527	after agency notification is subject to a $1,000 fine per day.
5528	(8)  Any licensed facility whose owner or administrator
5529	concurrently operates an unlicensed facility shall be subject to
5530	an administrative fine of $5,000 per day.
5531	(9)  Any facility whose owner fails to apply for a change-
5532	of-ownership license in accordance with s. 400.412 and operates
5533	the facility under the new ownership is subject to a fine of
5534	$5,000.
5535	(6)(10)  In addition to any administrative fines imposed,
5536	the agency may assess a survey fee, equal to the lesser of one
5537	half of the facility's biennial license and bed fee or $500, to
5538	cover the cost of conducting initial complaint investigations
5539	that result in the finding of a violation that was the subject
5540	of the complaint or monitoring visits conducted under s.
5541	400.428(3)(c) to verify the correction of the violations.
5542	(7)(11)  The agency, as an alternative to or in conjunction
5543	with an administrative action against a facility for violations
5544	of this part and adopted rules, shall make a reasonable attempt
5545	to discuss each violation and recommended corrective action with
5546	the owner or administrator of the facility, prior to written
5547	notification. The agency, instead of fixing a period within
5548	which the facility shall enter into compliance with standards,
5549	may request a plan of corrective action from the facility which
5550	demonstrates a good faith effort to remedy each violation by a
5551	specific date, subject to the approval of the agency.
5552	(12)  Administrative fines paid by any facility under this
5553	section shall be deposited into the Health Care Trust Fund and
5554	expended as provided in s. 400.418.
5555	(8)(13)  The agency shall develop and disseminate an annual
5556	list of all facilities sanctioned or fined $5,000 or more for
5557	violations of state standards, the number and class of
5558	violations involved, the penalties imposed, and the current
5559	status of cases. The list shall be disseminated, at no charge,
5560	to the Department of Elderly Affairs, the Department of Health,
5561	the Department of Children and Family Services, the area
5562	agencies on aging, the Florida Statewide Advocacy Council, and
5563	the state and local ombudsman councils. The Department of
5564	Children and Family Services shall disseminate the list to
5565	service providers under contract to the department who are
5566	responsible for referring persons to a facility for residency.
5567	The agency may charge a fee commensurate with the cost of
5568	printing and postage to other interested parties requesting a
5569	copy of this list.
5570	Section 98.  Section 400.421, Florida Statutes, is
5571	repealed.
5572	Section 99.  Subsection (9) of section 400.422, Florida
5573	Statutes, is amended to read:
5574	400.422  Receivership proceedings.--
5575	(9)  The court may direct the agency to allocate funds from
5576	the Health Care Trust Fund to the receiver, subject to the
5577	provisions of s. 400.418(1).
5578	Section 100.  Subsection (10) of section 400.423, Florida
5579	Statutes, is amended to read:
5580	400.423  Internal risk management and quality assurance
5581	program; adverse incidents and reporting requirements.--
5582	(10)  The agency Department of Elderly Affairs may adopt
5583	rules necessary to administer this section.
5584	Section 101.  Subsections (3) and (8) of section 400.424,
5585	Florida Statutes, are amended to read:
5586	400.424  Contracts.--
5587	(3)(a)  The contract shall include a refund policy to be
5588	implemented at the time of a resident's transfer, discharge, or
5589	death. The refund policy shall provide that the resident or
5590	responsible party is entitled to a prorated refund based on the
5591	daily rate for any unused portion of payment beyond the
5592	termination date after all charges, including the cost of
5593	damages to the residential unit resulting from circumstances
5594	other than normal use, have been paid to the licensee. For the
5595	purpose of this paragraph, the termination date shall be the
5596	date the unit is vacated by the resident and cleared of all
5597	personal belongings. If the amount of belongings does not
5598	preclude renting the unit, the facility may clear the unit and
5599	charge the resident or his or her estate for moving and storing
5600	the items at a rate equal to the actual cost to the facility,
5601	not to exceed 20 percent of the regular rate for the unit,
5602	provided that 14 days' advance written notification is given. If
5603	the resident's possessions are not claimed within 45 days after
5604	notification, the facility may dispose of them. The contract
5605	shall also specify any other conditions under which claims will
5606	be made against the refund due the resident. Except in the case
5607	of death or a discharge due to medical reasons, the refunds
5608	shall be computed in accordance with the notice of relocation
5609	requirements specified in the contract. However, a resident may
5610	not be required to provide the licensee with more than 30 days'
5611	notice of termination. If after a contract is terminated, the
5612	facility intends to make a claim against a refund due the
5613	resident, the facility shall notify the resident or responsible
5614	party in writing of the claim and shall provide said party with
5615	a reasonable time period of no less than 14 calendar days to
5616	respond. The facility shall provide a refund to the resident or
5617	responsible party within 45 days after the transfer, discharge,
5618	or death of the resident. The agency shall impose a fine upon a
5619	facility that fails to comply with the refund provisions of this
5620	the paragraph, which fine shall be equal to three times the
5621	amount due to the resident and not subject to the provisions of
5622	s. 400.419(3). One-half of the fine shall be remitted to the
5623	resident or his or her estate, and the other half to the Health
5624	Care Trust Fund to be used for the purpose specified in s.
5625	400.418.
5626	(b)  If a licensee agrees to reserve a bed for a resident
5627	who is admitted to a medical facility, including, but not
5628	limited to, a nursing home, health care facility, or psychiatric
5629	facility, the resident or his or her responsible party shall
5630	notify the licensee of any change in status that would prevent
5631	the resident from returning to the facility. Until such notice
5632	is received, the agreed-upon daily rate may be charged by the
5633	licensee.
5634	(c)  The purpose of any advance payment and a refund policy
5635	for such payment, including any advance payment for housing,
5636	meals, or personal services, shall be covered in the contract.
5637	(8)  The agency department may by rule clarify terms,
5638	establish procedures, clarify refund policies and contract
5639	provisions, and specify documentation as necessary to administer
5640	this section.
5641	Section 102.  Subsection (3) of section 400.4255, Florida
5642	Statutes, is amended to read:
5643	400.4255  Use of personnel; emergency care.--
5644	(3)  Facility staff may withhold or withdraw
5645	cardiopulmonary resuscitation if presented with an order not to
5646	resuscitate executed pursuant to s. 401.45. The agency
5647	department shall adopt rules providing for the implementation of
5648	such orders. Facility staff and facilities shall not be subject
5649	to criminal prosecution or civil liability, nor be considered to
5650	have engaged in negligent or unprofessional conduct, for
5651	withholding or withdrawing cardiopulmonary resuscitation
5652	pursuant to such an order and applicable rules adopted by the
5653	department. The absence of an order to resuscitate executed
5654	pursuant to s. 401.45 does not preclude a physician from
5655	withholding or withdrawing cardiopulmonary resuscitation as
5656	otherwise permitted by law.
5657	Section 103.  Subsection (6) of section 400.4256, Florida
5658	Statutes, is amended to read:
5659	400.4256  Assistance with self-administration of
5660	medication.--
5661	(6)  The agency department may by rule establish facility
5662	procedures and interpret terms as necessary to implement this
5663	section.
5664	Section 104.  Subsection (9) of section 400.426, Florida
5665	Statutes, is amended to read:
5666	400.426  Appropriateness of placements; examinations of
5667	residents.--
5668	(9)  If, at any time after admission to a facility, a
5669	resident appears to need care beyond that which the facility is
5670	licensed to provide, the agency shall require the resident to be
5671	physically examined by a licensed physician or licensed nurse
5672	practitioner. This examination shall, to the extent possible, be
5673	performed by the resident's preferred physician or nurse
5674	practitioner and shall be paid for by the resident with personal
5675	funds, except as provided in s. 400.418(2)(1)(b). Following this
5676	examination, the examining physician or licensed nurse
5677	practitioner shall complete and sign a medical form provided by
5678	the agency. The completed medical form shall be submitted to the
5679	agency within 30 days after the date the facility owner or
5680	administrator is notified by the agency that the physical
5681	examination is required. After consultation with the physician
5682	or licensed nurse practitioner who performed the examination, a
5683	medical review team designated by the agency shall then
5684	determine whether the resident is appropriately residing in the
5685	facility. The medical review team shall base its decision on a
5686	comprehensive review of the resident's physical and functional
5687	status, including the resident's preferences, and not on an
5688	isolated health-related problem. In the case of a mental health
5689	resident, if the resident appears to have needs in addition to
5690	those identified in the community living support plan, the
5691	agency may require an evaluation by a mental health
5692	professional, as determined by the Department of Children and
5693	Family Services. A facility may not be required to retain a
5694	resident who requires more services or care than the facility is
5695	able to provide in accordance with its policies and criteria for
5696	admission and continued residency. Members of the medical review
5697	team making the final determination may not include the agency
5698	personnel who initially questioned the appropriateness of a
5699	resident's placement. Such determination is final and binding
5700	upon the facility and the resident. Any resident who is
5701	determined by the medical review team to be inappropriately
5702	residing in a facility shall be given 30 days' written notice to
5703	relocate by the owner or administrator, unless the resident's
5704	continued residence in the facility presents an imminent danger
5705	to the health, safety, or welfare of the resident or a
5706	substantial probability exists that death or serious physical
5707	harm would result to the resident if allowed to remain in the
5708	facility.
5709	Section 105.  Subsection (8) of section 400.427, Florida
5710	Statutes, is amended to read:
5711	400.427  Property and personal affairs of residents.--
5712	(8)  The agency department may by rule clarify terms and
5713	specify procedures and documentation necessary to administer the
5714	provisions of this section relating to the proper management of
5715	residents' funds and personal property and the execution of
5716	surety bonds.
5717	Section 106.  Subsection (4) of section 400.4275, Florida
5718	Statutes, is amended to read:
5719	400.4275  Business practice; personnel records; liability
5720	insurance.--The assisted living facility shall be administered
5721	on a sound financial basis that is consistent with good business
5722	practices.
5723	(4)  The agency department may by rule clarify terms,
5724	establish requirements for financial records, accounting
5725	procedures, personnel procedures, insurance coverage, and
5726	reporting procedures, and specify documentation as necessary to
5727	implement the requirements of this section.
5728	Section 107.  Subsections (1), (4), and (5) of section
5729	400.431, Florida Statutes, are amended to read:
5730	400.431  Closing of facility; notice; penalty.--
5731	(1)  In addition to the requirements of part II of chapter
5732	408, Whenever a facility voluntarily discontinues operation, it
5733	shall inform the agency in writing at least 90 days prior to the
5734	discontinuance of operation. the facility shall also inform each
5735	resident or the next of kin, legal representative, or agency
5736	acting on each resident's behalf, of the fact and the proposed
5737	time of such discontinuance of operation, following the
5738	notification requirements provided in s. 400.428(1)(k). In the
5739	event a resident has no person to represent him or her, the
5740	facility shall be responsible for referral to an appropriate
5741	social service agency for placement.
5742	(4)  Immediately upon discontinuance of the operation of a
5743	facility, the owner shall surrender the license therefor to the
5744	agency, and the license shall be canceled.
5745	(4)(5)  The agency may levy a fine in an amount no greater
5746	than $5,000 upon each person or business entity that owns any
5747	interest in a facility that terminates operation without
5748	providing notice to the agency and the residents of the facility
5749	at least 30 days before operation ceases. This fine shall not be
5750	levied against any facility involuntarily closed at the
5751	initiation of the agency. The agency shall use the proceeds of
5752	the fines to operate the facility until all residents of the
5753	facility are relocated and shall deposit any balance of the
5754	proceeds into the Health Care Trust Fund established pursuant to
5755	s. 400.418.
5756	Section 108.  Section 400.434, Florida Statutes, is amended
5757	to read:
5758	400.434  Right of entry and inspection.--Any duly
5759	designated officer or employee of the department, the Department
5760	of Children and Family Services, the agency, the Medicaid Fraud
5761	Control Unit of the Department of Legal Affairs, the state or
5762	local fire marshal, or a member of the state or local long-term
5763	care ombudsman council, or the agency in accordance with s.
5764	408.811 shall have the right to enter unannounced upon and into
5765	the premises of any facility licensed pursuant to this part in
5766	order to determine the state of compliance with the provisions
5767	of this part, part II of chapter 408, and of applicable rules or
5768	standards in force pursuant thereto. The right of entry and
5769	inspection shall also extend to any premises which the agency
5770	has reason to believe is being operated or maintained as a
5771	facility without a license; but no such entry or inspection of
5772	any premises may be made without the permission of the owner or
5773	person in charge thereof, unless a warrant is first obtained
5774	from the circuit court authorizing such entry. The warrant
5775	requirement shall extend only to a facility which the agency has
5776	reason to believe is being operated or maintained as a facility
5777	without a license. Any application for a license or renewal
5778	thereof made pursuant to this part shall constitute permission
5779	for, and complete acquiescence in, any entry or inspection of
5780	the premises for which the license is sought, in order to
5781	facilitate verification of the information submitted on or in
5782	connection with the application; to discover, investigate, and
5783	determine the existence of abuse or neglect; or to elicit,
5784	receive, respond to, and resolve complaints. Any current valid
5785	license shall constitute unconditional permission for, and
5786	complete acquiescence in, any entry or inspection of the
5787	premises by authorized personnel. The agency shall retain the
5788	right of entry and inspection of facilities that have had a
5789	license revoked or suspended within the previous 24 months, to
5790	ensure that the facility is not operating unlawfully. However,
5791	before entering the facility, a statement of probable cause must
5792	be filed with the director of the agency, who must approve or
5793	disapprove the action within 48 hours. Probable cause shall
5794	include, but is not limited to, evidence that the facility holds
5795	itself out to the public as a provider of personal care services
5796	or the receipt of a complaint by the long-term care ombudsman
5797	council about the facility. Data collected by the state or local
5798	long-term care ombudsman councils or the state or local advocacy
5799	councils may be used by the agency in investigations involving
5800	violations of regulatory standards.
5801	Section 109.  Subsections (2) and (3) of section 400.435,
5802	Florida Statutes, are renumbered as subsections (1) and (2),
5803	respectively, and present subsection (1) of said section is
5804	amended to read:
5805	400.435  Inspection Maintenance of records; reports.--
5806	(1)  Every facility shall maintain, as public information
5807	available for public inspection under such conditions as the
5808	agency shall prescribe, records containing copies of all
5809	inspection reports pertaining to the facility that have been
5810	issued by the agency to the facility. Copies of inspection
5811	reports shall be retained in the records for 5 years from the
5812	date the reports are filed or issued.
5813	(1)(2)  Within 60 days after the date of the biennial
5814	inspection visit required under s. 408.811 or within 30 days
5815	after the date of any interim visit, the agency shall forward
5816	the results of the inspection to the local ombudsman council in
5817	whose planning and service area, as defined in part II, the
5818	facility is located; to at least one public library or, in the
5819	absence of a public library, the county seat in the county in
5820	which the inspected assisted living facility is located; and,
5821	when appropriate, to the district Adult Services and Mental
5822	Health Program Offices.
5823	Section 110.  Section 400.441, Florida Statutes, is amended
5824	to read:
5825	400.441  Rules establishing standards.--
5826	(1)  It is the intent of the Legislature that rules
5827	published and enforced pursuant to this section shall include
5828	criteria by which a reasonable and consistent quality of
5829	resident care and quality of life may be ensured and the results
5830	of such resident care may be demonstrated. Such rules shall also
5831	ensure a safe and sanitary environment that is residential and
5832	noninstitutional in design or nature. It is further intended
5833	that reasonable efforts be made to accommodate the needs and
5834	preferences of residents to enhance the quality of life in a
5835	facility. In order to provide safe and sanitary facilities and
5836	the highest quality of resident care accommodating the needs and
5837	preferences of residents, the agency department, in consultation
5838	with the department agency, the Department of Children and
5839	Family Services, and the Department of Health, shall adopt
5840	rules, policies, and procedures to administer this part and part
5841	II of chapter 408, which must include reasonable and fair
5842	minimum standards in relation to:
5843	(a)  The requirements for and maintenance of facilities,
5844	not in conflict with the provisions of chapter 553, relating to
5845	plumbing, heating, cooling, lighting, ventilation, living space,
5846	and other housing conditions, which will ensure the health,
5847	safety, and comfort of residents and protection from fire
5848	hazard, including adequate provisions for fire alarm and other
5849	fire protection suitable to the size of the structure. Uniform
5850	firesafety standards shall be established and enforced by the
5851	State Fire Marshal in cooperation with the agency, the
5852	department, and the Department of Health.
5853	1.  Evacuation capability determination.--
5854	a.  The provisions of the National Fire Protection
5855	Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
5856	for determining the ability of the residents, with or without
5857	staff assistance, to relocate from or within a licensed facility
5858	to a point of safety as provided in the fire codes adopted
5859	herein. An evacuation capability evaluation for initial
5860	licensure shall be conducted within 6 months after the date of
5861	licensure. For existing licensed facilities that are not
5862	equipped with an automatic fire sprinkler system, the
5863	administrator shall evaluate the evacuation capability of
5864	residents at least annually. The evacuation capability
5865	evaluation for each facility not equipped with an automatic fire
5866	sprinkler system shall be validated, without liability, by the
5867	State Fire Marshal, by the local fire marshal, or by the local
5868	authority having jurisdiction over firesafety, before the
5869	license renewal date. If the State Fire Marshal, local fire
5870	marshal, or local authority having jurisdiction over firesafety
5871	has reason to believe that the evacuation capability of a
5872	facility as reported by the administrator may have changed, it
5873	may, with assistance from the facility administrator, reevaluate
5874	the evacuation capability through timed exiting drills.
5875	Translation of timed fire exiting drills to evacuation
5876	capability may be determined:
5877	(I)  Three minutes or less: prompt.
5878	(II)  More than 3 minutes, but not more than 13 minutes:
5879	slow.
5880	(III)  More than 13 minutes: impractical.
5881	b.  The Office of the State Fire Marshal shall provide or
5882	cause the provision of training and education on the proper
5883	application of Chapter 5, NFPA 101A, 1995 edition, to its
5884	employees, to staff of the Agency for Health Care Administration
5885	who are responsible for regulating facilities under this part,
5886	and to local governmental inspectors. The Office of the State
5887	Fire Marshal shall provide or cause the provision of this
5888	training within its existing budget, but may charge a fee for
5889	this training to offset its costs. The initial training must be
5890	delivered within 6 months after July 1, 1995, and as needed
5891	thereafter.
5892	c.  The Office of the State Fire Marshal, in cooperation
5893	with provider associations, shall provide or cause the provision
5894	of a training program designed to inform facility operators on
5895	how to properly review bid documents relating to the
5896	installation of automatic fire sprinklers. The Office of the
5897	State Fire Marshal shall provide or cause the provision of this
5898	training within its existing budget, but may charge a fee for
5899	this training to offset its costs. The initial training must be
5900	delivered within 6 months after July 1, 1995, and as needed
5901	thereafter.
5902	d.  The administrator of a licensed facility shall sign an
5903	affidavit verifying the number of residents occupying the
5904	facility at the time of the evacuation capability evaluation.
5905	2.  Firesafety requirements.--
5906	a.  Except for the special applications provided herein,
5907	effective January 1, 1996, the provisions of the National Fire
5908	Protection Association, Life Safety Code, NFPA 101, 1994
5909	edition, Chapter 22 for new facilities and Chapter 23 for
5910	existing facilities shall be the uniform fire code applied by
5911	the State Fire Marshal for assisted living facilities, pursuant
5912	to s. 633.022.
5913	b.  Any new facility, regardless of size, that applies for
5914	a license on or after January 1, 1996, must be equipped with an
5915	automatic fire sprinkler system. The exceptions as provided in
5916	section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein,
5917	apply to any new facility housing eight or fewer residents. On
5918	July 1, 1995, local governmental entities responsible for the
5919	issuance of permits for construction shall inform, without
5920	liability, any facility whose permit for construction is
5921	obtained prior to January 1, 1996, of this automatic fire
5922	sprinkler requirement. As used in this part, the term "a new
5923	facility" does not mean an existing facility that has undergone
5924	change of ownership.
5925	c.  Notwithstanding any provision of s. 633.022 or of the
5926	National Fire Protection Association, NFPA 101A, Chapter 5, 1995
5927	edition, to the contrary, any existing facility housing eight or
5928	fewer residents is not required to install an automatic fire
5929	sprinkler system, nor to comply with any other requirement in
5930	Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
5931	requirements of NFPA 101, 1988 edition, that applies to this
5932	size facility, unless the facility has been classified as
5933	impractical to evacuate. Any existing facility housing eight or
5934	fewer residents that is classified as impractical to evacuate
5935	must install an automatic fire sprinkler system within the
5936	timeframes granted in this section.
5937	d.  Any existing facility that is required to install an
5938	automatic fire sprinkler system under this paragraph need not
5939	meet other firesafety requirements of Chapter 23, NFPA 101, 1994
5940	edition, which exceed the provisions of NFPA 101, 1988 edition.
5941	The mandate contained in this paragraph which requires certain
5942	facilities to install an automatic fire sprinkler system
5943	supersedes any other requirement.
5944	e.  This paragraph does not supersede the exceptions
5945	granted in NFPA 101, 1988 edition or 1994 edition.
5946	f.  This paragraph does not exempt facilities from other
5947	firesafety provisions adopted under s. 633.022 and local
5948	building code requirements in effect before July 1, 1995.
5949	g.  A local government may charge fees only in an amount
5950	not to exceed the actual expenses incurred by local government
5951	relating to the installation and maintenance of an automatic
5952	fire sprinkler system in an existing and properly licensed
5953	assisted living facility structure as of January 1, 1996.
5954	h.  If a licensed facility undergoes major reconstruction
5955	or addition to an existing building on or after January 1, 1996,
5956	the entire building must be equipped with an automatic fire
5957	sprinkler system. Major reconstruction of a building means
5958	repair or restoration that costs in excess of 50 percent of the
5959	value of the building as reported on the tax rolls, excluding
5960	land, before reconstruction. Multiple reconstruction projects
5961	within a 5-year period the total costs of which exceed 50
5962	percent of the initial value of the building at the time the
5963	first reconstruction project was permitted are to be considered
5964	as major reconstruction. Application for a permit for an
5965	automatic fire sprinkler system is required upon application for
5966	a permit for a reconstruction project that creates costs that go
5967	over the 50-percent threshold.
5968	i.  Any facility licensed before January 1, 1996, that is
5969	required to install an automatic fire sprinkler system shall
5970	ensure that the installation is completed within the following
5971	timeframes based upon evacuation capability of the facility as
5972	determined under subparagraph 1.:
5973	(I)  Impractical evacuation capability, 24 months.
5974	(II)  Slow evacuation capability, 48 months.
5975	(III)  Prompt evacuation capability, 60 months.
5976
5977	The beginning date from which the deadline for the automatic
5978	fire sprinkler installation requirement must be calculated is
5979	upon receipt of written notice from the local fire official that
5980	an automatic fire sprinkler system must be installed. The local
5981	fire official shall send a copy of the document indicating the
5982	requirement of a fire sprinkler system to the Agency for Health
5983	Care Administration.
5984	j.  It is recognized that the installation of an automatic
5985	fire sprinkler system may create financial hardship for some
5986	facilities. The appropriate local fire official shall, without
5987	liability, grant two 1-year extensions to the timeframes for
5988	installation established herein, if an automatic fire sprinkler
5989	installation cost estimate and proof of denial from two
5990	financial institutions for a construction loan to install the
5991	automatic fire sprinkler system are submitted. However, for any
5992	facility with a class I or class II, or a history of uncorrected
5993	class III, firesafety deficiencies, an extension must not be
5994	granted. The local fire official shall send a copy of the
5995	document granting the time extension to the Agency for Health
5996	Care Administration.
5997	k.  A facility owner whose facility is required to be
5998	equipped with an automatic fire sprinkler system under Chapter
5999	23, NFPA 101, 1994 edition, as adopted herein, must disclose to
6000	any potential buyer of the facility that an installation of an
6001	automatic fire sprinkler requirement exists. The sale of the
6002	facility does not alter the timeframe for the installation of
6003	the automatic fire sprinkler system.
6004	l.  Existing facilities required to install an automatic
6005	fire sprinkler system as a result of construction-type
6006	restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
6007	herein, or evacuation capability requirements shall be notified
6008	by the local fire official in writing of the automatic fire
6009	sprinkler requirement, as well as the appropriate date for final
6010	compliance as provided in this subparagraph. The local fire
6011	official shall send a copy of the document to the Agency for
6012	Health Care Administration.
6013	m.  Except in cases of life-threatening fire hazards, if an
6014	existing facility experiences a change in the evacuation
6015	capability, or if the local authority having jurisdiction
6016	identifies a construction-type restriction, such that an
6017	automatic fire sprinkler system is required, it shall be
6018	afforded time for installation as provided in this subparagraph.
6019
6020	Facilities that are fully sprinkled and in compliance with other
6021	firesafety standards are not required to conduct more than one
6022	of the required fire drills between the hours of 11 p.m. and 7
6023	a.m., per year. In lieu of the remaining drills, staff
6024	responsible for residents during such hours may be required to
6025	participate in a mock drill that includes a review of evacuation
6026	procedures. Such standards must be included or referenced in the
6027	rules adopted by the State Fire Marshal. Pursuant to s.
6028	633.022(1)(b), the State Fire Marshal is the final
6029	administrative authority for firesafety standards established
6030	and enforced pursuant to this section. All licensed facilities
6031	must have an annual fire inspection conducted by the local fire
6032	marshal or authority having jurisdiction.
6033	3.  Resident elopement requirements.--Facilities are
6034	required to conduct a minimum of two resident elopement
6035	prevention and response drills per year. All administrators and
6036	direct care staff must participate in the drills which shall
6037	include a review of procedures to address resident elopement.
6038	Facilities must document the implementation of the drills and
6039	ensure that the drills are conducted in a manner consistent with
6040	the facility's resident elopement policies and procedures.
6041	(b)  The preparation and annual update of a comprehensive
6042	emergency management plan. Such standards must be included in
6043	the rules adopted by the agency department after consultation
6044	with the Department of Community Affairs. At a minimum, the
6045	rules must provide for plan components that address emergency
6046	evacuation transportation; adequate sheltering arrangements;
6047	postdisaster activities, including provision of emergency power,
6048	food, and water; postdisaster transportation; supplies;
6049	staffing; emergency equipment; individual identification of
6050	residents and transfer of records; communication with families;
6051	and responses to family inquiries. The comprehensive emergency
6052	management plan is subject to review and approval by the local
6053	emergency management agency. During its review, the local
6054	emergency management agency shall ensure that the following
6055	agencies, at a minimum, are given the opportunity to review the
6056	plan: the Department of Elderly Affairs, the Department of
6057	Health, the Agency for Health Care Administration, and the
6058	Department of Community Affairs. Also, appropriate volunteer
6059	organizations must be given the opportunity to review the plan.
6060	The local emergency management agency shall complete its review
6061	within 60 days and either approve the plan or advise the
6062	facility of necessary revisions.
6063	(c)  The number, training, and qualifications of all
6064	personnel having responsibility for the care of residents. The
6065	rules must require adequate staff to provide for the safety of
6066	all residents. Facilities licensed for 17 or more residents are
6067	required to maintain an alert staff for 24 hours per day.
6068	(d)  All sanitary conditions within the facility and its
6069	surroundings which will ensure the health and comfort of
6070	residents. The rules must clearly delineate the responsibilities
6071	of the agency's licensure and survey staff, the county health
6072	departments, and the local authority having jurisdiction over
6073	fire safety and ensure that inspections are not duplicative. The
6074	agency may collect fees for food service inspections conducted
6075	by the county health departments and transfer such fees to the
6076	Department of Health.
6077	(e)  License application and license renewal, transfer of
6078	ownership, Proper management of resident funds and personal
6079	property, surety bonds, resident contracts, refund policies,
6080	financial ability to operate, and facility and staff records.
6081	(f)  Inspections, complaint investigations, moratoriums,
6082	classification of deficiencies, levying and enforcement of
6083	penalties, and use of income from fees and fines.
6084	(g)  The enforcement of the resident bill of rights
6085	specified in s. 400.428.
6086	(h)  The care and maintenance of residents, which must
6087	include, but is not limited to:
6088	1.  The supervision of residents;
6089	2.  The provision of personal services;
6090	3.  The provision of, or arrangement for, social and
6091	leisure activities;
6092	4.  The arrangement for appointments and transportation to
6093	appropriate medical, dental, nursing, or mental health services,
6094	as needed by residents;
6095	5.  The management of medication;
6096	6.  The nutritional needs of residents;
6097	7.  Resident records; and
6098	8.  Internal risk management and quality assurance.
6099	(i)  Facilities holding a limited nursing, extended
6100	congregate care, or limited mental health license.
6101	(j)  The establishment of specific criteria to define
6102	appropriateness of resident admission and continued residency in
6103	a facility holding a standard, limited nursing, extended
6104	congregate care, and limited mental health license.
6105	(k)  The use of physical or chemical restraints. The use of
6106	physical restraints is limited to half-bed rails as prescribed
6107	and documented by the resident's physician with the consent of
6108	the resident or, if applicable, the resident's representative or
6109	designee or the resident's surrogate, guardian, or attorney in
6110	fact. The use of chemical restraints is limited to prescribed
6111	dosages of medications authorized by the resident's physician
6112	and must be consistent with the resident's diagnosis. Residents
6113	who are receiving medications that can serve as chemical
6114	restraints must be evaluated by their physician at least
6115	annually to assess:
6116	1.  The continued need for the medication.
6117	2.  The level of the medication in the resident's blood.
6118	3.  The need for adjustments in the prescription.
6119	(l)  The establishment of specific policies and procedures
6120	on resident elopement. Facilities shall conduct a minimum of two
6121	resident elopement drills each year. All administrators and
6122	direct care staff shall participate in the drills. Facilities
6123	shall document the drills.
6124	(2)  In adopting any rules pursuant to this part, the
6125	agency department, in conjunction with the department agency,
6126	shall make distinct standards for facilities based upon facility
6127	size; the types of care provided; the physical and mental
6128	capabilities and needs of residents; the type, frequency, and
6129	amount of services and care offered; and the staffing
6130	characteristics of the facility. Rules developed pursuant to
6131	this section shall not restrict the use of shared staffing and
6132	shared programming in facilities that are part of retirement
6133	communities that provide multiple levels of care and otherwise
6134	meet the requirements of law and rule. Except for uniform
6135	firesafety standards, the agency department shall adopt by rule
6136	separate and distinct standards for facilities with 16 or fewer
6137	beds and for facilities with 17 or more beds. The standards for
6138	facilities with 16 or fewer beds shall be appropriate for a
6139	noninstitutional residential environment, provided that the
6140	structure is no more than two stories in height and all persons
6141	who cannot exit the facility unassisted in an emergency reside
6142	on the first floor. The agency department, in conjunction with
6143	the department agency, may make other distinctions among types
6144	of facilities as necessary to enforce the provisions of this
6145	part. Where appropriate, the agency shall offer alternate
6146	solutions for complying with established standards, based on
6147	distinctions made by the department and the agency relative to
6148	the physical characteristics of facilities and the types of care
6149	offered therein.
6150	(3)  The department shall submit a copy of proposed rules
6151	to the Speaker of the House of Representatives, the President of
6152	the Senate, and appropriate committees of substance for review
6153	and comment prior to the promulgation thereof.
6154	(a)  Rules adopted promulgated by the agency department
6155	shall encourage the development of homelike facilities which
6156	promote the dignity, individuality, personal strengths, and
6157	decisionmaking ability of residents.
6158	(4)(b)  The agency, in consultation with the department,
6159	may waive rules promulgated pursuant to this part in order to
6160	demonstrate and evaluate innovative or cost-effective congregate
6161	care alternatives which enable individuals to age in place. Such
6162	waivers may be granted only in instances where there is
6163	reasonable assurance that the health, safety, or welfare of
6164	residents will not be endangered. To apply for a waiver, the
6165	licensee shall submit to the agency a written description of the
6166	concept to be demonstrated, including goals, objectives, and
6167	anticipated benefits; the number and types of residents who will
6168	be affected, if applicable; a brief description of how the
6169	demonstration will be evaluated; and any other information
6170	deemed appropriate by the agency. Any facility granted a waiver
6171	shall submit a report of findings to the agency and the
6172	department within 12 months. At such time, the agency may renew
6173	or revoke the waiver or pursue any regulatory or statutory
6174	changes necessary to allow other facilities to adopt the same
6175	practices. The agency department may by rule clarify terms and
6176	establish waiver application procedures, criteria for reviewing
6177	waiver proposals, and procedures for reporting findings, as
6178	necessary to implement this subsection.
6179	(5)(4)  The agency may use an abbreviated biennial standard
6180	licensure inspection that consists of a review of key quality-
6181	of-care standards in lieu of a full inspection in facilities
6182	which have a good record of past performance. However, a full
6183	inspection shall be conducted in facilities which have had a
6184	history of class I or class II violations, uncorrected class III
6185	violations, confirmed ombudsman council complaints, or confirmed
6186	licensure complaints, within the previous licensure period
6187	immediately preceding the inspection or when a potentially
6188	serious problem is identified during the abbreviated inspection.
6189	The agency, in consultation with the department, shall develop
6190	the key quality-of-care standards with input from the State
6191	Long-Term Care Ombudsman Council and representatives of provider
6192	groups for incorporation into its rules. The department, in
6193	consultation with the agency, shall report annually to the
6194	Legislature concerning its implementation of this subsection.
6195	The report shall include, at a minimum, the key quality-of-care
6196	standards which have been developed; the number of facilities
6197	identified as being eligible for the abbreviated inspection; the
6198	number of facilities which have received the abbreviated
6199	inspection and, of those, the number that were converted to full
6200	inspection; the number and type of subsequent complaints
6201	received by the agency or department on facilities which have
6202	had abbreviated inspections; any recommendations for
6203	modification to this subsection; any plans by the agency to
6204	modify its implementation of this subsection; and any other
6205	information which the department believes should be reported.
6206	(5)  A fee shall be charged by the department to any person
6207	requesting a copy of this part or rules promulgated under this
6208	part. Such fees shall not exceed the actual cost of duplication
6209	and postage.
6210	Section 111.  Subsection (4) of section 400.442, Florida
6211	Statutes, is amended to read:
6212	400.442  Pharmacy and dietary services.--
6213	(4)  The agency department may by rule establish procedures
6214	and specify documentation as necessary to implement this
6215	section.
6216	Section 112.  Subsection (3) of section 400.444, Florida
6217	Statutes, is amended to read:
6218	400.444  Construction and renovation; requirements.--
6219	(3)  The agency department may adopt rules to establish
6220	procedures and specify the documentation necessary to implement
6221	this section.
6222	Section 113.  Subsections (4) through (7) of section
6223	400.447, Florida Statutes, are renumbered as subsections (1)
6224	through (4) and present subsections (1), (2), and (3) of said
6225	section are amended to read:
6226	400.447  Prohibited acts; penalties for violation.--
6227	(1)  It is unlawful for any person or public body to offer
6228	or advertise to the public, in any way by any medium whatever,
6229	personal services as defined in this act, without obtaining a
6230	valid current license. It is unlawful for any holder of a
6231	license issued pursuant to the provisions of this act to
6232	advertise or hold out to the public that it holds a license for
6233	a facility other than that for which it actually holds a
6234	license.
6235	(2)  It is unlawful for any holder of a license issued
6236	pursuant to the provisions of this act to withhold from the
6237	agency any evidence of financial instability, including, but not
6238	limited to, bad checks, delinquent accounts, nonpayment of
6239	withholding taxes, unpaid utility expenses, nonpayment for
6240	essential services, or adverse court action concerning the
6241	financial viability of the facility or any other facility
6242	licensed under part II or part III of this chapter which is
6243	owned by the licensee.
6244	(3)  Any person found guilty of violating subsection (1) or
6245	subsection (2) commits a misdemeanor of the second degree,
6246	punishable as provided in s. 775.083. Each day of continuing
6247	violation shall be considered a separate offense.
6248	Section 114.  Section 400.451, Florida Statutes, is
6249	repealed.
6250	Section 115.  Subsections (1), (3), and (6) of section
6251	400.452, Florida Statutes, as amended by section 3 of chapter
6252	2003-405, Laws of Florida, are amended to read:
6253	400.452  Staff training and educational programs; core
6254	educational requirement.--
6255	(1)  Administrators and other assisted living facility
6256	staff must meet minimum training and education requirements
6257	established by the Department of Elderly Affairs or agency by
6258	rule. This training and education is intended to assist
6259	facilities to appropriately respond to the needs of residents,
6260	to maintain resident care and facility standards, and to meet
6261	licensure requirements.
6262	(3)  Effective January 1, 2004, a new facility
6263	administrator must complete the required training and education,
6264	including the competency test, within a reasonable time after
6265	being employed as an administrator, as determined by the
6266	department. Failure to do so is a violation of this part and
6267	subjects the violator to an administrative fine as prescribed in
6268	s. 400.419. Administrators licensed in accordance with chapter
6269	468, part II, are exempt from this requirement. Other licensed
6270	professionals may be exempted, as determined by the department
6271	by rule.
6272	(6)  Other facility staff shall participate in training
6273	relevant to their job duties as specified by rule of the
6274	department.
6275	Section 116.  Section 400.454, Florida Statutes, is amended
6276	to read:
6277	400.454  Collection of information; local subsidy.--
6278	(1)  To enable the agency department to collect the
6279	information requested by the Legislature regarding the actual
6280	cost of providing room, board, and personal care in facilities,
6281	the agency may department is authorized to conduct field visits
6282	and audits of facilities as may be necessary. The owners of
6283	randomly sampled facilities shall submit such reports, audits,
6284	and accountings of cost as required the department may require
6285	by rule; provided that such reports, audits, and accountings
6286	shall be the minimum necessary to implement the provisions of
6287	this section. Any facility selected to participate in the study
6288	shall cooperate with the agency department by providing cost of
6289	operation information to interviewers.
6290	(2)  Local governments or organizations may contribute to
6291	the cost of care of local facility residents by further
6292	subsidizing the rate of state-authorized payment to such
6293	facilities. Implementation of local subsidy shall require agency
6294	departmental approval and shall not result in reductions in the
6295	state supplement.
6296	Section 117.  Subsections (1) and (4) of section 400.464,
6297	Florida Statutes, are amended to read:
6298	400.464  Home health agencies to be licensed; expiration of
6299	license; exemptions; unlawful acts; penalties.--
6300	(1)  The requirements of part II of chapter 408 shall apply
6301	to the provision of services that require licensure pursuant to
6302	this part and part II of chapter 408 and entities licensed or
6303	registered by or applying for such licensure or registration
6304	from the Agency for Health Care Administration pursuant to this
6305	part. However, each applicant for licensure and each licensee is
6306	exempt from the provisions of ss. 408.806(1)(e)2. and
6307	408.810(10). Any home health agency must be licensed by the
6308	agency to operate in this state. A license issued to a home
6309	health agency, unless sooner suspended or revoked, expires 1
6310	year after its date of issuance.
6311	(4)(a)  An organization may not provide, offer, or
6312	advertise home health services to the public unless the
6313	organization has a valid license or is specifically exempted
6314	under this part. An organization that offers or advertises to
6315	the public any service for which licensure or registration is
6316	required under this part must include in the advertisement the
6317	license number or regulation number issued to the organization
6318	by the agency. The agency shall assess a fine of not less than
6319	$100 to any licensee or registrant who fails to include the
6320	license or registration number when submitting the advertisement
6321	for publication, broadcast, or printing. The holder of a license
6322	issued under this part may not advertise or indicate to the
6323	public that it holds a home health agency or nurse registry
6324	license other than the one it has been issued.
6325	(b)  A person who violates paragraph (a) is subject to an
6326	injunctive proceeding under s. 408.816 400.515. A violation of
6327	paragraph (a) or s. 408.813 is a deceptive and unfair trade
6328	practice and constitutes a violation of the Florida Deceptive
6329	and Unfair Trade Practices Act.
6330	(c)  A person who violates the provisions of paragraph (a)
6331	commits a misdemeanor of the second degree, punishable as
6332	provided in s. 775.082 or s. 775.083. Any person who commits a
6333	second or subsequent violation commits a misdemeanor of the
6334	first degree, punishable as provided in s. 775.082 or s.
6335	775.083. Each day of continuing violation constitutes a separate
6336	offense.
6337	Section 118.  Section 400.471, Florida Statutes, is amended
6338	to read:
6339	400.471  Application for license; fee; provisional license;
6340	temporary permit.--
6341	(1)  Each applicant for licensure must comply with all
6342	provisions of this part and part II of chapter 408. Application
6343	for an initial license or for renewal of an existing license
6344	must be made under oath to the agency on forms furnished by it
6345	and must be accompanied by the appropriate license fee as
6346	provided in subsection (8). The agency must take final action on
6347	an initial licensure application within 60 days after receipt of
6348	all required documentation.
6349	(2)  In addition to the requirements of part II of chapter
6350	408, the applicant must file with the application satisfactory
6351	proof that the home health agency is in compliance with this
6352	part and applicable rules, including:
6353	(a)  A listing of services to be provided, either directly
6354	by the applicant or through contractual arrangements with
6355	existing providers.;
6356	(b)  The number and discipline of professional staff to be
6357	employed.; and
6358	(c)  Proof of financial ability to operate.
6359	(3)  An applicant for initial licensure must demonstrate
6360	financial ability to operate by submitting a balance sheet and
6361	income and expense statement for the first 2 years of operation
6362	which provide evidence of having sufficient assets, credit, and
6363	projected revenues to cover liabilities and expenses. The
6364	applicant shall have demonstrated financial ability to operate
6365	if the applicant's assets, credit, and projected revenues meet
6366	or exceed projected liabilities and expenses. All documents
6367	required under this subsection must be prepared in accordance
6368	with generally accepted accounting principles, and the financial
6369	statement must be signed by a certified public accountant.
6370	(4)  Each applicant for licensure must comply with the
6371	following requirements:
6372	(a)  Upon receipt of a completed, signed, and dated
6373	application, the agency shall require background screening of
6374	the applicant, in accordance with the level 2 standards for
6375	screening set forth in chapter 435. As used in this subsection,
6376	the term "applicant" means the administrator, or a similarly
6377	titled person who is responsible for the day-to-day operation of
6378	the licensed home health agency, and the financial officer, or
6379	similarly titled individual who is responsible for the financial
6380	operation of the licensed home health agency.
6381	(b)  The agency may require background screening for a
6382	member of the board of directors of the licensee or an officer
6383	or an individual owning 5 percent or more of the licensee if the
6384	agency reasonably suspects that such individual has been
6385	convicted of an offense prohibited under the level 2 standards
6386	for screening set forth in chapter 435.
6387	(c)  Proof of compliance with the level 2 background
6388	screening requirements of chapter 435 which has been submitted
6389	within the previous 5 years in compliance with any other health
6390	care or assisted living licensure requirements of this state is
6391	acceptable in fulfillment of paragraph (a). Proof of compliance
6392	with background screening which has been submitted within the
6393	previous 5 years to fulfill the requirements of the Financial
6394	Services Commission and the Office of Insurance Regulation
6395	pursuant to chapter 651 as part of an application for a
6396	certificate of authority to operate a continuing care retirement
6397	community is acceptable in fulfillment of the Department of Law
6398	Enforcement and Federal Bureau of Investigation background
6399	check.
6400	(d)  A provisional license may be granted to an applicant
6401	when each individual required by this section to undergo
6402	background screening has met the standards for the Department of
6403	Law Enforcement background check, but the agency has not yet
6404	received background screening results from the Federal Bureau of
6405	Investigation. A standard license may be granted to the licensee
6406	upon the agency's receipt of a report of the results of the
6407	Federal Bureau of Investigation background screening for each
6408	individual required by this section to undergo background
6409	screening which confirms that all standards have been met, or
6410	upon the granting of a disqualification exemption by the agency
6411	as set forth in chapter 435. Any other person who is required to
6412	undergo level 2 background screening may serve in his or her
6413	capacity pending the agency's receipt of the report from the
6414	Federal Bureau of Investigation. However, the person may not
6415	continue to serve if the report indicates any violation of
6416	background screening standards and a disqualification exemption
6417	has not been requested of and granted by the agency as set forth
6418	in chapter 435.
6419	(e)  Each applicant must submit to the agency, with its
6420	application, a description and explanation of any exclusions,
6421	permanent suspensions, or terminations of the licensee or
6422	potential licensee from the Medicare or Medicaid programs. Proof
6423	of compliance with the requirements for disclosure of ownership
6424	and control interest under the Medicaid or Medicare programs may
6425	be accepted in lieu of this submission.
6426	(f)  Each applicant must submit to the agency a description
6427	and explanation of any conviction of an offense prohibited under
6428	the level 2 standards of chapter 435 by a member of the board of
6429	directors of the applicant, its officers, or any individual
6430	owning 5 percent or more of the applicant. This requirement does
6431	not apply to a director of a not-for-profit corporation or
6432	organization if the director serves solely in a voluntary
6433	capacity for the corporation or organization, does not regularly
6434	take part in the day-to-day operational decisions of the
6435	corporation or organization, receives no remuneration for his or
6436	her services on the corporation or organization's board of
6437	directors, and has no financial interest and has no family
6438	members with a financial interest in the corporation or
6439	organization, provided that the director and the not-for-profit
6440	corporation or organization include in the application a
6441	statement affirming that the director's relationship to the
6442	corporation satisfies the requirements of this paragraph.
6443	(g)  A license may not be granted to an applicant if the
6444	applicant, administrator, or financial officer has been found
6445	guilty of, regardless of adjudication, or has entered a plea of
6446	nolo contendere or guilty to, any offense prohibited under the
6447	level 2 standards for screening set forth in chapter 435, unless
6448	an exemption from disqualification has been granted by the
6449	agency as set forth in chapter 435.
6450	(h)  The agency may deny or revoke licensure if the
6451	applicant:
6452	1.  Has falsely represented a material fact in the
6453	application required by paragraph (e) or paragraph (f), or has
6454	omitted any material fact from the application required by
6455	paragraph (e) or paragraph (f); or
6456	2.  Has been or is currently excluded, suspended,
6457	terminated from, or has involuntarily withdrawn from
6458	participation in this state's Medicaid program, or the Medicaid
6459	program of any other state, or from participation in the
6460	Medicare program or any other governmental or private health
6461	care or health insurance program.
6462	(i)  An application for license renewal must contain the
6463	information required under paragraphs (e) and (f).
6464	(3)(5)  In addition to the requirements of s. 408.810, the
6465	home health agency must also obtain and maintain the following
6466	insurance coverages in an amount of not less than $250,000 per
6467	claim, and the home health agency must submit proof of coverage
6468	with an initial application for licensure and with each annual
6469	application for license renewal:
6470	(a)  Malpractice insurance as defined in s. 624.605(1)(k).;
6471	(b)  Liability insurance as defined in s. 624.605(1)(b).
6472	(6)  Ninety days before the expiration date, an application
6473	for renewal must be submitted to the agency under oath on forms
6474	furnished by it, and a license must be renewed if the applicant
6475	has met the requirements established under this part and
6476	applicable rules. The home health agency must file with the
6477	application satisfactory proof that it is in compliance with
6478	this part and applicable rules. If there is evidence of
6479	financial instability, the home health agency must submit
6480	satisfactory proof of its financial ability to comply with the
6481	requirements of this part.
6482	(7)  When transferring the ownership of a home health
6483	agency, the transferee must submit an application for a license
6484	at least 60 days before the effective date of the transfer. If
6485	the home health agency is being leased, a copy of the lease
6486	agreement must be filed with the application.
6487	(4)(8)  In accordance with s. 408.805, an applicant or
6488	licensee shall pay a fee for each license application submitted
6489	under this part, part II of chapter 408, and applicable rules.
6490	The amount of the fee shall be established by rule and shall be
6491	set at The license fee and annual renewal fee required of a home
6492	health agency are nonrefundable. The agency shall set the fees
6493	in an amount that is sufficient to cover the agency's its costs
6494	in carrying out its responsibilities under this part, but not to
6495	exceed $2,000 per biennium $1,000. However, state, county, or
6496	municipal governments applying for licenses under this part are
6497	exempt from the payment of license fees. All fees collected
6498	under this part must be deposited in the Health Care Trust Fund
6499	for the administration of this part.
6500	(9)  The license must be displayed in a conspicuous place
6501	in the administrative office of the home health agency and is
6502	valid only while in the possession of the person to which it is
6503	issued. The license may not be sold, assigned, or otherwise
6504	transferred, voluntarily or involuntarily, and is valid only for
6505	the home health agency and location for which originally issued.
6506	(10)  A home health agency against whom a revocation or
6507	suspension proceeding is pending at the time of license renewal
6508	may be issued a provisional license effective until final
6509	disposition by the agency of such proceedings. If judicial
6510	relief is sought from the final disposition, the court that has
6511	jurisdiction may issue a temporary permit for the duration of
6512	the judicial proceeding.
6513	(5)(11)  The agency may not issue a license designated as
6514	certified to a home health agency that fails to satisfy the
6515	requirements of a Medicare certification survey from the agency.
6516	(12)  The agency may not issue a license to a home health
6517	agency that has any unpaid fines assessed under this part.
6518	Section 119.  Section 400.474, Florida Statutes, is amended
6519	to read:
6520	400.474  Denial, suspension, revocation of license;
6521	injunction; grounds; penalties.--
6522	(1)  The agency may deny, revoke, and or suspend a license,
6523	and or impose an administrative fine in the manner provided in
6524	chapter 120, or initiate injunctive proceedings under this part,
6525	part II of chapter 408, or applicable rules s. 400.515.
6526	(2)  Any of the following actions by a home health agency
6527	or its employee is grounds for disciplinary action by the
6528	agency:
6529	(a)  Violation of this part, part II of chapter 408, or of
6530	applicable rules.
6531	(b)  An intentional, reckless, or negligent act that
6532	materially affects the health or safety of a patient.
6533	(c)  Knowingly providing home health services in an
6534	unlicensed assisted living facility or unlicensed adult family-
6535	care home, unless the home health agency or employee reports the
6536	unlicensed facility or home to the agency within 72 hours after
6537	providing the services.
6538	(3)  The agency may impose the following penalties for
6539	operating without a license upon an applicant or owner who has
6540	in the past operated, or who currently operates, a licensed home
6541	health agency.
6542	(a)  If a home health agency that is found to be operating
6543	without a license wishes to apply for a license, the home health
6544	agency may submit an application only after the agency has
6545	verified that the home health agency no longer operates an
6546	unlicensed home health agency.
6547	(b)  Any person, partnership, or corporation that violates
6548	paragraph (a) and that previously operated a licensed home
6549	health agency or concurrently operates both a licensed home
6550	health agency and an unlicensed home health agency commits a
6551	felony of the third degree punishable as provided in s. 775.082,
6552	s. 775.083, or s. 775.084. If an owner has an interest in more
6553	than one home health agency and fails to license any one of
6554	those home health agencies, the agency must issue a cease and
6555	desist order for the activities of the unlicensed home health
6556	agency and impose a moratorium on any or all of the licensed
6557	related home health agencies until the unlicensed home health
6558	agency is licensed.
6559	(3)(c)  If any home health agency is found to be operating
6560	without a license meets the criteria in paragraph (a) or
6561	paragraph (b) and that home health agency has received any
6562	government reimbursement for services provided by an unlicensed
6563	home health agency, the agency shall make a fraud referral to
6564	the appropriate government reimbursement program.
6565	(4)  The agency may deny, revoke, or suspend the license of
6566	a home health agency, or may impose on a home health agency
6567	administrative fines not to exceed the aggregate sum of $5,000
6568	if:
6569	(a)  The agency is unable to obtain entry to the home
6570	health agency to conduct a licensure survey, complaint
6571	investigation, surveillance visit, or monitoring visit.
6572	(b)  An applicant or a licensed home health agency has
6573	falsely represented a material fact in the application, or has
6574	omitted from the application any material fact, including, but
6575	not limited to, the fact that the controlling or ownership
6576	interest is held by any officer, director, agent, manager,
6577	employee, affiliated person, partner, or shareholder who is not
6578	eligible to participate.
6579	(c)  An applicant, owner, or person who has a 5 percent or
6580	greater interest in a licensed entity:
6581	1.  Has been previously found by any licensing, certifying,
6582	or professional standards board or agency to have violated the
6583	standards or conditions that relate to home health-related
6584	licensure or certification, or to the quality of home health-
6585	related services provided; or
6586	2.  Has been or is currently excluded, suspended,
6587	terminated from, or has involuntarily withdrawn from,
6588	participation in the Medicaid program of this state or any other
6589	state, the Medicare program, or any other governmental health
6590	care or health insurance program.
6591	Section 120.  Subsection (1) and paragraphs (a) and (b) of
6592	subsection (2) of section 400.484, Florida Statutes, are amended
6593	to read:
6594	400.484  Right of inspection; deficiencies; fines.--
6595	(1)  In accordance with s. 408.811, Any duly authorized
6596	officer or employee of the agency may make such inspections and
6597	investigations as are necessary in order to determine the state
6598	of compliance with this part and with applicable rules. The
6599	right of inspection extends to any business that the agency has
6600	reason to believe is being operated as a home health agency
6601	without a license, but such inspection of any such business may
6602	not be made without the permission of the owner or person in
6603	charge unless a warrant is first obtained from a circuit court.
6604	Any application for a license issued under this part or for
6605	license renewal constitutes permission for an appropriate
6606	inspection to verify the information submitted on or in
6607	connection with the application.
6608	(2)  The agency shall impose fines for various classes of
6609	deficiencies in accordance with the following schedule:
6610	(a)  A class I deficiency is any act, omission, or practice
6611	that results in a patient's death, disablement, or permanent
6612	injury, or places a patient at imminent risk of death,
6613	disablement, or permanent injury. Upon finding a class I
6614	deficiency, the agency may impose an administrative fine in the
6615	amount of $5,000 for each occurrence and each day that the
6616	deficiency exists. In addition, the agency may immediately
6617	revoke the license and, or impose a moratorium pursuant to part
6618	II of chapter 408 on the admission of new patients, until the
6619	factors causing the deficiency have been corrected.
6620	(b)  A class II deficiency is any act, omission, or
6621	practice that has a direct adverse effect on the health, safety,
6622	or security of a patient. Upon finding a class II deficiency,
6623	the agency may impose an administrative fine in the amount of
6624	$1,000 for each occurrence and each day that the deficiency
6625	exists. In addition, the agency may suspend the license and, or
6626	impose a moratorium pursuant to part II of chapter 408 on the
6627	admission of new patients, until the deficiency has been
6628	corrected.
6629	Section 121.  Subsections (1) and (2) of section 400.487,
6630	Florida Statutes, are amended to read:
6631	400.487  Home health service agreements; physician's,
6632	physician assistant's, and advanced registered nurse
6633	practitioner's treatment orders; patient assessment;
6634	establishment and review of plan of care; provision of services;
6635	orders not to resuscitate.--
6636	(1)  Services provided by a home health agency must be
6637	covered by an agreement between the home health agency and the
6638	patient or the patient's legal representative specifying the
6639	home health services to be provided, the rates or charges for
6640	services paid with private funds, and the sources method of
6641	payment, which may include Medicare, Medicaid, private
6642	insurance, personal funds, or a combination thereof. A home
6643	health agency providing skilled care must make an assessment of
6644	the patient's needs within 48 hours after the start of services.
6645	(2)  When required by the provisions of chapter 464; part
6646	I, part III, or part V of chapter 468; or chapter 486, the
6647	attending physician, physician assistant, or advanced registered
6648	nurse practitioner, acting within his or her respective scope of
6649	practice, shall for a patient who is to receive skilled care
6650	must establish treatment orders for a patient who is to receive
6651	skilled care. The treatment orders must be signed by the
6652	physician, physician assistant, or advanced registered nurse
6653	practitioner before a claim is submitted to a managed care
6654	organization and the treatment orders must be signed in the time
6655	allowed under the provider agreement. The treatment orders shall
6656	within 30 days after the start of care and must be reviewed, as
6657	frequently as the patient's illness requires, by the physician,
6658	physician assistant, or advanced registered nurse practitioner,
6659	in consultation with the home health agency personnel that
6660	provide services to the patient.
6661	Section 122.  Section 400.494, Florida Statutes, is amended
6662	to read:
6663	400.494  Information about patients confidential.--
6664	(1)  Information about patients received by persons
6665	employed by, or providing services to, a home health agency or
6666	received by the licensing agency through reports or inspection
6667	shall be confidential and exempt from the provisions of s.
6668	119.07(1) and shall not be disclosed to any person other than
6669	the patient without the written consent of that patient or the
6670	patient's guardian.
6671	(2)  This section does not apply to information lawfully
6672	requested by the Medicaid Fraud Control Unit of the Office of
6673	the Attorney General or requested pursuant to 408.811 Department
6674	of Legal Affairs.
6675	Section 123.  Section 400.495, Florida Statutes, is amended
6676	to read:
6677	400.495  Notice of toll-free telephone number for central
6678	abuse hotline.--In addition to the requirements of 408.810(5),
6679	On or before the first day home health services are provided to
6680	a patient, any home health agency or nurse registry licensed
6681	under this part must inform the patient and his or her immediate
6682	family, if appropriate, of the right to report abusive,
6683	neglectful, or exploitative practices. The statewide toll-free
6684	telephone number for the central abuse hotline must be provided
6685	to patients in a manner that is clearly legible and must include
6686	the words: "To report abuse, neglect, or exploitation, please
6687	call toll-free   (phone number)  ." the Agency for Health Care
6688	Administration shall adopt rules that provide for 90 days'
6689	advance notice of a change in the toll-free telephone number and
6690	that outline due process procedures, as provided under chapter
6691	120, for home health agency personnel and nurse registry
6692	personnel who are reported to the central abuse hotline. Home
6693	health agencies and nurse registries shall establish appropriate
6694	policies and procedures for providing such notice to patients.
6695	Section 124.  Section 400.497, Florida Statutes, is amended
6696	to read:
6697	400.497  Rules establishing minimum standards.--The agency
6698	shall adopt, publish, and enforce rules to implement part II of
6699	chapter 408 and this part, including, as applicable, ss. 400.506
6700	and 400.509, which must provide reasonable and fair minimum
6701	standards relating to:
6702	(1)  The home health aide competency test and home health
6703	aide training. The agency shall create the home health aide
6704	competency test and establish the curriculum and instructor
6705	qualifications for home health aide training. Licensed home
6706	health agencies may provide this training and shall furnish
6707	documentation of such training to other licensed home health
6708	agencies upon request. Successful passage of the competency test
6709	by home health aides may be substituted for the training
6710	required under this section and any rule adopted pursuant
6711	thereto.
6712	(2)  Shared staffing. The agency shall allow shared
6713	staffing if the home health agency is part of a retirement
6714	community that provides multiple levels of care, is located on
6715	one campus, is licensed under this chapter, and otherwise meets
6716	the requirements of law and rule.
6717	(3)  The criteria for the frequency of onsite licensure
6718	surveys.
6719	(4)  Licensure application and renewal.
6720	(5)  The requirements for onsite and electronic
6721	accessibility of supervisory personnel of home health agencies.
6722	(6)  Information to be included in patients' records.
6723	(7)  Geographic service areas.
6724	(8)  Preparation of a comprehensive emergency management
6725	plan pursuant to s. 400.492.
6726	(a)  The Agency for Health Care Administration shall adopt
6727	rules establishing minimum criteria for the plan and plan
6728	updates, with the concurrence of the Department of Health and in
6729	consultation with the Department of Community Affairs.
6730	(b)  The rules must address the requirements in s. 400.492.
6731	In addition, the rules shall provide for the maintenance of
6732	patient-specific medication lists that can accompany patients
6733	who are transported from their homes.
6734	(c)  The plan is subject to review and approval by the
6735	county health department. During its review, the county health
6736	department shall ensure that the following agencies, at a
6737	minimum, are given the opportunity to review the plan:
6738	1.  The local emergency management agency.
6739	2.  The Agency for Health Care Administration.
6740	3.  The local chapter of the American Red Cross or other
6741	lead sheltering agency.
6742	4.  The district office of the Department of Children and
6743	Family Services.
6744
6745	The county health department shall complete its review within 60
6746	days after receipt of the plan and shall either approve the plan
6747	or advise the home health agency of necessary revisions.
6748	(d)  For any home health agency that operates in more than
6749	one county, the Department of Health shall review the plan,
6750	after consulting with all of the county health departments, the
6751	agency, and all the local chapters of the American Red Cross or
6752	other lead sheltering agencies in the areas of operation for
6753	that particular home health agency. The Department of Health
6754	shall complete its review within 90 days after receipt of the
6755	plan and shall either approve the plan or advise the home health
6756	agency of necessary revisions. The Department of Health shall
6757	make every effort to avoid imposing differing requirements based
6758	on differences between counties on the home health agency.
6759	(e)  The requirements in this subsection do not apply to:
6760	1.  A facility that is certified under chapter 651 and has
6761	a licensed home health agency used exclusively by residents of
6762	the facility; or
6763	2.  A retirement community that consists of residential
6764	units for independent living and either a licensed nursing home
6765	or an assisted living facility, and has a licensed home health
6766	agency used exclusively by the residents of the retirement
6767	community, provided the comprehensive emergency management plan
6768	for the facility or retirement community provides for continuous
6769	care of all residents with special needs during an emergency.
6770	Section 125.  Section 400.506, Florida Statutes, is amended
6771	to read:
6772	400.506  Licensure of nurse registries; requirements;
6773	penalties.--
6774	(1)  A nurse registry is exempt from the licensing
6775	requirements of a home health agency but must be licensed as a
6776	nurse registry. The requirements of part II of chapter 408 shall
6777	apply to the provision of services that require licensure
6778	pursuant to ss. 400.506-400.518 and part II of chapter 408 and
6779	to entities licensed by or applying for such license from the
6780	Agency for Health Care Administration pursuant to ss. 400.506-
6781	400.518. Each operational site of the nurse registry must be
6782	licensed, unless there is more than one site within a county. If
6783	there is more than one site within a county, only one license
6784	per county is required. Each operational site must be listed on
6785	the license.
6786	(2)  Each applicant for licensure and each licensee must
6787	comply with all provisions of part II and chapter 408, except
6788	ss. 408.806(1)(e)2., 408.810(6), and 408.810(10). the following
6789	requirements:
6790	(a)  Upon receipt of a completed, signed, and dated
6791	application, the agency shall require background screening, in
6792	accordance with the level 2 standards for screening set forth in
6793	chapter 435, of the managing employee, or other similarly titled
6794	individual who is responsible for the daily operation of the
6795	nurse registry, and of the financial officer, or other similarly
6796	titled individual who is responsible for the financial operation
6797	of the registry, including billings for patient care and
6798	services. The applicant shall comply with the procedures for
6799	level 2 background screening as set forth in chapter 435.
6800	(b)  The agency may require background screening of any
6801	other individual who is an applicant if the agency has probable
6802	cause to believe that he or she has been convicted of a crime or
6803	has committed any other offense prohibited under the level 2
6804	standards for screening set forth in chapter 435.
6805	(c)  Proof of compliance with the level 2 background
6806	screening requirements of chapter 435 which has been submitted
6807	within the previous 5 years in compliance with any other health
6808	care or assisted living licensure requirements of this state is
6809	acceptable in fulfillment of the requirements of paragraph (a).
6810	(d)  A provisional license may be granted to an applicant
6811	when each individual required by this section to undergo
6812	background screening has met the standards for the Department of
6813	Law Enforcement background check but the agency has not yet
6814	received background screening results from the Federal Bureau of
6815	Investigation. A standard license may be granted to the
6816	applicant upon the agency's receipt of a report of the results
6817	of the Federal Bureau of Investigation background screening for
6818	each individual required by this section to undergo background
6819	screening which confirms that all standards have been met, or
6820	upon the granting of a disqualification exemption by the agency
6821	as set forth in chapter 435. Any other person who is required to
6822	undergo level 2 background screening may serve in his or her
6823	capacity pending the agency's receipt of the report from the
6824	Federal Bureau of Investigation. However, the person may not
6825	continue to serve if the report indicates any violation of
6826	background screening standards and a disqualification exemption
6827	has not been requested of and granted by the agency as set forth
6828	in chapter 435.
6829	(e)  Each applicant must submit to the agency, with its
6830	application, a description and explanation of any exclusions,
6831	permanent suspensions, or terminations of the applicant from the
6832	Medicare or Medicaid programs. Proof of compliance with the
6833	requirements for disclosure of ownership and control interests
6834	under the Medicaid or Medicare programs may be accepted in lieu
6835	of this submission.
6836	(f)  Each applicant must submit to the agency a description
6837	and explanation of any conviction of an offense prohibited under
6838	the level 2 standards of chapter 435 by a member of the board of
6839	directors of the applicant, its officers, or any individual
6840	owning 5 percent or more of the applicant. This requirement does
6841	not apply to a director of a not-for-profit corporation or
6842	organization if the director serves solely in a voluntary
6843	capacity for the corporation or organization, does not regularly
6844	take part in the day-to-day operational decisions of the
6845	corporation or organization, receives no remuneration for his or
6846	her services on the corporation or organization's board of
6847	directors, and has no financial interest and has no family
6848	members with a financial interest in the corporation or
6849	organization, provided that the director and the not-for-profit
6850	corporation or organization include in the application a
6851	statement affirming that the director's relationship to the
6852	corporation satisfies the requirements of this paragraph.
6853	(g)  A license may not be granted to an applicant if the
6854	applicant or managing employee has been found guilty of,
6855	regardless of adjudication, or has entered a plea of nolo
6856	contendere or guilty to, any offense prohibited under the level
6857	2 standards for screening set forth in chapter 435, unless an
6858	exemption from disqualification has been granted by the agency
6859	as set forth in chapter 435.
6860	(h)  The agency may deny or revoke the license if any
6861	applicant:
6862	1.  Has falsely represented a material fact in the
6863	application required by paragraph (e) or paragraph (f), or has
6864	omitted any material fact from the application required by
6865	paragraph (e) or paragraph (f); or
6866	2.  Has had prior action taken against the applicant under
6867	the Medicaid or Medicare program as set forth in paragraph (e).
6868	(i)  An application for license renewal must contain the
6869	information required under paragraphs (e) and (f).
6870	(3)  In accordance with s. 408.805, an applicant or
6871	licensee shall pay a fee for each license application submitted
6872	under ss. 400.508-400.518, part II of chapter 408, and
6873	applicable rules. The amount of the fee shall be established by
6874	rule and may not exceed $2,000 per biennium. Application for
6875	license must be made to the Agency for Health Care
6876	Administration on forms furnished by it and must be accompanied
6877	by the appropriate licensure fee, as established by rule and not
6878	to exceed the cost of regulation under this part. The licensure
6879	fee for nurse registries may not exceed $1,000 and must be
6880	deposited in the Health Care Trust Fund.
6881	(4)  The Agency for Health Care Administration may deny,
6882	revoke, or suspend a license or impose an administrative fine in
6883	the manner provided in chapter 120 against a nurse registry
6884	that:
6885	(a)  Fails to comply with this section or applicable rules.
6886	(b)  Commits an intentional, reckless, or negligent act
6887	that materially affects the health or safety of a person
6888	receiving services.
6889	(5)  A license issued for the operation of a nurse
6890	registry, unless sooner suspended or revoked, expires 1 year
6891	after its date of issuance. Sixty days before the expiration
6892	date, an application for renewal must be submitted to the Agency
6893	for Health Care Administration on forms furnished by it. The
6894	Agency for Health Care Administration shall renew the license if
6895	the applicant has met the requirements of this section and
6896	applicable rules. A nurse registry against which a revocation or
6897	suspension proceeding is pending at the time of license renewal
6898	may be issued a conditional license effective until final
6899	disposition by the Agency for Health Care Administration of such
6900	proceedings. If judicial relief is sought from the final
6901	disposition, the court having jurisdiction may issue a
6902	conditional license for the duration of the judicial proceeding.
6903	(6)  The Agency for Health Care Administration may
6904	institute injunctive proceedings under s. 400.515.
6905	(4)(7)  A person that offers or advertises to the public
6906	that it provides any service for which licensure is required
6907	under this section must include in such advertisement the
6908	license number issued to it by the Agency for Health Care
6909	Administration.
6910	(8)  It is unlawful for a person to offer or advertise to
6911	the public services as defined by rule without obtaining a valid
6912	license from the Agency for Health Care Administration. It is
6913	unlawful for any holder of a license to advertise or hold out to
6914	the public that he or she holds a license for other than that
6915	for which he or she actually holds a license. A person who
6916	violates this subsection is subject to injunctive proceedings
6917	under s. 400.515.
6918	(9)  Any duly authorized officer or employee of the Agency
6919	for Health Care Administration may make such inspections and
6920	investigations as are necessary to respond to complaints or to
6921	determine the state of compliance with this section and
6922	applicable rules.
6923	(a)  If, in responding to a complaint, an agent or employee
6924	of the Agency for Health Care Administration has reason to
6925	believe that a crime has been committed, he or she shall notify
6926	the appropriate law enforcement agency.
6927	(b)  If, in responding to a complaint, an agent or employee
6928	of the Agency for Health Care Administration has reason to
6929	believe that abuse, neglect, or exploitation has occurred,
6930	according to the definitions in chapter 415, he or she shall
6931	file a report under chapter 415.
6932	(5)(10)(a)  A nurse registry may refer for contract in
6933	private residences registered nurses and licensed practical
6934	nurses registered and licensed under part I of chapter 464,
6935	certified nursing assistants certified under part II of chapter
6936	464, home health aides who present documented proof of
6937	successful completion of the training required by rule of the
6938	agency, and companions or homemakers for the purposes of
6939	providing those services authorized under s. 400.509(1). Each
6940	person referred by a nurse registry must provide current
6941	documentation that he or she is free from communicable diseases.
6942	(b)  A certified nursing assistant or home health aide may
6943	be referred for a contract to provide care to a patient in his
6944	or her home only if that patient is under a physician's care. A
6945	certified nursing assistant or home health aide referred for
6946	contract in a private residence shall be limited to assisting a
6947	patient with bathing, dressing, toileting, grooming, eating,
6948	physical transfer, and those normal daily routines the patient
6949	could perform for himself or herself were he or she physically
6950	capable. A certified nursing assistant or home health aide may
6951	not provide medical or other health care services that require
6952	specialized training and that may be performed only by licensed
6953	health care professionals. The nurse registry shall obtain the
6954	name and address of the attending physician and send written
6955	notification to the physician within 48 hours after a contract
6956	is concluded that a certified nursing assistant or home health
6957	aide will be providing care for that patient.
6958	(c)  A nurse registry shall, at the time of contracting for
6959	services through the nurse registry, advise the patient, the
6960	patient's family, or a person acting on behalf of the patient of
6961	the availability of registered nurses to make visits to the
6962	patient's home at an additional cost. A registered nurse shall
6963	make monthly visits to the patient's home to assess the
6964	patient's condition and quality of care being provided by the
6965	certified nursing assistant or home health aide. Any condition
6966	that which in the professional judgment of the nurse requires
6967	further medical attention shall be reported to the attending
6968	physician and the nurse registry. The assessment shall become a
6969	part of the patient's file with the nurse registry and may be
6970	reviewed by the agency during their survey procedure.
6971	(6)(11)  A person who is referred by a nurse registry for
6972	contract in private residences and who is not a nurse licensed
6973	under part I of chapter 464 may perform only those services or
6974	care to clients that the person has been certified to perform or
6975	trained to perform as required by law or rules of the Agency for
6976	Health Care Administration or the Department of Business and
6977	Professional Regulation. Providing services beyond the scope
6978	authorized under this subsection constitutes the unauthorized
6979	practice of medicine or a violation of the Nurse Practice Act
6980	and is punishable as provided under chapter 458, chapter 459, or
6981	part I of chapter 464.
6982	(7)(12)  Each nurse registry must require every applicant
6983	for contract to complete an application form providing the
6984	following information:
6985	(a)  The name, address, date of birth, and social security
6986	number of the applicant.
6987	(b)  The educational background and employment history of
6988	the applicant.
6989	(c)  The number and date of the applicable license or
6990	certification.
6991	(d)  When appropriate, information concerning the renewal
6992	of the applicable license, registration, or certification.
6993	(8)(13)  Each nurse registry must comply with the
6994	procedures set forth in s. 400.512 for maintaining records of
6995	the employment history of all persons referred for contract and
6996	is subject to the standards and conditions set forth in that
6997	section. However, an initial screening may not be required for
6998	persons who have been continuously registered with the nurse
6999	registry since September 30, 1990.
7000	(9)(14)  The nurse registry must maintain the application
7001	on file, and that file must be open to the inspection of the
7002	Agency for Health Care Administration. The nurse registry must
7003	maintain on file the name and address of the client to whom the
7004	nurse or other nurse registry personnel is sent for contract and
7005	the amount of the fee received by the nurse registry. A nurse
7006	registry must maintain the file that includes the application
7007	and other applicable documentation for 3 years after the date of
7008	the last file entry of client-related information.
7009	(10)(15)  Nurse registries shall assist persons who would
7010	need assistance and sheltering during evacuations because of
7011	physical, mental, or sensory disabilities in registering with
7012	the appropriate local emergency management agency pursuant to s.
7013	252.355.
7014	(11)(16)  Each nurse registry shall prepare and maintain a
7015	comprehensive emergency management plan that is consistent with
7016	the criteria in this subsection and with the local special needs
7017	plan. The plan shall be updated annually. The plan shall specify
7018	how the nurse registry shall facilitate the provision of
7019	continuous care by persons referred for contract to persons who
7020	are registered pursuant to s. 252.355 during an emergency that
7021	interrupts the provision of care or services in private
7022	residencies.
7023	(a)  All persons referred for contract who care for persons
7024	registered pursuant to s. 252.355 must include in the patient
7025	record a description of how care will be continued during a
7026	disaster or emergency that interrupts the provision of care in
7027	the patient's home. It shall be the responsibility of the person
7028	referred for contract to ensure that continuous care is
7029	provided.
7030	(b)  Each nurse registry shall maintain a current
7031	prioritized list of patients in private residences who are
7032	registered pursuant to s. 252.355 and are under the care of
7033	persons referred for contract and who need continued services
7034	during an emergency. This list shall indicate, for each patient,
7035	if the client is to be transported to a special needs shelter
7036	and if the patient is receiving skilled nursing services. Nurse
7037	registries shall make this list available to county health
7038	departments and to local emergency management agencies upon
7039	request.
7040	(c)  Each person referred for contract who is caring for a
7041	patient who is registered pursuant to s. 252.355 shall provide a
7042	list of the patient's medication and equipment needs to the
7043	nurse registry. Each person referred for contract shall make
7044	this information available to county health departments and to
7045	local emergency management agencies upon request.
7046	(d)  Each person referred for contract shall not be
7047	required to continue to provide care to patients in emergency
7048	situations that are beyond the person's control and that make it
7049	impossible to provide services, such as when roads are
7050	impassable or when patients do not go to the location specified
7051	in their patient records.
7052	(e)  The comprehensive emergency management plan required
7053	by this subsection is subject to review and approval by the
7054	county health department. During its review, the county health
7055	department shall ensure that, at a minimum, the local emergency
7056	management agency, the Agency for Health Care Administration,
7057	and the local chapter of the American Red Cross or other lead
7058	sheltering agency are given the opportunity to review the plan.
7059	The county health department shall complete its review within 60
7060	days after receipt of the plan and shall either approve the plan
7061	or advise the nurse registry of necessary revisions.
7062	(f)  The Agency for Health Care Administration shall adopt
7063	rules establishing minimum criteria for the comprehensive
7064	emergency management plan and plan updates required by this
7065	subsection, with the concurrence of the Department of Health and
7066	in consultation with the Department of Community Affairs.
7067	(12)(17)  All persons referred for contract in private
7068	residences by a nurse registry must comply with the following
7069	requirements for a plan of treatment:
7070	(a)  When, in accordance with the privileges and
7071	restrictions imposed upon a nurse under part I of chapter 464,
7072	the delivery of care to a patient is under the direction or
7073	supervision of a physician or when a physician is responsible
7074	for the medical care of the patient, a medical plan of treatment
7075	must be established for each patient receiving care or treatment
7076	provided by a licensed nurse in the home. The original medical
7077	plan of treatment must be timely signed by the physician,
7078	physician assistant, or advanced registered nurse practitioner,
7079	acting within his or her respective scope of practice, and
7080	reviewed by him or her in consultation with the licensed nurse
7081	at least every 2 months. Any additional order or change in
7082	orders must be obtained from the physician, physician assistant,
7083	or advanced registered nurse practitioner and reduced to writing
7084	and timely signed by the physician, physician assistant, or
7085	advanced registered nurse practitioner. The delivery of care
7086	under a medical plan of treatment must be substantiated by the
7087	appropriate nursing notes or documentation made by the nurse in
7088	compliance with nursing practices established under part I of
7089	chapter 464.
7090	(b)  Whenever a medical plan of treatment is established
7091	for a patient, the initial medical plan of treatment, any
7092	amendment to the plan, additional order or change in orders, and
7093	copy of nursing notes must be filed in the office of the nurse
7094	registry.
7095	(13)(18)  The nurse registry must comply with the notice
7096	requirements of s. 400.495, relating to abuse reporting.
7097	(14)(19)  In addition to any other penalties imposed
7098	pursuant to this section or part, the agency may assess costs
7099	related to an investigation that results in a successful
7100	prosecution., excluding costs associated with an attorney's
7101	time. If the agency imposes such an assessment and the
7102	assessment is not paid, and if challenged is not the subject of
7103	a pending appeal, prior to the renewal of the license, the
7104	license shall not be issued until the assessment is paid or
7105	arrangements for payment of the assessment are made.
7106	(15)(20)  The Agency for Health Care Administration shall
7107	adopt rules to implement this section and part II of chapter
7108	408.
7109	Section 126.  Section 400.509, Florida Statutes, is amended
7110	to read:
7111	400.509  Registration of particular service providers
7112	exempt from licensure; certificate of registration; regulation
7113	of registrants.--
7114	(1)  Any organization that provides companion services or
7115	homemaker services and does not provide a home health service to
7116	a person is exempt from licensure under this part. However, any
7117	organization that provides companion services or homemaker
7118	services must register with the agency.
7119	(2)  The requirements of part II of chapter 408 shall apply
7120	to the provision of services that require registration or
7121	licensure pursuant to this section and part II of chapter 408
7122	and entities registered by or applying for such registration
7123	from the Agency for Health Care Administration pursuant to this
7124	section. Each applicant for registration and each registrant
7125	must comply with all provisions of part II of chapter 408 except
7126	ss. 408.806(1)(e) and 408.810(6)-(10). Registration consists of
7127	annually filing with the agency, under oath, on forms provided
7128	by it, the following information:
7129	(a)  If the registrant is a firm or partnership, the name,
7130	address, date of birth, and social security number of every
7131	member.
7132	(b)  If the registrant is a corporation or association, its
7133	name and address; the name, address, date of birth, and social
7134	security number of each of its directors and officers; and the
7135	name and address of each person having at least a 5 percent
7136	interest in the corporation or association.
7137	(c)  The name, address, date of birth, and social security
7138	number of each person employed by or under contract with the
7139	organization.
7140	(3)  In accordance with s. 408.805, applicants and
7141	registrants shall pay fees for all registrations issued under
7142	this part, part II of chapter 408, and applicable rules. The
7143	amount of the fee shall be $50 per biennium. The agency shall
7144	charge a registration fee of $25 to be submitted with the
7145	information required under subsection (2).
7146	(4)  Each applicant for registration must comply with the
7147	following requirements:
7148	(a)  Upon receipt of a completed, signed, and dated
7149	application, the agency shall require background screening, in
7150	accordance with the level 1 standards for screening set forth in
7151	chapter 435, of every individual who will have contact with the
7152	client. The agency shall require background screening of the
7153	managing employee or other similarly titled individual who is
7154	responsible for the operation of the entity, and of the
7155	financial officer or other similarly titled individual who is
7156	responsible for the financial operation of the entity, including
7157	billings for client services in accordance with the level 2
7158	standards for background screening as set forth in chapter 435.
7159	(b)  The agency may require background screening of any
7160	other individual who is affiliated with the applicant if the
7161	agency has a reasonable basis for believing that he or she has
7162	been convicted of a crime or has committed any other offense
7163	prohibited under the level 2 standards for screening set forth
7164	in chapter 435.
7165	(c)  Proof of compliance with the level 2 background
7166	screening requirements of chapter 435 which has been submitted
7167	within the previous 5 years in compliance with any other health
7168	care or assisted living licensure requirements of this state is
7169	acceptable in fulfillment of paragraph (a).
7170	(d)  A provisional registration may be granted to an
7171	applicant when each individual required by this section to
7172	undergo background screening has met the standards for the
7173	abuse-registry background check through the agency and the
7174	Department of Law Enforcement background check, but the agency
7175	has not yet received background screening results from the
7176	Federal Bureau of Investigation. A standard registration may be
7177	granted to the applicant upon the agency's receipt of a report
7178	of the results of the Federal Bureau of Investigation background
7179	screening for each individual required by this section to
7180	undergo background screening which confirms that all standards
7181	have been met, or upon the granting of a disqualification
7182	exemption by the agency as set forth in chapter 435. Any other
7183	person who is required to undergo level 2 background screening
7184	may serve in his or her capacity pending the agency's receipt of
7185	the report from the Federal Bureau of Investigation. However,
7186	the person may not continue to serve if the report indicates any
7187	violation of background screening standards and if a
7188	disqualification exemption has not been requested of and granted
7189	by the agency as set forth in chapter 435.
7190	(e)  Each applicant must submit to the agency, with its
7191	application, a description and explanation of any exclusions,
7192	permanent suspensions, or terminations of the applicant from the
7193	Medicare or Medicaid programs. Proof of compliance with the
7194	requirements for disclosure of ownership and control interests
7195	under the Medicaid or Medicare programs may be accepted in lieu
7196	of this submission.
7197	(f)  Each applicant must submit to the agency a description
7198	and explanation of any conviction of an offense prohibited under
7199	the level 2 standards of chapter 435 which was committed by a
7200	member of the board of directors of the applicant, its officers,
7201	or any individual owning 5 percent or more of the applicant.
7202	This requirement does not apply to a director of a not-for-
7203	profit corporation or organization who serves solely in a
7204	voluntary capacity for the corporation or organization, does not
7205	regularly take part in the day-to-day operational decisions of
7206	the corporation or organization, receives no remuneration for
7207	his or her services on the corporation's or organization's board
7208	of directors, and has no financial interest and no family
7209	members having a financial interest in the corporation or
7210	organization, if the director and the not-for-profit corporation
7211	or organization include in the application a statement affirming
7212	that the director's relationship to the corporation satisfies
7213	the requirements of this paragraph.
7214	(g)  A registration may not be granted to an applicant if
7215	the applicant or managing employee has been found guilty of,
7216	regardless of adjudication, or has entered a plea of nolo
7217	contendere or guilty to, any offense prohibited under the level
7218	2 standards for screening set forth in chapter 435, unless an
7219	exemption from disqualification has been granted by the agency
7220	as set forth in chapter 435.
7221	(h)  The agency may deny or revoke the registration of any
7222	applicant who:
7223	1.  Has falsely represented a material fact in the
7224	application required by paragraph (e) or paragraph (f), or has
7225	omitted any material fact from the application required by
7226	paragraph (e) or paragraph (f); or
7227	2.  Has had prior action taken against the applicant under
7228	the Medicaid or Medicare program as set forth in paragraph (e).
7229	(i)  An application for licensure renewal must contain the
7230	information required under paragraphs (e) and (f).
7231	(4)(5)  Each registrant must obtain the employment or
7232	contract history of persons who are employed by or under
7233	contract with the organization and who will have contact at any
7234	time with patients or clients in their homes by:
7235	(a)  Requiring such persons to submit an employment or
7236	contractual history to the registrant; and
7237	(b)  Verifying the employment or contractual history,
7238	unless through diligent efforts such verification is not
7239	possible. The agency shall prescribe by rule the minimum
7240	requirements for establishing that diligent efforts have been
7241	made.
7242
7243	There is no monetary liability on the part of, and no cause of
7244	action for damages arises against, a former employer of a
7245	prospective employee of or prospective independent contractor
7246	with a registrant who reasonably and in good faith communicates
7247	his or her honest opinions about the former employee's or
7248	contractor's job performance. This subsection does not affect
7249	the official immunity of an officer or employee of a public
7250	corporation.
7251	(6)  On or before the first day on which services are
7252	provided to a patient or client, any registrant under this part
7253	must inform the patient or client and his or her immediate
7254	family, if appropriate, of the right to report abusive,
7255	neglectful, or exploitative practices. The statewide toll-free
7256	telephone number for the central abuse hotline must be provided
7257	to patients or clients in a manner that is clearly legible and
7258	must include the words: "To report abuse, neglect, or
7259	exploitation, please call toll-free   (phone number)  ."
7260	Registrants must establish appropriate policies and procedures
7261	for providing such notice to patients or clients.
7262	(7)  The provisions of s. 400.512 regarding screening apply
7263	to any person or business entity registered under this section
7264	on or after October 1, 1994.
7265	(8)  Upon verification that all requirements for
7266	registration have been met, the Agency for Health Care
7267	Administration shall issue a certificate of registration valid
7268	for no more than 1 year.
7269	(9)  The Agency for Health Care Administration may deny,
7270	suspend, or revoke the registration of a person that:
7271	(a)  Fails to comply with this section or applicable rules.
7272	(b)  Commits an intentional, reckless, or negligent act
7273	that materially affects the health or safety of a person
7274	receiving services.
7275	(10)  The Agency for Health Care Administration may
7276	institute injunctive proceedings under s. 400.515.
7277	(5)(11)  A person that offers or advertises to the public a
7278	service for which registration is required must include in its
7279	advertisement the registration number issued by the Agency for
7280	Health Care Administration.
7281	(12)  It is unlawful for a person to offer or advertise to
7282	the public services, as defined by rule, without obtaining a
7283	certificate of registration from the Agency for Health Care
7284	Administration. It is unlawful for any holder of a certificate
7285	of registration to advertise or hold out to the public that he
7286	or she holds a certificate of registration for other than that
7287	for which he or she actually holds a certificate of
7288	registration. Any person who violates this subsection is subject
7289	to injunctive proceedings under s. 400.515.
7290	(13)  Any duly authorized officer or employee of the Agency
7291	for Health Care Administration has the right to make such
7292	inspections and investigations as are necessary in order to
7293	respond to complaints or to determine the state of compliance
7294	with this section and applicable rules.
7295	(a)  If, in responding to a complaint, an officer or
7296	employee of the Agency for Health Care Administration has reason
7297	to believe that a crime has been committed, he or she shall
7298	notify the appropriate law enforcement agency.
7299	(b)  If, in responding to a complaint, an officer or
7300	employee of the Agency for Health Care Administration has reason
7301	to believe that abuse, neglect, or exploitation has occurred,
7302	according to the definitions in chapter 415, he or she shall
7303	file a report under chapter 415.
7304	(6)(14)  In addition to any other penalties imposed
7305	pursuant to this section or part, the agency may assess costs
7306	related to an investigation that results in a successful
7307	prosecution, excluding costs associated with an attorney's time.
7308	If the agency imposes such an assessment and the assessment is
7309	not paid, and if challenged is not the subject of a pending
7310	appeal, prior to the renewal of the registration, the
7311	registration shall not be issued until the assessment is paid or
7312	arrangements for payment of the assessment are made.
7313	(7)(15)  The Agency for Health Care Administration shall
7314	adopt rules to administer this section and part II of chapter
7315	408.
7316	Section 127.  Subsections (3) through (7) of section
7317	400.512, Florida Statutes, are renumbered as subsections (2)
7318	through (6) and present subsections (2) and (7) are amended to
7319	read:
7320	400.512  Screening of home health agency personnel; nurse
7321	registry personnel; and companions and homemakers.--The agency
7322	shall require employment or contractor screening as provided in
7323	chapter 435, using the level 1 standards for screening set forth
7324	in that chapter, for home health agency personnel; persons
7325	referred for employment by nurse registries; and persons
7326	employed by companion or homemaker services registered under s.
7327	400.509.
7328	(2)  The administrator of each home health agency, the
7329	managing employee of each nurse registry, and the managing
7330	employee of each companion or homemaker service registered under
7331	s. 400.509 must sign an affidavit annually, under penalty of
7332	perjury, stating that all personnel hired, contracted with, or
7333	registered on or after October 1, 1994, who enter the home of a
7334	patient or client in their service capacity have been screened
7335	and that its remaining personnel have worked for the home health
7336	agency or registrant continuously since before October 1, 1994.
7337	(6)(7)(a)  It is a misdemeanor of the first degree,
7338	punishable under s. 775.082 or s. 775.083, for any person
7339	willfully, knowingly, or intentionally to:
7340	1.  Fail, by false statement, misrepresentation,
7341	impersonation, or other fraudulent means, to disclose in any
7342	application for voluntary or paid employment a material fact
7343	used in making a determination as to such person's
7344	qualifications to be an employee under this section; or
7345	2.  Operate or attempt to operate an entity licensed or
7346	registered under this part with persons who do not meet the
7347	minimum standards for good moral character as contained in this
7348	section; or
7349	2.3.  Use information from the criminal records obtained
7350	under this section for any purpose other than screening that
7351	person for employment as specified in this section or release
7352	such information to any other person for any purpose other than
7353	screening for employment under this section.
7354	(b)  It is a felony of the third degree, punishable under
7355	s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
7356	knowingly, or intentionally to use information from the juvenile
7357	records of a person obtained under this section for any purpose
7358	other than screening for employment under this section.
7359	Section 128.  Section 400.515, Florida Statutes, is
7360	repealed.
7361	Section 129.  Subsections (6) and (7) of section 400.551,
7362	Florida Statutes, are amended to read:
7363	400.551  Definitions.--As used in this part, the term:
7364	(6)  "Operator" means the licensee or person having general
7365	administrative charge of an adult day care center.
7366	(7)  "Owner" means the licensee owner of an adult day care
7367	center.
7368	Section 130.  Section 400.554, Florida Statutes, is amended
7369	to read:
7370	400.554  License requirement; fee; exemption; display.--
7371	(1)  The requirements of part II of chapter 408 shall apply
7372	to the provision of services that require licensure pursuant
7373	this part and part II of chapter 408 and to entities licensed by
7374	or applying for such licensure from the Agency for Health Care
7375	Administration pursuant this part. However, each applicant for
7376	licensure and each licensee is exempt from the provisions of s.
7377	408.810(10). It is unlawful to operate an adult day care center
7378	without first obtaining from the agency a license authorizing
7379	such operation. The agency is responsible for licensing adult
7380	day care centers in accordance with this part.
7381	(2)  Separate licenses are required for centers operated on
7382	separate premises, even though operated under the same
7383	management. Separate licenses are not required for separate
7384	buildings on the same premises.
7385	(3)  In accordance with s. 408.805, an applicant or
7386	licensee shall pay a fee for each license application submitted
7387	under this part and part II of chapter 408. The amount of the
7388	fee shall be established by rule and The biennial license fee
7389	required of a center shall be determined by the department, but
7390	may not exceed $150.
7391	(4)  County-operated or municipally operated centers
7392	applying for licensure under this part are exempt from the
7393	payment of license fees.
7394	(5)  The license for a center shall be displayed in a
7395	conspicuous place inside the center.
7396	(6)  A license is valid only in the possession of the
7397	individual, firm, partnership, association, or corporation to
7398	which it is issued and is not subject to sale, assignment, or
7399	other transfer, voluntary or involuntary; nor is a license valid
7400	for any premises other than the premises for which originally
7401	issued.
7402	Section 131.  Section 400.555, Florida Statutes, is amended
7403	to read:
7404	400.555  Application for license.--
7405	(1)  An application for a license to operate an adult day
7406	care center must be made to the agency on forms furnished by the
7407	agency and must be accompanied by the appropriate license fee
7408	unless the applicant is exempt from payment of the fee as
7409	provided in s. 400.554(4).
7410	(2)  In addition to all provisions of part II of chapter
7411	408, the applicant for licensure must furnish:
7412	(a)  a description of the physical and mental capabilities
7413	and needs of the participants to be served and the availability,
7414	frequency, and intensity of basic services and of supportive and
7415	optional services to be provided and proof of adequate liability
7416	insurance coverage.;
7417	(b)  Satisfactory proof of financial ability to operate and
7418	conduct the center in accordance with the requirements of this
7419	part, which must include, in the case of an initial application,
7420	a 1-year operating plan and proof of a 3-month operating reserve
7421	fund; and
7422	(c)  Proof of adequate liability insurance coverage.
7423	(d)  Proof of compliance with level 2 background screening
7424	as required under s. 400.5572.
7425	(e)  A description and explanation of any exclusions,
7426	permanent suspensions, or terminations of the application from
7427	the Medicare or Medicaid programs. Proof of compliance with
7428	disclosure of ownership and control interest requirements of the
7429	Medicare or Medicaid programs shall be accepted in lieu of this
7430	submission.
7431	Section 132.  Section 400.556, Florida Statutes, is amended
7432	to read:
7433	400.556  Denial, suspension, revocation of license;
7434	emergency action; administrative fines; investigations and
7435	inspections.--
7436	(1)  The agency may deny, revoke, or suspend a license
7437	under this part, impose an action under s. 408.814, and or may
7438	impose an administrative fine against the owner of an adult day
7439	care center or its operator or employee in the manner provided
7440	in chapter 120 for the violation of any provision of this part,
7441	part II of chapter 408, or applicable rules.
7442	(2)  Each of the following actions by the owner of an adult
7443	day care center or by its operator or employee is a ground for
7444	action by the agency against the owner of the center or its
7445	operator or employee:
7446	(a)  An intentional or negligent act materially affecting
7447	the health or safety of center participants.
7448	(b)  A violation of this part or of any standard or rule
7449	under this part.
7450	(b)(c)  A failure of persons subject to level 2 background
7451	screening under s. 408.809 400.4174(1) to meet the screening
7452	standards of s. 435.04, or the retention by the center of an
7453	employee subject to level 1 background screening standards under
7454	s. 400.4174(2) who does not meet the screening standards of s.
7455	435.03 and for whom exemptions from disqualification have not
7456	been provided by the agency.
7457	(c)(d)  Failure to follow the criteria and procedures
7458	provided under part I of chapter 394 relating to the
7459	transportation, voluntary admission, and involuntary examination
7460	of center participants.
7461	(d)(e)  Multiple or repeated violations of this part or of
7462	any standard or rule adopted under this part or part II of
7463	chapter 408.
7464	(f)  Exclusion, permanent suspension, or termination of the
7465	owner, if an individual, officer, or board member of the adult
7466	day care center, if the owner is a firm, corporation,
7467	partnership, or association, or any person owning 5 percent or
7468	more of the center, from the Medicare or Medicaid program.
7469	(3)  The agency is responsible for all investigations and
7470	inspections conducted pursuant to this part.
7471	Section 133.  Section 400.5565, Florida Statutes, is
7472	amended to read:
7473	400.5565  Administrative fines; interest.--
7474	(1)(a)  If the agency determines that an adult day care
7475	center is not operated in compliance with this part, part II of
7476	chapter 408, or applicable with rules adopted under this part,
7477	the agency, notwithstanding any other administrative action it
7478	takes, shall make a reasonable attempt to discuss with the owner
7479	each violation and recommended corrective action prior to
7480	providing the owner with written notification. The agency may
7481	request the submission of a corrective action plan for the
7482	center which demonstrates a good faith effort to remedy each
7483	violation by a specific date, subject to the approval of the
7484	agency.
7485	(b)  The owner of a center or its operator or employee
7486	found in violation of this part, part II of chapter 408, or
7487	applicable rules or of rules adopted under this part may be
7488	fined by the agency. A fine may not exceed $500 for each
7489	violation. In no event, however, may such fines in the aggregate
7490	exceed $5,000.
7491	(c)  The failure to correct a violation by the date set by
7492	the agency, or the failure to comply with an approved corrective
7493	action plan, is a separate violation for each day such failure
7494	continues, unless the agency approves an extension to a specific
7495	date.
7496	(d)  If the owner of a center or its operator or employee
7497	appeals an agency action under this section and the fine is
7498	upheld, the violator shall pay the fine, plus interest at the
7499	legal rate specified in s. 687.01 for each day that the fine
7500	remains unpaid after the date set by the agency for payment of
7501	the fine.
7502	(2)  In determining whether to impose a fine and in fixing
7503	the amount of any fine, the agency shall consider the following
7504	factors:
7505	(a)  The gravity of the violation, including the
7506	probability that death or serious physical or emotional harm to
7507	a participant will result or has resulted, the severity of the
7508	actual or potential harm, and the extent to which the provisions
7509	of the applicable statutes or rules were violated.
7510	(b)  Actions taken by the owner or operator to correct
7511	violations.
7512	(c)  Any previous violations.
7513	(d)  The financial benefit to the center of committing or
7514	continuing the violation.
7515	Section 134.  Section 400.557, Florida Statutes, is amended
7516	to read:
7517	400.557  Expiration of license; renewal; Conditional
7518	license or permit.--
7519	(1)  A license issued for the operation of an adult day
7520	care center, unless sooner suspended or revoked, expires 2 years
7521	after the date of issuance. The agency shall notify a licensee
7522	at least 120 days before the expiration date that license
7523	renewal is required to continue operation. The notification must
7524	be provided electronically or by mail delivery. At least 90 days
7525	prior to the expiration date, an application for renewal must be
7526	submitted to the agency. A license shall be renewed, upon the
7527	filing of an application on forms furnished by the agency, if
7528	the applicant has first met the requirements of this part and of
7529	the rules adopted under this part. The applicant must file with
7530	the application satisfactory proof of financial ability to
7531	operate the center in accordance with the requirements of this
7532	part and in accordance with the needs of the participants to be
7533	served and an affidavit of compliance with the background
7534	screening requirements of s. 400.5572.
7535	(2)  A licensee against whom a revocation or suspension
7536	proceeding is pending at the time for license renewal may be
7537	issued a conditional license effective until final disposition
7538	by the agency of the proceeding. If judicial relief is sought
7539	from the final disposition, the court having jurisdiction may
7540	issue a conditional permit effective for the duration of the
7541	judicial proceeding.
7542	(3)  The agency may issue a conditional license to an
7543	applicant for license renewal or change of ownership if the
7544	applicant fails to meet all standards and requirements for
7545	licensure. A conditional license issued under this subsection
7546	must be limited to a specific period not exceeding 6 months, as
7547	determined by the agency, and must be accompanied by an approved
7548	plan of correction.
7549	Section 135.  Section 400.5572, Florida Statutes, is
7550	amended to read:
7551	400.5572  Background screening.--
7552	(1)(a)  Level 2 background screening must be conducted on
7553	each of the following persons, who shall be considered employees
7554	for the purposes of conducting screening under chapter 435:
7555	1.  The adult day care center owner if an individual, the
7556	operator, and the financial officer.
7557	2.  An officer or board member if the owner of the adult
7558	day care center is a firm, corporation, partnership, or
7559	association, or any person owning 5 percent or more of the
7560	facility, if the agency has probable cause to believe that such
7561	person has been convicted of any offense prohibited by s.
7562	435.04. For each officer, board member, or person owning 5
7563	percent or more who has been convicted of any such offense, the
7564	facility shall submit to the agency a description and
7565	explanation of the conviction at the time of license
7566	application. This subparagraph does not apply to a board member
7567	of a not-for-profit corporation or organization if the board
7568	member serves solely in a voluntary capacity, does not regularly
7569	take part in the day-to-day operational decisions of the
7570	corporation or organization, receives no remuneration for his or
7571	her services, and has no financial interest and has no family
7572	members with a financial interest in the corporation or
7573	organization, provided that the board member and facility submit
7574	a statement affirming that the board member's relationship to
7575	the facility satisfies the requirements of this subparagraph.
7576	(b)  Proof of compliance with level 2 screening standards
7577	which has been submitted within the previous 5 years to meet any
7578	facility or professional licensure requirements of the agency or
7579	the Department of Health satisfies the requirements of this
7580	subsection.
7581	(c)  The agency may grant a provisional license to an adult
7582	day care center applying for an initial license when each
7583	individual required by this subsection to undergo screening has
7584	completed the Department of Law Enforcement background check,
7585	but has not yet received results from the Federal Bureau of
7586	Investigation, or when a request for an exemption from
7587	disqualification has been submitted to the agency pursuant to s.
7588	435.07, but a response has not been issued.
7589	(2)  The owner or administrator of an adult day care center
7590	must conduct level 1 background screening as set forth in
7591	chapter 435 on all employees hired on or after October 1, 1998,
7592	who provide basic services or supportive and optional services
7593	to the participants. Such persons satisfy this requirement if:
7594	(1)(a)  Proof of compliance with level 1 screening
7595	requirements obtained to meet any professional license
7596	requirements in this state is provided and accompanied, under
7597	penalty of perjury, by a copy of the person's current
7598	professional license and an affidavit of current compliance with
7599	the background screening requirements.
7600	(2)(b)  The person required to be screened has been
7601	continuously employed, without a breach in service that exceeds
7602	180 days, in the same type of occupation for which the person is
7603	seeking employment and provides proof of compliance with the
7604	level 1 screening requirement which is no more than 2 years old.
7605	Proof of compliance must be provided directly from one employer
7606	or contractor to another, and not from the person screened. Upon
7607	request, a copy of screening results shall be provided to the
7608	person screened by the employer retaining documentation of the
7609	screening.
7610	(3)(c)  The person required to be screened is employed by a
7611	corporation or business entity or related corporation or
7612	business entity that owns, operates, or manages more than one
7613	facility or agency licensed under this chapter, and for whom a
7614	level 1 screening was conducted by the corporation or business
7615	entity as a condition of initial or continued employment.
7616	Section 136.  Section 400.5575, Florida Statutes, is
7617	repealed.
7618	Section 137.  Section 400.558, Florida Statutes, is
7619	repealed.
7620	Section 138.  Section 400.559, Florida Statutes, is amended
7621	to read:
7622	400.559  Discontinuance of operation of adult day care
7623	centers Closing or change of owner or operator of center.--
7624	(1)  Before operation of an adult day care center may be
7625	voluntarily discontinued, the operator must inform the agency in
7626	writing at least 60 days prior to the discontinuance of
7627	operation. The operator must also, at such time, inform each
7628	participant of the fact and the proposed date of such
7629	discontinuance of operation.
7630	(2)  Immediately upon discontinuance of the operation of a
7631	center, the owner or operator shall surrender the license for
7632	the center to the agency, and the license shall be canceled by
7633	the agency.
7634	(3)  If a center has a change of ownership, the new owner
7635	shall apply to the agency for a new license at least 60 days
7636	before the date of the change of ownership.
7637	(4)  If a center has a change of operator, the new operator
7638	shall notify the agency in writing within 30 days after the
7639	change of operator.
7640	Section 139.  Section 400.56, Florida Statutes, is amended
7641	to read:
7642	400.56  Right of entry and inspection.--In accordance with
7643	s. 408.811, Any duly designated officer or employee of the
7644	agency or department has the right to enter the premises of any
7645	adult day care center licensed pursuant to this part, at any
7646	reasonable time, in order to determine the state of compliance
7647	with this part, part II of chapter 408, and applicable the rules
7648	or standards in force pursuant to this part. The right of entry
7649	and inspection also extends to any premises that the agency has
7650	reason to believe are being operated as a center without a
7651	license, but no entry or inspection of any unlicensed premises
7652	may be made without the permission of the owner or operator
7653	unless a warrant is first obtained from the circuit court
7654	authorizing entry or inspection. Any application for a center
7655	license or license renewal made pursuant to this part
7656	constitutes permission for, and complete acquiescence in, any
7657	entry or inspection of the premises for which the license is
7658	sought in order to facilitate verification of the information
7659	submitted on or in connection with the application.
7660	Section 140.  Section 400.562, Florida Statutes, is amended
7661	to read:
7662	400.562  Rules establishing standards.--
7663	(1)  The agency Department of Elderly Affairs, in
7664	conjunction with the Department of Elderly Affairs agency, shall
7665	adopt rules to implement the provisions of this part and part II
7666	of chapter 408. The rules must include reasonable and fair
7667	standards. Any conflict between these standards and those that
7668	may be set forth in local, county, or municipal ordinances shall
7669	be resolved in favor of those having statewide effect. Such
7670	standards must relate to:
7671	(a)  The maintenance of adult day care centers with respect
7672	to plumbing, heating, lighting, ventilation, and other building
7673	conditions, including adequate meeting space, to ensure the
7674	health, safety, and comfort of participants and protection from
7675	fire hazard. Such standards may not conflict with chapter 553
7676	and must be based upon the size of the structure and the number
7677	of participants.
7678	(b)  The number and qualifications of all personnel
7679	employed by adult day care centers who have responsibilities for
7680	the care of participants.
7681	(c)  All sanitary conditions within adult day care centers
7682	and their surroundings, including water supply, sewage disposal,
7683	food handling, and general hygiene, and maintenance of sanitary
7684	conditions, to ensure the health and comfort of participants.
7685	(d)  Basic services provided by adult day care centers.
7686	(e)  Supportive and optional services provided by adult day
7687	care centers.
7688	(f)  Data and information relative to participants and
7689	programs of adult day care centers, including, but not limited
7690	to, the physical and mental capabilities and needs of the
7691	participants, the availability, frequency, and intensity of
7692	basic services and of supportive and optional services provided,
7693	the frequency of participation, the distances traveled by
7694	participants, the hours of operation, the number of referrals to
7695	other centers or elsewhere, and the incidence of illness.
7696	(g)  Components of a comprehensive emergency management
7697	plan, developed in consultation with the Department of Health,
7698	the Department of Elderly Affairs Agency for Health Care
7699	Administration, and the Department of Community Affairs.
7700	(2)  Pursuant to s. 119.07, the agency may charge a fee for
7701	furnishing a copy of this part, or of the rules adopted under
7702	this part, to any person upon request for the copy.
7703	(2)(3)  Pursuant to this part, s. 408.811, and applicable
7704	rules adopted by the department, the agency may conduct an
7705	abbreviated biennial inspection of key quality-of-care
7706	standards, in lieu of a full inspection, of a center that has a
7707	record of good performance. However, the agency must conduct a
7708	full inspection of a center that has had one or more confirmed
7709	complaints within the licensure period immediately preceding the
7710	inspection or which has a serious problem identified during the
7711	abbreviated inspection. The agency shall by rule develop the key
7712	quality-of-care standards, taking into consideration the
7713	comments and recommendations of the Department of Elderly
7714	Affairs and of provider groups. These standards shall be
7715	included in rules adopted by the Department of Elderly Affairs.
7716	Section 141.  Section 400.564, Florida Statutes, is
7717	repealed.
7718	Section 142.  Section 400.602, Florida Statutes, is amended
7719	to read:
7720	400.602  Licensure required; prohibited acts; exemptions;
7721	display, transferability of license.--
7722	(1)(a)  The requirements of part II of chapter 408 shall
7723	apply to the provision of services that require licensure
7724	pursuant to this part and part II of chapter 408 and to entities
7725	licensed by or applying for such licensure from the agency
7726	pursuant to this part. It is unlawful to operate or maintain a
7727	hospice without first obtaining a license from the agency.
7728	(b)  It is unlawful for Any person or legal entity not
7729	licensed as a hospice under this part may not to use the word
7730	"hospice" in its name, or to offer or advertise hospice services
7731	or hospice-like services in such a way as to mislead a person to
7732	believe that the offeror is a hospice licensed under this part.
7733	(2)  Services provided by a hospital, nursing home, or
7734	other health care facility, health care provider, or caregiver,
7735	or under the Community Care for the Elderly Act, do not
7736	constitute a hospice unless the facility, provider, or caregiver
7737	establishes a separate and distinct administrative program to
7738	provide home, residential, and homelike inpatient hospice
7739	services.
7740	(3)(a)  A separately licensed hospice may not use a name
7741	which is substantially the same as the name of another hospice
7742	licensed under this part.
7743	(b)  A licensed hospice which intends to change its name or
7744	address must notify the agency at least 60 days before making
7745	the change.
7746	(4)  The license shall be displayed in a conspicuous place
7747	inside the hospice program office; shall be valid only in the
7748	possession of the person or public agency to which it is issued;
7749	shall not be subject to sale, assignment, or other transfer,
7750	voluntary or involuntary; and shall not be valid for any hospice
7751	other than the hospice for which originally issued.
7752	(4)(5)  Notwithstanding s. 400.601(3), any hospice
7753	operating in corporate form exclusively as a hospice,
7754	incorporated on or before July 1, 1978, may be transferred to a
7755	for-profit or not-for-profit entity, and may transfer the
7756	license to that entity.
7757	(5)(6)  Notwithstanding s. 400.601(3), at any time after
7758	July 1, 1995, any entity entitled to licensure under subsection
7759	(5) may obtain a license for up to two additional hospices in
7760	accordance with the other requirements of this part and upon
7761	receipt of any certificate of need that may be required under
7762	the provisions of part I of chapter 408 ss. 408.031-408.045.
7763	Section 143.  Section 400.605, Florida Statutes, is amended
7764	to read:
7765	400.605  Administration; forms; fees; rules; inspections;
7766	fines.--
7767	(1)  The agency department, in consultation with the
7768	department agency, shall by rule establish minimum standards and
7769	procedures for a hospice pursuant to this part and part II of
7770	chapter 408. The rules must include:
7771	(a)  License application procedures and requirements.
7772	(a)(b)  The qualifications of professional and ancillary
7773	personnel to ensure the provision of appropriate and adequate
7774	hospice care.
7775	(b)(c)  Standards and procedures for the administrative
7776	management of a hospice.
7777	(c)(d)  Standards for hospice services that ensure the
7778	provision of quality patient care.
7779	(d)(e)  Components of a patient plan of care.
7780	(e)(f)  Procedures relating to the implementation of
7781	advanced directives and do-not-resuscitate orders.
7782	(f)(g)  Procedures for maintaining and ensuring
7783	confidentiality of patient records.
7784	(g)(h)  Standards for hospice care provided in freestanding
7785	inpatient facilities that are not otherwise licensed medical
7786	facilities and in residential care facilities such as nursing
7787	homes, assisted living facilities, adult family care homes, and
7788	hospice residential units and facilities.
7789	(h)(i)  Physical plant standards for hospice residential
7790	and inpatient facilities and units.
7791	(i)(j)  Components of a comprehensive emergency management
7792	plan, developed in consultation with the Department of Health,
7793	the Department of Elderly Affairs, and the Department of
7794	Community Affairs.
7795	(j)(k)  Standards and procedures relating to the
7796	establishment and activities of a quality assurance and
7797	utilization review committee.
7798	(k)(l)  Components and procedures relating to the
7799	collection of patient demographic data and other information on
7800	the provision of hospice care in this state.
7801	(2)  In accordance with s. 408.805, an applicant or
7802	licensee shall pay a fee for each license application submitted
7803	under this part, part II of chapter 408, and applicable rules.
7804	The amount of the fee shall be established by rule and may not
7805	exceed $1,200 per biennium. The agency shall:
7806	(a)  Prepare and furnish all forms necessary under the
7807	provisions of this part in relation to applications for
7808	licensure or licensure renewals.
7809	(b)  Collect from the applicant at the time of filing an
7810	application for a license or at the time of renewal of a license
7811	a fee which must be reasonably calculated to cover the cost of
7812	regulation under this part, but may not exceed $600 per program.
7813	All fees collected under this part shall be deposited in the
7814	Health Care Trust Fund for the administration of this part.
7815	(c)  Issue hospice licenses to all applicants which meet
7816	the provisions of this part and applicable rules.
7817	(3)(d)  In accordance with s. 408.811, the agency shall
7818	conduct annual licensure inspections of all licensees, except
7819	that licensure inspections may be conducted biennially for
7820	hospices having a 3-year record of substantial compliance. The
7821	agency shall
7822	(e)  conduct such inspections and investigations as are
7823	necessary in order to determine the state of compliance with the
7824	provisions of this part, part II of chapter 408, and applicable
7825	adopted rules. The right of inspection also extends to any
7826	program that the agency has reason to believe is offering or
7827	advertising itself as a hospice without a license, but no
7828	inspection may be made without the permission of the owner or
7829	person in charge thereof unless a warrant is first obtained from
7830	a circuit court authorizing such inspection. An application for
7831	a license or license renewal made pursuant to this part
7832	constitutes permission for an inspection of the hospice for
7833	which the license is sought in order to facilitate verification
7834	of the information submitted on or in connection with the
7835	application.
7836	(4)(f)  In accordance with part II of chapter 408, the
7837	agency may impose an administrative fine for any violation of
7838	the provisions of this part, part II of chapter 408, or
7839	applicable rules.
7840	Section 144.  Section 400.606, Florida Statutes, is amended
7841	to read:
7842	400.606  License; application; renewal; conditional license
7843	or permit; certificate of need.--
7844	(1)  A license application must be filed on a form provided
7845	by the agency and must be accompanied by the appropriate license
7846	fee as well as satisfactory proof that the hospice is in
7847	compliance with this part and any rules adopted by the
7848	department and proof of financial ability to operate and conduct
7849	the hospice in accordance with the requirements of this part.
7850	The initial application and change of ownership application must
7851	be accompanied by a plan for the delivery of home, residential,
7852	and homelike inpatient hospice services to terminally ill
7853	persons and their families. Such plan must contain, but need not
7854	be limited to:
7855	(a)  The estimated average number of terminally ill persons
7856	to be served monthly.
7857	(b)  The geographic area in which hospice services will be
7858	available.
7859	(c)  A listing of services which are or will be provided,
7860	either directly by the applicant or through contractual
7861	arrangements with existing providers.
7862	(d)  Provisions for the implementation of hospice home care
7863	within 3 months after licensure.
7864	(e)  Provisions for the implementation of hospice homelike
7865	inpatient care within 12 months after licensure.
7866	(f)  The number and disciplines of professional staff to be
7867	employed.
7868	(g)  The name and qualifications of any existing or
7869	potential contractee.
7870	(h)  A plan for attracting and training volunteers.
7871	(i)  The projected annual operating cost of the hospice.
7872	(j)  A statement of financial resources and personnel
7873	available to the applicant to deliver hospice care.
7874
7875	If the applicant is an existing licensed health care provider,
7876	the application must be accompanied by a copy of the most recent
7877	profit-loss statement and, if applicable, the most recent
7878	licensure inspection report.
7879	(2)  Each applicant must submit to the agency with its
7880	application a description and explanation of any exclusions,
7881	permanent suspensions, or terminations from the Medicaid or
7882	Medicare programs of the owner, if an individual; of any officer
7883	or board member of the hospice, if the owner is a firm,
7884	corporation, partnership, or association; or of any person
7885	owning 5 percent or more of the hospice. Proof of compliance
7886	with disclosure of ownership and control interest requirements
7887	of the Medicaid or Medicare programs may be accepted in lieu of
7888	this submission.
7889	(2)(3)  A license issued for the operation of a hospice,
7890	unless sooner suspended or revoked, shall expire automatically 1
7891	year from the date of issuance. Sixty days prior to the
7892	expiration date, a hospice wishing to renew its license shall
7893	submit an application for renewal to the agency on forms
7894	furnished by the agency. The agency shall renew the license if
7895	the applicant has first met the requirements established under
7896	this part and all applicable rules and has provided the
7897	information described under this section in addition to the
7898	application. However, The application for license renewal shall
7899	be accompanied by an update of the plan for delivery of hospice
7900	care only if information contained in the plan submitted
7901	pursuant to subsection (1) is no longer applicable.
7902	(4)  A hospice against which a revocation or suspension
7903	proceeding is pending at the time of license renewal may be
7904	issued a conditional license by the agency effective until final
7905	disposition of such proceeding. If judicial relief is sought
7906	from the final agency action, the court having jurisdiction may
7907	issue a conditional permit for the duration of the judicial
7908	proceeding.
7909	(3)(5)  The agency shall not issue a license to a hospice
7910	that fails to receive a certificate of need under the provisions
7911	of part I of chapter 408 ss. 408.031-408.045. A licensed hospice
7912	is a health care facility as that term is used in s. 408.039(5)
7913	and is entitled to initiate or intervene in an administrative
7914	hearing.
7915	(4)(6)  A freestanding hospice facility that is primarily
7916	engaged in providing inpatient and related services and that is
7917	not otherwise licensed as a health care facility shall be
7918	required to obtain a certificate of need. However, a
7919	freestanding hospice facility with six or fewer beds shall not
7920	be required to comply with institutional standards such as, but
7921	not limited to, standards requiring sprinkler systems, emergency
7922	electrical systems, or special lavatory devices.
7923	Section 145.  Section 400.6065, Florida Statutes, is
7924	amended to read:
7925	400.6065  Background screening.--
7926	(1)  Upon receipt of a completed application under s.
7927	400.606, the agency shall require level 2 background screening
7928	on each of the following persons, who shall be considered
7929	employees for the purposes of conducting screening under chapter
7930	435:
7931	(a)  The hospice administrator and financial officer.
7932	(b)  An officer or board member if the hospice is a firm,
7933	corporation, partnership, or association, or any person owning 5
7934	percent or more of the hospice if the agency has probable cause
7935	to believe that such officer, board member, or owner has been
7936	convicted of any offense prohibited by s. 435.04. For each
7937	officer, board member, or person owning 5 percent or more who
7938	has been convicted of any such offense, the hospice shall submit
7939	to the agency a description and explanation of the conviction at
7940	the time of license application. This paragraph does not apply
7941	to a board member of a not-for-profit corporation or
7942	organization if the board member serves solely in a voluntary
7943	capacity, does not regularly take part in the day-to-day
7944	operational decisions of the corporation or organization,
7945	receives no remuneration for his or her services, and has no
7946	financial interest and has no family members with a financial
7947	interest in the corporation or organization, provided that the
7948	board member and the corporation or organization submit a
7949	statement affirming that the board member's relationship to the
7950	corporation or organization satisfies the requirements of this
7951	paragraph.
7952	(2)  Proof of compliance with level 2 screening standards
7953	which has been submitted within the previous 5 years to meet any
7954	facility or professional licensure requirements of the agency or
7955	the Department of Health satisfies the requirements of this
7956	section.
7957	(3)  The agency may grant a provisional license to a
7958	hospice applying for an initial license when each individual
7959	required by this section to undergo screening has completed the
7960	Department of Law Enforcement background check, but has not yet
7961	received results from the Federal Bureau of Investigation.
7962	(1)(4)  The agency shall require employment or contractor
7963	screening as provided in chapter 435, using the level 1
7964	standards for screening set forth in that chapter, for hospice
7965	personnel.
7966	(2)(5)  The agency may grant exemptions from
7967	disqualification from employment under this section as provided
7968	in s. 435.07.
7969	(6)  The administration of each hospice must sign an
7970	affidavit annually, under penalty of perjury, stating that all
7971	personnel employed or contracted with on or after October 1,
7972	1998, who provide hospice services in a facility, or who enter
7973	the home of a patient in their service capacity, have been
7974	screened.
7975	(3)(7)  Proof of compliance with the screening requirements
7976	of chapter 435 shall be accepted in lieu of the requirements of
7977	this section if the person has been continuously employed or
7978	registered without a breach in service that exceeds 180 days,
7979	the proof of compliance is not more than 2 years old, and the
7980	person has been screened, at the discretion of the hospice.
7981	(4)(8)(a)  It is a misdemeanor of the first degree,
7982	punishable under s. 775.082 or s. 775.083, for any person
7983	willfully, knowingly, or intentionally to:
7984	1.  Fail, by false statement, misrepresentation,
7985	impersonation, or other fraudulent means, to disclose in any
7986	application for voluntary or paid employment a material fact
7987	used in making a determination as to such person's
7988	qualifications to be employed or contracted with under this
7989	section;
7990	2.  Operate or attempt to operate an entity licensed under
7991	this part with persons who do not meet the minimum standards for
7992	good moral character as contained in this section; or
7993	2.3.  Use information from the criminal records obtained
7994	under this section for any purpose other than screening as
7995	specified in this section, or release such information to any
7996	other person for any purpose other than screening under this
7997	section.
7998	(b)  It is a felony of the third degree, punishable under
7999	s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
8000	knowingly, or intentionally to use information from the juvenile
8001	records of a person obtained under this section for any purpose
8002	other than screening for employment under this section.
8003	Section 146.  Section 400.607, Florida Statutes, is amended
8004	to read:
8005	400.607  Denial, suspension, or revocation of license;
8006	emergency actions; imposition of administrative fine; grounds;
8007	injunctions.--
8008	(1)  The agency may deny, revoke, and or suspend a license,
8009	impose an action under s. 408.814, and or impose an
8010	administrative fine, which may not exceed $5,000 per violation,
8011	for the violation of any provision of this part, part II of
8012	chapter 408, or applicable rules in the manner provided in
8013	chapter 120.
8014	(2)  Any of the following actions by a licensed hospice or
8015	any of its employees shall be grounds for action by the agency
8016	against a hospice:
8017	(a)  A violation of the provisions of this part or
8018	applicable rules.
8019	(b)  An intentional or negligent act materially affecting
8020	the health or safety of a patient.
8021	(3)  The agency may deny or revoke a license upon a
8022	determination that:
8023	(a)  Persons subject to level 2 background screening under
8024	s. 400.6065 do not meet the screening standards of s. 435.04,
8025	and exemptions from disqualification have not been provided by
8026	the agency.
8027	(b)  An officer, board member, or person owning 5 percent
8028	or more of the hospice has been excluded, permanently suspended,
8029	or terminated from the Medicare or Medicaid programs.
8030	(3)(4)  If, 3 months after the date of obtaining a license,
8031	or at any time thereafter, a hospice does not have in operation
8032	the home-care component of hospice care, the agency shall
8033	immediately revoke the license of such hospice.
8034	(4)(5)  If, 12 months after the date of obtaining a license
8035	pursuant to s. 400.606, or at any time thereafter, a hospice
8036	does not have in operation the inpatient components of hospice
8037	care, the agency shall immediately revoke the license of such
8038	hospice.
8039	(6)  The agency may institute a civil action in a court of
8040	competent jurisdiction to seek injunctive relief to enforce
8041	compliance with this part or any rule adopted pursuant to this
8042	part.
8043	(5)(7)  The remedies set forth in this section are
8044	independent of and cumulative to other remedies provided by law.
8045	Section 147.  Subsection (8) of section 400.6095, Florida
8046	Statutes, is amended to read:
8047	400.6095  Patient admission; assessment; plan of care;
8048	discharge; death.--
8049	(8)  The hospice care team may withhold or withdraw
8050	cardiopulmonary resuscitation if presented with an order not to
8051	resuscitate executed pursuant to s. 401.45. The agency
8052	department shall adopt rules providing for the implementation of
8053	such orders. Hospice staff shall not be subject to criminal
8054	prosecution or civil liability, nor be considered to have
8055	engaged in negligent or unprofessional conduct, for withholding
8056	or withdrawing cardiopulmonary resuscitation pursuant to such an
8057	order and applicable rules adopted by the department. The
8058	absence of an order to resuscitate executed pursuant to s.
8059	401.45 does not preclude a physician from withholding or
8060	withdrawing cardiopulmonary resuscitation as otherwise permitted
8061	by law.
8062	Section 148.  Subsection (5) of section 400.617, Florida
8063	Statutes, is amended to read:
8064	400.617  Legislative intent; purpose.--
8065	(5)  Rules of the agency department relating to adult
8066	family-care homes shall be as minimal and flexible as possible
8067	to ensure the protection of residents while minimizing the
8068	obstacles that could inhibit the establishment of adult family-
8069	care homes.
8070	Section 149.  Section 400.619, Florida Statutes, is amended
8071	to read:
8072	400.619  Licensure application and renewal.--
8073	(1)  The requirements of part II of chapter 408 shall apply
8074	to the provision of services that require licensure pursuant to
8075	this part and part II of chapter 408 and to entities licensed by
8076	or applying for such licensure from the Agency for Health Care
8077	Administration pursuant to this part. However, each applicant
8078	for licensure and each licensee is exempt from s. 408.810(7)-
8079	(10). Each person who intends to be an adult family-care home
8080	provider must apply for a license from the agency at least 90
8081	days before the applicant intends to operate the adult family-
8082	care home.
8083	(2)  A person who intends to be an adult family-care home
8084	provider must own or rent the adult family-care home that is to
8085	be licensed and reside therein.
8086	(3)  In accordance with s. 408.805, an applicant or
8087	licensee shall pay a fee for each license application submitted
8088	under this part, part II of chapter 408, and applicable rules.
8089	The amount of the fee shall be $200 per biennium. The agency
8090	shall notify a licensee at least 120 days before the expiration
8091	date that license renewal is required to continue operation. The
8092	notification must be provided electronically or by mail
8093	delivery. Application for a license or annual license renewal
8094	must be made on a form provided by the agency, signed under
8095	oath, and must be accompanied by a licensing fee of $100 per
8096	year.
8097	(4)  Upon receipt of a completed license application or
8098	license renewal, and the fee, the agency shall initiate a level
8099	1 background screening as provided under chapter 435 on the
8100	adult family-care home provider, the designated relief person,
8101	all adult household members, and all staff members. The
8102	applicant or licensee is responsible for paying the fees
8103	associated with obtaining the required screening. The agency
8104	shall conduct an onsite visit to the home that is to be
8105	licensed.
8106	(a)  Proof of compliance with level 1 screening standards
8107	which has been submitted within the previous 5 years to meet any
8108	facility or professional licensure requirements of the agency or
8109	the Department of Health satisfies the requirements of this
8110	subsection. Such proof must be accompanied, under penalty of
8111	perjury, by a copy of the person's current professional license
8112	and an affidavit of current compliance with the background
8113	screening requirements.
8114	(b)  The person required to be screened must have been
8115	continuously employed in the same type of occupation for which
8116	the person is seeking employment without a breach in service
8117	that exceeds 180 days, and proof of compliance with the level 1
8118	screening requirement which is no more than 2 years old must be
8119	provided. Proof of compliance shall be provided directly from
8120	one employer or contractor to another, and not from the person
8121	screened. Upon request, a copy of screening results shall be
8122	provided to the person screened by the employer retaining
8123	documentation of the screening.
8124	(5)  The application must be accompanied by a description
8125	and explanation of any exclusions, permanent suspensions, or
8126	terminations of the applicant from participation in the Medicaid
8127	or Medicare programs or any other governmental health care or
8128	health insurance program.
8129	(6)  Unless the adult family-care home is a community
8130	residential home subject to chapter 419, the applicant must
8131	provide documentation, signed by the appropriate governmental
8132	official, that the home has met local zoning requirements for
8133	the location for which the license is sought.
8134	(5)(7)  Access to a licensed adult family-care home must be
8135	provided at reasonable times for the appropriate officials of
8136	the department, the Department of Health, the Department of
8137	Children and Family Services, the agency, and the State Fire
8138	Marshal, who are responsible for the development and maintenance
8139	of fire, health, sanitary, and safety standards, to inspect the
8140	facility to assure compliance with these standards. In addition,
8141	access to a licensed adult family-care home must be provided at
8142	reasonable times for the local long-term care ombudsman council.
8143	(8)  A license is effective for 1 year after the date of
8144	issuance unless revoked sooner. Each license must state the name
8145	of the provider, the address of the home to which the license
8146	applies, and the maximum number of residents of the home.
8147	Failure to timely file a license renewal application shall
8148	result in a late fee equal to 50 percent of the license fee.
8149	(9)  A license is not transferable or applicable to any
8150	location or person other than the location and person indicated
8151	on the license.
8152	(6)(10)  The licensed maximum capacity of each adult
8153	family-care home is based on the service needs of the residents
8154	and the capability of the provider to meet the needs of the
8155	residents. Any relative who lives in the adult family-care home
8156	and who is a disabled adult or frail elder must be included in
8157	that limitation.
8158	(7)(11)  Each adult family-care home must designate at
8159	least one licensed space for a resident receiving optional state
8160	supplementation. The Department of Children and Family Services
8161	shall specify by rule the procedures to be followed for
8162	referring residents who receive optional state supplementation
8163	to adult family-care homes. Those homes licensed as adult foster
8164	homes or assisted living facilities prior to January 1, 1994,
8165	that convert to adult family-care homes, are exempt from this
8166	requirement.
8167	(8)(12)  The agency may issue a conditional license to a
8168	provider for the purpose of bringing the adult family-care home
8169	into compliance with licensure requirements. A conditional
8170	license must be limited to a specific period, not exceeding 6
8171	months. The agency department shall, by rule, establish criteria
8172	for issuing conditional licenses.
8173	(13)  All moneys collected under this section must be
8174	deposited into the Department of Elderly Affairs Administrative
8175	Trust Fund.
8176	(9)(14)  The agency department may adopt rules to establish
8177	procedures, identify forms, specify documentation, and clarify
8178	terms, as necessary, to administer this section and part II of
8179	chapter 408.
8180	Section 150.  Section 400.6194, Florida Statutes, is
8181	amended to read:
8182	400.6194  Denial, revocation, or suspension of a
8183	license.--In addition to the requirements of part II of chapter
8184	408 the agency may deny, suspend, and or revoke a license for
8185	any of the following reasons:
8186	(1)  Failure of any of the persons required to undergo
8187	background screening under s. 400.619 to meet the level 1
8188	screening standards of s. 435.03, unless an exemption from
8189	disqualification has been provided by the agency.
8190	(2)  An intentional or negligent act materially affecting
8191	the health, safety, or welfare of the adult family-care home
8192	residents.
8193	(3)  Submission of fraudulent information or omission of
8194	any material fact on a license application or any other document
8195	required by the agency.
8196	(4)  Failure to pay an administrative fine assessed under
8197	this part.
8198	(5)  A violation of this part or adopted rules which
8199	results in conditions or practices that directly threaten the
8200	physical or emotional health, safety, or welfare of residents.
8201	(3)(6)  Failure to correct cited fire code violations that
8202	threaten the health, safety, or welfare of residents.
8203	(7)  Failure to submit a completed initial license
8204	application or to complete an application for license renewal
8205	within the specified timeframes.
8206	(8)  Exclusion, permanent suspension, or termination of the
8207	provider from the Medicare or Medicaid program.
8208	Section 151.  Section 400.6196, Florida Statutes, is
8209	amended to read:
8210	400.6196  Classification of deficiencies; administrative
8211	fines Violations; penalties.--
8212	(1)  In accordance with part II of chapter 408 and in
8213	addition to any other liability or penalty provided by law, the
8214	agency may impose an administrative fine a civil penalty on a
8215	provider according to the following classification for the
8216	violation of any provision of this part, part II of chapter 408,
8217	or applicable rules:
8218	(a)  Class I violations are those conditions or practices
8219	related to the operation and maintenance of an adult family-care
8220	home or to the care of residents which the agency determines
8221	present an imminent danger to the residents or guests of the
8222	facility or a substantial probability that death or serious
8223	physical or emotional harm would result therefrom. The condition
8224	or practice that constitutes a class I violation must be abated
8225	or eliminated within 24 hours, unless a fixed period, as
8226	determined by the agency, is required for correction. A class I
8227	deficiency is subject to an administrative fine in an amount not
8228	less than $500 and not exceeding $1,000 for each violation. A
8229	fine may be levied notwithstanding the correction of the
8230	deficiency.
8231	(b)  Class II violations are those conditions or practices
8232	related to the operation and maintenance of an adult family-care
8233	home or to the care of residents which the agency determines
8234	directly threaten the physical or emotional health, safety, or
8235	security of the residents, other than class I violations. A
8236	class II violation is subject to an administrative fine in an
8237	amount not less than $250 and not exceeding $500 for each
8238	violation. A citation for a class II violation must specify the
8239	time within which the violation is required to be corrected. If
8240	a class II violation is corrected within the time specified, no
8241	civil penalty shall be imposed, unless it is a repeated offense.
8242	(c)  Class III violations are those conditions or practices
8243	related to the operation and maintenance of an adult family-care
8244	home or to the care of residents which the agency determines
8245	indirectly or potentially threaten the physical or emotional
8246	health, safety, or security of residents, other than class I or
8247	class II violations. A class III violation is subject to an
8248	administrative fine in an amount not less than $100 and not
8249	exceeding $250 for each violation. A citation for a class III
8250	violation shall specify the time within which the violation is
8251	required to be corrected. If a class III violation is corrected
8252	within the time specified, no civil penalty shall be imposed,
8253	unless it is a repeated offense.
8254	(d)  Class IV violations are those conditions or
8255	occurrences related to the operation and maintenance of an adult
8256	family-care home, or related to the required reports, forms, or
8257	documents, which do not have the potential of negatively
8258	affecting the residents. A provider that does not correct a
8259	class IV violation within the time limit specified by the agency
8260	is subject to an administrative fine in an amount not less than
8261	$50 and not exceeding $100 for each violation. Any class IV
8262	violation that is corrected during the time the agency survey is
8263	conducted will be identified as an agency finding and not as a
8264	violation.
8265	(2)  The agency may impose an administrative fine for
8266	violations which do not qualify as class I, class II, class III,
8267	or class IV violations. The amount of the fine shall not exceed
8268	$250 for each violation or $2,000 in the aggregate. Unclassified
8269	violations include:
8270	(a)  Violating any term or condition of a license.
8271	(b)  Violating any provision of rule adopted under this
8272	part, part II of chapter 408, or applicable rules.
8273	(c)  Failure to follow the criteria and procedures provided
8274	under part I of chapter 394 relating to the transportation,
8275	voluntary admission, and involuntary examination of adult
8276	family-care home residents.
8277	(d)  Exceeding licensed capacity.
8278	(e)  Providing services beyond the scope of the license.
8279	(f)  Violating a moratorium.
8280	(3)  Each day during which a violation occurs constitutes a
8281	separate offense.
8282	(3)(4)  In determining whether a penalty is to be imposed,
8283	and in fixing the amount of any penalty to be imposed, the
8284	agency must consider:
8285	(a)  The gravity of the violation.
8286	(b)  Actions taken by the provider to correct a violation.
8287	(c)  Any previous violation by the provider.
8288	(d)  The financial benefit to the provider of committing or
8289	continuing the violation.
8290	(4)(5)  As an alternative to or in conjunction with an
8291	administrative action against a provider, the agency may request
8292	a plan of corrective action that demonstrates a good faith
8293	effort to remedy each violation by a specific date, subject to
8294	the approval of the agency.
8295	(5)(6)  The agency department shall set forth, by rule,
8296	notice requirements and procedures for correction of
8297	deficiencies.
8298	(7)  Civil penalties paid by a provider must be deposited
8299	into the Department of Elderly Affairs Administrative Trust Fund
8300	and used to offset the expenses of departmental training and
8301	education for adult family-care home providers.
8302	(8)  The agency may impose an immediate moratorium on
8303	admissions to any adult family-care home if the agency finds
8304	that a condition in the home presents a threat to the health,
8305	safety, or welfare of its residents. The department may by rule
8306	establish facility conditions that constitute grounds for
8307	imposing a moratorium and establish procedures for imposing and
8308	lifting a moratorium.
8309	Section 152.  Section 400.621, Florida Statutes, is amended
8310	to read:
8311	400.621  Rules and standards relating to adult family-care
8312	homes.--
8313	(1)  The agency department, in consultation with the
8314	Department of Health, the Department of Children and Family
8315	Services, and the department agency shall, by rule, establish
8316	minimum standards to ensure the health, safety, and well-being
8317	of each resident in the adult family-care home pursuant to this
8318	part and part II of chapter 408. The rules must address:
8319	(a)  Requirements for the physical site of the facility and
8320	facility maintenance.
8321	(b)  Services that must be provided to all residents of an
8322	adult family-care home and standards for such services, which
8323	must include, but need not be limited to:
8324	1.  Room and board.
8325	2.  Assistance necessary to perform the activities of daily
8326	living.
8327	3.  Assistance necessary to administer medication.
8328	4.  Supervision of residents.
8329	5.  Health monitoring.
8330	6.  Social and leisure activities.
8331	(c)  Standards and procedures for license application and
8332	annual license renewal, advertising, proper management of each
8333	resident's funds and personal property and personal affairs,
8334	financial ability to operate, medication management,
8335	inspections, complaint investigations, and facility, staff, and
8336	resident records.
8337	(d)  Qualifications, training, standards, and
8338	responsibilities for providers and staff.
8339	(e)  Compliance with chapter 419, relating to community
8340	residential homes.
8341	(f)  Criteria and procedures for determining the
8342	appropriateness of a resident's placement and continued
8343	residency in an adult family-care home. A resident who requires
8344	24-hour nursing supervision may not be retained in an adult
8345	family-care home unless such resident is an enrolled hospice
8346	patient and the resident's continued residency is mutually
8347	agreeable to the resident and the provider.
8348	(g)  Procedures for providing notice and assuring the least
8349	possible disruption of residents' lives when residents are
8350	relocated, an adult family-care home is closed, or the ownership
8351	of an adult family-care home is transferred.
8352	(h)  Procedures to protect the residents' rights as
8353	provided in s. 400.628.
8354	(i)  Procedures to promote the growth of adult family-care
8355	homes as a component of a long-term care system.
8356	(j)  Procedures to promote the goal of aging in place for
8357	residents of adult family-care homes.
8358	(2)  The agency department shall by rule provide minimum
8359	standards and procedures for emergencies. Pursuant to s.
8360	633.022, the State Fire Marshal, in consultation with the
8361	department and the agency, shall adopt uniform firesafety
8362	standards for adult family-care homes.
8363	(3)  The agency department shall adopt rules providing for
8364	the implementation of orders not to resuscitate. The provider
8365	may withhold or withdraw cardiopulmonary resuscitation if
8366	presented with an order not to resuscitate executed pursuant to
8367	s. 401.45. The provider shall not be subject to criminal
8368	prosecution or civil liability, nor be considered to have
8369	engaged in negligent or unprofessional conduct, for withholding
8370	or withdrawing cardiopulmonary resuscitation pursuant to such an
8371	order and applicable rules adopted by the department.
8372	(4)  The provider of any adult family-care home that is in
8373	operation at the time any rules are adopted or amended under
8374	this part may be given a reasonable time, not exceeding 6
8375	months, within which to comply with the new or revised rules and
8376	standards.
8377	Section 153.  Subsection (3) of section 400.6211, Florida
8378	Statutes, is amended to read:
8379	400.6211  Training and education programs.--
8380	(3)  Effective January 1, 2004, providers must complete the
8381	training and education program within a reasonable time
8382	determined by the agency department. Failure to complete the
8383	training and education program within the time set by the agency
8384	department is a violation of this part and subjects the provider
8385	to revocation of the license.
8386	Section 154.  Section 400.622, Florida Statutes, is
8387	repealed.
8388	Section 155.  Subsection (2) of section 400.625, Florida
8389	Statutes, is amended to read:
8390	400.625  Residency agreements.--
8391	(2)  Each residency agreement must specify the personal
8392	care and accommodations to be provided by the adult family-care
8393	home, the rates or charges, a requirement of at least 30 days'
8394	notice before a rate increase, and any other provisions required
8395	by rule of the agency department.
8396	Section 156.  Section 400.801, Florida Statutes, is amended
8397	to read:
8398	400.801  Homes for special services.--
8399	(1)  As used in this section, the term:
8400	(a)  "Agency" means the "Agency for Health Care
8401	Administration."
8402	(b)  "Home for special services" means a site where
8403	specialized health care services are provided, including
8404	personal and custodial care, but not continuous nursing
8405	services.
8406	(2)  The requirements of part II of chapter 408 shall apply
8407	to the provision of services that require licensure pursuant to
8408	this section and part II of chapter 408 and entities licensed by
8409	or applying for such licensure from the agency pursuant to this
8410	section. However, each applicant for licensure and each licensee
8411	is exempt from the provisions of s. 408.810(7)-(10). A person
8412	must obtain a license from the agency to operate a home for
8413	special services. A license is valid for 1 year.
8414	(3)  In accordance with s. 408.805, an applicant or
8415	licensee shall pay a fee for each license application submitted
8416	under this part, part II of chapter 408, and applicable rules.
8417	The amount of the fee shall be established by rule and shall not
8418	be more than $2,000 per biennium. The application for a license
8419	under this section must be made on a form provided by the
8420	agency. A nonrefundable license fee of not more than $1,000 must
8421	be submitted with the license application.
8422	(4)  Each applicant for licensure must comply with the
8423	following requirements:
8424	(a)  Upon receipt of a completed, signed, and dated
8425	application, the agency shall require background screening, in
8426	accordance with the level 2 standards for screening set forth in
8427	chapter 435, of the managing employee, or other similarly titled
8428	individual who is responsible for the daily operation of the
8429	facility, and of the financial officer, or other similarly
8430	titled individual who is responsible for the financial operation
8431	of the facility, including billings for client care and
8432	services, in accordance with the level 2 standards for screening
8433	set forth in chapter 435. The applicant must comply with the
8434	procedures for level 2 background screening as set forth in
8435	chapter 435.
8436	(b)  The agency may require background screening of any
8437	other individual who is an applicant if the agency has probable
8438	cause to believe that he or she has been convicted of a crime or
8439	has committed any other offense prohibited under the level 2
8440	standards for screening set forth in chapter 435.
8441	(c)  Proof of compliance with the level 2 background
8442	screening requirements of chapter 435 which has been submitted
8443	within the previous 5 years in compliance with any other health
8444	care or assisted living licensure requirements of this state is
8445	acceptable in fulfillment of the requirements of paragraph (a).
8446	(d)  A provisional license may be granted to an applicant
8447	when each individual required by this section to undergo
8448	background screening has met the standards for the Department of
8449	Law Enforcement background check, but the agency has not yet
8450	received background screening results from the Federal Bureau of
8451	Investigation, or a request for a disqualification exemption has
8452	been submitted to the agency as set forth in chapter 435, but a
8453	response has not yet been issued. A standard license may be
8454	granted to the applicant upon the agency's receipt of a report
8455	of the results of the Federal Bureau of Investigation background
8456	screening for each individual required by this section to
8457	undergo background screening which confirms that all standards
8458	have been met, or upon the granting of a disqualification
8459	exemption by the agency as set forth in chapter 435. Any other
8460	person who is required to undergo level 2 background screening
8461	may serve in his or her capacity pending the agency's receipt of
8462	the report from the Federal Bureau of Investigation. However,
8463	the person may not continue to serve if the report indicates any
8464	violation of background screening standards and a
8465	disqualification exemption has not been requested of and granted
8466	by the agency as set forth in chapter 435.
8467	(e)  Each applicant must submit to the agency, with its
8468	application, a description and explanation of any exclusions,
8469	permanent suspensions, or terminations of the applicant from the
8470	Medicare or Medicaid programs. Proof of compliance with the
8471	requirements for disclosure of ownership and control interests
8472	under the Medicaid or Medicare programs may be accepted in lieu
8473	of this submission.
8474	(f)  Each applicant must submit to the agency a description
8475	and explanation of any conviction of an offense prohibited under
8476	the level 2 standards of chapter 435 by a member of the board of
8477	directors of the applicant, its officers, or any individual
8478	owning 5 percent or more of the applicant. This requirement does
8479	not apply to a director of a not-for-profit corporation or
8480	organization if the director serves solely in a voluntary
8481	capacity for the corporation or organization, does not regularly
8482	take part in the day-to-day operational decisions of the
8483	corporation or organization, receives no remuneration for his or
8484	her services on the corporation or organization's board of
8485	directors, and has no financial interest and has no family
8486	members with a financial interest in the corporation or
8487	organization, provided that the director and the not-for-profit
8488	corporation or organization include in the application a
8489	statement affirming that the director's relationship to the
8490	corporation satisfies the requirements of this paragraph.
8491	(g)  A license may not be granted to an applicant if the
8492	applicant or managing employee has been found guilty of,
8493	regardless of adjudication, or has entered a plea of nolo
8494	contendere or guilty to, any offense prohibited under the level
8495	2 standards for screening set forth in chapter 435, unless an
8496	exemption from disqualification has been granted by the agency
8497	as set forth in chapter 435.
8498	(h)  The agency may deny or revoke licensure if the
8499	applicant:
8500	1.  Has falsely represented a material fact in the
8501	application required by paragraph (e) or paragraph (f), or has
8502	omitted any material fact from the application required by
8503	paragraph (e) or paragraph (f); or
8504	2.  Has had prior action taken against the applicant under
8505	the Medicaid or Medicare program as set forth in paragraph (e).
8506	(i)  An application for license renewal must contain the
8507	information required under paragraphs (e) and (f).
8508	(5)  Application for license renewal must be submitted 90
8509	days before the expiration of the license.
8510	(6)  A change of ownership or control of a home for special
8511	services must be reported to the agency in writing at least 60
8512	days before the change is scheduled to take effect.
8513	(4)(7)  The agency may shall adopt rules for implementing
8514	and enforcing this section and part II of chapter 408.
8515	(8)(a)  It is unlawful for any person to establish,
8516	conduct, manage, or operate a home for special services without
8517	obtaining a license from the agency.
8518	(b)  It is unlawful for any person to offer or advertise to
8519	the public, in any medium whatever, specialized health care
8520	services without obtaining a license from the agency.
8521	(c)  It is unlawful for a holder of a license issued under
8522	this section to advertise or represent to the public that it
8523	holds a license for a type of facility other than the facility
8524	for which its license is issued.
8525	(5)(9)(a)  In accordance with part II of chapter 408, a
8526	violation of any provision of this section, part II of chapter
8527	408, or applicable rules adopted by the agency for implementing
8528	this section is punishable by payment of an administrative fine
8529	not to exceed $5,000.
8530	(b)  A violation of subsection (8) or rules adopted under
8531	that subsection is a misdemeanor of the first degree, punishable
8532	as provided in s. 775.082 or s. 775.083. Each day of continuing
8533	violation is a separate offense.
8534	Section 157.  Section 400.805, Florida Statutes, is amended
8535	to read:
8536	400.805  Transitional living facilities.--
8537	(1)  As used in this section, the term:
8538	(a)  "Agency" means the Agency for Health Care
8539	Administration.
8540	(b)  "Department" means the Department of Health.
8541	(c)  "Transitional living facility" means a site where
8542	specialized health care services are provided, including, but
8543	not limited to, rehabilitative services, community reentry
8544	training, aids for independent living, and counseling to spinal-
8545	cord-injured persons and head-injured persons. This term does
8546	not include a hospital licensed under chapter 395 or any
8547	federally operated hospital or facility.
8548	(2)(a)  The requirements of part II of chapter 408 shall
8549	apply to the provision of services that require licensure
8550	pursuant to this section and part II of chapter 408 and to
8551	entities licensed by or applying for such licensure from the
8552	agency pursuant to this section. However, each applicant for
8553	licensure and each licensee is exempt from the provisions of s.
8554	408.810(7)-(10). A person must obtain a license from the agency
8555	to operate a transitional living facility. A license issued
8556	under this section is valid for 1 year.
8557	(b)  In accordance with this section, an applicant or a
8558	licensee shall pay a fee for each license application submitted
8559	under this part, part II of chapter 408, and applicable rules.
8560	The fee shall consist of a $4,000 license fee and a $78.50 per
8561	bed fee per biennium, unless modified by rule. The application
8562	for a license must be made on a form provided by the agency. A
8563	nonrefundable license fee of $2,000 and a fee of up to $39.25
8564	per bed must be submitted with the license application.
8565	(c)  The agency may not issue a license to an applicant
8566	until the agency receives notice from the department as provided
8567	in paragraph (3)(6)(b).
8568	(3)  Each applicant for licensure must comply with the
8569	following requirements:
8570	(a)  Upon receipt of a completed, signed, and dated
8571	application, the agency shall require background screening, in
8572	accordance with the level 2 standards for screening set forth in
8573	chapter 435, of the managing employee, or other similarly titled
8574	individual who is responsible for the daily operation of the
8575	facility, and of the financial officer, or other similarly
8576	titled individual who is responsible for the financial operation
8577	of the facility, including billings for client care and
8578	services. The applicant must comply with the procedures for
8579	level 2 background screening as set forth in chapter 435.
8580	(b)  The agency may require background screening of any
8581	other individual who is an applicant if the agency has probable
8582	cause to believe that he or she has been convicted of a crime or
8583	has committed any other offense prohibited under the level 2
8584	standards for screening set forth in chapter 435.
8585	(c)  Proof of compliance with the level 2 background
8586	screening requirements of chapter 435 which has been submitted
8587	within the previous 5 years in compliance with any other health
8588	care or assisted living licensure requirements of this state is
8589	acceptable in fulfillment of the requirements of paragraph (a).
8590	(d)  A provisional license may be granted to an applicant
8591	when each individual required by this section to undergo
8592	background screening has met the standards for the Department of
8593	Law Enforcement background check, but the agency has not yet
8594	received background screening results from the Federal Bureau of
8595	Investigation, or a request for a disqualification exemption has
8596	been submitted to the agency as set forth in chapter 435, but a
8597	response has not yet been issued. A standard license may be
8598	granted to the applicant upon the agency's receipt of a report
8599	of the results of the Federal Bureau of Investigation background
8600	screening for each individual required by this section to
8601	undergo background screening which confirms that all standards
8602	have been met, or upon the granting of a disqualification
8603	exemption by the agency as set forth in chapter 435. Any other
8604	person who is required to undergo level 2 background screening
8605	may serve in his or her capacity pending the agency's receipt of
8606	the report from the Federal Bureau of Investigation. However,
8607	the person may not continue to serve if the report indicates any
8608	violation of background screening standards and a
8609	disqualification exemption has not been requested of and granted
8610	by the agency as set forth in chapter 435.
8611	(e)  Each applicant must submit to the agency, with its
8612	application, a description and explanation of any exclusions,
8613	permanent suspensions, or terminations of the applicant from the
8614	Medicare or Medicaid programs. Proof of compliance with the
8615	requirements for disclosure of ownership and control interests
8616	under the Medicaid or Medicare programs may be accepted in lieu
8617	of this submission.
8618	(f)  Each applicant must submit to the agency a description
8619	and explanation of any conviction of an offense prohibited under
8620	the level 2 standards of chapter 435 by a member of the board of
8621	directors of the applicant, its officers, or any individual
8622	owning 5 percent or more of the applicant. This requirement does
8623	not apply to a director of a not-for-profit corporation or
8624	organization if the director serves solely in a voluntary
8625	capacity for the corporation or organization, does not regularly
8626	take part in the day-to-day operational decisions of the
8627	corporation or organization, receives no remuneration for his or
8628	her services on the corporation or organization's board of
8629	directors, and has no financial interest and has no family
8630	members with a financial interest in the corporation or
8631	organization, provided that the director and the not-for-profit
8632	corporation or organization include in the application a
8633	statement affirming that the director's relationship to the
8634	corporation satisfies the requirements of this paragraph.
8635	(g)  A license may not be granted to an applicant if the
8636	applicant or managing employee has been found guilty of,
8637	regardless of adjudication, or has entered a plea of nolo
8638	contendere or guilty to, any offense prohibited under the level
8639	2 standards for screening set forth in chapter 435, unless an
8640	exemption from disqualification has been granted by the agency
8641	as set forth in chapter 435.
8642	(h)  The agency may deny or revoke licensure if the
8643	applicant:
8644	1.  Has falsely represented a material fact in the
8645	application required by paragraph (e) or paragraph (f), or has
8646	omitted any material fact from the application required by
8647	paragraph (e) or paragraph (f); or
8648	2.  Has had prior action taken against the applicant under
8649	the Medicaid or Medicare program as set forth in paragraph (e).
8650	(i)  An application for license renewal must contain the
8651	information required under paragraphs (e) and (f).
8652	(4)  An application for renewal of license must be
8653	submitted 90 days before the expiration of the license. Upon
8654	renewal of licensure, each applicant must submit to the agency,
8655	under penalty of perjury, an affidavit as set forth in paragraph
8656	(3)(d).
8657	(5)  A change of ownership or control of a transitional
8658	living facility must be reported to the agency in writing at
8659	least 60 days before the change is scheduled to take effect.
8660	(3)(6)(a)  The agency shall adopt rules in consultation
8661	with the department governing the physical plant of transitional
8662	living facilities and the fiscal management of transitional
8663	living facilities.
8664	(b)  The department shall adopt rules in consultation with
8665	the agency governing the services provided to clients of
8666	transitional living facilities. The department shall enforce all
8667	requirements for providing services to the facility's clients.
8668	The department must notify the agency when it determines that an
8669	applicant for licensure meets the service requirements adopted
8670	by the department.
8671	(c)  The agency and the department shall enforce
8672	requirements under this section, as such requirements relate to
8673	them respectively, and their respective adopted rules.
8674	(7)(a)  It is unlawful for any person to establish,
8675	conduct, manage, or operate a transitional living facility
8676	without obtaining a license from the agency.
8677	(b)  It is unlawful for any person to offer or advertise to
8678	the public, in any medium whatever, services or care defined in
8679	paragraph (1)(c) without obtaining a license from the agency.
8680	(c)  It is unlawful for a holder of a license issued under
8681	this section to advertise or represent to the public that it
8682	holds a license for a type of facility other than the facility
8683	for which its license is issued.
8684	(4)(8)  Any designated officer or employee of the agency,
8685	of the state, or of the local fire marshal may enter unannounced
8686	upon and into the premises of any facility licensed under this
8687	section in order to determine the state of compliance with this
8688	section and the rules or standards in force under this section.
8689	The right of entry and inspection also extends to any premises
8690	that the agency has reason to believe are being operated or
8691	maintained as a facility without a license; but such an entry or
8692	inspection may not be made without the permission of the owner
8693	or person in charge of the facility unless a warrant that
8694	authorizes the entry is first obtained from the circuit court.
8695	The warrant requirement extends only to a facility that the
8696	agency has reason to believe is being operated or maintained as
8697	a facility without a license. An application for a license or
8698	renewal thereof which is made under this section constitutes
8699	permission for, and acquiescence in, any entry or inspection of
8700	the premises for which the license is sought, in order to
8701	facilitate verification of the information submitted on or in
8702	connection with the application; to discover, investigate, and
8703	determine the existence of abuse or neglect; or to elicit,
8704	receive, respond to, and resolve complaints. A current valid
8705	license constitutes unconditional permission for, and
8706	acquiescence in, any entry or inspection of the premises by
8707	authorized personnel. The agency retains the right of entry and
8708	inspection of facilities that have had a license revoked or
8709	suspended within the previous 24 months, to ensure that the
8710	facility is not operating unlawfully. However, before the
8711	facility is entered, a statement of probable cause must be filed
8712	with the director of the agency, who must approve or disapprove
8713	the action within 48 hours. Probable cause includes, but is not
8714	limited to, evidence that the facility holds itself out to the
8715	public as a provider of personal assistance services, or the
8716	receipt by the advisory council on brain and spinal cord
8717	injuries of a complaint about the facility.
8718	(5)(9)  The agency may institute injunctive proceedings in
8719	a court of competent jurisdiction for temporary or permanent
8720	relief to:
8721	(a)  Enforce this section or any minimum standard, rule, or
8722	order issued pursuant thereto if the agency's effort to correct
8723	a violation through administrative fines has failed or when the
8724	violation materially affects the health, safety, or welfare of
8725	residents; or
8726	(b)  Terminate the operation of a facility if a violation
8727	of this section or of any standard or rule adopted pursuant
8728	thereto exists which materially affects the health, safety, or
8729	welfare of residents.
8730
8731	The Legislature recognizes that, in some instances, action is
8732	necessary to protect residents of facilities from immediately
8733	life-threatening situations. If it appears by competent evidence
8734	or a sworn, substantiated affidavit that a temporary injunction
8735	should issue, the court, pending the determination on final
8736	hearing, shall enjoin operation of the facility.
8737	(10)  The agency may impose an immediate moratorium on
8738	admissions to a facility when the agency determines that any
8739	condition in the facility presents a threat to the health,
8740	safety, or welfare of the residents in the facility. If a
8741	facility's license is denied, revoked, or suspended, the
8742	facility may be subject to the immediate imposition of a
8743	moratorium on admissions to run concurrently with licensure
8744	denial, revocation, or suspension.
8745	(6)(11)(a)  In accordance with part II of chapter 408, a
8746	violation of any provision of this section, part II of chapter
8747	408, or applicable rules adopted by the agency or department
8748	under this section is punishable by payment of an administrative
8749	or a civil penalty fine not to exceed $5,000.
8750	(b)  A violation of subsection (7) or rules adopted under
8751	that subsection is a misdemeanor of the first degree, punishable
8752	as provided in s. 775.082 or s. 775.083. Each day of a
8753	continuing violation is a separate offense.
8754	Section 158.  Subsection (4) of section 400.902, Florida
8755	Statutes, is amended to read:
8756	400.902  Definitions.--As used in this part, the term:
8757	(4)  "Owner or operator" means a licensee any individual
8758	who has general administrative charge of a PPEC center.
8759	Section 159.  Subsection (3) is added to section 400.903,
8760	Florida Statutes, to read:
8761	400.903  PPEC centers to be licensed; exemptions.--
8762	(3)  The requirements of part II of chapter 408 shall apply
8763	to the provision of services that require licensure pursuant to
8764	this part and part II of chapter 408 and to entities licensed by
8765	or applying for such licensure from the agency pursuant to this
8766	part. However, each applicant for licensure and each licensee is
8767	exempt from the provisions of s. 408.810(10).
8768	Section 160.  Section 400.905, Florida Statutes, is amended
8769	to read:
8770	400.905  License required; fee; exemption; display.--
8771	(1)(a)  It is unlawful to operate or maintain a PPEC center
8772	without first obtaining from the agency a license authorizing
8773	such operation. The agency is responsible for licensing PPEC
8774	centers in accordance with the provisions of this part.
8775	(b)  Any person who violates paragraph (a) is guilty of a
8776	felony of the third degree, punishable as provided in s.
8777	775.082, s. 775.083, or s. 775.084.
8778	(1)(2)  Separate licenses are required for PPEC centers
8779	maintained on separate premises, even though they are operated
8780	under the same management. Separate licenses are not required
8781	for separate buildings on the same grounds.
8782	(2)(3)  In accordance with s. 408.805, an applicant or
8783	licensee shall pay a fee for each license application submitted
8784	under this part, part II of chapter 408, and applicable rules.
8785	The amount of the fee shall be established by rule and shall not
8786	be less than $1,000 or more than $3,000 per biennium. The annual
8787	license fee required of a PPEC center shall be in an amount
8788	determined by the agency to be sufficient to cover the agency's
8789	costs in carrying out its responsibilities under this part, but
8790	shall not be less than $500 or more than $1,500.
8791	(3)(4)  County-operated or municipally operated PPEC
8792	centers applying for licensure under this part are exempt from
8793	the payment of license fees.
8794	(5)  The license shall be displayed in a conspicuous place
8795	inside the PPEC center.
8796	(6)  A license shall be valid only in the possession of the
8797	individual, firm, partnership, association, or corporation to
8798	whom it is issued and shall not be subject to sale, assignment,
8799	or other transfer, voluntary or involuntary; nor shall a license
8800	be valid for any premises other than that for which originally
8801	issued.
8802	(7)  Any license granted by the agency shall state the
8803	maximum capacity of the facility, the date the license was
8804	issued, the expiration date of the license, and any other
8805	information deemed necessary by the agency.
8806	Section 161.  Section 400.906, Florida Statutes, is
8807	repealed.
8808	Section 162.  Section 400.907, Florida Statutes, is amended
8809	to read:
8810	400.907  Denial, suspension, revocation of licensure;
8811	administrative fines; grounds.--
8812	(1)  In accordance with part II of chapter 408, the agency
8813	may deny, revoke, and or suspend a license and or impose an
8814	administrative fine for the violation of any provision of this
8815	part, part II of chapter 408, or applicable rules in the manner
8816	provided in chapter 120.
8817	(2)  Any of the following actions by a PPEC center or its
8818	employee is grounds for action by the agency against a PPEC
8819	center or its employee:
8820	(a)  An intentional or negligent act materially affecting
8821	the health or safety of children in the PPEC center.
8822	(b)  A violation of the provisions of this part, part II of
8823	chapter 408, or applicable rules or of any standards or rules
8824	adopted pursuant to this part.
8825	(c)  Multiple and repeated violations of this part or of
8826	minimum standards or rules adopted pursuant to this part.
8827	(3)  The agency shall be responsible for all investigations
8828	and inspections conducted pursuant to this part.
8829	Section 163.  Section 400.908, Florida Statutes, is amended
8830	to read:
8831	400.908  Administrative fines; disposition of fees and
8832	fines.--
8833	(1)(a)  If the agency determines that a PPEC center is
8834	being operated without a license or is otherwise not in
8835	compliance with rules adopted under this part, part II of
8836	chapter 408, or applicable rules, the agency, notwithstanding
8837	any other administrative action it takes, shall make a
8838	reasonable attempt to discuss each violation and recommended
8839	corrective action with the owner of the PPEC center prior to
8840	written notification thereof. The agency may request that the
8841	PPEC center submit a corrective action plan which demonstrates a
8842	good faith effort to remedy each violation by a specific date,
8843	subject to the approval of the agency.
8844	(b)  In accordance with part II of chapter 408, the agency
8845	may fine a PPEC center or employee found in violation of rules
8846	adopted pursuant to this part, part II of chapter 408, or
8847	applicable rules, in an amount not to exceed $500 for each
8848	violation. Such fine may not exceed $5,000 in the aggregate.
8849	(c)  The failure to correct a violation by the date set by
8850	the agency, or the failure to comply with an approved corrective
8851	action plan, is a separate violation for each day such failure
8852	continues, unless the agency approves an extension to a specific
8853	date.
8854	(d)  If a PPEC center desires to appeal any agency action
8855	under this section and the fine is upheld, the violator shall
8856	pay the fine, plus interest at the legal rate specified in s.
8857	687.01, for each day beyond the date set by the agency for
8858	payment of the fine.
8859	(2)  In determining if a fine is to be imposed and in
8860	fixing the amount of any fine, the agency shall consider the
8861	following factors:
8862	(a)  The gravity of the violation, including the
8863	probability that death or serious physical or emotional harm to
8864	a child will result or has resulted, the severity of the actual
8865	or potential harm, and the extent to which the provisions of the
8866	applicable statutes or rules were violated.
8867	(b)  Actions taken by the owner or operator to correct
8868	violations.
8869	(c)  Any previous violations.
8870	(d)  The financial benefit to the PPEC center of committing
8871	or continuing the violation.
8872	(3)  Fees and fines received by the agency under this part
8873	shall be deposited in the Health Care Trust Fund created in s.
8874	408.16.
8875	Section 164.  Section 400.910, Florida Statutes, is
8876	repealed.
8877	Section 165.  Section 400.911, Florida Statutes, is
8878	repealed.
8879	Section 166.  Section 400.912, Florida Statutes, is amended
8880	to read:
8881	400.912  Closing of a PPEC center.--
8882	(1)  Whenever a PPEC center voluntarily discontinues
8883	operation, it shall, inform the agency in writing at least 30
8884	days before the discontinuance of operation. The PPEC center
8885	shall also, at such time, inform each child's legal guardian of
8886	the fact and the proposed time of such discontinuance.
8887	(2)  Immediately upon discontinuance of the operation of a
8888	PPEC center, the owner or operator shall surrender the license
8889	therefor to the agency and the license shall be canceled.
8890	Section 167.  Section 400.913, Florida Statutes, is
8891	repealed.
8892	Section 168.  Subsection (1) of section 400.914, Florida
8893	Statutes, is amended to read:
8894	400.914  Rules establishing standards.--
8895	(1)  Pursuant to the intention of the Legislature to
8896	provide safe and sanitary facilities and healthful programs, the
8897	agency in conjunction with the Division of Children's Medical
8898	Services Prevention and Intervention of the Department of Health
8899	shall adopt and publish rules to implement the provisions of
8900	this part and part II of chapter 408, which shall include
8901	reasonable and fair standards. Any conflict between these
8902	standards and those that may be set forth in local, county, or
8903	city ordinances shall be resolved in favor of those having
8904	statewide effect. Such standards shall relate to:
8905	(a)  The assurance that PPEC services are family centered
8906	and provide individualized medical, developmental, and family
8907	training services.
8908	(b)  The maintenance of PPEC centers, not in conflict with
8909	the provisions of chapter 553 and based upon the size of the
8910	structure and number of children, relating to plumbing, heating,
8911	lighting, ventilation, and other building conditions, including
8912	adequate space, which will ensure the health, safety, comfort,
8913	and protection from fire of the children served.
8914	(c)  The appropriate provisions of the most recent edition
8915	of the "Life Safety Code" (NFPA-101) shall be applied.
8916	(d)  The number and qualifications of all personnel who
8917	have responsibility for the care of the children served.
8918	(e)  All sanitary conditions within the PPEC center and its
8919	surroundings, including water supply, sewage disposal, food
8920	handling, and general hygiene, and maintenance thereof, which
8921	will ensure the health and comfort of children served.
8922	(f)  Programs and basic services promoting and maintaining
8923	the health and development of the children served and meeting
8924	the training needs of the children's legal guardians.
8925	(g)  Supportive, contracted, other operational, and
8926	transportation services.
8927	(h)  Maintenance of appropriate medical records, data, and
8928	information relative to the children and programs. Such records
8929	shall be maintained in the facility for inspection by the
8930	agency.
8931	Section 169.  Subsection (3) of section 400.915, Florida
8932	Statutes, is amended to read:
8933	400.915  Construction and renovation; requirements.--The
8934	requirements for the construction or renovation of a PPEC center
8935	shall comply with:
8936	(3)  The standards or rules adopted pursuant to this part
8937	and part II of chapter 408.
8938	Section 170.  Section 400.916, Florida Statutes, is
8939	repealed.
8940	Section 171.  Section 400.917, Florida Statutes, is
8941	repealed.
8942	Section 172.  Section 400.925, Florida Statutes, is amended
8943	to read:
8944	400.925  Definitions.--As used in this part, the term:
8945	(1)  "Accrediting organizations" means the Joint Commission
8946	on Accreditation of Healthcare Organizations or other national
8947	accreditation agencies whose standards for accreditation are
8948	comparable to those required by this part for licensure.
8949	(2)  "Affiliated person" means any person who directly or
8950	indirectly manages, controls, or oversees the operation of a
8951	corporation or other business entity that is a licensee,
8952	regardless of whether such person is a partner, shareholder,
8953	owner, officer, director, agent, or employee of the entity.
8954	(2)(3)  "Agency" means the Agency for Health Care
8955	Administration.
8956	(4)  "Applicant" means an individual applicant in the case
8957	of a sole proprietorship, or any officer, director, agent,
8958	managing employee, general manager, or affiliated person, or any
8959	partner or shareholder having an ownership interest equal to 5
8960	percent or greater in the corporation, partnership, or other
8961	business entity.
8962	(3)(5)  "Consumer" or "patient" means any person who uses
8963	home medical equipment in his or her place of residence.
8964	(4)(6)  "Department" means the Department of Children and
8965	Family Services.
8966	(5)(7)  "General manager" means the individual who has the
8967	general administrative charge of the premises of a licensed home
8968	medical equipment provider.
8969	(6)(8)  "Home medical equipment" includes any product as
8970	defined by the Federal Drug Administration's Drugs, Devices and
8971	Cosmetics Act, any products reimbursed under the Medicare Part B
8972	Durable Medical Equipment benefits, or any products reimbursed
8973	under the Florida Medicaid durable medical equipment program.
8974	Home medical equipment includes oxygen and related respiratory
8975	equipment; manual, motorized, or customized wheelchairs and
8976	related seating and positioning, but does not include
8977	prosthetics or orthotics or any splints, braces, or aids custom
8978	fabricated by a licensed health care practitioner; motorized
8979	scooters; personal transfer systems; and specialty beds, for use
8980	by a person with a medical need.
8981	(7)(9)  "Home medical equipment provider" means any person
8982	or entity that sells or rents or offers to sell or rent to or
8983	for a consumer:
8984	(a)  Any home medical equipment and services; or
8985	(b)  Home medical equipment that requires any home medical
8986	equipment services.
8987	(8)(10)  "Home medical equipment provider personnel" means
8988	persons who are employed by or under contract with a home
8989	medical equipment provider.
8990	(9)(11)  "Home medical equipment services" means equipment
8991	management and consumer instruction, including selection,
8992	delivery, setup, and maintenance of equipment, and other related
8993	services for the use of home medical equipment in the consumer's
8994	regular or temporary place of residence.
8995	(10)(12)  "Licensee" means the person or entity to whom a
8996	license to operate as a home medical equipment provider is
8997	issued by the agency.
8998	(11)(13)  "Moratorium" has the same meaning as in s.
8999	408.803, except that means a mandated temporary cessation or
9000	suspension of the sale, rental, or offering of equipment after
9001	the imposition of the moratorium. services related to equipment
9002	sold or rented prior to the moratorium must be continued without
9003	interruption, unless deemed otherwise by the agency.
9004	(12)(14)  "Person" means any individual, firm, partnership,
9005	corporation, or association.
9006	(13)(15)  "Premises" means those buildings and equipment
9007	which are located at the address of the licensed home medical
9008	equipment provider for the provision of home medical equipment
9009	services, which are in such reasonable proximity as to appear to
9010	the public to be a single provider location, and which comply
9011	with zoning ordinances.
9012	(14)(16)  "Residence" means the consumer's home or place of
9013	residence, which may include nursing homes, assisted living
9014	facilities, transitional living facilities, adult family-care
9015	homes, or other congregate residential facilities.
9016	Section 173.  Subsection (3) and paragraphs (b), (d), and
9017	(e) of subsection (6) of section 400.93, Florida Statutes, are
9018	amended to read:
9019	400.93  Licensure required; exemptions; unlawful acts;
9020	penalties.--
9021	(3)  The requirements of part II of chapter 408 shall apply
9022	to the provision of services that require licensure pursuant to
9023	this part and part II of chapter 408 and to entities licensed by
9024	or applying for such licensure from the agency pursuant to this
9025	part. However, each applicant for licensure and each licensee is
9026	exempt from the provisions of s. 408.810(10). A home medical
9027	equipment provider must be licensed by the agency to operate in
9028	this state or to provide home medical equipment and services to
9029	consumers in this state. A standard license issued to a home
9030	medical equipment provider, unless sooner suspended or revoked,
9031	expires 2 years after its effective date.
9032	(6)
9033	(b)  A person who violates paragraph (a) is subject to an
9034	injunctive proceeding under this part, part II of chapter 408,
9035	or applicable rules s. 400.956. A violation of paragraph (a) is
9036	a deceptive and unfair trade practice and constitutes a
9037	violation of the Florida Deceptive and Unfair Trade Practices
9038	Act.
9039	(d)  The following penalties shall be imposed for operating
9040	an unlicensed home medical equipment provider:
9041	1.  Any person or entity who operates an unlicensed
9042	provider commits a felony of the third degree.
9043	2.  For any person or entity who has received government
9044	reimbursement for services provided by an unlicensed provider,
9045	the agency shall make a fraud referral to the appropriate
9046	government reimbursement program.
9047	3.  For any licensee found to be concurrently operating
9048	licensed and unlicensed provider premises, the agency may impose
9049	a fine or moratorium, or revoke existing licenses of any or all
9050	of the licensee's licensed provider locations until such time as
9051	the unlicensed provider premises is licensed.
9052	(e)  A provider found to be operating without a license may
9053	apply for licensure, and must cease operations until a license
9054	is awarded by the agency.
9055	Section 174.  Section 400.931, Florida Statutes, is amended
9056	to read:
9057	400.931  Application for license; fee; provisional license;
9058	temporary permit.--
9059	(1)  Application for an initial license or for renewal of
9060	an existing license must be made under oath to the agency on
9061	forms furnished by it and must be accompanied by the appropriate
9062	license fee as provided in subsection (12).
9063	(1)(2)  The applicant must file with the application
9064	satisfactory proof that the home medical equipment provider is
9065	in compliance with this part and applicable rules, including:
9066	(a)  A report, by category, of the equipment to be
9067	provided, indicating those offered either directly by the
9068	applicant or through contractual arrangements with existing
9069	providers. Categories of equipment include:
9070	1.  Respiratory modalities.
9071	2.  Ambulation aids.
9072	3.  Mobility aids.
9073	4.  Sickroom setup.
9074	5.  Disposables.
9075	(b)  A report, by category, of the services to be provided,
9076	indicating those offered either directly by the applicant or
9077	through contractual arrangements with existing providers.
9078	Categories of services include:
9079	1.  Intake.
9080	2.  Equipment selection.
9081	3.  Delivery.
9082	4.  Setup and installation.
9083	5.  Patient training.
9084	6.  Ongoing service and maintenance.
9085	7.  Retrieval.
9086	(c)  A listing of those with whom the applicant contracts,
9087	both the providers the applicant uses to provide equipment or
9088	services to its consumers and the providers for whom the
9089	applicant provides services or equipment.
9090	(2)(3)  As an alternative to submitting proof of financial
9091	ability to operate as required in s. 408.810(8) The applicant
9092	for initial licensure must demonstrate financial ability to
9093	operate, the applicant may submit which may be accomplished by
9094	the submission of a $50,000 surety bond to the agency.
9095	(4)  An applicant for renewal who has demonstrated
9096	financial inability to operate must demonstrate financial
9097	ability to operate.
9098	(5)  Each applicant for licensure must comply with the
9099	following requirements:
9100	(a)  Upon receipt of a completed, signed, and dated
9101	application, the agency shall require background screening of
9102	the applicant, in accordance with the level 2 standards for
9103	screening set forth in chapter 435. As used in this subsection,
9104	the term "applicant" means the general manager and the financial
9105	officer or similarly titled individual who is responsible for
9106	the financial operation of the licensed facility.
9107	(b)  The agency may require background screening for a
9108	member of the board of directors of the licensee or an officer
9109	or an individual owning 5 percent or more of the licensee if the
9110	agency has probable cause to believe that such individual has
9111	been convicted of an offense prohibited under the level 2
9112	standards for screening set forth in chapter 435.
9113	(c)  Proof of compliance with the level 2 background
9114	screening requirements of chapter 435 which has been submitted
9115	within the previous 5 years in compliance with any other health
9116	care licensure requirements of this state is acceptable in
9117	fulfillment of paragraph (a).
9118	(d)  Each applicant must submit to the agency, with its
9119	application, a description and explanation of any exclusions,
9120	permanent suspensions, or terminations of the applicant from the
9121	Medicare or Medicaid programs. Proof of compliance with
9122	disclosure of ownership and control interest requirements of the
9123	Medicaid or Medicare programs shall be accepted in lieu of this
9124	submission.
9125	(e)  Each applicant must submit to the agency a description
9126	and explanation of any conviction of an offense prohibited under
9127	the level 2 standards of chapter 435 by a member of the board of
9128	directors of the applicant, its officers, or any individual
9129	owning 5 percent or more of the applicant. This requirement does
9130	not apply to a director of a not-for-profit corporation or
9131	organization if the director serves solely in a voluntary
9132	capacity for the corporation or organization, does not regularly
9133	take part in the day-to-day operational decisions of the
9134	corporation or organization, receives no remuneration for his or
9135	her services on the corporation's or organization's board of
9136	directors, and has no financial interest and has no family
9137	members with a financial interest in the corporation or
9138	organization, provided that the director and the not-for-profit
9139	corporation or organization include in the application a
9140	statement affirming that the director's relationship to the
9141	corporation satisfies the requirements of this provision.
9142	(f)  A license may not be granted to any potential licensee
9143	if any applicant, administrator, or financial officer has been
9144	found guilty of, regardless of adjudication, or has entered a
9145	plea of nolo contendere or guilty to, any offense prohibited
9146	under the level 2 standards for screening set forth in chapter
9147	435, unless an exemption from disqualification has been granted
9148	by the agency as set forth in chapter 435.
9149	(g)  The agency may deny or revoke licensure to any
9150	potential licensee if any applicant:
9151	1.  Has falsely represented a material fact in the
9152	application required by paragraphs (d) and (e), or has omitted
9153	any material fact from the application required by paragraphs
9154	(d) and (e); or
9155	2.  Has had prior Medicaid or Medicare action taken against
9156	the applicant as set forth in paragraph (d).
9157	(h)  Upon licensure renewal, each applicant must submit to
9158	the agency, under penalty of perjury, an affidavit of compliance
9159	with the background screening provisions of this section.
9160	(3)(6)  As specified in part II of chapter 408, the home
9161	medical equipment provider must also obtain and maintain
9162	professional and commercial liability insurance. Proof of
9163	liability insurance, as defined in s. 624.605, must be submitted
9164	with the application. The agency shall set the required amounts
9165	of liability insurance by rule, but the required amount must not
9166	be less than $250,000 per claim. In the case of contracted
9167	services, it is required that the contractor have liability
9168	insurance not less than $250,000 per claim.
9169	(7)  A provisional license shall be issued to an approved
9170	applicant for initial licensure for a period of 90 days, during
9171	which time a survey must be conducted demonstrating substantial
9172	compliance with this section. A provisional license shall also
9173	be issued pending the results of an applicant's Federal Bureau
9174	of Investigation report of background screening confirming that
9175	all standards have been met. If substantial compliance is
9176	demonstrated, a standard license shall be issued to expire 2
9177	years after the effective date of the provisional license.
9178	(8)  Ninety days before the expiration date, an application
9179	for license renewal must be submitted to the agency under oath
9180	on forms furnished by the agency, and a license shall be renewed
9181	if the applicant has met the requirements established under this
9182	part and applicable rules. The home medical equipment provider
9183	must file with the application satisfactory proof that it is in
9184	compliance with this part and applicable rules. The home medical
9185	equipment provider must submit satisfactory proof of its
9186	financial ability to comply with the requirements of this part.
9187	(9)  When a change of ownership of a home medical equipment
9188	provider occurs, the prospective owner must submit an initial
9189	application for a license at least 15 days before the effective
9190	date of the change of ownership. An application for change of
9191	ownership of a license is required when ownership, a majority of
9192	the ownership, or controlling interest of a licensed home
9193	medical equipment provider is transferred or assigned and when a
9194	licensee agrees to undertake or provide services to the extent
9195	that legal liability for operation of the home medical equipment
9196	provider rests with the licensee. A provisional license shall be
9197	issued to the new owner for a period of 90 days, during which
9198	time all required documentation must be submitted and a survey
9199	must be conducted demonstrating substantial compliance with this
9200	section. If substantial compliance is demonstrated, a standard
9201	license shall be issued to expire 2 years after the issuance of
9202	the provisional license.
9203	(4)(10)  When a change of the general manager of a home
9204	medical equipment provider occurs, the licensee must notify the
9205	agency of the change within 45 days. thereof and must provide
9206	evidence of compliance with the background screening
9207	requirements in subsection (5); except that a general manager
9208	who has met the standards for the Department of Law Enforcement
9209	background check, but for whom background screening results from
9210	the Federal Bureau of Investigation have not yet been received,
9211	may be employed pending receipt of the Federal Bureau of
9212	Investigation background screening report. An individual may not
9213	continue to serve as general manager if the Federal Bureau of
9214	Investigation background screening report indicates any
9215	violation of background screening standards.
9216	(5)(11)  In accordance with s. 408.805, an applicant or a
9217	licensee shall pay a fee for each license application submitted
9218	under this part, part II of chapter 408, and applicable rules.
9219	The amount of the fee shall be established by rule and shall not
9220	exceed $300 per biennium. All licensure fees required of a home
9221	medical equipment provider are nonrefundable. The agency shall
9222	set the fees in an amount that is sufficient to cover its costs
9223	in carrying out its responsibilities under this part. However,
9224	state, county, or municipal governments applying for licenses
9225	under this part are exempt from the payment of license fees. All
9226	fees collected under this part must be deposited in the Health
9227	Care Trust Fund for the administration of this part.
9228	(6)(12)  An applicant for initial licensure, renewal, or
9229	change of ownership shall also pay a license processing fee not
9230	to exceed $300, to be paid by all applicants, and an inspection
9231	fee not to exceed $400, which shall to be paid by all applicants
9232	except those not subject to licensure inspection by the agency
9233	as described in s. 400.933(2).
9234	(13)  When a change is reported which requires issuance of
9235	a license, a fee must be assessed. The fee must be based on the
9236	actual cost of processing and issuing the license.
9237	(14)  When a duplicate license is issued, a fee must be
9238	assessed, not to exceed the actual cost of duplicating and
9239	mailing.
9240	(15)  When applications are mailed out upon request, a fee
9241	must be assessed, not to exceed the cost of the printing,
9242	preparation, and mailing.
9243	(16)  The license must be displayed in a conspicuous place
9244	in the administrative office of the home medical equipment
9245	provider and is valid only while in the possession of the person
9246	or entity to which it is issued. The license may not be sold,
9247	assigned, or otherwise transferred, voluntarily or
9248	involuntarily, and is valid only for the home medical equipment
9249	provider and location for which originally issued.
9250	(17)  A home medical equipment provider against whom a
9251	proceeding for revocation or suspension, or for denial of a
9252	renewal application, is pending at the time of license renewal
9253	may be issued a provisional license effective until final
9254	disposition by the agency of such proceedings. If judicial
9255	relief is sought from the final disposition, the court that has
9256	jurisdiction may issue a temporary permit for the duration of
9257	the judicial proceeding.
9258	Section 175.  Section 400.932, Florida Statutes, is amended
9259	to read:
9260	400.932  Administrative penalties; injunctions; emergency
9261	orders; moratoriums.--
9262	(1)  The agency may deny, revoke, and or suspend a license,
9263	and or impose an administrative fine not to exceed $5,000 per
9264	violation, per day, or initiate injunctive proceedings under s.
9265	408.816 400.956.
9266	(2)  Any of the following actions by an employee of a home
9267	medical equipment provider or any of its employees is grounds
9268	for administrative action or penalties by the agency:
9269	(a)  Violation of this part or of applicable rules.
9270	(b)  An intentional, reckless, or negligent act that
9271	materially affects the health or safety of a patient.
9272	(3)  The agency may deny and or revoke the license of any
9273	applicant that:
9274	(a)  Made a false representation or omission of any
9275	material fact in making the application, including the
9276	submission of an application that conceals the controlling or
9277	ownership interest or any officer, director, agent, managing
9278	employee, affiliated person, partner, or shareholder who may not
9279	be eligible to participate;
9280	(a)(b)  Has been previously found by any professional
9281	licensing, certifying, or standards board or agency to have
9282	violated the standards or conditions relating to licensure or
9283	certification or the quality of services provided. "Professional
9284	licensing, certifying, or standards board or agency" shall
9285	include, but is not limited to, practitioners, health care
9286	facilities, programs, or services, or residential care,
9287	treatment programs, or other human services; or
9288	(b)(c)  Has been or is currently excluded, suspended, or
9289	terminated from, or has involuntarily withdrawn from,
9290	participation in Florida's Medicaid program or any other state's
9291	Medicaid program, or participation in the Medicare program or
9292	any other governmental or private health care or health
9293	insurance program.
9294	(4)  The agency may issue an emergency order immediately
9295	suspending or revoking a license when it determines that any
9296	condition within the responsibility of the home medical
9297	equipment provider presents a clear and present danger to public
9298	health and safety.
9299	(5)  The agency may impose an immediate moratorium on any
9300	licensed home medical equipment provider when the agency
9301	determines that any condition within the responsibility of the
9302	home medical equipment provider presents a threat to public
9303	health or safety.
9304	Section 176.  Section 400.933, Florida Statutes, is amended
9305	to read:
9306	400.933  Licensure inspections; alternatives and
9307	investigations.--
9308	(1)  The agency shall make or cause to be made such
9309	inspections and investigations as it considers necessary,
9310	including:
9311	(a)  Licensure inspections.
9312	(b)  Inspections directed by the federal Health Care
9313	Financing Administration.
9314	(c)  Licensure complaint investigations, including full
9315	licensure investigations with a review of all licensure
9316	standards as outlined in the administrative rules. Complaints
9317	received by the agency from individuals, organizations, or other
9318	sources are subject to review and investigation by the agency.
9319	(2)  The agency shall accept, in lieu of its own periodic
9320	inspections for licensure, submission of the following:
9321	(1)(a)  The survey or inspection of an accrediting
9322	organization, provided the accreditation of the licensed home
9323	medical equipment provider is not provisional and provided the
9324	licensed home medical equipment provider authorizes release of,
9325	and the agency receives the report of, the accrediting
9326	organization; or
9327	(2)(b)  A copy of a valid medical oxygen retail
9328	establishment permit issued by the Department of Health,
9329	pursuant to chapter 499.
9330	Section 177.  Section 400.935, Florida Statutes, is amended
9331	to read:
9332	400.935  Rules establishing minimum standards.--The agency
9333	shall adopt, publish, and enforce rules to implement this part
9334	and part II of chapter 408, which must provide reasonable and
9335	fair minimum standards relating to:
9336	(1)  The qualifications and minimum training requirements
9337	of all home medical equipment provider personnel.
9338	(2)  License application and renewal.
9339	(3)  License and inspection fees.
9340	(2)(4)  Financial ability to operate.
9341	(3)(5)  The administration of the home medical equipment
9342	provider.
9343	(4)(6)  Procedures for maintaining patient records.
9344	(5)(7)  Ensuring that the home medical equipment and
9345	services provided by a home medical equipment provider are in
9346	accordance with the plan of treatment established for each
9347	patient, when provided as a part of a plan of treatment.
9348	(6)(8)  Contractual arrangements for the provision of home
9349	medical equipment and services by providers not employed by the
9350	home medical equipment provider providing for the consumer's
9351	needs.
9352	(7)(9)  Physical location and zoning requirements.
9353	(8)(10)  Home medical equipment requiring home medical
9354	equipment services.
9355	Section 178.  Section 400.95, Florida Statutes, is
9356	repealed.
9357	Section 179.  Subsections (3) through (7) of section
9358	400.953, Florida Statutes, are renumbered as subsections (2)
9359	through (6), respectively, and present subsection (2) is amended
9360	to read:
9361	400.953  Background screening of home medical equipment
9362	provider personnel.--The agency shall require employment
9363	screening as provided in chapter 435, using the level 1
9364	standards for screening set forth in that chapter, for home
9365	medical equipment provider personnel.
9366	(2)  The general manager of each home medical equipment
9367	provider must sign an affidavit annually, under penalty of
9368	perjury, stating that all home medical equipment provider
9369	personnel hired on or after July 1, 1999, who enter the home of
9370	a patient in the capacity of their employment have been screened
9371	and that its remaining personnel have worked for the home
9372	medical equipment provider continuously since before July 1,
9373	1999.
9374	Section 180.  Subsection (4) of section 400.955, Florida
9375	Statutes, is amended to read:
9376	400.955  Procedures for screening of home medical equipment
9377	provider personnel.--
9378	(4)  The general manager of each home medical equipment
9379	provider must sign an affidavit annually, under penalty of
9380	perjury, stating that all personnel hired on or after July 1,
9381	1999, have been screened and that its remaining personnel have
9382	worked for the home medical equipment provider continuously
9383	since before July 1, 1999.
9384	Section 181.  Section 400.956, Florida Statutes, is
9385	repealed.
9386	Section 182.  Section 400.960, Florida Statutes, is amended
9387	to read:
9388	400.960  Definitions.--As used in this part, the term:
9389	(1)  "Active treatment" means the provision of services by
9390	an interdisciplinary team which are necessary to maximize a
9391	resident's client's individual independence or prevent
9392	regression or loss of functional status.
9393	(2)  "Agency" means the Agency for Health Care
9394	Administration.
9395	(3)  "Autism" means a pervasive, neurologically based
9396	developmental disability of extended duration which causes
9397	severe learning, communication, and behavior disorders with age
9398	of onset during infancy or childhood. Individuals with autism
9399	exhibit impairment in reciprocal social interaction, impairment
9400	in verbal and nonverbal communication and imaginative ability,
9401	and a markedly restricted repertoire of activities and
9402	interests.
9403	(4)  "Cerebral palsy" means a group of disabling symptoms
9404	of extended duration which results from damage to the developing
9405	brain occurring before, during, or after birth and resulting in
9406	the loss or impairment of control over voluntary muscles. The
9407	term does not include those symptoms or impairments resulting
9408	solely from a stroke.
9409	(5)  "Client" means any person determined by the department
9410	to be eligible for developmental services.
9411	(6)  "Client advocate" means a friend or relative of the
9412	client, or of the client's immediate family, who advocates for
9413	the best interests of the client in any proceedings under this
9414	part in which the client or his or her family has the right or
9415	duty to participate.
9416	(5)(7)  "Department" means the Department of Children and
9417	Family Services.
9418	(6)(8)  "Developmental disability" means a disorder or
9419	syndrome that is attributable to retardation, cerebral palsy,
9420	autism, spina bifida, or Prader-Willi syndrome and that
9421	constitutes a substantial handicap that can reasonably be
9422	expected to continue indefinitely.
9423	(7)(9)  "Direct service provider" means a person 18 years
9424	of age or older who has direct contact with individuals with
9425	developmental disabilities and who is unrelated to the
9426	individuals with developmental disabilities.
9427	(8)(10)  "Epilepsy" means a chronic brain disorder of
9428	various causes which is characterized by recurrent seizures due
9429	to excessive discharge of cerebral neurons. When found
9430	concurrently with retardation, autism, or cerebral palsy,
9431	epilepsy is considered a secondary disability for which the
9432	resident client is eligible to receive services to ameliorate
9433	this condition according to the provisions of this part.
9434	(9)(11)  "Guardian advocate" means a person appointed by
9435	the circuit court to represent a person with developmental
9436	disabilities in any proceedings brought pursuant to s. 393.12,
9437	and is distinct from a guardian advocate for mentally ill
9438	persons under chapter 394.
9439	(10)(12)  "Intermediate care facility for the
9440	developmentally disabled" means a residential facility licensed
9441	and certified in accordance with state law, and certified by the
9442	Federal Government, pursuant to the Social Security Act, as a
9443	provider of Medicaid services to persons who are developmentally
9444	disabled.
9445	(11)(13)  "Prader-Willi syndrome" means an inherited
9446	condition typified by neonatal hypotonia with failure to thrive,
9447	hyperphagia, or an excessive drive to eat which leads to
9448	obesity, usually at 18 to 36 months of age, mild to moderate
9449	retardation, hypogonadism, short stature, mild facial
9450	dysmorphism, and a characteristic neurobehavior.
9451	(12)  "Resident" means any person receiving services in an
9452	intermediate care facility.
9453	(13)  "Resident advocate" means a friend or relative of the
9454	resident, or of the resident's immediate family, who advocates
9455	for the best interests of the resident in any proceedings under
9456	this part in which the resident or his or her family has the
9457	right or duty to participate.
9458	(14)  "Retardation" means significantly subaverage general
9459	intellectual functioning existing concurrently with deficits in
9460	adaptive behavior and manifested during the period from
9461	conception to age 18. "Significantly subaverage general
9462	intellectual functioning," for the purpose of this definition,
9463	means performance that is two or more standard deviations from
9464	the mean score on a standardized intelligence test specified in
9465	rules of the department. "Deficits in adaptive behavior," for
9466	the purpose of this definition, means deficits in the
9467	effectiveness or degree with which an individual meets the
9468	standards of personal independence and social responsibility
9469	expected of his or her age, cultural group, and community.
9470	(15)  "Spina bifida" means a medical diagnosis of spina
9471	bifida cystica or myelomeningocele.
9472	Section 183.  Section 400.962, Florida Statutes, is amended
9473	to read:
9474	400.962  License required; license application.--
9475	(1)  The requirements of part II of chapter 408 shall apply
9476	to the provision of services that require licensure pursuant to
9477	this part and part II of chapter 408 and to entities licensed by
9478	or applying for such licensure from the Agency for Health Care
9479	Administration pursuant to this part. However, each applicant
9480	for licensure and each licensee is exempt from s. 408.810(7). It
9481	is unlawful to operate an intermediate care facility for the
9482	developmentally disabled without a license.
9483	(2)  Separate licenses are required for facilities
9484	maintained on separate premises even if operated under the same
9485	management. However, a separate license is not required for
9486	separate buildings on the same grounds.
9487	(3)  In accordance with s. 408.805, an applicant or
9488	licensee shall pay a fee for each license application submitted
9489	under this part, part II of chapter 408, and applicable rules.
9490	The amount of the fee shall be $234 per bed unless modified by
9491	rule.
9492	(3)  The basic license fee collected shall be deposited in
9493	the Health Care Trust Fund, established for carrying out the
9494	purposes of this chapter.
9495	(4)  The license must be conspicuously displayed inside the
9496	facility.
9497	(5)  A license is valid only in the hands of the
9498	individual, firm, partnership, association, or corporation to
9499	whom it is issued. A license is not valid for any premises other
9500	than those for which it was originally issued and may not be
9501	sold, assigned, or otherwise transferred, voluntarily or
9502	involuntarily.
9503	(6)  An application for a license shall be made to the
9504	agency on forms furnished by it and must be accompanied by the
9505	appropriate license fee.
9506	(7)  The application must be under oath and must contain
9507	the following:
9508	(a)  The name, address, and social security number of the
9509	applicant if an individual; if the applicant is a firm,
9510	partnership, or association, its name, address, and employer
9511	identification number (EIN), and the name and address of every
9512	member; if the applicant is a corporation, its name, address,
9513	and employer identification number (EIN), and the name and
9514	address of its director and officers and of each person having
9515	at least a 5 percent interest in the corporation; and the name
9516	by which the facility is to be known.
9517	(b)  The name of any person whose name is required on the
9518	application under paragraph (a) and who owns at least a 10
9519	percent interest in any professional service, firm, association,
9520	partnership, or corporation providing goods, leases, or services
9521	to the facility for which the application is made, and the name
9522	and address of the professional service, firm, association,
9523	partnership, or corporation in which such interest is held.
9524	(c)  The location of the facility for which a license is
9525	sought and an indication that such location conforms to the
9526	local zoning ordinances.
9527	(d)  The name of the persons under whose management or
9528	supervision the facility will be operated.
9529	(e)  The total number of beds.
9530	(4)(8)  The applicant must demonstrate that sufficient
9531	numbers of staff, qualified by training or experience, will be
9532	employed to properly care for the type and number of residents
9533	who will reside in the facility.
9534	(9)  The applicant must submit evidence that establishes
9535	the good moral character of the applicant, manager, supervisor,
9536	and administrator. An applicant who is an individual or a member
9537	of a board of directors or officer of an applicant that is a
9538	firm, partnership, association, or corporation must not have
9539	been convicted, or found guilty, regardless of adjudication, of
9540	a crime in any jurisdiction which affects or may potentially
9541	affect residents in the facility.
9542	(10)(a)  Upon receipt of a completed, signed, and dated
9543	application, the agency shall require background screening of
9544	the applicant, in accordance with the level 2 standards for
9545	screening set forth in chapter 435. As used in this subsection,
9546	the term "applicant" means the facility administrator, or
9547	similarly titled individual who is responsible for the day-to-
9548	day operation of the licensed facility, and the facility
9549	financial officer, or similarly titled individual who is
9550	responsible for the financial operation of the licensed
9551	facility.
9552	(b)  The agency may require background screening for a
9553	member of the board of directors of the licensee or an officer
9554	or an individual owning 5 percent or more of the licensee if the
9555	agency has probable cause to believe that such individual has
9556	been convicted of an offense prohibited under the level 2
9557	standards for screening set forth in chapter 435.
9558	(c)  Proof of compliance with the level 2 background
9559	screening requirements of chapter 435 which has been submitted
9560	within the previous 5 years in compliance with any other
9561	licensure requirements under this chapter satisfies the
9562	requirements of paragraph (a). Proof of compliance with
9563	background screening which has been submitted within the
9564	previous 5 years to fulfill the requirements of the Financial
9565	Services Commission and the Office of Insurance Regulation under
9566	chapter 651 as part of an application for a certificate of
9567	authority to operate a continuing care retirement community
9568	satisfies the requirements for the Department of Law Enforcement
9569	and Federal Bureau of Investigation background checks.
9570	(d)  A provisional license may be granted to an applicant
9571	when each individual required by this section to undergo
9572	background screening has met the standards for the Department of
9573	Law Enforcement background check, but the agency has not yet
9574	received background screening results from the Federal Bureau of
9575	Investigation, or a request for a disqualification exemption has
9576	been submitted to the agency as set forth in chapter 435, but a
9577	response has not yet been issued. A license may be granted to
9578	the applicant upon the agency's receipt of a report of the
9579	results of the Federal Bureau of Investigation background
9580	screening for each individual required by this section to
9581	undergo background screening which confirms that all standards
9582	have been met, or upon the granting of a disqualification
9583	exemption by the agency as set forth in chapter 435. Any other
9584	person who is required to undergo level 2 background screening
9585	may serve in his or her capacity pending the agency's receipt of
9586	the report from the Federal Bureau of Investigation; however,
9587	the person may not continue to serve if the report indicates any
9588	violation of background screening standards and a
9589	disqualification exemption has not been granted by the agency as
9590	set forth in chapter 435.
9591	(e)  Each applicant must submit to the agency, with its
9592	application, a description and explanation of any exclusions,
9593	permanent suspensions, or terminations of the applicant from the
9594	Medicare or Medicaid programs. Proof of compliance with
9595	disclosure of ownership and control interest requirements of the
9596	Medicaid or Medicare programs shall be accepted in lieu of this
9597	submission.
9598	(f)  Each applicant must submit to the agency a description
9599	and explanation of any conviction of an offense prohibited under
9600	the level 2 standards of chapter 435 by a member of the board of
9601	directors of the applicant, its officers, or any individual
9602	owning 5 percent or more of the applicant. This requirement does
9603	not apply to a director of a not-for-profit corporation or
9604	organization if the director serves solely in a voluntary
9605	capacity for the corporation or organization, does not regularly
9606	take part in the day-to-day operational decisions of the
9607	corporation or organization, receives no remuneration for his or
9608	her services on the corporation's or organization's board of
9609	directors, and has no financial interest and has no family
9610	members with a financial interest in the corporation or
9611	organization, provided that the director and the not-for-profit
9612	corporation or organization include in the application a
9613	statement affirming that the director's relationship to the
9614	corporation satisfies the requirements of this paragraph.
9615	(g)  An application for license renewal must contain the
9616	information required under paragraphs (e) and (f).
9617	(11)  The applicant must furnish satisfactory proof of
9618	financial ability to operate and conduct the facility in
9619	accordance with the requirements of this part and all rules
9620	adopted under this part, and the agency shall establish
9621	standards for this purpose.
9622	Section 184.  Section 400.963, Florida Statutes, is
9623	repealed.
9624	Section 185.  Section 400.965, Florida Statutes, is
9625	repealed.
9626	Section 186.  Section 400.967, Florida Statutes, is amended
9627	to read:
9628	400.967  Rules and classification of deficiencies.--
9629	(1)  It is the intent of the Legislature that rules adopted
9630	and enforced under this part and part II of chapter 408 include
9631	criteria by which a reasonable and consistent quality of
9632	resident care may be ensured, the results of such resident care
9633	can be demonstrated, and safe and sanitary facilities can be
9634	provided.
9635	(2)  Pursuant to the intention of the Legislature, the
9636	agency, in consultation with the Agency for Persons with
9637	Disabilities Department of Children and Family Services and the
9638	Department of Elderly Affairs, shall adopt and enforce rules to
9639	administer this part, which shall include reasonable and fair
9640	criteria governing:
9641	(a)  The location and construction of the facility;
9642	including fire and life safety, plumbing, heating, cooling,
9643	lighting, ventilation, and other housing conditions that will
9644	ensure the health, safety, and comfort of residents. The agency
9645	shall establish standards for facilities and equipment to
9646	increase the extent to which new facilities and a new wing or
9647	floor added to an existing facility after July 1, 2000, are
9648	structurally capable of serving as shelters only for residents,
9649	staff, and families of residents and staff, and equipped to be
9650	self-supporting during and immediately following disasters. The
9651	Agency for Health Care Administration shall work with facilities
9652	licensed under this part and report to the Governor and the
9653	Legislature by April 1, 2000, its recommendations for cost-
9654	effective renovation standards to be applied to existing
9655	facilities. In making such rules, the agency shall be guided by
9656	criteria recommended by nationally recognized, reputable
9657	professional groups and associations having knowledge concerning
9658	such subject matters. The agency shall update or revise such
9659	criteria as the need arises. All facilities must comply with
9660	those lifesafety code requirements and building code standards
9661	applicable at the time of approval of their construction plans.
9662	The agency may require alterations to a building if it
9663	determines that an existing condition constitutes a distinct
9664	hazard to life, health, or safety. The agency shall adopt fair
9665	and reasonable rules setting forth conditions under which
9666	existing facilities undergoing additions, alterations,
9667	conversions, renovations, or repairs are required to comply with
9668	the most recent updated or revised standards.
9669	(b)  The number and qualifications of all personnel,
9670	including management, medical nursing, and other personnel,
9671	having responsibility for any part of the care given to
9672	residents.
9673	(c)  All sanitary conditions within the facility and its
9674	surroundings, including water supply, sewage disposal, food
9675	handling, and general hygiene, which will ensure the health and
9676	comfort of residents.
9677	(d)  The equipment essential to the health and welfare of
9678	the residents.
9679	(e)  A uniform accounting system.
9680	(f)  The care, treatment, and maintenance of residents and
9681	measurement of the quality and adequacy thereof.
9682	(g)  The preparation and annual update of a comprehensive
9683	emergency management plan. The agency shall adopt rules
9684	establishing minimum criteria for the plan after consultation
9685	with the Department of Community Affairs. At a minimum, the
9686	rules must provide for plan components that address emergency
9687	evacuation transportation; adequate sheltering arrangements;
9688	postdisaster activities, including emergency power, food, and
9689	water; postdisaster transportation; supplies; staffing;
9690	emergency equipment; individual identification of residents and
9691	transfer of records; and responding to family inquiries. The
9692	comprehensive emergency management plan is subject to review and
9693	approval by the local emergency management agency. During its
9694	review, the local emergency management agency shall ensure that
9695	the following agencies, at a minimum, are given the opportunity
9696	to review the plan: the Department of Elderly Affairs, the
9697	Department of Children and Family Services, the Agency for
9698	Health Care Administration, and the Department of Community
9699	Affairs. Also, appropriate volunteer organizations must be given
9700	the opportunity to review the plan. The local emergency
9701	management agency shall complete its review within 60 days and
9702	either approve the plan or advise the facility of necessary
9703	revisions.
9704	(h)  Each licensee shall post its license in a prominent
9705	place that is in clear and unobstructed public view at or near
9706	the place where residents are being admitted to the facility.
9707	(3)  In accordance with part II of chapter 408, the agency
9708	shall adopt rules to provide that, when the criteria established
9709	under this part and part II of chapter 408 subsection (2) are
9710	not met, such deficiencies shall be classified according to the
9711	nature of the deficiency. The agency shall indicate the
9712	classification on the face of the notice of deficiencies as
9713	follows:
9714	(a)  Class I deficiencies are those which the agency
9715	determines present an and imminent danger to the residents or
9716	guests of the facility or a substantial probability that death
9717	or serious physical harm would result therefrom. The condition
9718	or practice constituting a class I violation must be abated or
9719	eliminated immediately, unless a fixed period of time, as
9720	determined by the agency, is required for correction.
9721	Notwithstanding s. 400.121(2), A class I deficiency is subject
9722	to a civil penalty in an amount not less than $5,000 and not
9723	exceeding $10,000 for each deficiency. A fine may be levied
9724	notwithstanding the correction of the deficiency.
9725	(b)  Class II deficiencies are those which the agency
9726	determines have a direct or immediate relationship to the
9727	health, safety, or security of the facility residents, other
9728	than class I deficiencies. A class II deficiency is subject to a
9729	civil penalty in an amount not less than $1,000 and not
9730	exceeding $5,000 for each deficiency. A citation for a class II
9731	deficiency shall specify the time within which the deficiency
9732	must be corrected. If a class II deficiency is corrected within
9733	the time specified, no civil penalty shall be imposed, unless it
9734	is a repeated offense.
9735	(c)  Class III deficiencies are those which the agency
9736	determines to have an indirect or potential relationship to the
9737	health, safety, or security of the facility residents, other
9738	than class I or class II deficiencies. A class III deficiency is
9739	subject to a civil penalty of not less than $500 and not
9740	exceeding $1,000 for each deficiency. A citation for a class III
9741	deficiency shall specify the time within which the deficiency
9742	must be corrected. If a class III deficiency is corrected within
9743	the time specified, no civil penalty shall be imposed, unless it
9744	is a repeated offense.
9745	(4)  Civil penalties paid by any licensee under subsection
9746	(3) shall be deposited in the Health Care Trust Fund and
9747	expended as provided in s. 400.063.
9748	(4)(5)  The agency shall approve or disapprove the plans
9749	and specifications within 60 days after receipt of the final
9750	plans and specifications. The agency may be granted one 15-day
9751	extension for the review period, if the secretary of the agency
9752	so approves. If the agency fails to act within the specified
9753	time, it is deemed to have approved the plans and
9754	specifications. When the agency disapproves plans and
9755	specifications, it must set forth in writing the reasons for
9756	disapproval. Conferences and consultations may be provided as
9757	necessary.
9758	(5)(6)  The agency may charge an initial fee of $2,000 for
9759	review of plans and construction on all projects, no part of
9760	which is refundable. The agency may also collect a fee, not to
9761	exceed 1 percent of the estimated construction cost or the
9762	actual cost of review, whichever is less, for the portion of the
9763	review which encompasses initial review through the initial
9764	revised construction document review. The agency may collect its
9765	actual costs on all subsequent portions of the review and
9766	construction inspections. Initial fee payment must accompany the
9767	initial submission of plans and specifications. Any subsequent
9768	payment that is due is payable upon receipt of the invoice from
9769	the agency. Notwithstanding any other provision of law, all
9770	money received by the agency under this section shall be deemed
9771	to be trust funds, to be held and applied solely for the
9772	operations required under this section.
9773	(6) Each licensee of an intermediate care facility for
9774	persons with developmental disabilities shall adhere to all
9775	rights specified in s. 393.13, the Bill of Rights of Persons Who
9776	are Developmentally Disabled.
9777	Section 187.  Section 400.968, Florida Statutes, is amended
9778	to read:
9779	400.968  Right of entry; protection of health, safety, and
9780	welfare.--
9781	(1)  Any designated officer or employee of the agency, of
9782	the state, or of the local fire marshal may enter unannounced
9783	the premises of any facility licensed under this part in order
9784	to determine the state of compliance with this part and the
9785	rules or standards in force under this part. The right of entry
9786	and inspection also extends to any premises that the agency has
9787	reason to believe are being operated or maintained as a facility
9788	without a license; but such an entry or inspection may not be
9789	made without the permission of the owner or person in charge of
9790	the facility unless a warrant that authorizes the entry is first
9791	obtained from the circuit court. The warrant requirement extends
9792	only to a facility that the agency has reason to believe is
9793	being operated or maintained as a facility without a license. An
9794	application for a license or renewal thereof which is made under
9795	this section constitutes permission for, and acquiescence in,
9796	any entry or inspection of the premises for which the license is
9797	sought, in order to facilitate verification of the information
9798	submitted in connection with the application; to discover,
9799	investigate, and determine the existence of abuse or neglect; or
9800	to elicit, receive, respond to, and resolve complaints. A
9801	current valid license constitutes unconditional permission for,
9802	and acquiescence in, any entry or inspection of the premises by
9803	authorized personnel. The agency retains the right of entry and
9804	inspection of facilities that have had a license revoked or
9805	suspended within the previous 24 months, to ensure that the
9806	facility is not operating unlawfully. However, before the
9807	facility is entered, a statement of probable cause must be filed
9808	with the director of the agency, who must approve or disapprove
9809	the action within 48 hours.
9810	(2)  The agency may institute injunctive proceedings in a
9811	court of competent jurisdiction for temporary or permanent
9812	relief to:
9813	(a)  Enforce this section or any minimum standard, rule, or
9814	order issued pursuant thereto if the agency's effort to correct
9815	a violation through administrative fines has failed or when the
9816	violation materially affects the health, safety, or welfare of
9817	residents; or
9818	(b)  Terminate the operation of a facility if a violation
9819	of this section or of any standard or rule adopted pursuant
9820	thereto exists which materially affects the health, safety, or
9821	welfare of residents.
9822
9823	The Legislature recognizes that, in some instances, action is
9824	necessary to protect residents of facilities from immediately
9825	life-threatening situations. If it appears by competent evidence
9826	or a sworn, substantiated affidavit that a temporary injunction
9827	should issue, the court, pending the determination on final
9828	hearing, shall enjoin operation of the facility.
9829	(3)  The agency may impose an immediate moratorium on
9830	admissions to a facility when the agency determines that any
9831	condition in the facility presents a threat to the health,
9832	safety, or welfare of the residents in the facility. If a
9833	facility's license is denied, revoked, or suspended, the
9834	facility may be subject to the immediate imposition of a
9835	moratorium on admissions to run concurrently with licensure
9836	denial, revocation, or suspension.
9837	Section 188.  Section 400.9685, Florida Statutes, is
9838	amended to read:
9839	400.9685  Administration of medication.--
9840	(1)  Notwithstanding the provisions of the Nurse Practice
9841	Act, part I of chapter 464, unlicensed direct care services
9842	staff who are providing services to residents clients in
9843	intermediate care facilities for the developmentally disabled,
9844	licensed pursuant to this part, may administer prescribed,
9845	prepackaged, premeasured medications under the general
9846	supervision of a registered nurse as provided in this section
9847	and applicable rules. Training required by this section and
9848	applicable rules must be conducted by a registered nurse
9849	licensed pursuant to chapter 464 or a physician licensed
9850	pursuant to chapter 458 or chapter 459.
9851	(2)  Each facility that allows unlicensed direct care
9852	service staff to administer medications pursuant to this section
9853	must:
9854	(a)  Develop and implement policies and procedures that
9855	include a plan to ensure the safe handling, storage, and
9856	administration of prescription medication.
9857	(b)  Maintain written evidence of the expressed and
9858	informed consent for each resident client.
9859	(c)  Maintain a copy of the written prescription including
9860	the name of the medication, the dosage, and administration
9861	schedule.
9862	(d)  Maintain documentation regarding the prescription
9863	including the name, dosage, and administration schedule, reason
9864	for prescription, and the termination date.
9865	(e)  Maintain documentation of compliance with required
9866	training.
9867	(3)  Agency rules shall specify the following as it relates
9868	to the administration of medications by unlicensed staff:
9869	(a)  Medications authorized and packaging required.
9870	(b)  Acceptable methods of administration.
9871	(c)  A definition of "general supervision."
9872	(d)  Minimum educational requirements of staff.
9873	(e)  Criteria of required training and competency that must
9874	be demonstrated prior to the administration of medications by
9875	unlicensed staff including inservice training.
9876	(f)  Requirements for safe handling, storage, and
9877	administration of medications.
9878	Section 189.  Subsection (1) of section 400.969, Florida
9879	Statutes, is amended to read:
9880	400.969  Violation of part; penalties.--
9881	(1)  In accordance with part II of chapter 408, and except
9882	as provided in s. 400.967(3), a violation of any provision of
9883	this part, part II of chapter 408, or applicable rules adopted
9884	by the agency under this part is punishable by payment of an
9885	administrative or civil penalty not to exceed $5,000.
9886	Section 190.  Section 400.980, Florida Statutes, is amended
9887	to read:
9888	400.980  Health care services pools.--
9889	(1)  As used in this section, the term:
9890	(a)  "Agency" means the Agency for Health Care
9891	Administration.
9892	(b)  "Health care services pool" means any person, firm,
9893	corporation, partnership, or association engaged for hire in the
9894	business of providing temporary employment in health care
9895	facilities, residential facilities, and agencies for licensed,
9896	certified, or trained health care personnel including, without
9897	limitation, nursing assistants, nurses' aides, and orderlies.
9898	However, the term does not include nursing registries, a
9899	facility licensed under chapter 400, a health care services pool
9900	established within a health care facility to provide services
9901	only within the confines of such facility, or any individual
9902	contractor directly providing temporary services to a health
9903	care facility without use or benefit of a contracting agent.
9904	(2)  The requirements of part II of chapter 408 shall apply
9905	to the provision of services that require licensure or
9906	registration pursuant to this part and part II of chapter 408
9907	and to entities registered by or applying for such registration
9908	from the agency pursuant to this part. However, each applicant
9909	for licensure and each licensee is exempt from ss.
9910	408.806(1)(e)2. and 408.810(6)-(10). Each person who operates a
9911	health care services pool must register each separate business
9912	location with the agency. The agency shall adopt rules and
9913	provide forms required for such registration and shall impose a
9914	registration fee in an amount sufficient to cover the cost of
9915	administering this section. In addition, the registrant must
9916	provide the agency with any change of information contained on
9917	the original registration application within 14 days prior to
9918	the change. The agency may inspect the offices of any health
9919	care services pool at any reasonable time for the purpose of
9920	determining compliance with this section or the rules adopted
9921	under this section.
9922	(3)  Each application for registration must include:
9923	(a)  The name and address of any person who has an
9924	ownership interest in the business, and, in the case of a
9925	corporate owner, copies of the articles of incorporation,
9926	bylaws, and names and addresses of all officers and directors of
9927	the corporation.
9928	(b)  Any other information required by the agency.
9929	(3)(4)  Each applicant for registration must comply with
9930	the following requirements:
9931	(a)  Upon receipt of a completed, signed, and dated
9932	application, the agency shall require background screening, in
9933	accordance with the level 1 standards for screening set forth in
9934	chapter 435, of every individual who will have contact with
9935	patients. The agency shall require background screening of the
9936	managing employee or other similarly titled individual who is
9937	responsible for the operation of the entity, and of the
9938	financial officer or other similarly titled individual who is
9939	responsible for the financial operation of the entity, including
9940	billings for services in accordance with the level 2 standards
9941	for background screening as set forth in chapter 435.
9942	(b)  The agency may require background screening of any
9943	other individual who is affiliated with the applicant if the
9944	agency has a reasonable basis for believing that he or she has
9945	been convicted of a crime or has committed any other offense
9946	prohibited under the level 2 standards for screening set forth
9947	in chapter 435.
9948	(c)  Proof of compliance with the level 2 background
9949	screening requirements of chapter 435 which has been submitted
9950	within the previous 5 years in compliance with any other health
9951	care or assisted living licensure requirements of this state is
9952	acceptable in fulfillment of paragraph (a).
9953	(d)  A provisional registration may be granted to an
9954	applicant when each individual required by this section to
9955	undergo background screening has met the standards for the
9956	Department of Law Enforcement background check but the agency
9957	has not yet received background screening results from the
9958	Federal Bureau of Investigation. A standard registration may be
9959	granted to the applicant upon the agency's receipt of a report
9960	of the results of the Federal Bureau of Investigation background
9961	screening for each individual required by this section to
9962	undergo background screening which confirms that all standards
9963	have been met, or upon the granting of a disqualification
9964	exemption by the agency as set forth in chapter 435. Any other
9965	person who is required to undergo level 2 background screening
9966	may serve in his or her capacity pending the agency's receipt of
9967	the report from the Federal Bureau of Investigation. However,
9968	the person may not continue to serve if the report indicates any
9969	violation of background screening standards and if a
9970	disqualification exemption has not been requested of and granted
9971	by the agency as set forth in chapter 435.
9972	(e)  Each applicant must submit to the agency, with its
9973	application, a description and explanation of any exclusions,
9974	permanent suspensions, or terminations of the applicant from the
9975	Medicare or Medicaid programs. Proof of compliance with the
9976	requirements for disclosure of ownership and controlling
9977	interests under the Medicaid or Medicare programs may be
9978	accepted in lieu of this submission.
9979	(f)  Each applicant must submit to the agency a description
9980	and explanation of any conviction of an offense prohibited under
9981	the level 2 standards of chapter 435 which was committed by a
9982	member of the board of directors of the applicant, its officers,
9983	or any individual owning 5 percent or more of the applicant.
9984	This requirement does not apply to a director of a not-for-
9985	profit corporation or organization who serves solely in a
9986	voluntary capacity for the corporation or organization, does not
9987	regularly take part in the day-to-day operational decisions of
9988	the corporation or organization, receives no remuneration for
9989	his or her services on the corporation's or organization's board
9990	of directors, and has no financial interest and no family
9991	members having a financial interest in the corporation or
9992	organization, if the director and the not-for-profit corporation
9993	or organization include in the application a statement affirming
9994	that the director's relationship to the corporation satisfies
9995	the requirements of this paragraph.
9996	(g)  A registration may not be granted to an applicant if
9997	the applicant or managing employee has been found guilty of,
9998	regardless of adjudication, or has entered a plea of nolo
9999	contendere or guilty to, any offense prohibited under the level
10000	2 standards for screening set forth in chapter 435, unless an
10001	exemption from disqualification has been granted by the agency
10002	as set forth in chapter 435.
10003	(h)  Failure to provide all required documentation within
10004	30 days after a written request from the agency will result in
10005	denial of the application for registration.
10006	(i)  The agency must take final action on an application
10007	for registration within 60 days after receipt of all required
10008	documentation.
10009	(j)  The agency may deny, revoke, or suspend the
10010	registration of any applicant or registrant who:
10011	1.  Has falsely represented a material fact in the
10012	application required by paragraph (e) or paragraph (f), or has
10013	omitted any material fact from the application required by
10014	paragraph (e) or paragraph (f); or
10015	2.  Has had prior action taken against the applicant under
10016	the Medicaid or Medicare program as set forth in paragraph (e).
10017	3.  Fails to comply with this section or applicable rules.
10018	4.  Commits an intentional, reckless, or negligent act that
10019	materially affects the health or safety of a person receiving
10020	services.
10021	(4)(5)  It is a misdemeanor of the first degree, punishable
10022	under s. 775.082 or s. 775.083, for any person willfully,
10023	knowingly, or intentionally to:
10024	(a)  Fail, by false statement, misrepresentation,
10025	impersonation, or other fraudulent means, to disclose in any
10026	application for voluntary or paid employment a material fact
10027	used in making a determination as to an applicant's
10028	qualifications to be a contractor under this section;
10029	(b)  Operate or attempt to operate an entity registered
10030	under this part with persons who do not meet the minimum
10031	standards of chapter 435 as contained in this section; or
10032	(c)  Use information from the criminal records obtained
10033	under this section for any purpose other than screening an
10034	applicant for temporary employment as specified in this section,
10035	or release such information to any other person for any purpose
10036	other than screening for employment under this section.
10037	(5)(6)  It is a felony of the third degree, punishable
10038	under s. 775.082, s. 775.083, or s. 775.084, for any person
10039	willfully, knowingly, or intentionally to use information from
10040	the juvenile records of a person obtained under this section for
10041	any purpose other than screening for employment under this
10042	section.
10043	(7)  It is unlawful for a person to offer or advertise
10044	services, as defined by rule, to the public without obtaining a
10045	certificate of registration from the Agency for Health Care
10046	Administration. It is unlawful for any holder of a certificate
10047	of registration to advertise or hold out to the public that he
10048	or she holds a certificate of registration for other than that
10049	for which he or she actually holds a certificate of
10050	registration. Any person who violates this subsection is subject
10051	to injunctive proceedings under s. 400.515.
10052	(8)  Each registration shall be for a period of 2 years.
10053	The application for renewal must be received by the agency at
10054	least 30 days before the expiration date of the registration. An
10055	application for a new registration is required within 30 days
10056	prior to the sale of a controlling interest in a health care
10057	services pool.
10058	(6)(9)  A health care services pool may not require an
10059	employee to recruit new employees from persons employed at a
10060	health care facility to which the health care services pool
10061	employee is assigned. Nor shall a health care facility to which
10062	employees of a health care services pool are assigned recruit
10063	new employees from the health care services pool.
10064	(7)(10)  A health care services pool shall document that
10065	each temporary employee provided to a health care facility has
10066	met the licensing, certification, training, or continuing
10067	education requirements, as established by the appropriate
10068	regulatory agency, for the position in which he or she will be
10069	working.
10070	(8)(11)  When referring persons for temporary employment in
10071	health care facilities, a health care services pool shall comply
10072	with all pertinent state and federal laws, rules, and
10073	regulations relating to health, background screening, and other
10074	qualifications required of persons working in a facility of that
10075	type.
10076	(9)(12)(a)  As a condition of registration and prior to the
10077	issuance or renewal of a certificate of registration, a health
10078	care services pool applicant must prove financial responsibility
10079	to pay claims, and costs ancillary thereto, arising out of the
10080	rendering of services or failure to render services by the pool
10081	or by its employees in the course of their employment with the
10082	pool. The agency shall promulgate rules establishing minimum
10083	financial responsibility coverage amounts which shall be
10084	adequate to pay potential claims and costs ancillary thereto.
10085	(b)  Each health care services pool shall give written
10086	notification to the agency within 20 days after any change in
10087	the method of assuring financial responsibility or upon
10088	cancellation or nonrenewal of professional liability insurance.
10089	Unless the pool demonstrates that it is otherwise in compliance
10090	with the requirements of this section, the agency shall suspend
10091	the registration of the pool pursuant to ss. 120.569 and 120.57.
10092	Any suspension under this section shall remain in effect until
10093	the pool demonstrates compliance with the requirements of this
10094	section.
10095	(c)  Proof of financial responsibility must be demonstrated
10096	to the satisfaction of the agency, through one of the following
10097	methods:
10098	1.  Establishing and maintaining an escrow account
10099	consisting of cash or assets eligible for deposit in accordance
10100	with s. 625.52;
10101	2.  Obtaining and maintaining an unexpired irrevocable
10102	letter of credit established pursuant to chapter 675. Such
10103	letters of credit shall be nontransferable and nonassignable and
10104	shall be issued by any bank or savings association organized and
10105	existing under the laws of this state or any bank or savings
10106	association organized under the laws of the United States that
10107	has its principal place of business in this state or has a
10108	branch office which is authorized under the laws of this state
10109	or of the United States to receive deposits in this state; or
10110	3.  Obtaining and maintaining professional liability
10111	coverage from one of the following:
10112	a.  An authorized insurer as defined under s. 624.09;
10113	b.  An eligible surplus lines insurer as defined under s.
10114	626.918(2);
10115	c.  A risk retention group or purchasing group as defined
10116	under s. 627.942; or
10117	d.  A plan of self-insurance as provided in s. 627.357.
10118	(d)  If financial responsibility requirements are met by
10119	maintaining an escrow account or letter of credit, as provided
10120	in this section, upon the entry of an adverse final judgment
10121	arising from a medical malpractice arbitration award from a
10122	claim of medical malpractice either in contract or tort, or from
10123	noncompliance with the terms of a settlement agreement arising
10124	from a claim of medical malpractice either in contract or tort,
10125	the financial institution holding the escrow account or the
10126	letter of credit shall pay directly to the claimant the entire
10127	amount of the judgment together with all accrued interest or the
10128	amount maintained in the escrow account or letter of credit as
10129	required by this section, whichever is less, within 60 days
10130	after the date such judgment became final and subject to
10131	execution, unless otherwise mutually agreed to in writing by the
10132	parties. If timely payment is not made, the agency shall suspend
10133	the registration of the pool pursuant to procedures set forth by
10134	the agency through rule. Nothing in this paragraph shall
10135	abrogate a judgment debtor's obligation to satisfy the entire
10136	amount of any judgment.
10137	(e)  Each health care services pool carrying claims-made
10138	coverage must demonstrate proof of extended reporting coverage
10139	through either tail or nose coverage, in the event the policy is
10140	canceled, replaced, or not renewed. Such extended coverage shall
10141	provide coverage for incidents that occurred during the claims-
10142	made policy period but were reported after the policy period.
10143	(f)  The financial responsibility requirements of this
10144	section shall apply to claims for incidents that occur on or
10145	after January 1, 1991, or the initial date of registration in
10146	this state, whichever is later.
10147	(g)  Meeting the financial responsibility requirements of
10148	this section must be established at the time of issuance or
10149	renewal of a certificate of registration.
10150	(10)(13)  The agency shall adopt rules to implement this
10151	section and part II of chapter 408, including rules providing
10152	for the establishment of:
10153	(a)  Minimum standards for the operation and administration
10154	of health care personnel pools, including procedures for
10155	recordkeeping and personnel.
10156	(b)  In accordance with part II of chapter 408, fines for
10157	the violation of this part, part II of chapter 408, or
10158	applicable rules section in an amount not to exceed $2,500 and
10159	suspension or revocation of registration.
10160	(c)  Disciplinary sanctions for failure to comply with this
10161	section or the rules adopted under this section.
10162	Section 191.  Section 400.991, Florida Statutes, is amended
10163	to read:
10164	400.991  License requirements; background screenings;
10165	prohibitions.--
10166	(1)(a)  The requirements of part II of chapter 408 shall
10167	apply to the provision of services that require licensure
10168	pursuant to this part and part II of chapter 408 and to entities
10169	licensed by or applying for such licensure from the agency
10170	pursuant to this part. However, each applicant for licensure and
10171	each licensee is exempt from the provisions of s. 408.810(6),
10172	(7), and (10). Each clinic, as defined in s. 400.9905, must be
10173	licensed and shall at all times maintain a valid license with
10174	the agency. Each clinic location shall be licensed separately
10175	regardless of whether the clinic is operated under the same
10176	business name or management as another clinic.
10177	(b)  Each mobile clinic must obtain a separate health care
10178	clinic license and must provide to the agency, at least
10179	quarterly, its projected street location to enable the agency to
10180	locate and inspect such clinic. A portable equipment provider
10181	must obtain a health care clinic license for a single
10182	administrative office and is not required to submit quarterly
10183	projected street locations.
10184	(2)  The initial clinic license application shall be filed
10185	with the agency by all clinics, as defined in s. 400.9905, on or
10186	before July 1, 2004. A clinic license must be renewed
10187	biennially.
10188	(3)  Applicants that submit an application on or before
10189	July 1, 2004, which meets all requirements for initial licensure
10190	as specified in this section shall receive a temporary license
10191	until the completion of an initial inspection verifying that the
10192	applicant meets all requirements in rules authorized in s.
10193	400.9925. However, a clinic engaged in magnetic resonance
10194	imaging services may not receive a temporary license unless it
10195	presents evidence satisfactory to the agency that such clinic is
10196	making a good faith effort and substantial progress in seeking
10197	accreditation required under s. 400.9935.
10198	(4)  Application for an initial clinic license or for
10199	renewal of an existing license shall be notarized on forms
10200	furnished by the agency and must be accompanied by the
10201	appropriate license fee as provided in s. 400.9925. The agency
10202	shall take final action on an initial license application within
10203	60 days after receipt of all required documentation.
10204	(4)(5)  The application shall contain information that
10205	includes, but need not be limited to, information pertaining to
10206	the name, residence and business address, phone number, social
10207	security number, and license number of the medical or clinic
10208	director, of the licensed medical providers employed or under
10209	contract with the clinic, and of each person who, directly or
10210	indirectly, owns or controls 5 percent or more of an interest in
10211	the clinic, or general partners in limited liability
10212	partnerships.
10213	(5)(6)  The applicant must file with the application
10214	satisfactory proof that the clinic is in compliance with this
10215	part and applicable rules, including:
10216	(a)  A listing of services to be provided either directly
10217	by the applicant or through contractual arrangements with
10218	existing providers;
10219	(b)  The number and discipline of each professional staff
10220	member to be employed; and
10221	(c)  Proof of financial ability to operate. An applicant
10222	must demonstrate financial ability to operate a clinic by
10223	submitting a balance sheet and an income and expense statement
10224	for the first year of operation which provide evidence of the
10225	applicant's having sufficient assets, credit, and projected
10226	revenues to cover liabilities and expenses. The applicant shall
10227	have demonstrated financial ability to operate if the
10228	applicant's assets, credit, and projected revenues meet or
10229	exceed projected liabilities and expenses. All documents
10230	required under this subsection must be prepared in accordance
10231	with generally accepted accounting principles, may be in a
10232	compilation form, and the financial statement must be signed by
10233	a certified public accountant. As an alternative to submitting
10234	proof of financial ability to operate as required under s.
10235	408.810(8) a balance sheet and an income and expense statement
10236	for the first year of operation, the applicant may file a surety
10237	bond of at least $500,000 which guarantees that the clinic will
10238	act in full conformity with all legal requirements for operating
10239	a clinic, payable to the agency. The agency may adopt rules to
10240	specify related requirements for such surety bond.
10241	(6)(7)  Background screening required under s. 408.809
10242	shall also apply to licensed medical providers at the clinic.
10243	Each applicant for licensure shall comply with the following
10244	requirements:
10245	(a)  As used in this subsection, the term "applicant" means
10246	individuals owning or controlling, directly or indirectly, 5
10247	percent or more of an interest in a clinic; the medical or
10248	clinic director, or a similarly titled person who is responsible
10249	for the day-to-day operation of the licensed clinic; the
10250	financial officer or similarly titled individual who is
10251	responsible for the financial operation of the clinic; and
10252	licensed health care practitioners at the clinic.
10253	(b)  Upon receipt of a completed, signed, and dated
10254	application, the agency shall require background screening of
10255	the applicant, in accordance with the level 2 standards for
10256	screening set forth in chapter 435. Proof of compliance with the
10257	level 2 background screening requirements of chapter 435 which
10258	has been submitted within the previous 5 years in compliance
10259	with any other health care licensure requirements of this state
10260	is acceptable in fulfillment of this paragraph. Applicants who
10261	own less than 10 percent of a health care clinic are not
10262	required to submit fingerprints under this section.
10263	(c)  Each applicant must submit to the agency, with the
10264	application, a description and explanation of any exclusions,
10265	permanent suspensions, or terminations of an applicant from the
10266	Medicare or Medicaid programs. Proof of compliance with the
10267	requirements for disclosure of ownership and control interest
10268	under the Medicaid or Medicare programs may be accepted in lieu
10269	of this submission. The description and explanation may indicate
10270	whether such exclusions, suspensions, or terminations were
10271	voluntary or not voluntary on the part of the applicant.
10272	(d)  A license may not be granted to a clinic if the
10273	applicant has been found guilty of, regardless of adjudication,
10274	or has entered a plea of nolo contendere or guilty to, any
10275	offense prohibited under the level 2 standards for screening set
10276	forth in chapter 435, or a violation of insurance fraud under s.
10277	817.234, within the past 5 years. If the applicant has been
10278	convicted of an offense prohibited under the level 2 standards
10279	or insurance fraud in any jurisdiction, the applicant must show
10280	that his or her civil rights have been restored prior to
10281	submitting an application.
10282	(e)  The agency may deny or revoke licensure if the
10283	applicant has falsely represented any material fact or omitted
10284	any material fact from the application required by this part.
10285	(8)  Requested information omitted from an application for
10286	licensure, license renewal, or transfer of ownership must be
10287	filed with the agency within 21 days after receipt of the
10288	agency's request for omitted information, or the application
10289	shall be deemed incomplete and shall be withdrawn from further
10290	consideration.
10291	(9)  The failure to file a timely renewal application shall
10292	result in a late fee charged to the facility in an amount equal
10293	to 50 percent of the current license fee.
10294	Section 192.  Section 400.9915, Florida Statutes, is
10295	amended to read:
10296	400.9915  Clinic inspections; Emergency suspension;
10297	costs.--
10298	(1)  Any authorized officer or employee of the agency shall
10299	make inspections of the clinic as part of the initial license
10300	application or renewal application. The application for a clinic
10301	license issued under this part or for a renewal license
10302	constitutes permission for an appropriate agency inspection to
10303	verify the information submitted on or in connection with the
10304	application or renewal.
10305	(2)  An authorized officer or employee of the agency may
10306	make unannounced inspections of clinics licensed pursuant to
10307	this part as are necessary to determine that the clinic is in
10308	compliance with this part and with applicable rules. A licensed
10309	clinic shall allow full and complete access to the premises and
10310	to billing records or information to any representative of the
10311	agency who makes an inspection to determine compliance with this
10312	part and with applicable rules.
10313	(1)(3)  Failure by a clinic licensed under this part to
10314	allow full and complete access to the premises and to billing
10315	records or information to any representative of the agency who
10316	makes a request to inspect the clinic to determine compliance
10317	with this part or failure by a clinic to employ a qualified
10318	medical director or clinic director constitutes a ground for
10319	emergency suspension of the license by the agency pursuant to s.
10320	120.60(6) and part II of chapter 408.
10321	(2)(4)  In addition to any administrative fines imposed,
10322	the agency may assess a fee equal to the cost of conducting a
10323	complaint investigation.
10324	Section 193.  Section 400.992, Florida Statutes, is
10325	repealed.
10326	Section 194.  Section 400.9925, Florida Statutes, is
10327	amended to read:
10328	400.9925  Rulemaking authority; license fees.--
10329	(1)  The agency shall adopt rules necessary to administer
10330	the clinic administration, regulation, and licensure program,
10331	including rules pursuant to this part and part II of chapter
10332	408, establishing the specific licensure requirements,
10333	procedures, forms, and fees. It shall adopt rules establishing a
10334	procedure for the biennial renewal of licenses. The agency may
10335	issue initial licenses for less than the full 2-year period by
10336	charging a prorated licensure fee and specifying a different
10337	renewal date than would otherwise be required for biennial
10338	licensure. The rules shall specify the expiration dates of
10339	licenses, the process of tracking compliance with financial
10340	responsibility requirements, and any other conditions of renewal
10341	required by law or rule.
10342	(2)  The agency shall adopt rules specifying limitations on
10343	the number of licensed clinics and licensees for which a medical
10344	director or a clinic director may assume responsibility for
10345	purposes of this part. In determining the quality of supervision
10346	a medical director or a clinic director can provide, the agency
10347	shall consider the number of clinic employees, the clinic
10348	location, and the health care services provided by the clinic.
10349	(3)  In accordance with s. 408.805, an applicant or a
10350	licensee shall pay a fee for each license application submitted
10351	under this part, part II of chapter 408, and applicable rules.
10352	The amount of the fee shall be established by rule and shall not
10353	exceed $2,000 per biennium. License application and renewal fees
10354	must be reasonably calculated by the agency to cover its costs
10355	in carrying out its responsibilities under this part, including
10356	the cost of licensure, inspection, and regulation of clinics,
10357	and must be of such amount that the total fees collected do not
10358	exceed the cost of administering and enforcing compliance with
10359	this part. Clinic licensure fees are nonrefundable and may not
10360	exceed $2,000. The agency shall adjust the license fee annually
10361	by not more than the change in the Consumer Price Index based on
10362	the 12 months immediately preceding the increase. All fees
10363	collected under this part must be deposited in the Health Care
10364	Trust Fund for the administration of this part.
10365	Section 195.  Section 400.993, Florida Statutes, is amended
10366	to read:
10367	400.993  Unlicensed clinics; reporting penalties; fines;
10368	verification of licensure status.--
10369	(1)  It is unlawful to own, operate, or maintain a clinic
10370	without obtaining a license under this part.
10371	(2)  Any person who owns, operates, or maintains an
10372	unlicensed clinic commits a felony of the third degree,
10373	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
10374	Each day of continued operation is a separate offense.
10375	(3)  Any person found guilty of violating subsection (2) a
10376	second or subsequent time commits a felony of the second degree,
10377	punishable as provided under s. 775.082, s. 775.083, or s.
10378	775.084. Each day of continued operation is a separate offense.
10379	(4)  Any person who owns, operates, or maintains an
10380	unlicensed clinic due to a change in this part or a modification
10381	in agency rules within 6 months after the effective date of such
10382	change or modification and who, within 10 working days after
10383	receiving notification from the agency, fails to cease operation
10384	or apply for a license under this part commits a felony of the
10385	third degree, punishable as provided in s. 775.082, s. 775.083,
10386	or s. 775.084. Each day of continued operation is a separate
10387	offense.
10388	(5)  Any clinic that fails to cease operation after agency
10389	notification may be fined for each day of noncompliance pursuant
10390	to this part.
10391	(6)  When a person has an interest in more than one clinic,
10392	and fails to obtain a license for any one of these clinics, the
10393	agency may revoke the license, impose a moratorium, or impose a
10394	fine pursuant to this part on any or all of the licensed clinics
10395	until such time as the unlicensed clinic is licensed or ceases
10396	operation.
10397	(7)  Any person aware of the operation of an unlicensed
10398	clinic must report that facility to the agency.
10399	(8)  In addition to the requirements of part II of chapter
10400	408, any health care provider who is aware of the operation of
10401	an unlicensed clinic shall report that facility to the agency.
10402	Failure to report a clinic that the provider knows or has
10403	reasonable cause to suspect is unlicensed shall be reported to
10404	the provider's licensing board.
10405	(9)  The agency may not issue a license to a clinic that
10406	has any unpaid fines assessed under this part.
10407	Section 196.  Section 400.9935, Florida Statutes, is
10408	amended to read:
10409	400.9935  Clinic responsibilities.--
10410	(1)  Each clinic shall appoint a medical director or clinic
10411	director who shall agree in writing to accept legal
10412	responsibility for the following activities on behalf of the
10413	clinic. The medical director or the clinic director shall:
10414	(a)  Have signs identifying the medical director or clinic
10415	director posted in a conspicuous location within the clinic
10416	readily visible to all patients.
10417	(b)  Ensure that all practitioners providing health care
10418	services or supplies to patients maintain a current active and
10419	unencumbered Florida license.
10420	(c)  Review any patient referral contracts or agreements
10421	executed by the clinic.
10422	(d)  Ensure that all health care practitioners at the
10423	clinic have active appropriate certification or licensure for
10424	the level of care being provided.
10425	(e)  Serve as the clinic records owner as defined in s.
10426	456.057.
10427	(f)  Ensure compliance with the recordkeeping, office
10428	surgery, and adverse incident reporting requirements of chapter
10429	456, the respective practice acts, and rules adopted under this
10430	part and part II of chapter 408.
10431	(g)  Conduct systematic reviews of clinic billings to
10432	ensure that the billings are not fraudulent or unlawful. Upon
10433	discovery of an unlawful charge, the medical director or clinic
10434	director shall take immediate corrective action. If the clinic
10435	performs only the technical component of magnetic resonance
10436	imaging, static radiographs, computed tomography, or positron
10437	emission tomography, and provides the professional
10438	interpretation of such services, in a fixed facility that is
10439	accredited by the Joint Commission on Accreditation of
10440	Healthcare Organizations or the Accreditation Association for
10441	Ambulatory Health Care, and the American College of Radiology;
10442	and if, in the preceding quarter, the percentage of scans
10443	performed by that clinic which was billed to all personal injury
10444	protection insurance carriers was less than 15 percent, the
10445	chief financial officer of the clinic may, in a written
10446	acknowledgment provided to the agency, assume the responsibility
10447	for the conduct of the systematic reviews of clinic billings to
10448	ensure that the billings are not fraudulent or unlawful.
10449	(2)  Any business that becomes a clinic after commencing
10450	operations must, within 5 days after becoming a clinic, file a
10451	license application under this part and shall be subject to all
10452	provisions of this part applicable to a clinic.
10453	(2)(3)  Any contract to serve as a medical director or a
10454	clinic director entered into or renewed by a physician or a
10455	licensed health care practitioner in violation of this part is
10456	void as contrary to public policy. This subsection shall apply
10457	to contracts entered into or renewed on or after March 1, 2004.
10458	(3)(4)  All charges or reimbursement claims made by or on
10459	behalf of a clinic that is required to be licensed under this
10460	part, but that is not so licensed, or that is otherwise
10461	operating in violation of this part, are unlawful charges, and
10462	therefore are noncompensable and unenforceable.
10463	(4)(5)  Any person establishing, operating, or managing an
10464	unlicensed clinic otherwise required to be licensed under this
10465	part, or any person who knowingly files a false or misleading
10466	license application or license renewal application, or false or
10467	misleading information related to such application or department
10468	rule, commits a felony of the third degree, punishable as
10469	provided in s. 775.082, s. 775.083, or s. 775.084.
10470	(5)(6)  Any licensed health care provider who violates this
10471	part is subject to discipline in accordance with this chapter
10472	and his or her respective practice act.
10473	(7)  The agency may fine, or suspend or revoke the license
10474	of, any clinic licensed under this part for operating in
10475	violation of the requirements of this part or the rules adopted
10476	by the agency.
10477	(8)  The agency shall investigate allegations of
10478	noncompliance with this part and the rules adopted under this
10479	part.
10480	(6)(9)  Any person or entity providing health care services
10481	which is not a clinic, as defined under s. 400.9905, may
10482	voluntarily apply for a certificate of exemption from licensure
10483	under its exempt status with the agency on a form that sets
10484	forth its name or names and addresses, a statement of the
10485	reasons why it cannot be defined as a clinic, and other
10486	information deemed necessary by the agency. An exemption is not
10487	transferable. The agency may charge an applicant for a
10488	certificate of exemption in an amount equal to $100 or the
10489	actual cost of processing the certificate, whichever is less.
10490	(10)  The clinic shall display its license in a conspicuous
10491	location within the clinic readily visible to all patients.
10492	(7)(11)(a)  Each clinic engaged in magnetic resonance
10493	imaging services must be accredited by the Joint Commission on
10494	Accreditation of Healthcare Organizations, the American College
10495	of Radiology, or the Accreditation Association for Ambulatory
10496	Health Care, within 1 year after licensure. However, a clinic
10497	may request a single, 6-month extension if it provides evidence
10498	to the agency establishing that, for good cause shown, such
10499	clinic can not be accredited within 1 year after licensure, and
10500	that such accreditation will be completed within the 6-month
10501	extension. After obtaining accreditation as required by this
10502	subsection, each such clinic must maintain accreditation as a
10503	condition of renewal of its license.
10504	(b)  The agency may deny the application or revoke the
10505	license of any entity formed for the purpose of avoiding
10506	compliance with the accreditation provisions of this subsection
10507	and whose principals were previously principals of an entity
10508	that was unable to meet the accreditation requirements within
10509	the specified timeframes. The agency may adopt rules as to the
10510	accreditation of magnetic resonance imaging clinics.
10511	(8)(12)  The agency shall give full faith and credit
10512	pertaining to any past variance and waiver granted to a magnetic
10513	resonance imaging clinic from rule 64-2002, Florida
10514	Administrative Code, by the Department of Health, until
10515	September 2004. After that date, such clinic must request a
10516	variance and waiver from the agency under s. 120.542.
10517	Section 197.  Section 400.994, Florida Statutes, is
10518	repealed.
10519	Section 198.  Section 400.9945, Florida Statutes, is
10520	repealed.
10521	Section 199.  Section 400.995, Florida Statutes, is amended
10522	to read:
10523	400.995  Agency administrative penalties.--
10524	(1)  The agency may deny the application for a license
10525	renewal, revoke or suspend the license, and impose
10526	administrative fines of up to $5,000 per violation for
10527	violations of the requirements of this part or rules of the
10528	agency. In determining if a penalty is to be imposed and in
10529	fixing the amount of the fine, the agency shall consider the
10530	following factors:
10531	(a)  The gravity of the violation, including the
10532	probability that death or serious physical or emotional harm to
10533	a patient will result or has resulted, the severity of the
10534	action or potential harm, and the extent to which the provisions
10535	of the applicable laws or rules were violated.
10536	(b)  Actions taken by the owner, medical director, or
10537	clinic director to correct violations.
10538	(c)  Any previous violations.
10539	(d)  The financial benefit to the clinic of committing or
10540	continuing the violation.
10541	(2)  Each day of continuing violation after the date fixed
10542	for termination of the violation, as ordered by the agency,
10543	constitutes an additional, separate, and distinct violation.
10544	(2)(3)  Any action taken to correct a violation shall be
10545	documented in writing by the owner, medical director, or clinic
10546	director of the clinic and verified through followup visits by
10547	agency personnel. The agency may impose a fine and, in the case
10548	of an owner-operated clinic, revoke and or deny a clinic's
10549	license when a clinic medical director or clinic director
10550	knowingly misrepresents actions taken to correct a violation.
10551	(4)  For fines that are upheld following administrative or
10552	judicial review, the violator shall pay the fine, plus interest
10553	at the rate as specified in s. 55.03, for each day beyond the
10554	date set by the agency for payment of the fine.
10555	(5)  Any unlicensed clinic that continues to operate after
10556	agency notification is subject to a $1,000 fine per day.
10557	(3)(6)  Any licensed clinic whose owner, medical director,
10558	or clinic director concurrently operates an unlicensed clinic
10559	shall be subject to an administrative fine of $5,000 per day.
10560	(7)  Any clinic whose owner fails to apply for a change-of-
10561	ownership license in accordance with s. 400.992 and operates the
10562	clinic under the new ownership is subject to a fine of $5,000.
10563	(4)(8)  The agency, as an alternative to or in conjunction
10564	with an administrative action against a clinic for violations of
10565	this part, part II of chapter 408, and adopted rules, shall make
10566	a reasonable attempt to discuss each violation and recommended
10567	corrective action with the owner, medical director, or clinic
10568	director of the clinic, prior to written notification. The
10569	agency, instead of fixing a period within which the clinic shall
10570	enter into compliance with standards, may request a plan of
10571	corrective action from the clinic which demonstrates a good
10572	faith effort to remedy each violation by a specific date,
10573	subject to the approval of the agency.
10574	(9)  Administrative fines paid by any clinic under this
10575	section shall be deposited into the Health Care Trust Fund.
10576	(5)(10)  If the agency issues a notice of intent to deny a
10577	license application after a temporary license has been issued
10578	pursuant to s. 400.991(3), the temporary license shall expire on
10579	the date of the notice and may not be extended during any
10580	proceeding for administrative or judicial review pursuant to
10581	chapter 120.
10582	Section 200.  Subsection (2) of section 401.265, Florida
10583	Statutes, is amended to read:
10584	401.265  Medical directors.--
10585	(2)  Each licensee medical director shall establish a
10586	quality assurance committee to provide for quality assurance
10587	review of all emergency medical technicians and paramedics
10588	providing basic life support or advanced life support services
10589	for that licensee. The medical director employed by the licensee
10590	or with whom the licensee has a contract shall provide medical
10591	direction and oversight of the licensee's quality assurance
10592	committee operating under his or her supervision. If the medical
10593	director has reasonable belief that conduct by an emergency
10594	medical technician or paramedic may constitute one or more
10595	grounds for discipline as provided by this part, he or she shall
10596	document facts and other information related to the alleged
10597	violation. The medical director shall report to the department
10598	any emergency medical technician or paramedic whom the medical
10599	director reasonably believes to have acted in a manner which
10600	might constitute grounds for disciplinary action. Such a report
10601	of disciplinary concern must include a statement and
10602	documentation of the specific acts of the disciplinary concern.
10603	Within 7 days after receipt of such a report, the department
10604	shall provide the emergency medical technician or paramedic a
10605	copy of the report of the disciplinary concern and documentation
10606	of the specific acts related to the disciplinary concern. If the
10607	department determines that the report is insufficient for
10608	disciplinary action against the emergency medical technician or
10609	paramedic pursuant to s. 401.411, the report shall be expunged
10610	from the record of the emergency medical technician or
10611	paramedic.
10612	Section 201.  Paragraph (b) of subsection (2) of section
10613	402.164, Florida Statutes, is amended to read:
10614	402.164  Legislative intent; definitions.--
10615	(2)  As used in ss. 402.164-402.167, the term:
10616	(b)  "Client" means a client as defined in s. 393.063, s.
10617	394.67, or s. 397.311, or s. 400.960, a forensic client or
10618	client as defined in s. 916.106, a child or youth as defined in
10619	s. 39.01, a child as defined in s. 827.01, a family as defined
10620	in s. 414.0252, a participant as defined in s. 400.551, a
10621	resident as defined in s. 400.402 or s. 400.960, a Medicaid
10622	recipient or recipient as defined in s. 409.901, a child
10623	receiving child care as defined in s. 402.302, a disabled adult
10624	as defined in s. 410.032 or s. 410.603, or a victim as defined
10625	in s. 39.01 or s. 415.102 as each definition applies within its
10626	respective chapter.
10627	Section 202.  Section 408.831, Florida Statutes, is amended
10628	to read:
10629	408.831  Denial, suspension, or revocation of a license,
10630	registration, certificate, or application.--
10631	(1)  In addition to any other remedies provided by law, the
10632	agency may deny each application or suspend or revoke each
10633	license, registration, or certificate of entities regulated or
10634	licensed by it:
10635	(a)  If the applicant, licensee, registrant, or
10636	certificateholder, or, in the case of a corporation,
10637	partnership, or other business entity, if any affiliated
10638	business entity, officer, director, agent, or managing employee
10639	of that business entity or any affiliated person, partner, or
10640	shareholder having an ownership interest equal to 5 percent or
10641	greater in that business entity, has failed to pay all
10642	outstanding fines, liens, or overpayments assessed by final
10643	order of the agency or final order of the Centers for Medicare
10644	and Medicaid Services, not subject to further appeal, unless a
10645	repayment plan is approved by the agency; or
10646	(b)  For failure to comply with any repayment plan.
10647	(2)  In reviewing any application requesting a change of
10648	ownership or change of the licensee, registrant, or
10649	certificateholder, the transferor shall, prior to agency
10650	approval of the change, repay or make arrangements to repay any
10651	amounts owed to the agency. Should the transferor fail to repay
10652	or make arrangements to repay the amounts owed to the agency,
10653	the issuance of a license, registration, or certificate to the
10654	transferee shall be delayed until repayment or until
10655	arrangements for repayment are made.
10656	(3)  This section provides standards of enforcement
10657	applicable to all entities licensed or regulated by the Agency
10658	for Health Care Administration. This section controls over any
10659	conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
10660	394, 395, 400, 408, 468, 483, and 641, and 765 or rules adopted
10661	pursuant to those chapters.
10662	Section 203.  Paragraph (g) of subsection (2) of section
10663	409.815, Florida Statutes, is amended to read:
10664	409.815  Health benefits coverage; limitations.--
10665	(2)  BENCHMARK BENEFITS.--In order for health benefits
10666	coverage to qualify for premium assistance payments for an
10667	eligible child under ss. 409.810-409.820, the health benefits
10668	coverage, except for coverage under Medicaid and Medikids, must
10669	include the following minimum benefits, as medically necessary.
10670	(g)  Behavioral health services.--
10671	1.  Mental health benefits include:
10672	a.  Inpatient services, limited to not more than 30
10673	inpatient days per contract year for psychiatric admissions, or
10674	residential services in facilities licensed under s.
10675	394.875(6)(8) or s. 395.003 in lieu of inpatient psychiatric
10676	admissions; however, a minimum of 10 of the 30 days shall be
10677	available only for inpatient psychiatric services when
10678	authorized by a physician; and
10679	b.  Outpatient services, including outpatient visits for
10680	psychological or psychiatric evaluation, diagnosis, and
10681	treatment by a licensed mental health professional, limited to a
10682	maximum of 40 outpatient visits each contract year.
10683	2.  Substance abuse services include:
10684	a.  Inpatient services, limited to not more than 7
10685	inpatient days per contract year for medical detoxification only
10686	and 30 days of residential services; and
10687	b.  Outpatient services, including evaluation, diagnosis,
10688	and treatment by a licensed practitioner, limited to a maximum
10689	of 40 outpatient visits per contract year.
10690	Section 204.  Subsection (8) of section 409.905, Florida
10691	Statutes, is amended to read:
10692	409.905  Mandatory Medicaid services.--The agency may make
10693	payments for the following services, which are required of the
10694	state by Title XIX of the Social Security Act, furnished by
10695	Medicaid providers to recipients who are determined to be
10696	eligible on the dates on which the services were provided. Any
10697	service under this section shall be provided only when medically
10698	necessary and in accordance with state and federal law.
10699	Mandatory services rendered by providers in mobile units to
10700	Medicaid recipients may be restricted by the agency. Nothing in
10701	this section shall be construed to prevent or limit the agency
10702	from adjusting fees, reimbursement rates, lengths of stay,
10703	number of visits, number of services, or any other adjustments
10704	necessary to comply with the availability of moneys and any
10705	limitations or directions provided for in the General
10706	Appropriations Act or chapter 216.
10707	(8)  NURSING FACILITY SERVICES.--The agency shall pay for
10708	24-hour-a-day nursing and rehabilitative services for a
10709	recipient in a nursing facility licensed under part II of
10710	chapter 400 or in a rural hospital, as defined in s. 395.602, or
10711	in a Medicare certified skilled nursing facility operated by a
10712	hospital, as defined by s. 395.002(10)(11), that is licensed
10713	under part I of chapter 395, and in accordance with provisions
10714	set forth in s. 409.908(2)(a), which services are ordered by and
10715	provided under the direction of a licensed physician. However,
10716	if a nursing facility has been destroyed or otherwise made
10717	uninhabitable by natural disaster or other emergency and another
10718	nursing facility is not available, the agency must pay for
10719	similar services temporarily in a hospital licensed under part I
10720	of chapter 395 provided federal funding is approved and
10721	available. The agency shall pay only for bed-hold days if the
10722	facility has an occupancy rate of 95 percent or greater. The
10723	agency is authorized to seek any federal waivers to implement
10724	this policy.
10725	Section 205.  Subsection (7) of section 409.907, Florida
10726	Statutes, is amended to read:
10727	409.907  Medicaid provider agreements.--The agency may make
10728	payments for medical assistance and related services rendered to
10729	Medicaid recipients only to an individual or entity who has a
10730	provider agreement in effect with the agency, who is performing
10731	services or supplying goods in accordance with federal, state,
10732	and local law, and who agrees that no person shall, on the
10733	grounds of handicap, race, color, or national origin, or for any
10734	other reason, be subjected to discrimination under any program
10735	or activity for which the provider receives payment from the
10736	agency.
10737	(7)  The agency may require, as a condition of
10738	participating in the Medicaid program and before entering into
10739	the provider agreement, that the provider submit information, in
10740	an initial and any required renewal applications, concerning the
10741	professional, business, and personal background of the provider
10742	and permit an onsite inspection of the provider's service
10743	location by agency staff or other personnel designated by the
10744	agency to perform this function. The agency shall perform a
10745	random onsite inspection, within 60 days after receipt of a
10746	fully complete new provider's application, of the provider's
10747	service location prior to making its first payment to the
10748	provider for Medicaid services to determine the applicant's
10749	ability to provide the services that the applicant is proposing
10750	to provide for Medicaid reimbursement. The agency is not
10751	required to perform an onsite inspection of a provider or
10752	program that is licensed by the agency, that provides services
10753	under waiver programs for home and community-based services, or
10754	that is licensed as a medical foster home by the Department of
10755	Children and Family Services. As a continuing condition of
10756	participation in the Medicaid program, a provider shall
10757	immediately notify the agency of any current or pending
10758	bankruptcy filing. Before entering into the provider agreement,
10759	or as a condition of continuing participation in the Medicaid
10760	program, the agency may also require that Medicaid providers
10761	reimbursed on a fee-for-services basis or fee schedule basis
10762	which is not cost-based, post a surety bond not to exceed
10763	$50,000 or the total amount billed by the provider to the
10764	program during the current or most recent calendar year,
10765	whichever is greater. For new providers, the amount of the
10766	surety bond shall be determined by the agency based on the
10767	provider's estimate of its first year's billing. If the
10768	provider's billing during the first year exceeds the bond
10769	amount, the agency may require the provider to acquire an
10770	additional bond equal to the actual billing level of the
10771	provider. A provider's bond shall not exceed $50,000 if a
10772	physician or group of physicians licensed under chapter 458,
10773	chapter 459, or chapter 460 has a 50 percent or greater
10774	ownership interest in the provider or if the provider is an
10775	assisted living facility licensed under part III of chapter 400.
10776	The bonds permitted by this section are in addition to the bonds
10777	referenced in s. 400.179(2)(4)(d). If the provider is a
10778	corporation, partnership, association, or other entity, the
10779	agency may require the provider to submit information concerning
10780	the background of that entity and of any principal of the
10781	entity, including any partner or shareholder having an ownership
10782	interest in the entity equal to 5 percent or greater, and any
10783	treating provider who participates in or intends to participate
10784	in Medicaid through the entity. The information must include:
10785	(a)  Proof of holding a valid license or operating
10786	certificate, as applicable, if required by the state or local
10787	jurisdiction in which the provider is located or if required by
10788	the Federal Government.
10789	(b)  Information concerning any prior violation, fine,
10790	suspension, termination, or other administrative action taken
10791	under the Medicaid laws, rules, or regulations of this state or
10792	of any other state or the Federal Government; any prior
10793	violation of the laws, rules, or regulations relating to the
10794	Medicare program; any prior violation of the rules or
10795	regulations of any other public or private insurer; and any
10796	prior violation of the laws, rules, or regulations of any
10797	regulatory body of this or any other state.
10798	(c)  Full and accurate disclosure of any financial or
10799	ownership interest that the provider, or any principal, partner,
10800	or major shareholder thereof, may hold in any other Medicaid
10801	provider or health care related entity or any other entity that
10802	is licensed by the state to provide health or residential care
10803	and treatment to persons.
10804	(d)  If a group provider, identification of all members of
10805	the group and attestation that all members of the group are
10806	enrolled in or have applied to enroll in the Medicaid program.
10807	Section 206.  Subsections (9) and (10) of section 440.102,
10808	Florida Statutes, are amended to read:
10809	440.102  Drug-free workplace program requirements.--The
10810	following provisions apply to a drug-free workplace program
10811	implemented pursuant to law or to rules adopted by the Agency
10812	for Health Care Administration:
10813	(9)  DRUG-TESTING STANDARDS FOR LABORATORIES.--
10814	(a)  The requirements of part II of chapter 408 shall apply
10815	to the provision of services that require licensure pursuant to
10816	this section and part II of chapter 408 and to entities licensed
10817	by or applying for such licensure from the agency pursuant to
10818	this section.
10819	(b)(a)  A laboratory may analyze initial or confirmation
10820	test specimens only if:
10821	1.  The laboratory obtains a license under part II of
10822	chapter 408 and s. 112.0455(17). Each applicant for licensure
10823	and each licensee must comply with all requirements of this
10824	section, part II of chapter 408, and applicable rules, except s.
10825	408.810(5)-(10). is licensed and approved by the Agency for
10826	Health Care Administration using criteria established by the
10827	United States Department of Health and Human Services as general
10828	guidelines for modeling the state drug-testing program pursuant
10829	to this section or the laboratory is certified by the United
10830	States Department of Health and Human Services.
10831	2.  The laboratory has written procedures to ensure the
10832	chain of custody.
10833	3.  The laboratory follows proper quality control
10834	procedures, including, but not limited to:
10835	a.  The use of internal quality controls, including the use
10836	of samples of known concentrations which are used to check the
10837	performance and calibration of testing equipment, and periodic
10838	use of blind samples for overall accuracy.
10839	b.  An internal review and certification process for drug
10840	test results, conducted by a person qualified to perform that
10841	function in the testing laboratory.
10842	c.  Security measures implemented by the testing laboratory
10843	to preclude adulteration of specimens and drug test results.
10844	d.  Other necessary and proper actions taken to ensure
10845	reliable and accurate drug test results.
10846	(c)(b)  A laboratory shall disclose to the medical review
10847	officer a written positive confirmed test result report within 7
10848	working days after receipt of the sample. All laboratory reports
10849	of a drug test result must, at a minimum, state:
10850	1.  The name and address of the laboratory that performed
10851	the test and the positive identification of the person tested.
10852	2.  Positive results on confirmation tests only, or
10853	negative results, as applicable.
10854	3.  A list of the drugs for which the drug analyses were
10855	conducted.
10856	4.  The type of tests conducted for both initial tests and
10857	confirmation tests and the minimum cutoff levels of the tests.
10858	5.  Any correlation between medication reported by the
10859	employee or job applicant pursuant to subparagraph (5)(b)2. and
10860	a positive confirmed drug test result.
10861
10862	A report must not disclose the presence or absence of any drug
10863	other than a specific drug and its metabolites listed pursuant
10864	to this section.
10865	(d)(c)  The laboratory shall submit to the Agency for
10866	Health Care Administration a monthly report with statistical
10867	information regarding the testing of employees and job
10868	applicants. The report must include information on the methods
10869	of analysis conducted, the drugs tested for, the number of
10870	positive and negative results for both initial tests and
10871	confirmation tests, and any other information deemed appropriate
10872	by the Agency for Health Care Administration. A monthly report
10873	must not identify specific employees or job applicants.
10874	(10)  RULES.--The Agency for Health Care Administration
10875	shall adopt rules pursuant to s. 112.0455, part II of chapter
10876	408, and criteria established by the United States Department of
10877	Health and Human Services as general guidelines for modeling
10878	drug-free workplace laboratories the state drug-testing program,
10879	concerning, but not limited to:
10880	(a)  Standards for licensing drug-testing laboratories and
10881	suspension and revocation of such licenses.
10882	(b)  Urine, hair, blood, and other body specimens and
10883	minimum specimen amounts that are appropriate for drug testing.
10884	(c)  Methods of analysis and procedures to ensure reliable
10885	drug-testing results, including standards for initial tests and
10886	confirmation tests.
10887	(d)  Minimum cutoff detection levels for each drug or
10888	metabolites of such drug for the purposes of determining a
10889	positive test result.
10890	(e)  Chain-of-custody procedures to ensure proper
10891	identification, labeling, and handling of specimens tested.
10892	(f)  Retention, storage, and transportation procedures to
10893	ensure reliable results on confirmation tests and retests.
10894	Section 207.  Subsections (5), (6), and (7) of section
10895	464.015, Florida Statutes, are renumbered as subsections (6),
10896	(7), and (8), respectively, present subsection (6) is amended,
10897	and a new subsection (5) is added to said section, to read:
10898	464.015  Titles and abbreviations; restrictions; penalty.--
10899	(5)  Only persons who hold valid certificates to practice
10900	as certified registered nurse anesthetists in this state shall
10901	have the right to use the title "Certified Registered Nurse
10902	Anesthetist," the term "anesthetist," and the abbreviation
10903	"C.R.N.A."
10904	(7)(6)  No person shall practice or advertise as, or assume
10905	the title of, "Registered nurse," "Licensed Practical Nurse,"
10906	"Certified Registered Nurse Anesthetist," "anesthetist," or
10907	"Advanced Registered Nurse Practitioner" or use the abbreviation
10908	"R.N.," "L.P.N.," "C.R.N.A.," or "A.R.N.P." or take any other
10909	action that would lead the public to believe that person was
10910	certified as such or is performing nursing services pursuant to
10911	the exception set forth in s. 464.022(8), unless that person is
10912	licensed or certified to practice as such.
10913	Section 208.  Paragraph (a) of subsection (2) of section
10914	464.016, Florida Statutes, is amended to read:
10915	464.016  Violations and penalties.--
10916	(2)  Each of the following acts constitutes a misdemeanor
10917	of the first degree, punishable as provided in s. 775.082 or s.
10918	775.083:
10919	(a)  Using the name or title "Nurse," "Registered Nurse,"
10920	"Licensed Practical Nurse," "Certified Registered Nurse
10921	Anesthetist," "Advanced Registered Nurse Practitioner," or any
10922	other name or title which implies that a person was licensed or
10923	certified as same, unless such person is duly licensed or
10924	certified.
10925	Section 209.  Paragraph (l) of subsection (1) of section
10926	468.505, Florida Statutes, is amended to read:
10927	468.505  Exemptions; exceptions.--
10928	(1)  Nothing in this part may be construed as prohibiting
10929	or restricting the practice, services, or activities of:
10930	(l)  A person employed by a nursing facility exempt from
10931	licensing under s. 395.002(12)(13), or a person exempt from
10932	licensing under s. 464.022.
10933	Section 210.  Subsection (3) is added to section 483.035,
10934	Florida Statutes, to read:
10935	483.035  Clinical laboratories operated by practitioners
10936	for exclusive use; licensure and regulation.--
10937	(3)  The requirements of part II of chapter 408 shall apply
10938	to the provision of services that require licensure pursuant to
10939	this part and part II of chapter 408 and to entities licensed by
10940	or applying for such licensure from the agency pursuant to this
10941	part. However, each applicant for licensure and each licensee is
10942	exempt from s. 408.810(5)-(10).
10943	Section 211.  Subsection (1) of section 483.051, Florida
10944	Statutes, is amended to read:
10945	483.051  Powers and duties of the agency.--The agency shall
10946	adopt rules to implement this part, which rules must include,
10947	but are not limited to, the following:
10948	(1)  LICENSING; QUALIFICATIONS.--The agency shall provide
10949	for biennial licensure of all clinical laboratories meeting the
10950	requirements of this part and shall prescribe the qualifications
10951	necessary for such licensure. A license issued for operating a
10952	clinical laboratory, unless sooner suspended or revoked, expires
10953	on the date set forth by the agency on the face of the license.
10954	Section 212.  Section 483.061, Florida Statutes, is amended
10955	to read:
10956	483.061  Inspection of clinical laboratories.--
10957	(1)  The agency shall ensure that each clinical laboratory
10958	subject to this part is inspected either onsite or offsite when
10959	deemed necessary by the agency, but at least every 2 years, for
10960	the purpose of evaluating the operation, supervision, and
10961	procedures of the facility to ensure compliance with this part.
10962	Collection stations and branch offices may be inspected either
10963	onsite or offsite, when deemed necessary by the agency. The
10964	agency may conduct or cause to be conducted the following
10965	announced or unannounced inspections at any reasonable time:
10966	(a)  An inspection conducted at the direction of the
10967	federal Health Care Financing Administration.
10968	(b)  A licensure inspection.
10969	(c)  A validation inspection.
10970	(d)  a complaint investigation, including a full licensure
10971	investigation with a review of all licensure standards as
10972	outlined in rule. Complaints received by the agency from
10973	individuals, organizations, or other sources are subject to
10974	review and investigation by the agency. If a complaint has been
10975	filed against a laboratory or if a laboratory has a substantial
10976	licensure deficiency, the agency may inspect the laboratory
10977	annually or as the agency considers necessary.
10978	(2) However, For laboratories operated under s. 483.035,
10979	biennial licensure inspections shall be scheduled so as to cause
10980	the least disruption to the practitioner's scheduled patients.
10981	(2)  The right of entry and inspection is extended to any
10982	premises that is maintained as a laboratory without a license,
10983	but such entry or inspection may not be made without the
10984	permission of the owner or person in charge of the laboratory,
10985	unless an inspection warrant as defined in s. 933.20 is first
10986	obtained.
10987	(3)  The agency may shall inspect an out-of-state clinical
10988	laboratory under this section at the expense of the out-of-state
10989	clinical laboratory to determine whether the laboratory meets
10990	the requirements of this part and part II of chapter 408.
10991	(4)  The agency shall accept, in lieu of its own periodic
10992	inspections for licensure, the survey of or inspection by
10993	private accrediting organizations that perform inspections of
10994	clinical laboratories accredited by such organizations,
10995	including postinspection activities required by the agency.
10996	(a)  The agency shall accept inspections performed by such
10997	organizations if the accreditation is not provisional, if such
10998	organizations perform postinspection activities required by the
10999	agency and provide the agency with all necessary inspection and
11000	postinspection reports and information necessary for
11001	enforcement, if such organizations apply standards equal to or
11002	exceeding standards established and approved by the agency, and
11003	if such accrediting organizations are approved by the federal
11004	Health Care Financing Administration to perform such
11005	inspections.
11006	(b)  The agency may conduct complaint investigations made
11007	against laboratories inspected by accrediting organizations.
11008	(c)  The agency may conduct sample validation inspections
11009	of laboratories inspected by accrediting organizations to
11010	evaluate the accreditation process used by an accrediting
11011	organization.
11012	(d)  The agency may conduct a full inspection if an
11013	accrediting survey has not been conducted within the previous 24
11014	months, and the laboratory must pay the appropriate inspection
11015	fee under s. 483.172.
11016	(e)  The agency shall develop, and adopt, by rule, criteria
11017	for accepting inspection and postinspection reports of
11018	accrediting organizations in lieu of conducting a state
11019	licensure inspection.
11020	Section 213.  Section 483.091, Florida Statutes, is amended
11021	to read:
11022	483.091  Clinical laboratory license.--A person may not
11023	conduct, maintain, or operate a clinical laboratory in this
11024	state, except a laboratory that is exempt under s. 483.031,
11025	unless the clinical laboratory has obtained a license from the
11026	agency. A clinical laboratory may not send a specimen drawn
11027	within this state to any clinical laboratory outside the state
11028	for examination unless the out-of-state laboratory has obtained
11029	a license from the agency. A license is valid only for the
11030	person or persons to whom it is issued and may not be sold,
11031	assigned, or transferred, voluntarily or involuntarily, and is
11032	not valid for any premises other than those for which the
11033	license is issued. However, A new license may be secured for the
11034	new location before the actual change, if the contemplated
11035	change complies with this part, part II of chapter 408, and the
11036	applicable rules adopted under this part. Application for a new
11037	clinical laboratory license must be made 60 days before a change
11038	in the ownership of the clinical laboratory.
11039	Section 214.  Section 483.101, Florida Statutes, is amended
11040	to read:
11041	483.101  Application for Clinical laboratory license.--
11042	(1)  An application for a clinical laboratory license must
11043	be made under oath by the owner or director of the clinical
11044	laboratory or by the public official responsible for operating a
11045	state, municipal, or county clinical laboratory or institution
11046	that contains a clinical laboratory, upon forms provided by the
11047	agency.
11048	(2)  Each applicant for licensure must comply with the
11049	following requirements:
11050	(a)  Upon receipt of a completed, signed, and dated
11051	application, the agency shall require background screening, in
11052	accordance with the level 2 standards for screening set forth in
11053	chapter 435, of the managing director or other similarly titled
11054	individual who is responsible for the daily operation of the
11055	laboratory and of the financial officer, or other similarly
11056	titled individual who is responsible for the financial operation
11057	of the laboratory, including billings for patient services. The
11058	applicant must comply with the procedures for level 2 background
11059	screening as set forth in chapter 435, as well as the
11060	requirements of s. 435.03(3).
11061	(b)  The agency may require background screening of any
11062	other individual who is an applicant if the agency has probable
11063	cause to believe that he or she has been convicted of a crime or
11064	has committed any other offense prohibited under the level 2
11065	standards for screening set forth in chapter 435.
11066	(c)  Proof of compliance with the level 2 background
11067	screening requirements of chapter 435 which has been submitted
11068	within the previous 5 years in compliance with any other health
11069	care licensure requirements of this state is acceptable in
11070	fulfillment of the requirements of paragraph (a).
11071	(d)  A provisional license may be granted to an applicant
11072	when each individual required by this section to undergo
11073	background screening has met the standards for the Department of
11074	Law Enforcement background check but the agency has not yet
11075	received background screening results from the Federal Bureau of
11076	Investigation, or a request for a disqualification exemption has
11077	been submitted to the agency as set forth in chapter 435 but a
11078	response has not yet been issued. A license may be granted to
11079	the applicant upon the agency's receipt of a report of the
11080	results of the Federal Bureau of Investigation background
11081	screening for each individual required by this section to
11082	undergo background screening which confirms that all standards
11083	have been met, or upon the granting of a disqualification
11084	exemption by the agency as set forth in chapter 435. Any other
11085	person who is required to undergo level 2 background screening
11086	may serve in his or her capacity pending the agency's receipt of
11087	the report from the Federal Bureau of Investigation. However,
11088	the person may not continue to serve if the report indicates any
11089	violation of background screening standards and a
11090	disqualification exemption has not been requested of and granted
11091	by the agency as set forth in chapter 435.
11092	(e)  Each applicant must submit to the agency, with its
11093	application, a description and explanation of any exclusions,
11094	permanent suspensions, or terminations of the applicant from the
11095	Medicare or Medicaid programs. Proof of compliance with the
11096	requirements for disclosure of ownership and control interests
11097	under the Medicaid or Medicare programs may be accepted in lieu
11098	of this submission.
11099	(f)  Each applicant must submit to the agency a description
11100	and explanation of any conviction of an offense prohibited under
11101	the level 2 standards of chapter 435 by a member of the board of
11102	directors of the applicant, its officers, or any individual
11103	owning 5 percent or more of the applicant. This requirement does
11104	not apply to a director of a not-for-profit corporation or
11105	organization if the director serves solely in a voluntary
11106	capacity for the corporation or organization, does not regularly
11107	take part in the day-to-day operational decisions of the
11108	corporation or organization, receives no remuneration for his or
11109	her services on the corporation or organization's board of
11110	directors, and has no financial interest and has no family
11111	members with a financial interest in the corporation or
11112	organization, provided that the director and the not-for-profit
11113	corporation or organization include in the application a
11114	statement affirming that the director's relationship to the
11115	corporation satisfies the requirements of this paragraph.
11116	(g)  A license may not be granted to an applicant if the
11117	applicant or managing employee has been found guilty of,
11118	regardless of adjudication, or has entered a plea of nolo
11119	contendere or guilty to, any offense prohibited under the level
11120	2 standards for screening set forth in chapter 435, unless an
11121	exemption from disqualification has been granted by the agency
11122	as set forth in chapter 435.
11123	(h)  The agency may deny or revoke licensure if the
11124	applicant:
11125	1.  Has falsely represented a material fact in the
11126	application required by paragraph (e) or paragraph (f), or has
11127	omitted any material fact from the application required by
11128	paragraph (e) or paragraph (f); or
11129	2.  Has had prior action taken against the applicant under
11130	the Medicaid or Medicare program as set forth in paragraph (e).
11131	(i)  An application for license renewal must contain the
11132	information required under paragraphs (e) and (f).
11133	(3)  A license must be issued authorizing the performance
11134	of one or more clinical laboratory procedures or one or more
11135	tests on each specialty or subspecialty. A separate license is
11136	required of all laboratories maintained on separate premises
11137	even if the laboratories are operated under the same management.
11138	Upon receipt of a request for an application for a clinical
11139	laboratory license, the agency shall provide to the applicant a
11140	copy of the rules relating to licensure and operations
11141	applicable to the laboratory for which licensure is sought.
11142	Section 215.  Section 483.106, Florida Statutes, is amended
11143	to read:
11144	483.106  Application for a certificate of exemption.--An
11145	application for a certificate of exemption must be made under
11146	oath by the owner or director of a clinical laboratory that
11147	performs only waived tests as defined in s. 483.041. A
11148	certificate of exemption authorizes a clinical laboratory to
11149	perform waived tests. Laboratories maintained on separate
11150	premises and operated under the same management may apply for a
11151	single certificate of exemption or multiple certificates of
11152	exemption. The agency shall, by rule, specify the process for
11153	biennially issuing certificates of exemption. Sections 483.011,
11154	483.021, 483.031, 483.041, 483.172, and 483.23, and 483.25 apply
11155	to a clinical laboratory that obtains a certificate of exemption
11156	under this section.
11157	Section 216.  Section 483.111, Florida Statutes, is amended
11158	to read:
11159	483.111  Limitations on licensure.--A license may be issued
11160	to a clinical laboratory to perform only those clinical
11161	laboratory procedures and tests that are within the specialties
11162	or subspecialties in which the clinical laboratory personnel are
11163	qualified. A license may not be issued unless the agency
11164	determines that the clinical laboratory is adequately staffed
11165	and equipped to operate in conformity with the requirements of
11166	this part, part II of chapter 408, and applicable the rules
11167	adopted under this part.
11168	Section 217.  Section 483.131, Florida Statutes, is
11169	repealed.
11170	Section 218.  Subsections (1) and (2) of section 483.172,
11171	Florida Statutes, are amended to read:
11172	483.172  License fees.--
11173	(1)  In accordance with s. 408.805, an applicant or a
11174	licensee shall pay a fee for each license application submitted
11175	under this part, part II of chapter 408, and applicable rules.
11176	The agency shall collect fees for all licenses issued under this
11177	part. Each fee is due at the time of application and must be
11178	payable to the agency to be deposited in the Health Care Trust
11179	Fund administered by the agency.
11180	(2)  The biennial license fee schedule is as follows,
11181	unless modified by rule:
11182	(a)  If a laboratory performs not more than 2,000 tests
11183	annually, the fee is $400.
11184	(b)  If a laboratory performs not more than 3 categories of
11185	procedures with a total annual volume of more than 2,000 but no
11186	more than 10,000 tests, the license fee is $965.
11187	(c)  If a laboratory performs at least 4 categories of
11188	procedures with a total annual volume of not more than 10,000
11189	tests, the license fee is $1,294.
11190	(d)  If a laboratory performs not more than 3 categories of
11191	procedures with a total annual volume of more than 10,000 but
11192	not more than 25,000 tests, the license fee is $1,592.
11193	(e)  If a laboratory performs at least 4 categories of
11194	procedures with a total annual volume of more than 10,000 but
11195	not more than 25,000 tests, the license fee is $2,103.
11196	(f)  If a laboratory performs a total of more than 25,000
11197	but not more than 50,000 tests annually, the license fee is
11198	$2,364.
11199	(g)  If a laboratory performs a total of more than 50,000
11200	but not more than 75,000 tests annually, the license fee is
11201	$2,625.
11202	(h)  If a laboratory performs a total of more than 75,000
11203	but not more than 100,000 tests annually, the license fee is
11204	$2,886.
11205	(i)  If a laboratory performs a total of more than 100,000
11206	but not more than 500,000 tests annually, the license fee is
11207	$3,397.
11208	(j)  If a laboratory performs a total of more than 500,000
11209	but not more than 1 million tests annually, the license fee is
11210	$3,658.
11211	(k)  If a laboratory performs a total of more than 1
11212	million tests annually, the license fee is $3,919.
11213	Section 219.  Section 483.201, Florida Statutes, is amended
11214	to read:
11215	483.201  Grounds for disciplinary action against clinical
11216	laboratories.--In addition to the requirements of part II of
11217	chapter 408, the following acts constitute grounds for which a
11218	disciplinary action specified in s. 483.221 may be taken against
11219	a clinical laboratory:
11220	(1)  Making a fraudulent statement on an application for a
11221	clinical laboratory license or any other document required by
11222	the agency.
11223	(1)(2)  Permitting unauthorized persons to perform
11224	technical procedures or to issue reports.
11225	(2)(3)  Demonstrating incompetence or making consistent
11226	errors in the performance of clinical laboratory examinations
11227	and procedures or erroneous reporting.
11228	(3)(4)  Performing a test and rendering a report thereon to
11229	a person not authorized by law to receive such services.
11230	(4)(5)  Knowingly having professional connection with or
11231	knowingly lending the use of the name of the licensed clinical
11232	laboratory or its director to an unlicensed clinical laboratory.
11233	(5)(6)  Violating or aiding and abetting in the violation
11234	of any provision of this part or the rules adopted under this
11235	part.
11236	(6)(7)  Failing to file any report required by the
11237	provisions of this part or the rules adopted under this part.
11238	(7)(8)  Reporting a test result for a clinical specimen if
11239	the test was not performed on the clinical specimen.
11240	(8)(9)  Performing and reporting tests in a specialty or
11241	subspecialty in which the laboratory is not licensed.
11242	(9)(10)  Knowingly advertising false services or
11243	credentials.
11244	(10)(11)  Failing to correct deficiencies within the time
11245	required by the agency.
11246	Section 220.  Section 483.221, Florida Statutes, is amended
11247	to read:
11248	483.221  Administrative fines penalties.--
11249	(1)(a)  In accordance with part II of chapter 408, the
11250	agency may deny, suspend, revoke, annul, limit, or deny renewal
11251	of a license or impose an administrative fine, not to exceed
11252	$1,000 per violation, for the violation of any provision of this
11253	part or rules adopted under this part. Each day of violation
11254	constitutes a separate violation and is subject to a separate
11255	fine.
11256	(2)(b)  In determining the penalty to be imposed for a
11257	violation, as provided in subsection (1) paragraph (a), the
11258	following factors must be considered:
11259	(a)1.  The severity of the violation, including the
11260	probability that death or serious harm to the health or safety
11261	of any person will result or has resulted; the severity of the
11262	actual or potential harm; and the extent to which the provisions
11263	of this part were violated.
11264	(b)2.  Actions taken by the licensee to correct the
11265	violation or to remedy complaints.
11266	(c)3.  Any previous violation by the licensee.
11267	(d)4.  The financial benefit to the licensee of committing
11268	or continuing the violation.
11269	(c)  All amounts collected under this section must be
11270	deposited into the Health Care Trust Fund administered by the
11271	agency.
11272	(2)  The agency may issue an emergency order immediately
11273	suspending, revoking, annulling, or limiting a license if it
11274	determines that any condition in the licensed facility presents
11275	a clear and present danger to public health or safety.
11276	Section 221.  Section 483.23, Florida Statutes, is amended
11277	to read:
11278	483.23  Offenses; criminal penalties.--
11279	(1)(a)  It is unlawful for any person to:
11280	1.  Operate, maintain, direct, or engage in the business of
11281	operating a clinical laboratory unless she or he has obtained a
11282	clinical laboratory license from the agency or is exempt under
11283	s. 483.031.
11284	1.2.  Conduct, maintain, or operate a clinical laboratory,
11285	other than an exempt laboratory or a laboratory operated under
11286	s. 483.035, unless the clinical laboratory is under the direct
11287	and responsible supervision and direction of a person licensed
11288	under part III of this chapter.
11289	2.3.  Allow any person other than an individual licensed
11290	under part III of this chapter to perform clinical laboratory
11291	procedures, except in the operation of a laboratory exempt under
11292	s. 483.031 or a laboratory operated under s. 483.035.
11293	3.4.  Violate or aid and abet in the violation of any
11294	provision of this part or the rules adopted under this part.
11295	(b)  The performance of any act specified in paragraph (a)
11296	constitutes a misdemeanor of the second degree, punishable as
11297	provided in s. 775.082 or s. 775.083.
11298	(2)  Any use or attempted use of a forged license under
11299	this part or part IV III of this chapter constitutes the crime
11300	of forgery.
11301	Section 222.  Section 483.25, Florida Statutes, is
11302	repealed.
11303	Section 223.  Section 483.291, Florida Statutes, is amended
11304	to read:
11305	483.291  Powers and duties of the agency; rules.--The
11306	agency shall adopt rules to implement this part and part II of
11307	chapter 408, which rules must include the following:
11308	(1)  LICENSING STANDARDS.--The agency shall license all
11309	multiphasic health testing centers meeting the requirements of
11310	this part and shall prescribe standards necessary for licensure.
11311	(2)  FEES.-- In accordance with s. 408.805, an applicant or
11312	a licensee shall pay a fee for each license application
11313	submitted under this part, part II of chapter 408, and
11314	applicable rules. The agency shall establish annual fees, which
11315	shall be reasonable in amount, for licensing of centers. The
11316	fees must be sufficient in amount to cover the cost of licensing
11317	and inspecting centers.
11318	(a)  The annual licensure fee is due at the time of
11319	application and is payable to the agency to be deposited in the
11320	Health Care Trust Fund administered by the agency. The license
11321	fee must be not less than $600 $300 or more than $2,000 per
11322	biennium $1,000.
11323	(b)  The fee for late filing of an application for license
11324	renewal is $200 and is in addition to the licensure fee due for
11325	renewing the license.
11326	(3)  ANNUAL LICENSING.--The agency shall provide for annual
11327	licensing of centers. Any center that fails to pay the proper
11328	fee or otherwise fails to qualify by the date of expiration of
11329	its license is delinquent, and its license is automatically
11330	canceled without notice or further proceeding. Upon cancellation
11331	of its license under this subsection, a center may have its
11332	license reinstated only upon application and qualification as
11333	provided for initial applicants and upon payment of all
11334	delinquent fees.
11335	(3)(4)  STANDARDS OF PERFORMANCE.--The agency shall
11336	prescribe standards for the performance of health testing
11337	procedures.
11338	(4)(5)  CONSTRUCTION OF CENTERS.--The agency may adopt
11339	rules to ensure that centers comply with all local, county,
11340	state, and federal standards for the construction, renovation,
11341	maintenance, or repair of centers, which standards must ensure
11342	the conduct and operation of the centers in a manner that will
11343	protect the public health.
11344	(5)(6)  SAFETY AND SANITARY CONDITIONS WITHIN THE CENTER
11345	AND ITS SURROUNDINGS.--The agency shall establish standards
11346	relating to safety and sanitary conditions within the center and
11347	its surroundings, including water supply; sewage; the handling
11348	of specimens; identification, segregation, and separation of
11349	biohazardous waste as required by s. 381.0098; storage of
11350	chemicals; workspace; firesafety; and general measures, which
11351	standards must ensure the protection of the public health. The
11352	agency shall determine compliance by a multiphasic health
11353	testing center with the requirements of s. 381.0098 by verifying
11354	that the center has obtained all required permits.
11355	(6)(7)  EQUIPMENT.--The agency shall establish minimum
11356	standards for center equipment essential to the proper conduct
11357	and operation of the center.
11358	(7)(8)  PERSONNEL.--The agency shall prescribe minimum
11359	qualifications for center personnel. A center may employ as a
11360	medical assistant a person who has at least one of the following
11361	qualifications:
11362	(a)  Prior experience of not less than 6 months as a
11363	medical assistant in the office of a licensed medical doctor or
11364	osteopathic physician or in a hospital, an ambulatory surgical
11365	center, a home health agency, or a health maintenance
11366	organization.
11367	(b)  Certification and registration by the American Medical
11368	Technologists Association or other similar professional
11369	association approved by the agency.
11370	(c)  Prior employment as a medical assistant in a licensed
11371	center for at least 6 consecutive months at some time during the
11372	preceding 2 years.
11373	Section 224.  Section 483.294, Florida Statutes, is amended
11374	to read:
11375	483.294  Inspection of centers.--The agency shall, at least
11376	once annually, inspect the premises and operations of all
11377	centers subject to licensure under this part, without prior
11378	notice to the centers, for the purpose of studying and
11379	evaluating the operation, supervision, and procedures of such
11380	facilities, to determine their compliance with agency standards
11381	and to determine their effect upon the health and safety of the
11382	people of this state.
11383	Section 225.  Section 483.30, Florida Statutes, is amended
11384	to read:
11385	483.30  Licensing of centers.--The requirements of part II
11386	of chapter 408 shall apply to the provision of services that
11387	require licensure pursuant to this part and part II of chapter
11388	408 and to entities licensed by or applying for such licensure
11389	from the agency pursuant to this part. However, each applicant
11390	for licensure and each licensee is exempt from s. 408.810(5)-
11391	(10).
11392	(1)  A person may not conduct, maintain, or operate a
11393	multiphasic health testing center in this state without
11394	obtaining a multiphasic health testing center license from the
11395	agency. The license is valid only for the person or persons to
11396	whom it is issued and may not be sold, assigned, or transferred,
11397	voluntarily or involuntarily. A license is not valid for any
11398	premises other than the center for which it is issued. However,
11399	a new license may be secured for the new location for a fixed
11400	center before the actual change, if the contemplated change is
11401	in compliance with this part and the rules adopted under this
11402	part. A center must be relicensed if a change of ownership
11403	occurs. Application for relicensure must be made 60 days before
11404	the change of ownership.
11405	(2)  Each applicant for licensure must comply with the
11406	following requirements:
11407	(a)  Upon receipt of a completed, signed, and dated
11408	application, the agency shall require background screening, in
11409	accordance with the level 2 standards for screening set forth in
11410	chapter 435, of the managing employee, or other similarly titled
11411	individual who is responsible for the daily operation of the
11412	center, and of the financial officer, or other similarly titled
11413	individual who is responsible for the financial operation of the
11414	center, including billings for patient services. The applicant
11415	must comply with the procedures for level 2 background screening
11416	as set forth in chapter 435, as well as the requirements of s.
11417	435.03(3).
11418	(b)  The agency may require background screening of any
11419	other individual who is an applicant if the agency has probable
11420	cause to believe that he or she has been convicted of a crime or
11421	has committed any other offense prohibited under the level 2
11422	standards for screening set forth in chapter 435.
11423	(c)  Proof of compliance with the level 2 background
11424	screening requirements of chapter 435 which has been submitted
11425	within the previous 5 years in compliance with any other health
11426	care licensure requirements of this state is acceptable in
11427	fulfillment of the requirements of paragraph (a).
11428	(d)  A provisional license may be granted to an applicant
11429	when each individual required by this section to undergo
11430	background screening has met the standards for the Department of
11431	Law Enforcement background check, but the agency has not yet
11432	received background screening results from the Federal Bureau of
11433	Investigation, or a request for a disqualification exemption has
11434	been submitted to the agency as set forth in chapter 435 but a
11435	response has not yet been issued. A license may be granted to
11436	the applicant upon the agency's receipt of a report of the
11437	results of the Federal Bureau of Investigation background
11438	screening for each individual required by this section to
11439	undergo background screening which confirms that all standards
11440	have been met, or upon the granting of a disqualification
11441	exemption by the agency as set forth in chapter 435. Any other
11442	person who is required to undergo level 2 background screening
11443	may serve in his or her capacity pending the agency's receipt of
11444	the report from the Federal Bureau of Investigation. However,
11445	the person may not continue to serve if the report indicates any
11446	violation of background screening standards and a
11447	disqualification exemption has not been requested of and granted
11448	by the agency as set forth in chapter 435.
11449	(e)  Each applicant must submit to the agency, with its
11450	application, a description and explanation of any exclusions,
11451	permanent suspensions, or terminations of the applicant from the
11452	Medicare or Medicaid programs. Proof of compliance with the
11453	requirements for disclosure of ownership and control interests
11454	under the Medicaid or Medicare programs may be accepted in lieu
11455	of this submission.
11456	(f)  Each applicant must submit to the agency a description
11457	and explanation of any conviction of an offense prohibited under
11458	the level 2 standards of chapter 435 by a member of the board of
11459	directors of the applicant, its officers, or any individual
11460	owning 5 percent or more of the applicant. This requirement does
11461	not apply to a director of a not-for-profit corporation or
11462	organization if the director serves solely in a voluntary
11463	capacity for the corporation or organization, does not regularly
11464	take part in the day-to-day operational decisions of the
11465	corporation or organization, receives no remuneration for his or
11466	her services on the corporation or organization's board of
11467	directors, and has no financial interest and has no family
11468	members with a financial interest in the corporation or
11469	organization, provided that the director and the not-for-profit
11470	corporation or organization include in the application a
11471	statement affirming that the director's relationship to the
11472	corporation satisfies the requirements of this paragraph.
11473	(g)  A license may not be granted to an applicant if the
11474	applicant or managing employee has been found guilty of,
11475	regardless of adjudication, or has entered a plea of nolo
11476	contendere or guilty to, any offense prohibited under the level
11477	2 standards for screening set forth in chapter 435, unless an
11478	exemption from disqualification has been granted by the agency
11479	as set forth in chapter 435.
11480	(h)  The agency may deny or revoke licensure if the
11481	applicant:
11482	1.  Has falsely represented a material fact in the
11483	application required by paragraph (e) or paragraph (f), or has
11484	omitted any material fact from the application required by
11485	paragraph (e) or paragraph (f); or
11486	2.  Has had prior action taken against the applicant under
11487	the Medicaid or Medicare program as set forth in paragraph (e).
11488	(i)  An application for license renewal must contain the
11489	information required under paragraphs (e) and (f).
11490	Section 226.  Section 483.302, Florida Statutes, is amended
11491	to read:
11492	483.302  Application for license.--
11493	(1)  Application for a license as required by s. 483.30
11494	must be made to the agency on forms furnished by it and must be
11495	accompanied by the appropriate license fee.
11496	(2)  The application for a license must shall contain:
11497	(1)(a)  A determination as to whether the facility will be
11498	fixed or mobile and the location for a fixed facility.
11499	(b)  The name and address of the owner if an individual; if
11500	the owner is a firm, partnership, or association, the name and
11501	address of every member thereof; if the owner is a corporation,
11502	its name and address and the name and address of its medical
11503	director and officers and of each person having at least a 10
11504	percent interest in the corporation.
11505	(2)(c)  The name of any person whose name is required on
11506	the application under the provisions of paragraph (b) and who
11507	owns at least a 10 percent interest in any professional service,
11508	firm, association, partnership, or corporation providing goods,
11509	leases, or services to the center for which the application is
11510	made, and the name and address of the professional service,
11511	firm, association, partnership, or corporation in which such
11512	interest is held.
11513	(d)  The name by which the facility is to be known.
11514	(3)(e)  The name, address, and Florida physician's license
11515	number of the medical director.
11516	Section 227.  Section 483.311, Florida Statutes, is
11517	repealed.
11518	Section 228.  Subsections (2) through (8) of section
11519	483.317, Florida Statutes, are renumbered as subsections (1)
11520	through (7), respectively, and present subsection (1) is amended
11521	to read:
11522	483.317  Grounds for disciplinary action against
11523	centers.--The following acts constitute grounds for which a
11524	disciplinary action specified in s. 483.32 may be taken against
11525	a center:
11526	(1)  Making a fraudulent statement on an application for a
11527	license or on any other document required by the agency pursuant
11528	to this part.
11529	Section 229.  Section 483.32, Florida Statutes, is amended
11530	to read:
11531	483.32  Administrative fines penalties.--
11532	(1)(a)  The agency may deny, suspend, revoke, annul, limit,
11533	or deny renewal of a license or impose an administrative fine,
11534	not to exceed $500 per violation, for the violation of any
11535	provision of this part, part II of chapter 408, or applicable
11536	rules adopted under this part. Each day of violation constitutes
11537	a separate violation and is subject to a separate fine.
11538	(2)(b)  In determining the amount of the fine to be levied
11539	for a violation, as provided in subsection (1) paragraph (a),
11540	the following factors shall be considered:
11541	(a)1.  The severity of the violation, including the
11542	probability that death or serious harm to the health or safety
11543	of any person will result or has resulted; the severity of the
11544	actual or potential harm; and the extent to which the provisions
11545	of this part were violated.
11546	(b)2.  Actions taken by the licensee to correct the
11547	violation or to remedy complaints.
11548	(c)3.  Any previous violation by the licensee.
11549	(d)4.  The financial benefit to the licensee of committing
11550	or continuing the violation.
11551	(c)  All amounts collected under this section must be
11552	deposited into the Health Care Trust Fund administered by the
11553	agency.
11554	(2)  The agency may issue an emergency order immediately
11555	suspending, revoking, annulling, or limiting a license when it
11556	determines that any condition in the licensed facility presents
11557	a clear and present danger to public health and safety.
11558	Section 230.  Subsections (2) and (3) of section 483.322,
11559	Florida Statutes, are renumbered as subsections (1) and (2),
11560	respectively, and present subsection (1) of said section is
11561	amended to read:
11562	483.322  Offenses.--It is unlawful for any person to:
11563	(1)  Operate, maintain, direct, or engage in the business
11564	of operating a multiphasic health testing center unless the
11565	person has obtained a license for the center.
11566	Section 231.  Section 483.328, Florida Statutes, is
11567	repealed.
11568	Section 232.  Subsection (2) of section 765.541, Florida
11569	Statutes, is amended to read:
11570	765.541  Certification of organizations engaged in the
11571	practice of cadaveric organ and tissue procurement.--The Agency
11572	for Health Care Administration shall:
11573	(2)  Adopt rules that set forth appropriate standards and
11574	guidelines for the program in accordance with ss. 765.541-
11575	765.546 and part II of chapter 408. These standards and
11576	guidelines must be substantially based on the existing laws of
11577	the Federal Government and this state and the existing standards
11578	and guidelines of the United Network for Organ Sharing (UNOS),
11579	the American Association of Tissue Banks (AATB), the South-
11580	Eastern Organ Procurement Foundation (SEOPF), the North American
11581	Transplant Coordinators Organization (NATCO), and the Eye Bank
11582	Association of America (EBAA). In addition, the Agency for
11583	Health Care Administration shall, before adopting these
11584	standards and guidelines, seek input from all organ procurement
11585	organizations, tissue banks, and eye banks based in this state;
11586	Section 233.  Subsection (1) of section 765.542, Florida
11587	Statutes, is amended to read:
11588	765.542  Certification of organ procurement organizations,
11589	tissue banks, and eye banks.--
11590	(1)  The requirements of part II of chapter 408 shall apply
11591	to the provision of services that require licensure pursuant to
11592	ss. 765.541-765.546 and part II of chapter 408 and to entities
11593	licensed or certified by or applying for such licensure or
11594	certification from the Agency for Health Care Administration
11595	pursuant to ss. 765.541-765.546. However, each applicant for
11596	licensure or certification and each certificateholder is exempt
11597	from s. 408.810(5)-(10). An organization, agency, or other
11598	entity may not engage in the practice of organ procurement in
11599	this state without being designated as an organ procurement
11600	organization by the secretary of the United States Department of
11601	Health and Human Services and being appropriately certified by
11602	the Agency for Health Care Administration. As used in this
11603	subsection, the term "procurement" includes the retrieval,
11604	processing, or distribution of human organs. A physician or
11605	organ procurement organization based outside this state is
11606	exempt from these certification requirements if:
11607	(a)  The organs are procured for an out-of-state patient
11608	who is listed on, or referred through, the United Network for
11609	Organ Sharing System; and
11610	(b)  The organs are procured through an agreement of an
11611	organ procurement organization certified by the state.
11612	Section 234.  Section 765.544, Florida Statutes, is amended
11613	to read:
11614	765.544  Fees; Florida Organ and Tissue Donor Education and
11615	Procurement Trust Fund.--
11616	(1)  In accordance with s. 408.805, an applicant or a
11617	certificateholder shall pay a fee for each application submitted
11618	under this part, part II of chapter 408, and applicable rules.
11619	The amount of the fee shall be as follows unless modified by
11620	rule: The Agency for Health Care Administration shall collect
11621	(a)  An initial application fee of $1,000 from organ
11622	procurement organizations and tissue banks and $500 from eye
11623	banks. The fee must be submitted with each application for
11624	initial certification and is nonrefundable.
11625	(b)(2)  The Agency for Health Care Administration shall
11626	assess Annual fees to be used, in the following order of
11627	priority, for the certification program, the advisory board,
11628	maintenance of the organ and tissue donor registry, and the
11629	organ and tissue donor education program in the following
11630	amounts, which may not exceed $35,000 per organization:
11631	1.(a)  Each general organ procurement organization shall
11632	pay the greater of $1,000 or 0.25 percent of its total revenues
11633	produced from procurement activity in this state by the
11634	certificateholder during its most recently completed fiscal year
11635	or operational year.
11636	2.(b)  Each bone and tissue procurement agency or bone and
11637	tissue bank shall pay the greater of $1,000 or 0.25 percent of
11638	its total revenues from procurement and processing activity in
11639	this state by the certificateholder during its most recently
11640	completed fiscal year or operational year.
11641	3.(c)  Each eye bank shall pay the greater of $500 or 0.25
11642	percent of its total revenues produced from procurement activity
11643	in this state by the certificateholder during its most recently
11644	completed fiscal year or operational year.
11645	(2)(3)  The Agency for Health Care Administration shall
11646	specify provide by rule the for administrative penalties for the
11647	purpose of ensuring adherence to the standards of quality and
11648	practice required by this chapter, part II of chapter 408, and
11649	applicable rules of the agency for continued certification.
11650	(3)(4)(a)  Proceeds from fees, administrative penalties,
11651	and surcharges collected pursuant to this section subsections
11652	(2) and (3) must be deposited into the Florida Organ and Tissue
11653	Donor Education and Procurement Trust Fund created by s.
11654	765.52155.
11655	(b)  Moneys deposited in the trust fund pursuant to this
11656	section must be used exclusively for the implementation,
11657	administration, and operation of the certification program and
11658	the advisory board, for maintaining the organ and tissue donor
11659	registry, and for organ and tissue donor education.
11660	(4)(5)  As used in this section, the term "procurement
11661	activity in this state" includes the bringing into this state
11662	for processing, storage, distribution, or transplantation of
11663	organs or tissues that are initially procured in another state
11664	or country.
11665	Section 235.  Subsection (4) of section 766.118, Florida
11666	Statutes, is amended to read:
11667	766.118  Determination of noneconomic damages.--
11668	(4)  LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF
11669	PRACTITIONERS PROVIDING EMERGENCY SERVICES AND
11670	CARE.--Notwithstanding subsections (2) and (3), with respect to
11671	a cause of action for personal injury or wrongful death arising
11672	from medical negligence of practitioners providing emergency
11673	services and care, as defined in s. 395.002(9)(10), or providing
11674	services as provided in s. 401.265, or providing services
11675	pursuant to obligations imposed by 42 U.S.C. s. 1395dd to
11676	persons with whom the practitioner does not have a then-existing
11677	health care patient-practitioner relationship for that medical
11678	condition:
11679	(a)  Regardless of the number of such practitioner
11680	defendants, noneconomic damages shall not exceed $150,000 per
11681	claimant.
11682	(b)  Notwithstanding paragraph (a), the total noneconomic
11683	damages recoverable by all claimants from all such practitioners
11684	shall not exceed $300,000.
11685
11686	The limitation provided by this subsection applies only to
11687	noneconomic damages awarded as a result of any act or omission
11688	of providing medical care or treatment, including diagnosis that
11689	occurs prior to the time the patient is stabilized and is
11690	capable of receiving medical treatment as a nonemergency
11691	patient, unless surgery is required as a result of the emergency
11692	within a reasonable time after the patient is stabilized, in
11693	which case the limitation provided by this subsection applies to
11694	any act or omission of providing medical care or treatment which
11695	occurs prior to the stabilization of the patient following the
11696	surgery.
11697	Section 236.  Section 766.316, Florida Statutes, is amended
11698	to read:
11699	766.316  Notice to obstetrical patients of participation in
11700	the plan.--Each hospital with a participating physician on its
11701	staff and each participating physician, other than residents,
11702	assistant residents, and interns deemed to be participating
11703	physicians under s. 766.314(4)(c), under the Florida Birth-
11704	Related Neurological Injury Compensation Plan shall provide
11705	notice to the obstetrical patients as to the limited no-fault
11706	alternative for birth-related neurological injuries. Such notice
11707	shall be provided on forms furnished by the association and
11708	shall include a clear and concise explanation of a patient's
11709	rights and limitations under the plan. The hospital or the
11710	participating physician may elect to have the patient sign a
11711	form acknowledging receipt of the notice form. Signature of the
11712	patient acknowledging receipt of the notice form raises a
11713	rebuttable presumption that the notice requirements of this
11714	section have been met. Notice need not be given to a patient
11715	when the patient has an emergency medical condition as defined
11716	in s. 395.002(8)(9)(b) or when notice is not practicable.
11717	Section 237.  Paragraph (b) of subsection (2) of section
11718	812.014, Florida Statutes, is amended to read:
11719	812.014  Theft.--
11720	(2)
11721	(b)1.  If the property stolen is valued at $20,000 or more,
11722	but less than $100,000;
11723	2.  The property stolen is cargo valued at less than
11724	$50,000 that has entered the stream of interstate or intrastate
11725	commerce from the shipper's loading platform to the consignee's
11726	receiving dock; or
11727	3.  The property stolen is emergency medical equipment,
11728	valued at $300 or more, that is taken from a facility licensed
11729	under chapter 395 or from an aircraft or vehicle permitted under
11730	chapter 401,
11731
11732	the offender commits grand theft in the second degree,
11733	punishable as a felony of the second degree, as provided in s.
11734	775.082, s. 775.083, or s. 775.084. Emergency medical equipment
11735	means mechanical or electronic apparatus used to provide
11736	emergency services and care as defined in s. 395.002(9)(10) or
11737	to treat medical emergencies.
11738	Section 238.  In case of conflict between the provisions of
11739	part II of chapter 408, Florida Statutes, and the authorizing
11740	statutes governing the licensure of health care providers by the
11741	Agency for Health Care Administration found in chapter 112,
11742	chapter 383, chapter 390, chapter 394, chapter 395, chapter 400,
11743	chapter 440, chapter 483, and chapter 765, Florida Statutes, the
11744	provisions of part II of chapter 408, Florida Statutes, shall
11745	prevail.
11746	Section 239.  Rules adopted by the Department of Elderly
11747	Affairs under parts III, V, VI, and VII of chapter 400, Florida
11748	Statutes, shall be transferred by a type two transfer, as
11749	defined in s. 20.06, Florida Statutes, to the Agency for Health
11750	Care Administration.
11751	Section 240.  Between October 1, 2005, and September 30,
11752	2006, inclusive, the Agency for Health Care Administration may
11753	issue any license for less than a 2-year period by charging a
11754	prorated licensure fee and specifying a different renewal date
11755	than would otherwise be required for biennial licensure.
11756	Section 241.  This act shall take effect October 1, 2005.

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