HB 7139

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5
6	A bill to be entitled
7	An act relating to emergency management; amending s.
8	252.355, F.S.; specifying additional entities and agencies
9	that are required to provide registration information to
10	persons with special needs for purposes of inclusion
11	within the registry of persons with special needs
12	maintained by local emergency management agencies;
13	providing that the Department of Community Affairs shall
14	be the designated lead agency responsible for community
15	education and outreach to the general public, including
16	persons with special needs, regarding registration as a
17	person with special needs, special needs shelters, and
18	general information regarding shelter stays; providing
19	that a person with special needs shall be allowed to bring
20	his or her service animal into a special needs shelter;
21	revising provisions with respect to the required
22	notification of residential utility customers of the
23	availability of the special needs registration program;
24	providing that special needs shelter roster information
25	shall be provided to local law enforcement agencies upon
26	request; creating s. 252.3568, F.S.; requiring the
27	Division of Emergency Management to address strategies for
28	the evacuation of persons with pets in the shelter
29	component of the state comprehensive emergency management
30	plan; providing for the inclusion of the requirement for
31	similar strategies within local comprehensive emergency
32	management plans; requiring the Department of Agriculture
33	and Consumer Services to provide specified assistance to
34	the division; creating s. 252.357, F.S., requiring the
35	Florida Comprehensive Emergency Management Plan to permit
36	the Agency for Health Care Administration to make initial
37	contact with each nursing home and assisted living
38	facility in a disaster area; requiring the agency to
39	annually publish an emergency telephone number that may be
40	used by nursing homes and assisted living facilities to
41	contact the agency; amending s. 252.385, F.S., relating to
42	public shelter space; requiring the Division of Emergency
43	Management of the Department of Community Affairs to
44	biennially prepare and submit a statewide emergency
45	shelter plan to the Governor and the Cabinet for approval;
46	providing plan requirements; requiring the Department of
47	Health to provide specified assistance to the division;
48	revising those facilities which are excluded as being
49	suitable for use as public hurricane evacuation shelters;
50	requiring local emergency management agencies to
51	coordinate with public facilities to determine readiness
52	prior to activation; amending s. 381.0303, F.S.; providing
53	for the operation and closure of special needs shelters;
54	providing that local Children's Medical Services offices
55	shall assume lead responsibility for specified
56	coordination with respect to the development of a plan for
57	the staffing and medical management of pediatric special
58	needs shelters; requiring such plans to conform to the
59	local comprehensive emergency management plan; requiring
60	county governments to assist the Department of Health with
61	nonmedical staffing and operation of special needs
62	shelters; requiring county health departments and
63	emergency management agencies to coordinate such efforts
64	to ensure appropriate staffing; providing that the
65	appropriate county health department, Children's Medical
66	Services office, and local emergency management agency
67	shall jointly determine the responsibility for medical
68	supervision in a special needs shelter; requiring the
69	local health department and emergency management agency to
70	coordinate efforts to ensure appropriate designation,
71	operation, and closure of special needs shelters;
72	requiring the Secretary of Elderly Affairs to convene
73	multiagency special needs shelter discharge planning teams
74	to assist local areas that are severely impacted by a
75	natural or manmade disaster that requires the use of
76	special needs shelters; providing duties and
77	responsibilities of such discharge planning teams;
78	providing for the inclusion of specified state agency
79	representatives on each discharge planning team; revising
80	provisions relating to reimbursement of health care
81	practitioners; providing for eligibility of specified
82	health care facilities for reimbursement when a
83	multiagency special needs shelter discharge planning team
84	discharges persons with special needs to such receiving
85	facilities; providing procedures and requirements with
86	respect to such reimbursement; requiring the department to
87	specify by rule expenses that are reimbursable and the
88	rate of reimbursement for services; revising provisions
89	which prescribe means of and procedures for reimbursement;
90	disallowing specified reimbursements; revising provisions
91	with respect to the organization, role, duties, and
92	composition of the special needs shelter interagency
93	committee; requiring the department to adopt specified
94	rules with respect to special needs shelters; amending ss.
95	400.492, 400.497, 400.506, 400.610, and 400.934, F.S.;
96	revising requirements with respect to the comprehensive
97	emergency management plans of home health agencies, nurse
98	registries, and hospices, and providing such requirements
99	with respect to home medical equipment providers, to
100	include the means by which continuing services will be
101	provided to patients who evacuate to special needs
102	shelters; authorizing the establishment of links to local
103	emergency operations centers for specified purposes;
104	revising requirements of a county health department with
105	respect to review of a comprehensive emergency management
106	plan submitted by a home health agency, nurse registry, or
107	hospice; providing requirements upon failure to submit a
108	plan or requested information to the department; providing
109	for imposition of a fine; revising requirements of the
110	Department of Health with respect to review of the plan of
111	a home health agency or hospice that operates in more than
112	one county; providing that the preparation and maintenance
113	of a comprehensive emergency management plan by a home
114	medical equipment provider is a requirement for licensure
115	and must meet minimum criteria established by the Agency
116	for Health Care Administration; providing plan
117	requirements; providing that the plan is subject to review
118	and approval by the county health department; requiring
119	each home medical equipment provider to maintain a current
120	prioritized list of patients who need continued services
121	during an emergency; amending s. 400.925, F.S.; defining
122	"life-supporting or life-sustaining equipment" for
123	purposes of pt. X of ch. 400, F.S., relating to home
124	medical equipment providers; amending s. 400.935, F.S.;
125	requiring the Agency for Health Care Administration to
126	adopt rules with respect to the comprehensive emergency
127	management plan prepared by a home medical equipment
128	services provider; amending s. 408.831, F.S.; providing
129	that entities regulated or licensed by the Agency for
130	Health Care Administration may exceed their licensed
131	capacity to act as a receiving facility under specified
132	circumstances; providing requirements while such entities
133	are in an overcapacity status; providing for issuance of
134	an inactive license to such licensees under specified
135	conditions; providing requirements and procedures with
136	respect to the issuance and reactivation of an inactive
137	license; providing fees; requiring certain health
138	insurance entities to waive time restrictions on refilling
139	prescriptions for medication during specified emergency
140	conditions; providing legislative findings with respect to
141	the equipping of all designated public special needs
142	hurricane evacuation shelters with permanent emergency
143	power generating capacity by a specified date; requiring
144	the Department of Community Affairs to work with local
145	communities to ensure a sufficient number of public
146	special needs shelters designated to meet anticipated
147	demand; specifying the percentage of local match for such
148	projects; providing an appropriation to the Department of
149	Community Affairs to establish a competitive award
150	process; specifying a limit with respect to administration
151	of the funding; providing legislative findings with
152	respect to retrofitting public hurricane evacuation
153	shelters; providing criteria for the retrofitting of a
154	public hurricane evacuation shelter; providing an
155	appropriation to the Department of Community Affairs to
156	establish a competitive award process; specifying a limit
157	with respect to administration of the funding; providing
158	an appropriation to implement the provisions of emergency
159	management plan reviews for home health agencies and nurse
160	registry, hospice, and home medical equipment providers;
161	providing an effective date.
162
163	Be It Enacted by the Legislature of the State of Florida:
164
165	Section 1.  Section 252.355, Florida Statutes, is amended
166	to read:
167	252.355  Registry of persons with special needs; notice.--
168	(1)  In order to meet the special needs of persons who
169	would need assistance during evacuations and sheltering because
170	of physical, mental, cognitive impairment, or sensory
171	disabilities, each local emergency management agency in the
172	state shall maintain a registry of persons with special needs
173	located within the jurisdiction of the local agency. The
174	registration shall identify those persons in need of assistance
175	and plan for resource allocation to meet those identified needs.
176	To assist the local emergency management agency in identifying
177	such persons, home health agencies, hospices, nurse registries,
178	home medical equipment providers, the Department of Children and
179	Family Services, the Department of Health, the Agency for Health
180	Care Administration, the Department of Education, the Agency for
181	Persons with Disabilities, Department of Labor and Employment
182	Security, and the Department of Elderly Affairs shall provide
183	registration information to all of their special needs clients
184	and to all people with special needs who receive services
185	incoming clients as a part of the intake process. The registry
186	shall be updated annually. The registration program shall give
187	persons with special needs the option of preauthorizing
188	emergency response personnel to enter their homes during search
189	and rescue operations if necessary to assure their safety and
190	welfare following disasters.
191	(2)  The Department of Community Affairs shall be the
192	designated lead agency responsible for community education and
193	outreach to the general public, including special needs clients,
194	regarding registration and special needs shelters and general
195	information regarding shelter stays.
196	(3)  A person with special needs shall be allowed to bring
197	his or her service animal into a special needs shelter in
198	accordance with s. 413.08.
199	(4)(2)  On or before May 1 of each year each electric
200	utility in the state shall annually notify residential customers
201	in its service area of the availability of the registration
202	program available through their local emergency management
203	agency with either:
204	(a)  An initial notification upon the activation of new
205	residential service with the electric utility followed by one
206	annual notification between January 1 and May 31; or
207	(b)  Two separate annual notifications between January 1
208	and May 31.
209
210	The notification required under this subsection may be made by
211	any available means, including, but not limited to, written,
212	electronic, or verbal notification, and may be made concurrently
213	with any other notification to residential customers required by
214	law or rule.
215	(5)(3)  All records, data, information, correspondence, and
216	communications relating to the registration of persons with
217	special needs as provided in subsection (1) are confidential and
218	exempt from the provisions of s. 119.07(1), except that such
219	information shall be available to other emergency response
220	agencies, as determined by the local emergency management
221	director. Local law enforcement agencies shall be provided
222	complete shelter roster information upon request.
223	(6)(4)  All appropriate agencies and community-based
224	service providers, including home health care providers,
225	hospices, nurse registries, and home medical equipment
226	providers, shall assist emergency management agencies by
227	collecting registration information for persons with special
228	needs as part of program intake processes, establishing programs
229	to increase the awareness of the registration process, and
230	educating clients about the procedures that may be necessary for
231	their safety during disasters. Clients of state or federally
232	funded service programs with physical, mental, cognitive
233	impairment, or sensory disabilities who need assistance in
234	evacuating, or when in shelters, must register as persons with
235	special needs.
236	Section 2.  Section 252.3568, Florida Statutes, is created
237	to read:
238	252.3568  Emergency sheltering of persons with pets.--In
239	accordance with the provisions of s. 252.35, the division shall
240	address strategies for the evacuation of persons with pets in
241	the shelter component of the state comprehensive emergency
242	management plan and shall include the requirement for similar
243	strategies in its standards and requirements for local
244	comprehensive emergency management plans. The Department of
245	Agriculture and Consumer Services shall assist the division in
246	determining strategies regarding this activity.
247	Section 3.  Section 252.357, Florida Statutes, is created
248	to read:
249	252.357  Monitoring of nursing homes and assisted living
250	facilities during disaster.--The Florida Comprehensive Emergency
251	Management Plan shall permit the Agency for Health Care
252	Administration, working from the agency's offices or in the
253	Emergency Operations Center, ESF-8, to make initial contact with
254	each nursing home and assisted living facility in the disaster
255	area. The agency, by July 15, 2006, and annually thereafter,
256	shall publish on the Internet an emergency telephone number that
257	may be used by nursing homes and assisted living facilities to
258	contact the agency on a schedule established by the agency to
259	report requests for assistance. The agency may also provide the
260	telephone number to each facility when it makes the initial
261	facility call.
262	Section 4.  Subsection (2) and paragraphs (a) and (b) of
263	subsection (4) of section 252.385, Florida Statutes, are amended
264	to read:
265	252.385  Public shelter space.--
266	(2)(a)  The division shall administer a program to survey
267	existing schools, universities, community colleges, and other
268	state-owned, municipally owned, and county-owned public
269	buildings and any private facility that the owner, in writing,
270	agrees to provide for use as a public hurricane evacuation
271	shelter to identify those that are appropriately designed and
272	located to serve as such shelters. The owners of the facilities
273	must be given the opportunity to participate in the surveys. The
274	state university boards of trustees Board of Regents, district
275	school boards, community college boards of trustees, and the
276	Department of Education are responsible for coordinating and
277	implementing the survey of public schools, universities, and
278	community colleges with the division or the local emergency
279	management agency.
280	(b)  By January 31 of each even-numbered year, the division
281	shall prepare and submit a statewide emergency shelter plan to
282	the Governor and the Cabinet for approval, subject to the
283	requirements for approval provided in s. 1013.37(2). The plan
284	shall identify the general location and square footage of
285	special needs shelters, by regional planning council region,
286	during the next 5 years. The plan shall also include information
287	on the availability of shelters that accept pets. The Department
288	of Health shall assist the division in determining the estimated
289	need for special needs shelter space and the adequacy of
290	facilities to meet the needs of persons with special needs based
291	on information from the registries of persons with special needs
292	and other information.
293	(4)(a)  Public facilities, including schools, postsecondary
294	education facilities, and other facilities owned or leased by
295	the state or local governments, but excluding hospitals, hospice
296	care facilities, assisted living facilities, or nursing homes,
297	which are suitable for use as public hurricane evacuation
298	shelters shall be made available at the request of the local
299	emergency management agencies. The local emergency management
300	agency shall coordinate with these entities to ensure that
301	designated facilities are ready to activate prior to a specific
302	hurricane or disaster. Such agencies shall coordinate with the
303	appropriate school board, university, community college, or
304	local governing board when requesting the use of such facilities
305	as public hurricane evacuation shelters.
306	(b)  The Department of Management Services shall
307	incorporate provisions for the use of suitable leased public
308	facilities as public hurricane evacuation shelters into lease
309	agreements for state agencies. Suitable leased public facilities
310	include leased public facilities that are solely occupied by
311	state agencies and have at least 2,000 square feet of net floor
312	area in a single room or in a combination of rooms having a
313	minimum of 400 square feet in each room. The net square footage
314	of floor area shall must be determined by subtracting from the
315	gross square footage the square footage of spaces such as
316	mechanical and electrical rooms, storage rooms, open corridors,
317	restrooms, kitchens, science or computer laboratories, shop or
318	mechanical areas, administrative offices, records vaults, and
319	crawl spaces.
320	Section 5.  Section 381.0303, Florida Statutes, is amended
321	to read:
322	381.0303  Health practitioner recruitment for Special needs
323	shelters.--
324	(1)  PURPOSE.--The purpose of this section is to provide
325	for the operation and closure of special needs shelters and to
326	designate the Department of Health, through its county health
327	departments, as the lead agency for coordination of the
328	recruitment of health care practitioners, as defined in s.
329	456.001(4), to staff special needs shelters in times of
330	emergency or disaster and to provide resources to the department
331	to carry out this responsibility. However, nothing in this
332	section prohibits a county health department from entering into
333	an agreement with a local emergency management agency to assume
334	the lead responsibility for recruiting health care
335	practitioners.
336	(2)  SPECIAL NEEDS SHELTER PLAN; STAFFING; STATE AGENCY
337	ASSISTANCE AND STAFFING.--Provided funds have been appropriated
338	to support medical services disaster coordinator positions in
339	county health departments:,
340	(a)  The department shall assume lead responsibility for
341	the local coordination of local medical and health care
342	providers, the American Red Cross, and other interested parties
343	in developing a plan for the staffing and medical management of
344	special needs shelters. The local Children's Medical Services
345	offices shall assume lead responsibility for the coordination of
346	local medical and health care providers, the American Red Cross,
347	and other interested parties in developing a plan for the
348	staffing and medical management of pediatric special needs
349	shelters. Plans shall conform to The plan shall be in
350	conformance with the local comprehensive emergency management
351	plan.
352	(b)(a)  County health departments shall, in conjunction
353	with the local emergency management agencies, have the lead
354	responsibility for coordination of the recruitment of health
355	care practitioners to staff local special needs shelters. County
356	health departments shall assign their employees to work in
357	special needs shelters when those employees are needed to
358	protect the health and safety of persons with special needs of
359	patients. County governments shall assist the department with
360	nonmedical staffing and the operation of special needs shelters.
361	The local health department and emergency management agency
362	shall coordinate these efforts to ensure appropriate staffing in
363	special needs shelters.
364	(c)(b)  The appropriate county health department,
365	Children's Medical Services office, and local emergency
366	management agency shall jointly decide determine who has
367	responsibility for medical supervision in each a special needs
368	shelter.
369	(d)(c)  Local emergency management agencies shall be
370	responsible for the designation and operation of special needs
371	shelters during times of emergency or disaster and the closure
372	of the facilities following an emergency or disaster. The local
373	health department and emergency management agency shall
374	coordinate these efforts to ensure the appropriate designation,
375	operation, and closure of special needs shelters. County health
376	departments shall assist the local emergency management agency
377	with regard to the management of medical services in special
378	needs shelters.
379	(e)  The Secretary of Elderly Affairs, or his or her
380	designee, shall convene, at any time that he or she deems
381	appropriate and necessary, a multiagency special needs shelter
382	discharge planning team or teams to assist local areas that are
383	severely impacted by a natural or manmade disaster that requires
384	the use of special needs shelters. Multiagency special needs
385	shelter discharge planning teams shall provide assistance to
386	local emergency management agencies with the continued operation
387	or closure of the shelters, as well as with the discharge of
388	special needs clients to alternate facilities if necessary.
389	Local emergency management agencies may request the assistance
390	of a multiagency special needs shelter discharge planning team
391	by alerting statewide emergency management officials of the
392	necessity for additional assistance in their area. The Secretary
393	of Elderly Affairs is encouraged to proactively work with other
394	state agencies prior to any natural disasters for which warnings
395	are provided to ensure that multiagency special needs shelter
396	discharge planning teams are ready to assemble and deploy
397	rapidly upon a determination by state emergency management
398	officials that a disaster area requires additional assistance.
399	The Secretary of Elderly Affairs may call upon any state agency
400	or office to provide staff to assist a multiagency special needs
401	shelter discharge planning team or teams. Unless the secretary
402	determines that the nature or circumstances surrounding the
403	disaster do not warrant participation from a particular agency's
404	staff, each multiagency special needs shelter discharge planning
405	team shall include at least one representative from each of the
406	following state agencies:
407	1.  Department of Elderly Affairs.
408	2.  Department of Health.
409	3.  Department of Children and Family Services.
410	4.  Department of Veterans' Affairs.
411	5.  Department of Community Affairs.
412	6.  Agency for Health Care Administration.
413	7.  Agency for Persons with Disabilities.
414	(3)  REIMBURSEMENT TO HEALTH CARE PRACTITIONERS AND
415	FACILITIES.--
416	(a)  The department of Health shall upon request reimburse,
417	in accordance with paragraph (b): subject to the availability of
418	funds for this purpose,
419	1.  Health care practitioners, as defined in s. 456.001,
420	provided the practitioner is not providing care to a patient
421	under an existing contract, and emergency medical technicians
422	and paramedics licensed under pursuant to chapter 401 for
423	medical care provided at the request of the department in
424	special needs shelters or at other locations during times of
425	emergency or a declared major disaster. Reimbursement for health
426	care practitioners, except for physicians licensed under
427	pursuant to chapter 458 or chapter 459, shall be based on the
428	average hourly rate that such practitioners were paid according
429	to the most recent survey of Florida hospitals conducted by the
430	Florida Hospital Association or other nationally or state
431	recognized data source. Reimbursement shall be requested on
432	forms prepared by the Department of Health.
433	2.  Health care facilities, such as hospitals, nursing
434	homes, assisted living facilities, and community residential
435	homes, if, upon closure of a special needs shelter, a
436	multiagency special needs shelter discharge planning team
437	determines that it is necessary to discharge persons with
438	special needs to other health care facilities. The receiving
439	facilities shall be eligible for reimbursement for services
440	provided to the individuals for up to 90 days. A facility must
441	show proof of a written request from a representative of an
442	agency serving on the multiagency special needs shelter
443	discharge planning team that the individual for whom the
444	facility is seeking reimbursement for services rendered was
445	referred to that facility from a special needs shelter. The
446	department shall specify by rule which expenses are reimbursable
447	and the rate of reimbursement for each service.
448	(b)  Reimbursement is subject to the availability of
449	federal funds and shall be requested on forms prepared by the
450	department. If a Presidential Disaster Declaration has been
451	issued made, and the Federal Government makes funds available,
452	the department shall request federal use such funds for
453	reimbursement of eligible expenditures. In other situations, or
454	if federal funds do not fully compensate the department for
455	reimbursement made pursuant to this section, the department
456	shall process a budget amendment to obtain reimbursement from
457	unobligated, unappropriated moneys in the General Revenue Fund.
458	The department shall not provide reimbursement to facilities
459	under this subsection for services provided to a person with
460	special needs if, during the period of time in which the
461	services were provided, the individual was enrolled in another
462	state-funded program, such as Medicaid or another similar
463	program, was covered under a policy of health insurance as
464	defined in s. 624.603, or was a member of a health maintenance
465	organization or prepaid health clinic as defined in chapter 641,
466	which would otherwise pay for the same services. Travel expense
467	and per diem costs shall be reimbursed pursuant to s. 112.061.
468	(4)  HEALTH CARE PRACTITIONER REGISTRY.--The department may
469	use the registries established in ss. 401.273 and 456.38 when
470	health care practitioners are needed to staff special needs
471	shelters or to assist with other disaster-related activities
472	staff disaster medical assistance teams.
473	(5)  SPECIAL NEEDS SHELTER INTERAGENCY COMMITTEE.--The
474	Secretary Department of Health may establish a special needs
475	shelter interagency committee and serve as or appoint a designee
476	to serve as the committee's chair. The department shall provide
477	any necessary staff and resources to support the committee in
478	the performance of its duties, to be chaired and staffed by the
479	department. The committee shall address and resolve problems
480	related to special needs shelters not addressed in the state
481	comprehensive emergency medical plan and shall consult on serve
482	as an oversight committee to monitor the planning and operation
483	of special needs shelters.
484	(a)  The committee shall may:
485	1.  Develop, and negotiate, and regularly review any
486	necessary interagency agreements.
487	2.  Undertake other such activities as the department deems
488	necessary to facilitate the implementation of this section.
489	3.  Submit recommendations to the Legislature as necessary.
490	(b)  The special needs shelter interagency committee shall
491	be composed of representatives of emergency management, health,
492	medical, and social services organizations. Membership shall
493	include, but shall not be limited to, representatives of the
494	Departments of Health, Community Affairs, Children and Family
495	Services, Elderly Affairs, Labor and Employment Security, and
496	Education; the Agency for Health Care Administration; the
497	Florida Medical Association; the Florida Osteopathic Medical
498	Association; Associated Home Health Industries of Florida, Inc.;
499	the Florida Nurses Association; the Florida Health Care
500	Association; the Florida Assisted Living Affiliation
501	Association; the Florida Hospital Association; the Florida
502	Statutory Teaching Hospital Council; the Florida Association of
503	Homes for the Aging; the Florida Emergency Preparedness
504	Association; the American Red Cross; Florida Hospices and
505	Palliative Care, Inc.; the Association of Community Hospitals
506	and Health Systems; the Florida Association of Health
507	Maintenance Organizations; the Florida League of Health Systems;
508	Private Care Association; and the Salvation Army; the Florida
509	Association of Aging Services Providers; AARP; and the Florida
510	Renal Coalition.
511	(c)  Meetings of the committee shall be held in
512	Tallahassee, and members of the committee shall serve at the
513	expense of the agencies or organizations they represent. The
514	committee shall make every effort to use teleconference or video
515	conference capabilities in order to ensure statewide input and
516	participation.
517	(6)  RULES.--The department has the authority to adopt
518	rules necessary to implement this section. Rules shall may
519	include:
520	(a)  The a definition of a "person with special needs",
521	including eligibility criteria for individuals with physical,
522	mental, cognitive impairment, or sensory disabilities and the
523	services a person with special needs can expect to receive in a
524	special needs shelter patient, specify physician reimbursement,
525	and designate which county health departments will have
526	responsibility for implementation of subsections (2) and (3).
527	(b)  The process for special needs shelter health care
528	practitioners and facility reimbursement for services provided
529	in a disaster.
530	(c)  Guidelines for special needs shelter staffing levels
531	to provide services.
532	(d)  The definition of and standards for special needs
533	shelter supplies and equipment, including durable medical
534	equipment.
535	(e)  Standards for the special needs shelter registration
536	process, including guidelines for addressing the needs of
537	unregistered persons in need of a special needs shelter.
538	(f)  Standards for addressing the needs of families where
539	only one dependent is eligible for admission to a special needs
540	shelter and the needs of adults with special needs who are
541	caregivers for individuals without special needs.
542	(g)  The requirement of the county health departments to
543	seek the participation of hospitals, nursing homes, assisted
544	living facilities, home health agencies, hospice providers,
545	nurse registries, home medical equipment providers, dialysis
546	centers, and other health and medical emergency preparedness
547	stakeholders in pre-event planning activities.
548	(7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
549	of emergency management plans to county health departments by
550	home health agencies, pursuant to s. 400.497(8)(c) and (d) and
551	by nurse registries, pursuant to s. 400.506(16)(e) and by
552	hospice programs, pursuant to s. 400.610(1)(b) and home medical
553	equipment providers is conditional upon the receipt of an
554	appropriation by the department to establish medical services
555	disaster coordinator positions in county health departments
556	unless the secretary of the department and a local county
557	commission jointly determine to require such plans to be
558	submitted based on a determination that there is a special need
559	to protect public health in the local area during an emergency.
560	Section 6.  Section 400.492, Florida Statutes, is amended
561	to read:
562	400.492  Provision of services during an emergency.--Each
563	home health agency shall prepare and maintain a comprehensive
564	emergency management plan that is consistent with the standards
565	adopted by national or state accreditation organizations and
566	consistent with the local special needs plan. The plan shall be
567	updated annually and shall provide for continuing home health
568	services during an emergency that interrupts patient care or
569	services in the patient's home. The plan shall include the means
570	by which the home health agency will continue to provide staff
571	to perform the same type and quantity of services to their
572	patients who evacuate to special needs shelters that were being
573	provided to those patients prior to evacuation. The plan shall
574	describe how the home health agency establishes and maintains an
575	effective response to emergencies and disasters, including:
576	notifying staff when emergency response measures are initiated;
577	providing for communication between staff members, county health
578	departments, and local emergency management agencies, including
579	a backup system; identifying resources necessary to continue
580	essential care or services or referrals to other organizations
581	subject to written agreement; and prioritizing and contacting
582	patients who need continued care or services.
583	(1)  Each patient record for patients who are listed in the
584	registry established pursuant to s. 252.355 shall include a
585	description of how care or services will be continued in the
586	event of an emergency or disaster. The home health agency shall
587	discuss the emergency provisions with the patient and the
588	patient's caregivers, including where and how the patient is to
589	evacuate, procedures for notifying the home health agency in the
590	event that the patient evacuates to a location other than the
591	shelter identified in the patient record, and a list of
592	medications and equipment which must either accompany the
593	patient or will be needed by the patient in the event of an
594	evacuation.
595	(2)  Each home health agency shall maintain a current
596	prioritized list of patients who need continued services during
597	an emergency. The list shall indicate how services shall be
598	continued in the event of an emergency or disaster for each
599	patient and if the patient is to be transported to a special
600	needs shelter, and shall indicate if the patient is receiving
601	skilled nursing services and the patient's medication and
602	equipment needs. The list shall be furnished to county health
603	departments and to local emergency management agencies, upon
604	request.
605	(3)  Home health agencies shall not be required to continue
606	to provide care to patients in emergency situations that are
607	beyond their control and that make it impossible to provide
608	services, such as when roads are impassable or when patients do
609	not go to the location specified in their patient records. Home
610	health agencies may establish links to local emergency
611	operations centers to determine a mechanism to approach specific
612	areas within a disaster area in order for the agency to reach
613	its clients. Home health agencies shall demonstrate a good faith
614	effort to comply with the requirements of this subsection by
615	documenting attempts of staff to follow procedures as outlined
616	in the home health agency's comprehensive emergency management
617	plan, and by the patient's record, which support a finding that
618	attempts were made to provide continuing care for those patients
619	who have been identified as needing care by the home health
620	agency and who are registered under s. 252.355 in the event of
621	an emergency or disaster under subsection (1).
622	(4)  Notwithstanding the provisions of s. 400.464(2) or any
623	other provision of law to the contrary, a home health agency may
624	provide services in a special needs shelter located in any
625	county.
626	Section 7.  Paragraphs (c) and (d) of subsection (8) of
627	section 400.497, Florida Statutes, are amended to read:
628	400.497  Rules establishing minimum standards.--The agency
629	shall adopt, publish, and enforce rules to implement this part,
630	including, as applicable, ss. 400.506 and 400.509, which must
631	provide reasonable and fair minimum standards relating to:
632	(8)  Preparation of a comprehensive emergency management
633	plan pursuant to s. 400.492.
634	(c)  The plan is subject to review and approval by the
635	county health department. During its review, the county health
636	department shall contact state and local health and medical
637	stakeholders during its review when necessary. ensure that the
638	following agencies, at a minimum, are given the opportunity to
639	review the plan:
640	1.  The local emergency management agency.
641	2.  The Agency for Health Care Administration.
642	3.  The local chapter of the American Red Cross or other
643	lead sheltering agency.
644	4.  The district office of the Department of Children and
645	Family Services.
646
647	The county health department shall complete its review to ensure
648	that the plan is in accordance with the criteria set forth in
649	the rules of the Agency for Health Care Administration within 90
650	60 days after receipt of the plan and shall either approve the
651	plan or advise the home health agency of necessary revisions. If
652	the home health agency fails to submit a plan or fails to submit
653	the requested information or revisions to the county health
654	department within 30 days after written notification from the
655	county health department, the county health department shall
656	notify the Agency for Health Care Administration. The agency
657	shall notify the home health agency that such failure
658	constitutes a deficiency, subject to a fine of $5,000 per
659	occurrence. If the plan is not submitted, information is not
660	provided, or revisions are not made as requested, the agency may
661	impose the fine.
662	(d)  For any home health agency that operates in more than
663	one county, the Department of Health shall review the plan,
664	after consulting with state and local health and medical
665	stakeholders, when necessary all of the county health
666	departments, the agency, and all the local chapters of the
667	American Red Cross or other lead sheltering agencies in the
668	areas of operation for that particular home health agency. The
669	department of Health shall complete its review within 90 days
670	after receipt of the plan and shall either approve the plan or
671	advise the home health agency of necessary revisions. The
672	department of Health shall make every effort to avoid imposing
673	differing requirements on a home health agency that operates in
674	more than one county as a result of differing or conflicting
675	comprehensive plan requirements of the based on differences
676	between counties in which on the home health agency operates.
677	Section 8.  Subsection (16) of section 400.506, Florida
678	Statutes, is amended to read:
679	400.506  Licensure of nurse registries; requirements;
680	penalties.--
681	(16)  Each nurse registry shall prepare and maintain a
682	comprehensive emergency management plan that is consistent with
683	the criteria in this subsection and with the local special needs
684	plan. The plan shall be updated annually. The plan shall include
685	the means by which the nurse registry will continue to perform
686	the same type and quantity of services to their patients who
687	evacuate to special needs shelters that were being provided to
688	those patients prior to evacuation. The plan shall specify how
689	the nurse registry shall facilitate the provision of continuous
690	care by persons referred for contract to persons who are
691	registered pursuant to s. 252.355 during an emergency that
692	interrupts the provision of care or services in private
693	residencies. Nurse registries may establish links to local
694	emergency operations centers to determine a mechanism to
695	approach specific areas within a disaster area in order for a
696	provider to reach its clients. Nurse registries shall
697	demonstrate a good faith effort to comply with the requirements
698	of this subsection by documenting attempts of staff to follow
699	procedures as outlined in the nurse registry's comprehensive
700	emergency management plan which support a finding that attempts
701	were made to provide continuing care for those patients who have
702	been identified as needing care by the nurse registry and who
703	are registered under s. 252.355 in the event of an emergency.
704	(a)  All persons referred for contract who care for persons
705	registered pursuant to s. 252.355 must include in the patient
706	record a description of how care will be continued during a
707	disaster or emergency that interrupts the provision of care in
708	the patient's home. It shall be the responsibility of the person
709	referred for contract to ensure that continuous care is
710	provided.
711	(b)  Each nurse registry shall maintain a current
712	prioritized list of patients in private residences who are
713	registered pursuant to s. 252.355 and are under the care of
714	persons referred for contract and who need continued services
715	during an emergency. This list shall indicate, for each patient,
716	if the client is to be transported to a special needs shelter
717	and if the patient is receiving skilled nursing services. Nurse
718	registries shall make this list available to county health
719	departments and to local emergency management agencies upon
720	request.
721	(c)  Each person referred for contract who is caring for a
722	patient who is registered pursuant to s. 252.355 shall provide a
723	list of the patient's medication and equipment needs to the
724	nurse registry. Each person referred for contract shall make
725	this information available to county health departments and to
726	local emergency management agencies upon request.
727	(d)  Each person referred for contract shall not be
728	required to continue to provide care to patients in emergency
729	situations that are beyond the person's control and that make it
730	impossible to provide services, such as when roads are
731	impassable or when patients do not go to the location specified
732	in their patient records.
733	(e)  The comprehensive emergency management plan required
734	by this subsection is subject to review and approval by the
735	county health department. During its review, the county health
736	department shall contact state and local health and medical
737	stakeholders, when necessary ensure that, at a minimum, the
738	local emergency management agency, the Agency for Health Care
739	Administration, and the local chapter of the American Red Cross
740	or other lead sheltering agency are given the opportunity to
741	review the plan. The county health department shall complete its
742	review to ensure that the plan is in accordance with the
743	criteria set forth in the rules of the Agency for Health Care
744	Administration within 90 60 days after receipt of the plan and
745	shall either approve the plan or advise the nurse registry of
746	necessary revisions. If a nurse registry fails to submit a plan
747	or fails to submit requested information or revisions to the
748	county health department within 30 days after written
749	notification from the county health department, the county
750	health department shall notify the Agency for Health Care
751	Administration. The agency shall notify the nurse registry that
752	such failure constitutes a deficiency, subject to a fine of
753	$5,000 per occurrence. If the plan is not submitted, information
754	is not provided, or revisions are not made as requested, the
755	agency may impose the fine.
756	(f)  The Agency for Health Care Administration shall adopt
757	rules establishing minimum criteria for the comprehensive
758	emergency management plan and plan updates required by this
759	subsection, with the concurrence of the Department of Health and
760	in consultation with the Department of Community Affairs.
761	Section 9.  Paragraph (b) of subsection (1) of section
762	400.610, Florida Statutes, is amended to read:
763	400.610  Administration and management of a hospice.--
764	(1)  A hospice shall have a clearly defined organized
765	governing body, consisting of a minimum of seven persons who are
766	representative of the general population of the community
767	served. The governing body shall have autonomous authority and
768	responsibility for the operation of the hospice and shall meet
769	at least quarterly. The governing body shall:
770	(b)1.  Prepare and maintain a comprehensive emergency
771	management plan that provides for continuing hospice services in
772	the event of an emergency that is consistent with local special
773	needs plans. The plan shall include provisions for ensuring
774	continuing care to hospice patients who go to special needs
775	shelters. The plan shall include the means by which the hospice
776	provider will continue to provide staff to perform the same type
777	and quantity of services to their patients who evacuate to
778	special needs shelters that were being provided to those
779	patients prior to evacuation. The plan is subject to review and
780	approval by the county health department, except as provided in
781	subparagraph 2. During its review, the county health department
782	shall contact state and local health and medical stakeholders,
783	when necessary ensure that the department, the agency, and the
784	local chapter of the American Red Cross or other lead sheltering
785	agency have an opportunity to review and comment on the plan.
786	The county health department shall complete its review to ensure
787	that the plan is in accordance with the criteria set forth in
788	the rules of the Department of Elderly Affairs within 90 60 days
789	after receipt of the plan and shall either approve the plan or
790	advise the hospice of necessary revisions. Hospice providers may
791	establish links to local emergency operations centers to
792	determine a mechanism to approach specific areas within a
793	disaster area in order for the provider to reach its clients. A
794	hospice shall demonstrate a good faith effort to comply with the
795	requirements of this paragraph by documenting attempts of staff
796	to follow procedures as outlined in the hospice's comprehensive
797	emergency management plan and to provide continuing care for
798	those hospice clients who have been identified as needing
799	alternative caregiver services in the event of an emergency.
800	2.  For any hospice that operates in more than one county,
801	the Department of Health during its review shall contact state
802	and local health and medical stakeholders, when necessary review
803	the plan, after consulting with all of the county health
804	departments, the agency, and all the local chapters of the
805	American Red Cross or other lead sheltering agency in the areas
806	of operation for that particular hospice. The Department of
807	Health shall complete its review to ensure that the plan is in
808	accordance with the criteria set forth in the rules of the
809	Department of Elderly Affairs within 90 days after receipt of
810	the plan and shall either approve the plan or advise the hospice
811	of necessary revisions. The Department of Health shall make
812	every effort to avoid imposing on the hospice differing
813	requirements on a hospice that operates in more than one county
814	as a result of differing or conflicting comprehensive plan
815	requirements of the based on differences between counties in
816	which the hospice operates.
817	Section 10.  Subsections (13) through (16) of section
818	400.925, Florida Statutes, are renumbered as subsections (14)
819	through (17), respectively, and a new subsection (13) is added
820	to that section to read:
821	400.925  Definitions.--As used in this part, the term:
822	(13)  "Life-supporting or life-sustaining equipment" means
823	a device that is essential to, or that yields information that
824	is essential to, the restoration or continuation of a bodily
825	function important to the continuation of human life. Life-
826	supporting or life-sustaining equipment includes apnea monitors,
827	enteral feeding pumps, infusion pumps, portable home dialysis
828	equipment, and ventilator equipment and supplies for all related
829	equipment, including oxygen equipment and related respiratory
830	equipment.
831	Section 11.  Subsections (20), (21), and (22) are added to
832	section 400.934, Florida Statutes, to read:
833	400.934  Minimum standards.--As a requirement of licensure,
834	home medical equipment providers shall:
835	(20)(a)  Prepare and maintain a comprehensive emergency
836	management plan that meets minimum criteria established by the
837	agency in rule under s. 400.935. The plan shall be updated
838	annually and shall provide for continuing home medical equipment
839	services for life-supporting or life-sustaining equipment, as
840	defined in 400.925, during an emergency that interrupts home
841	medical equipment services in a patient's home. The plan shall
842	include:
843	1.  The means by which the home medical equipment provider
844	will continue to provide equipment to perform the same type and
845	quantity of services to its patients who evacuate to special
846	needs shelters that were being provided to those patients prior
847	to evacuation.
848	2.  The means by which the home medical equipment provider
849	establishes and maintains an effective response to emergencies
850	and disasters, including plans for:
851	a.  Notification of staff when emergency response measures
852	are initiated.
853	b.  Communication between staff members, county health
854	departments, and local emergency management agencies, which
855	shall include provisions for a backup communications system.
856	c.  Identification of resources necessary to continue
857	essential care or services or referrals to other organizations
858	subject to written agreement.
859	d.  Contacting and prioritizing patients in need of
860	continued medical equipment services and supplies.
861	(b)  The plan is subject to review and approval by the
862	county health department. During its review, the county health
863	department shall contact state and local health and medical
864	stakeholders, when necessary. The county health department shall
865	complete its review to ensure that the plan is in accordance
866	with the criteria set forth in the rules of the Agency for
867	Health Care Administration within 90 days after receipt of the
868	plan. If a home medical equipment provider fails to submit a
869	plan or fails to submit requested information or revisions to
870	the county health department within 30 days after written
871	notification from the county health department, the county
872	health department shall notify the Agency for Health Care
873	Administration. The agency shall notify the home medical
874	equipment provider that such failure constitutes a deficiency,
875	subject to a fine of $5,000 per occurrence. If the plan is not
876	submitted, information is not provided, or revisions are not
877	made as requested, the agency may impose the fine.
878	(21)  Each home medical equipment provider shall maintain a
879	current prioritized list of patients who need continued services
880	during an emergency. The list shall indicate the means by which
881	services shall be continued for each patient in the event of an
882	emergency or disaster, whether the patient is to be transported
883	to a special needs shelter, and whether the patient has life-
884	supporting or life-sustaining equipment, including the specific
885	type of equipment and related supplies. The list shall be
886	furnished to county health departments and local emergency
887	management agencies, upon request.
888	(22)  Home medical equipment providers may establish links
889	to local emergency operations centers to determine a mechanism
890	to approach specific areas within a disaster area in order for
891	the provider to reach its patients.
892	Section 12.  Subsection (11) is added to section 400.935,
893	Florida Statutes, to read:
894	400.935  Rules establishing minimum standards.--The agency
895	shall adopt, publish, and enforce rules to implement this part,
896	which must provide reasonable and fair minimum standards
897	relating to:
898	(11)  Preparation of the comprehensive emergency management
899	plan under s. 400.934 and the establishment of minimum criteria
900	for the plan, including the maintenance of patient equipment and
901	supply lists that can accompany patients who are transported
902	from their homes. Such rules shall be formulated in consultation
903	with the Department of Health and the Department of Community
904	Affairs.
905	Section 13.  Section 408.831, Florida Statutes, is amended
906	to read:
907	408.831  Denial, suspension, or revocation of a license,
908	registration, certificate, or application.--
909	(1)  In addition to any other remedies provided by law, the
910	agency may deny each application or suspend or revoke each
911	license, registration, or certificate of entities regulated or
912	licensed by it:
913	(a)  If the applicant, licensee, registrant, or
914	certificateholder, or, in the case of a corporation,
915	partnership, or other business entity, if any officer, director,
916	agent, or managing employee of that business entity or any
917	affiliated person, partner, or shareholder having an ownership
918	interest equal to 5 percent or greater in that business entity,
919	has failed to pay all outstanding fines, liens, or overpayments
920	assessed by final order of the agency or final order of the
921	Centers for Medicare and Medicaid Services, not subject to
922	further appeal, unless a repayment plan is approved by the
923	agency; or
924	(b)  For failure to comply with any repayment plan.
925	(2)  In reviewing any application requesting a change of
926	ownership or change of the licensee, registrant, or
927	certificateholder, the transferor shall, prior to agency
928	approval of the change, repay or make arrangements to repay any
929	amounts owed to the agency. Should the transferor fail to repay
930	or make arrangements to repay the amounts owed to the agency,
931	the issuance of a license, registration, or certificate to the
932	transferee shall be delayed until repayment or until
933	arrangements for repayment are made.
934	(3)  Entities subject to this section may exceed their
935	licensed capacity to act as a receiving facility in accordance
936	with an emergency operations plan for clients of evacuating
937	providers from a geographic area where an evacuation order has
938	been issued by a local authority having jurisdiction. While in
939	an overcapacity status, each provider must furnish or arrange
940	for appropriate care and services to all clients. In addition,
941	the agency may approve requests for overcapacity beyond 15 days,
942	which approvals may be based upon satisfactory justification and
943	need as provided by the receiving and sending facility.
944	(4)  An inactive license may be issued to a licensee
945	subject to this section when the provider is located in a
946	geographic area where a state of emergency was declared by the
947	Governor if the provider:
948	(a)  Suffered damage to the provider's operation during
949	that state of emergency.
950	(b)  Is currently licensed.
951	(c)  Does not have a provisional license.
952	(d)  Will be temporarily unable to provide services but is
953	reasonably expected to resume services within 12 months.
954
955	An inactive license may be issued for a period not to exceed 12
956	months but may be renewed by the agency for up to 12 additional
957	months upon demonstration to the agency of progress toward
958	reopening. A request by a licensee for an inactive license or to
959	extend the previously approved inactive period must be submitted
960	in writing to the agency, accompanied by written justification
961	for the inactive license which states the beginning and ending
962	dates of inactivity and includes a plan for the transfer of any
963	clients to other providers and appropriate licensure fees. Upon
964	agency approval, the licensee shall notify clients of any
965	necessary discharge or transfer as required by authorizing
966	statutes or applicable rules. The beginning of the inactive
967	licensure period shall be the date the provider ceases
968	operations. The end of the inactive period shall become the
969	licensee expiration date, and all licensure fees must be
970	current, paid in full, and may be prorated. Reactivation of an
971	inactive license requires the prior approval by the agency of a
972	renewal application, including payment of licensure fees and
973	agency inspections indicating compliance with all requirements
974	of this part and applicable rules and statutes.
975	(5)(3) This section provides standards of enforcement
976	applicable to all entities licensed or regulated by the Agency
977	for Health Care Administration. This section controls over any
978	conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
979	394, 395, 400, 408, 468, 483, and 641 or rules adopted pursuant
980	to those chapters.
981	Section 14.  Emergency preparedness prescription medication
982	refills.--
983	(1)  All health insurers, managed care organizations, and
984	other entities licensed by the Office of Insurance Regulation
985	that provide prescription medication coverage as part of a
986	policy or contract shall waive time restrictions on prescription
987	medication refills, which includes suspension of electronic
988	"refill too soon" edits to pharmacies, to enable insureds or
989	subscribers to refill prescriptions in advance, as long as there
990	are authorized refills remaining, and shall authorize payment to
991	pharmacies for at least a 30-day supply of any prescription
992	medication, regardless of the date upon which the prescription
993	had most recently been filled by a pharmacist, when the
994	following conditions occur:
995	(a)  The person seeking the prescription medication refill
996	resides in a county that:
997	1.  Is under a hurricane warning issued by the National
998	Weather Service;
999	2.  Is declared to be under a state of emergency in an
1000	executive order issued by the Governor; or
1001	3.  Has activated its emergency operations center and its
1002	emergency management plan.
1003	(b)  The prescription medication refill is requested:
1004	1.  Within 30 days of the date upon which the conditions
1005	set forth in paragraph (a) originated; or
1006	2.  Prior to the date upon which the conditions set forth
1007	in paragraph (a) are terminated by the issuing authority or no
1008	longer exist.
1009
1010	The time period for the waiver of prescription medication
1011	refills may be extended in 15-day or 30-day increments by
1012	emergency orders issued by the Office of Insurance Regulation.
1013	(2)  Nothing in this section excuses or exempts an insured
1014	or subscriber from compliance with all the other terms of the
1015	policy or contract providing prescription medication coverage.
1016	Section 15.  The Legislature finds that all designated
1017	public special needs hurricane evacuation shelters should be
1018	equipped with permanent emergency power generating capacity to
1019	provide the necessary equipment, heating, ventilation, and air-
1020	conditioning to meet the medical needs of patients by June 1,
1021	2007. The Department of Community Affairs shall work with local
1022	communities to ensure that there is a sufficient number of
1023	public special needs shelters designated to meet the anticipated
1024	demand based on best available data as determined by the
1025	department and the Department of Health. Local match for these
1026	projects shall be no less than 25 percent of project cost. There
1027	is hereby appropriated $21.5 million from the U.S. Contributions
1028	Trust Fund in fixed capital outlay to the Department of
1029	Community Affairs to establish a competitive award process to
1030	implement this section. No more than 5 percent of the funds
1031	provided under this section may be used by the department for
1032	administration of the funding.
1033	Section 16.  The Legislature finds that retrofitting public
1034	hurricane evacuation shelters is an efficient and economical
1035	method of accelerating the state and local efforts to reduce the
1036	shelter deficit. Criteria for the retrofitting of a public
1037	hurricane evacuation shelter shall include, but not be limited
1038	to, the project's ability to meet the structural and siting
1039	requirements of American Red Cross Standard ARC 4496,
1040	"Guidelines for Hurricane Evacuation Shelter Selection," once
1041	completed; the shelter needs for the local government, as well
1042	as the overall needs of the hurricane evacuation planning
1043	region; the cost-effectiveness of the project in terms of the
1044	number of public hurricane evacuation spaces; and the priority
1045	ranking of the proposed project in the applicable local
1046	mitigation strategy. There is hereby appropriated $9 million
1047	from the U.S. Contributions Trust Fund in fixed capital outlay
1048	to the Department of Community Affairs to establish a
1049	competitive award process to implement this section. No more
1050	than 5 percent of the funds provided under this section may be
1051	used by the department for administration of this funding.
1052	Section 17.  For the 2006-2007 fiscal year, the sums of
1053	$896,799 from recurring general revenue funds and $104,156 from
1054	nonrecurring general revenue funds are appropriated, and 20
1055	full-time equivalent positions are authorized at 872,644 salary
1056	rate, to implement the provisions of emergency management plan
1057	reviews for home health agencies and nurse registry, hospice,
1058	and home medical equipment providers.
1059	Section 18.  This act shall take effect July 1, 2006.

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