HB 7141

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 short title;
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 and conditions for assessment
11	thereof; providing a method for calculating annual
12	adjustment of fees; providing for inspection fees;
13	providing that fees are nonrefundable; creating s.
14	408.806, F.S.; providing a license application process;
15	requiring specified information to be included on the
16	application; requiring payment of late fees under certain
17	circumstances; requiring inspections; providing an
18	exception; authorizing the Agency for Health Care
19	Administration to establish procedures and rules for
20	electronic transmission of required information; creating
21	s. 408.807, F.S.; providing procedures for change of
22	ownership; requiring the transferor to notify the agency
23	in writing within a specified time period; providing for
24	duties and liability of the transferor; providing for
25	maintenance of certain records; creating s. 408.808, F.S.;
26	providing license categories and requirements therefor;
27	creating s. 408.809, F.S.; requiring background screening
28	of specified employees; providing for submission of proof
29	of compliance, under certain circumstances; providing
30	conditions for granting provisional and standard licenses;
31	providing an exception to screening requirements; creating
32	s. 408.810, F.S.; providing minimum licensure
33	requirements; providing procedures for discontinuance of
34	operation and surrender of license; requiring forwarding
35	of client records; requiring publication of a notice of
36	discontinuance of operation of a provider; providing for
37	statewide toll-free telephone numbers for reporting
38	complaints and abusive, neglectful, and exploitative
39	practices; requiring proof of legal right to occupy
40	property, proof of insurance, and proof of financial
41	viability, under certain circumstances; requiring
42	disclosure of information relating to financial
43	instability; providing a penalty; prohibiting the agency
44	from licensing a health care provider that does not have a
45	certificate of need or an exemption; creating s. 408.811,
46	F.S.; providing for inspections and investigations to
47	determine compliance; providing that inspection reports
48	are public records; requiring retention of records for a
49	specified period of time; creating s. 408.812, F.S.;
50	prohibiting certain unlicensed activity by a provider;
51	requiring unlicensed providers to cease activity;
52	providing penalties; requiring reporting of unlicensed
53	providers; creating s. 408.813, F.S.; authorizing the
54	agency to impose administrative fines; creating s.
55	408.814, F.S.; providing conditions for the agency to
56	impose a moratorium or emergency suspension on a provider;
57	requiring notice; creating s. 408.815, F.S.; providing
58	grounds for denial or revocation of a license or change-
59	of-ownership application; providing conditions to continue
60	operation; exempting renewal applications from provisions
61	requiring the agency to approve or deny an application
62	within a specified period of time, under certain
63	circumstances; creating s. 408.816, F.S.; authorizing the
64	agency to institute injunction proceedings, under certain
65	circumstances; creating s. 408.817, F.S.; providing basis
66	for review of administrative proceedings challenging
67	agency licensure enforcement action; creating s. 408.818,
68	F.S.; requiring fees and fines related to health care
69	licensing to be deposited into the Health Care Trust Fund;
70	creating s. 408.819, F.S.; authorizing the agency to adopt
71	rules; providing a timeframe for compliance; creating s.
72	408.820, F.S.; providing exemptions from specified
73	requirements of pt. II of ch. 408, F.S.; amending s.
74	400.801, F.S.; providing that the definition of homes for
75	special services applies to sites licensed by the agency
76	after a certain date; amending s. 400.9905, F.S.;
77	excluding certain entities from the definition of
78	"clinic"; amending s. 408.036, F.S.; exempting a nursing
79	home created by combining certain licensed beds from
80	requirements for obtaining a certificate of need from the
81	agency; providing for future repeal; amending s. 408.831,
82	F.S.; revising provisions relating to agency action to
83	deny, suspend, or revoke a license, registration,
84	certificate, or application; conforming cross-references;
85	providing for priority of application in case of conflict;
86	authorizing the agency to adjust annual licensure fees to
87	provide biennial licensure fees; requesting interim
88	assistance of the Division of Statutory Revision to
89	prepare conforming legislation for the 2007 Regular
90	Session; authorizing the agency to issue licenses for less
91	than a specified time period and providing conditions
92	therefor; amending s. 395.4001, F.S.; providing
93	definitions; repealing s. 395.4035, F.S., to terminate the
94	Trauma Services Trust Fund; amending s. 395.4036, F.S.;
95	revising provisions relating to distribution of funds to
96	trauma centers and use thereof; creating s. 395.41, F.S.;
97	establishing a trauma center startup grant program;
98	providing conditions for the receipt of a startup grant;
99	providing limitations; making the trauma center startup
100	grant program subject to an appropriation in the General
101	Appropriations Act; providing effective dates. providing
102	an effective date.
103
104	Be It Enacted by the Legislature of the State of Florida:
105
106	Section 1.  Part I of chapter 408, Florida Statutes,
107	consisting of sections 408.031, 408.032, 408.033, 408.034,
108	408.035, 408.036, 408.0361, 408.037, 408.038, 408.039, 408.040,
109	408.041, 408.042, 408.043, 408.044, 408.045, 408.0455, 408.05,
110	408.061, 408.062, 408.063, 408.07, 408.08, 408.09, 408.10,
111	408.15, 408.16, 408.18, 408.185, 408.20, 408.301, 408.302,
112	408.40, 408.50, 408.70, 408.7056, 408.7057, and 408.7071,
113	Florida Statutes, is created and entitled "Health Facility and
114	Services Planning."
115	Section 2.  Part II of chapter 408, Florida Statutes,
116	consisting of sections 408.801, 408.802, 408.803, 408.804,
117	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
118	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
119	408.819, 408.820, and 408.831, Florida Statutes, is created and
120	entitled "Health Care Licensing: General Provisions."
121	Section 3.  Part III of chapter 408, Florida Statutes,
122	consisting of sections 408.90, 408.901, 408.902, 408.903,
123	408.904, 408.905, 408.906, 408.907, 408.908, and 408.909,
124	Florida Statutes, is created and entitled "Health Insurance
125	Access."
126	Section 4.  Part IV of chapter 408, Florida Statutes,
127	consisting of sections 408.911, 408.913, 408.914, 408.915,
128	408.916, 408.917, and 408.918, Florida Statutes, is created and
129	entitled "Health and Human Services Eligibility Access System."
130	Section 5.  Sections 408.801, 408.802, 408.803, 408.804,
131	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
132	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
133	408.819, and 408.820, Florida Statutes, are created to read:
134	408.801  Short title; purpose.--
135	(1)  This part may be cited as the "Health Care Licensing
136	Procedures Act."
137	(2)  The Legislature finds that there is unnecessary
138	duplication and variation in the requirements for licensure by
139	the agency. It is the intent of the Legislature to provide a
140	streamlined and consistent set of basic licensing requirements
141	for all such providers in order to minimize confusion,
142	standardize terminology, and include issues that are otherwise
143	not adequately addressed in the Florida Statutes pertaining to
144	specific providers.
145	408.802  Applicability.--The provisions of this part apply
146	to the provision of services that require licensure as defined
147	in this part and to the following entities licensed, registered,
148	or certified by the agency, as described in chapters 112, 383,
149	390, 394, 395, 400, 440, 483, and 765:
150	(1)  Laboratories authorized to perform testing under the
151	Drug-Free Workplace Act, as provided under ss. 112.0455 and
152	440.102.
153	(2)  Birth centers, as provided under chapter 383.
154	(3)  Abortion clinics, as provided under chapter 390.
155	(4)  Crisis stabilization units, as provided under parts I
156	and IV of chapter 394.
157	(5)  Short-term residential treatment facilities, as
158	provided under parts I and IV of chapter 394.
159	(6)  Residential treatment facilities, as provided under
160	part IV of chapter 394.
161	(7)  Residential treatment centers for children and
162	adolescents, as provided under part IV of chapter 394.
163	(8)  Hospitals, as provided under part I of chapter 395.
164	(9)  Ambulatory surgical centers, as provided under part I
165	of chapter 395.
166	(10)  Mobile surgical facilities, as provided under part I
167	of chapter 395.
168	(11)  Private review agents, as provided under part I of
169	chapter 395.
170	(12)  Health care risk managers, as provided under part I
171	of chapter 395.
172	(13)  Nursing homes, as provided under part II of chapter
173	400.
174	(14)  Assisted living facilities, as provided under part
175	III of chapter 400.
176	(15)  Home health agencies, as provided under part IV of
177	chapter 400.
178	(16)  Nurse registries, as provided under part IV of
179	chapter 400.
180	(17)  Companion services or homemaker services providers,
181	as provided under part IV of chapter 400.
182	(18)  Adult day care centers, as provided under part V of
183	chapter 400.
184	(19)  Hospices, as provided under part VI of chapter 400.
185	(20)  Adult family-care homes, as provided under part VII
186	of chapter 400.
187	(21)  Homes for special services, as provided under part
188	VIII of chapter 400.
189	(22)  Transitional living facilities, as provided under
190	part VIII of chapter 400.
191	(23)  Prescribed pediatric extended care centers, as
192	provided under part IX of chapter 400.
193	(24)  Home medical equipment providers, as provided under
194	part X of chapter 400.
195	(25)  Intermediate care facilities for persons with
196	developmental disabilities, as provided under part XI of chapter
197	400.
198	(26)  Health care services pools, as provided under part
199	XII of chapter 400.
200	(27)  Health care clinics, as provided under part XIII of
201	chapter 400.
202	(28)  Clinical laboratories, as provided under part I of
203	chapter 483.
204	(29)  Multiphasic health testing centers, as provided under
205	part II of chapter 483.
206	(30)  Organ and tissue procurement agencies, as provided
207	under chapter 765.
208	408.803  Definitions.--As used in this part, the term:
209	(1)  "Agency" means the Agency for Health Care
210	Administration, which is the licensing agency under this part.
211	(2)  "Applicant" means an individual, corporation,
212	partnership, firm, association, or governmental entity that
213	submits an application for a license to the agency.
214	(3)  "Authorizing statute" means the statute authorizing
215	the licensed operation of a provider listed in s. 408.802 and
216	includes chapters 112, 383, 390, 394, 395, 400, 440, 483, and
217	765.
218	(4)  "Certification" means certification as a Medicare or
219	Medicaid provider of the services that require licensure, or
220	certification pursuant to the federal Clinical Laboratory
221	Improvement Amendment (CLIA).
222	(5)  "Change of ownership" means an event in which the
223	licensee changes to a different legal entity or in which 45
224	percent or more of the ownership, voting shares, or controlling
225	interest in a corporation whose shares are not publicly traded
226	on a recognized stock exchange is transferred or assigned,
227	including the final transfer or assignment of multiple transfers
228	or assignments over a 2-year period that cumulatively total 45
229	percent or greater. A change solely in the management company or
230	board of directors is not a change of ownership.
231	(6)  "Client" means any person receiving services from a
232	provider listed in s. 408.802.
233	(7)  "Controlling interest" means:
234	(a)  The applicant or licensee;
235	(b)  A person or entity that serves as an officer of, is on
236	the board of directors of, or has a 5-percent or greater
237	ownership interest in the applicant or licensee; or
238	(c)  A person or entity that serves as an officer of, is on
239	the board of directors of, or has a 5-percent or greater
240	ownership interest in the management company or other entity,
241	related or unrelated, with which the applicant or licensee
242	contracts to manage the provider.
243
244	The term does not include a voluntary board member.
245	(8)  "License" means any permit, registration, certificate,
246	or license issued by the agency.
247	(9)  "Licensee" means an individual, corporation,
248	partnership, firm, association, or governmental entity that is
249	issued a permit, registration, certificate, or license by the
250	agency. The licensee is legally responsible for all aspects of
251	the provider operation.
252	(10)  "Moratorium" means a prohibition on the acceptance of
253	new clients.
254	(11)  "Provider" means any activity, service, agency, or
255	facility regulated by the agency and listed in s. 408.802.
256	(12)  "Services that require licensure" means those
257	services, including residential services, that require a valid
258	license before those services may be provided in accordance with
259	authorizing statutes and agency rules.
260	(13)  "Voluntary board member" means a board member of a
261	not-for-profit corporation or organization who serves solely in
262	a voluntary capacity, does not receive any remuneration for his
263	or her services on the board of directors, and has no financial
264	interest in the corporation or organization. The agency shall
265	recognize a person as a voluntary board member following
266	submission of a statement to the agency by the board member and
267	the not-for-profit corporation or organization that affirms that
268	the board member conforms to this definition. The statement
269	affirming the status of the board member must be submitted to
270	the agency on a form provided by the agency.
271	408.804  License required; display.--
272	(1)  It is unlawful to provide services that require
273	licensure, or operate or maintain a provider that offers or
274	provides services that require licensure, without first
275	obtaining from the agency a license authorizing the provision of
276	such services or the operation or maintenance of such provider.
277	(2)  A license must be displayed in a conspicuous place
278	readily visible to clients who enter at the address that appears
279	on the license and is valid only in the hands of the licensee to
280	whom it is issued and may not be sold, assigned, or otherwise
281	transferred, voluntarily or involuntarily. The license is valid
282	only for the licensee, provider, and location for which the
283	license is issued.
284	408.805  Fees required; adjustments.--Unless otherwise
285	limited by authorizing statutes, license fees must be reasonably
286	calculated by the agency to cover its costs in carrying out its
287	responsibilities under this part, authorizing statutes, and
288	applicable rules, including the cost of licensure, inspection,
289	and regulation of providers.
290	(1)  Licensure fees shall be adjusted to provide for
291	biennial licensure under agency rules.
292	(2)  The agency shall annually adjust licensure fees,
293	including fees paid per bed, by not more than the change in the
294	Consumer Price Index based on the 12 months immediately
295	preceding the increase.
296	(3)  An inspection fee must be paid as required in
297	authorizing statutes.
298	(4)  Fees are nonrefundable.
299	(5)  When a change is reported that requires issuance of a
300	license, a fee may be assessed. The fee must be based on the
301	actual cost of processing and issuing the license.
302	(6)  A fee may be charged to a licensee requesting a
303	duplicate license. The fee may not exceed the actual cost of
304	duplication and postage.
305	(7)  Total fees collected may not exceed the cost of
306	administering this part, authorizing statutes, and applicable
307	rules.
308	408.806  License application process.--
309	(1)  An application for licensure must be made to the
310	agency on forms furnished by the agency, submitted under oath,
311	and accompanied by the appropriate fee in order to be accepted
312	and considered timely. The application must contain information
313	required by authorizing statutes and applicable rules and must
314	include:
315	(a)  The name, address, and social security number of the
316	applicant and each controlling interest if the applicant or
317	controlling interest is an individual.
318	(b)  The name, address, and federal employer identification
319	number or taxpayer identification number of the applicant and
320	each controlling interest if the applicant or controlling
321	interest is not an individual.
322	(c)  The name by which the provider is to be known.
323	(d)  The total number of beds or capacity requested, as
324	applicable.
325	(e)  The name of the person or persons under whose
326	management or supervision the provider will operate and the name
327	of the administrator, if required.
328	(f)  If the applicant offers continuing care agreements as
329	defined in chapter 651, proof shall be furnished that the
330	applicant has obtained a certificate of authority as required
331	for operation under chapter 651.
332	(g)  Other information, including satisfactory inspection
333	results, that the agency finds necessary to determine the
334	ability of the applicant to carry out its responsibilities under
335	this part, authorizing statutes, and applicable rules.
336	(2)(a)  The applicant for a renewal license must submit an
337	application that must be received by the agency at least 60 days
338	prior to the expiration of the current license. If the renewal
339	application and fee are received prior to the license expiration
340	date, the license shall not be deemed to have expired if the
341	license expiration date occurs during the agency's review of the
342	renewal application.
343	(b)  The applicant for initial licensure due to a change of
344	ownership must submit an application that must be received by
345	the agency at least 60 days prior to the date of change of
346	ownership.
347	(c)  For any other application or request, the applicant
348	must submit an application or request that must be received by
349	the agency at least 60 days prior to the requested effective
350	date, unless otherwise specified in authorizing statutes or
351	applicable rules.
352	(d)  The agency shall notify the licensee by mail or
353	electronically at least 90 days prior to the expiration of a
354	license that a renewal license is necessary to continue
355	operation. The failure to timely submit a renewal application
356	and license fee shall result in a $50 per day late fee charged
357	to the licensee by the agency; however, the aggregate amount of
358	the late fee may not exceed 50 percent of the licensure fee or
359	$500, whichever is less. If an application is received after the
360	required filing date and exhibits a hand-canceled postmark
361	obtained from a United States post office dated on or before the
362	required filing date, no fine will be levied.
363	(3)(a)  Upon receipt of an application for a license, the
364	agency shall examine the application and, within 30 days after
365	receipt, notify the applicant in writing of any apparent errors
366	or omissions and request any additional information required.
367	(b)  Requested information omitted from an application for
368	licensure, license renewal, or change of ownership, other than
369	an inspection, must be filed with the agency within 21 days
370	after the agency's request for omitted information or the
371	application shall be deemed incomplete and shall be withdrawn
372	from further consideration and the fees shall be forfeited.
373	(c)  Within 60 days after the receipt of a complete
374	application, the agency shall approve or deny the application.
375	(4)(a)  Licensees subject to the provisions of this part
376	shall be issued biennial licenses unless conditions of the
377	license category specify a shorter license period.
378	(b)  Each license issued shall indicate the name of the
379	licensee, the type of provider or service that the licensee is
380	required or authorized to operate or offer, the date the license
381	is effective, the expiration date of the license, the maximum
382	capacity of the licensed premises, if applicable, and any other
383	information required or deemed necessary by the agency.
384	(5)  In accordance with authorizing statutes and applicable
385	rules, proof of compliance with s. 408.810 must be submitted
386	with an application for licensure.
387	(6)  The agency may not issue an initial license to a
388	health care provider subject to the certificate-of-need
389	provisions in part I of this chapter if the licensee has not
390	been issued a certificate of need or certificate-of-need
391	exemption, when applicable. Failure to apply for the renewal of
392	a license prior to the expiration date renders the license void.
393	(7)(a)  An applicant must demonstrate compliance with the
394	requirements in this part, authorizing statutes, and applicable
395	rules during an inspection pursuant to s. 408.811, as required
396	by authorizing statutes.
397	(b)  An initial inspection is not required for companion
398	services or homemaker services providers, as provided under part
399	IV of chapter 400, or for health care services pools, as
400	provided under part XII of chapter 400.
401	(c)  If an inspection is required by the authorizing
402	statute for a license application other than an initial
403	application, the inspection must be unannounced. This paragraph
404	does not apply to inspections required pursuant to ss. 383.324,
405	395.0161(4), and 483.061(2).
406	(d)  If a provider is not available when an inspection is
407	attempted, the application shall be denied.
408	(8)  The agency may establish procedures for the electronic
409	notification and submission of required information, including,
410	but not limited to:
411	(a)  Licensure applications.
412	(b)  Required signatures.
413	(c)  Payment of fees.
414	(d)  Notarization of applications.
415
416	Requirements for electronic submission of any documents required
417	by this part or authorizing statutes may be established by rule.
418	408.807  Change of ownership.--Whenever a change of
419	ownership occurs:
420	(1)  The transferor shall notify the agency in writing at
421	least 60 days before the anticipated date of the change of
422	ownership.
423	(2)  The transferee shall make application to the agency
424	for a license within the timeframes required in s. 408.806.
425	(3)  The transferor shall be responsible and liable for:
426	(a)  The lawful operation of the provider and the welfare
427	of the clients served until the date the transferee is licensed
428	by the agency.
429	(b)  Any and all penalties imposed against the transferor
430	for violations occurring before the date of change of ownership.
431	(4)  Any restriction on licensure, including a conditional
432	license existing at the time of a change of ownership, shall
433	remain in effect until the agency determines that the grounds
434	for the restriction are corrected.
435	(5)  The transferee shall maintain records of the
436	transferor as required in this part, authorizing statutes, and
437	applicable rules, including:
438	(a)  All client records.
439	(b)  Inspection reports.
440	(c)  All records required to be maintained pursuant to s.
441	409.913, if applicable.
442	408.808  License categories.--
443	(1)  STANDARD LICENSE.--A standard license may be issued to
444	an applicant at the time of initial licensure, license renewal,
445	or change of ownership. A standard license shall be issued when
446	the applicant is in compliance with all statutory requirements
447	and agency rules. Unless sooner revoked, a standard license
448	expires 2 years after the date of issue.
449	(2)  PROVISIONAL LICENSE.--A provisional license may be
450	issued to an applicant pursuant to s. 408.809(3). An applicant
451	against whom a proceeding denying or revoking a license is
452	pending at the time of license renewal may be issued a
453	provisional license effective until final action not subject to
454	further appeal.
455	(3)  INACTIVE LICENSE.--An inactive license may be issued
456	to a health care provider subject to the certificate-of-need
457	provisions in part I of this chapter when the provider is
458	currently licensed, does not have a provisional license, and
459	will be temporarily unable to provide services but is reasonably
460	expected to resume services within 12 months. Such designation
461	may be made for a period not to exceed 12 months but may be
462	renewed by the agency for up to 12 additional months upon
463	demonstration by the licensee of the provider's progress toward
464	reopening. A request by a licensee for an inactive license or to
465	extend the previously approved inactive period must be submitted
466	to the agency and must include a written justification for the
467	inactive license with the beginning and ending dates of
468	inactivity specified, a plan for the transfer of any clients to
469	other providers, and the appropriate licensure fees. The agency
470	may not accept a request that is submitted after initiating
471	closure, after any suspension of service, or after notifying
472	clients of closure or suspension of service, unless the action
473	is a result of a disaster at the licensed premises. For the
474	purposes of this section, the term "disaster" means a sudden
475	emergency occurrence beyond the control of the licensee, whether
476	natural, technological, or manmade, which renders the provider
477	inoperable at the premises. Upon agency approval, the provider
478	shall notify clients of any necessary discharge or transfer as
479	required by authorizing statutes or applicable rules. The
480	beginning of the inactive license period is the date the
481	provider ceases operations. The end of the inactive license
482	period shall become the license expiration date. All licensure
483	fees must be current, must be paid in full, and may be prorated.
484	Reactivation of an inactive license requires the approval of a
485	renewal application, including payment of licensure fees and
486	agency inspections indicating compliance with all requirements
487	of this part, authorizing statutes, and applicable rules.
488	(4)  OTHER LICENSES.--Other types of license categories may
489	be issued pursuant to authorizing statutes or applicable rules.
490	408.809  Background screening; prohibited offenses.--
491	(1)  Level 2 background screening pursuant to chapter 435
492	must be conducted through the agency on each of the following
493	persons, who shall be considered an employee for the purposes of
494	conducting screening under chapter 435:
495	(a)  The licensee, if an individual.
496	(b)  The administrator or a similarly titled person who is
497	responsible for the day-to-day operation of the provider.
498	(c)  The financial officer or similarly titled individual
499	who is responsible for the financial operation of the licensee
500	or provider.
501	(d)  Any person who is a controlling interest if the agency
502	has reason to believe that such person has been convicted of any
503	offense prohibited by s. 435.04. For each controlling interest
504	who has been convicted of any such offense, the licensee shall
505	submit to the agency a description and explanation of the
506	conviction at the time of license application.
507	(2)  Proof of compliance with level 2 screening standards
508	submitted within the previous 5 years to meet any provider or
509	professional licensure requirements of the agency, the
510	Department of Health, the Agency for Persons with Disabilities,
511	or the Department of Children and Family Services satisfies the
512	requirements of this section, provided that such proof is
513	accompanied, under penalty of perjury, by an affidavit of
514	compliance with the provisions of chapter 435 using forms
515	provided by the agency. Proof of compliance with the background
516	screening requirements of the Department of Financial Services
517	submitted within the previous 5 years for an applicant for a
518	certificate of authority to operate a continuing care retirement
519	community under chapter 651 satisfies the Department of Law
520	Enforcement and Federal Bureau of Investigation portions of a
521	level 2 background check.
522	(3)  A provisional license may be granted to an applicant
523	when each individual required by this section to undergo
524	background screening has met the standards for the Department of
525	Law Enforcement background check but the agency has not yet
526	received background screening results from the Federal Bureau of
527	Investigation. A standard license may be granted to the licensee
528	upon the agency's receipt of a report of the results of the
529	Federal Bureau of Investigation background screening for each
530	individual required by this section to undergo background
531	screening that confirms that all standards have been met or upon
532	the granting of an exemption from disqualification by the agency
533	as set forth in chapter 435.
534	(4)  When a person is newly employed in a capacity that
535	requires screening under this section, the licensee must notify
536	the agency of the change within the time period specified in the
537	authorizing statute or rules and must submit to the agency
538	information necessary to conduct level 2 screening or provide
539	evidence of compliance with background screening requirements of
540	this section. The person may serve in his or her capacity
541	pending the agency's receipt of the report from the Federal
542	Bureau of Investigation if he or she has met the standards for
543	the Department of Law Enforcement background check. However, the
544	person may not continue to serve in his or her capacity if the
545	report indicates any violation of background screening standards
546	unless an exemption from disqualification has been granted by
547	the agency as set forth in chapter 435.
548	(5)  Background screening is not required to obtain a
549	certificate of exemption issued under s. 483.106.
550	408.810  Minimum licensure requirements.--In addition to
551	the licensure requirements specified in this part, authorizing
552	statutes, and applicable rules, each applicant and licensee must
553	comply with the requirements of this section in order to obtain
554	and maintain a license.
555	(1)  An applicant for licensure must comply with the
556	background screening requirements of s. 408.809.
557	(2)  An applicant for licensure must provide a description
558	and explanation of any exclusions, suspensions, or terminations
559	of the applicant from the Medicare, Medicaid, or federal
560	Clinical Laboratory Improvement Amendment (CLIA) programs.
561	(3)  Unless otherwise specified in this part, authorizing
562	statutes, or applicable rules, any information required to be
563	reported to the agency must be submitted within 21 calendar days
564	after the report period or effective date of the information.
565	(4)  Whenever a licensee discontinues operation of a
566	provider:
567	(a)  The licensee must inform the agency not less than 30
568	days prior to the discontinuance of operation and inform clients
569	of such discontinuance as required by authorizing statutes.
570	Immediately upon discontinuance of operation by a provider, the
571	licensee shall surrender the license to the agency and the
572	license shall be canceled.
573	(b)  The licensee shall remain responsible for retaining
574	and appropriately distributing all records within the timeframes
575	prescribed in authorizing statutes and applicable rules. In
576	addition, the licensee or, in the event of death or dissolution
577	of a licensee, the estate or agent of the licensee shall:
578	1.  Make arrangements to forward records for each client to
579	one of the following, based upon the client's choice: the client
580	or the client's legal representative, the client's attending
581	physician, or the health care provider where the client
582	currently receives services; or
583	2.  Cause a notice to be published in the newspaper of
584	greatest general circulation in the county in which the provider
585	was located that advises clients of the discontinuance of the
586	provider operation. The notice must inform clients that they may
587	obtain copies of their records and specify the name, address,
588	and telephone number of the person from whom the copies of
589	records may be obtained. The notice must appear at least once a
590	week for 4 consecutive weeks.
591	(5)(a)  On or before the first day services are provided to
592	a client, a licensee must inform the client and his or her
593	immediate family or representative, if appropriate, of the right
594	to report:
595	1.  Complaints. The statewide toll-free telephone number
596	for reporting complaints to the agency must be provided to
597	clients in a manner that is clearly legible and must include the
598	words: "To report a complaint regarding the services you
599	receive, please call toll-free (phone number)."
600	2.  Abusive, neglectful, or exploitative practices. The
601	statewide toll-free telephone number for the central abuse
602	hotline must be provided to clients in a manner that is clearly
603	legible and must include the words: "To report abuse, neglect,
604	or exploitation, please call toll-free (phone number)." The
605	agency shall publish a minimum of a 90-day advance notice of a
606	change in the toll-free telephone numbers.
607	(b)  Each licensee shall establish appropriate policies and
608	procedures for providing such notice to clients.
609	(6)  An applicant must provide the agency with proof of the
610	applicant's legal right to occupy the property before a license
611	may be issued. Proof may include, but need not be limited to,
612	copies of warranty deeds, lease or rental agreements, contracts
613	for deeds, quitclaim deeds, or other such documentation.
614	(7)  If proof of insurance is required by the authorizing
615	statute, that insurance must be in compliance with chapter 624,
616	chapter 626, chapter 627, or chapter 628 and with agency rules.
617	(8)  Upon application for initial licensure or change of
618	ownership licensure, the applicant shall furnish satisfactory
619	proof of the applicant's financial ability to operate in
620	accordance with the requirements of this part, authorizing
621	statutes, and applicable rules. The agency shall establish
622	standards for this purpose, including information concerning the
623	applicant's controlling interests. The agency shall also
624	establish documentation requirements, to be completed by each
625	applicant, that show anticipated provider revenues and
626	expenditures, the basis for financing the anticipated cash-flow
627	requirements of the provider, and an applicant's access to
628	contingency financing. A current certificate of authority,
629	pursuant to chapter 651, may be provided as proof of financial
630	ability to operate. The agency may require a licensee to provide
631	proof of financial ability to operate at any time if there is
632	evidence of financial instability, including, but not limited
633	to, unpaid expenses necessary for the basic operations of the
634	provider.
635	(9)  A controlling interest may not withhold from the
636	agency any evidence of financial instability, including, but not
637	limited to, checks returned due to insufficient funds,
638	delinquent accounts, nonpayment of withholding taxes, unpaid
639	utility expenses, nonpayment for essential services, or adverse
640	court action concerning the financial viability of the provider
641	or any other provider licensed under this part that is under the
642	control of the controlling interest. Any person who violates
643	this subsection commits a misdemeanor of the second degree,
644	punishable as provided in s. 775.082 or s. 775.083. Each day of
645	continuing violation is a separate offense.
646	(10)  The agency may not issue a license to a health care
647	provider subject to the certificate-of-need provisions in part I
648	of this chapter if the health care provider has not been issued
649	a certificate of need or an exemption. Upon initial licensure of
650	any such provider, the authorization contained in the
651	certificate of need shall be considered fully implemented and
652	merged into the license and shall have no force and effect upon
653	termination of the license for any reason.
654	408.811  Right of inspection; copies; inspection reports.--
655	(1)  An authorized officer or employee of the agency may
656	make or cause to be made any inspection or investigation deemed
657	necessary by the agency to determine the state of compliance
658	with this part, authorizing statutes, and applicable rules. The
659	right of inspection extends to any business that the agency has
660	reason to believe is being operated as a provider without a
661	license, but inspection of any business suspected of being
662	operated without the appropriate license may not be made without
663	the permission of the owner or person in charge unless a warrant
664	is first obtained from a circuit court. Any application for a
665	license issued under this part, authorizing statutes, or
666	applicable rules constitutes permission for an appropriate
667	inspection to verify the information submitted on or in
668	connection with the application.
669	(a)  All inspections shall be unannounced, except as
670	specified in s. 408.806.
671	(b)  Inspections for relicensure shall be conducted
672	biennially unless otherwise specified by authorizing statutes or
673	applicable rules.
674	(2)  Inspections conducted in conjunction with
675	certification may be accepted in lieu of a complete licensure
676	inspection. However, a licensure inspection may also be
677	conducted to review any licensure requirements that are not also
678	requirements for certification.
679	(3)  The agency shall have access to and the licensee shall
680	provide copies of all provider records required during an
681	inspection at no cost to the agency.
682	(4)(a)  Each licensee shall maintain as public information,
683	available upon request, records of all inspection reports
684	pertaining to that provider that have been filed by the agency
685	unless those reports are exempt from or contain information that
686	is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
687	Constitution or is otherwise made confidential by law. Effective
688	October 1, 2006, copies of such reports shall be retained in the
689	records of the provider for at least 3 years following the date
690	the reports are filed and issued, regardless of a change of
691	ownership.
692	(b)  A licensee shall, upon the request of any person who
693	has completed a written application with intent to be admitted
694	by such provider, any person who is a client of such provider,
695	or any relative, spouse, or guardian of any such person, furnish
696	to the requester a copy of the last inspection report pertaining
697	to the licensed provider that was issued by the agency or by an
698	accrediting organization if such report is used in lieu of a
699	licensure inspection.
700	408.812  Unlicensed activity.--
701	(1)  A person or entity may not offer or advertise services
702	that require licensure as defined by this part, authorizing
703	statutes, or applicable rules to the public without obtaining a
704	valid license from the agency. A licenseholder may not advertise
705	or hold out to the public that he or she holds a license for
706	other than that for which he or she actually holds the license.
707	(2)  The operation or maintenance of an unlicensed provider
708	or the performance of any services that require licensure
709	without proper licensure is a violation of this part and
710	authorizing statutes. Unlicensed activity constitutes harm that
711	materially affects the health, safety, and welfare of clients.
712	The agency or any state attorney may, in addition to other
713	remedies provided in this part, bring an action for an
714	injunction to restrain such violation, or to enjoin the future
715	operation or maintenance of the unlicensed provider or the
716	performance of any services in violation of this part and
717	authorizing statutes, until compliance with this part,
718	authorizing statutes, and agency rules has been demonstrated to
719	the satisfaction of the agency.
720	(3)  It is unlawful for any person or entity to own,
721	operate, or maintain an unlicensed provider. If after receiving
722	notification from the agency, such person or entity fails to
723	cease operation and apply for a license under this part and
724	authorizing statutes, the person or entity shall be subject to
725	penalties as prescribed by authorizing statutes and applicable
726	rules. Each day of continued operation is a separate offense.
727	(4)  Any person or entity that fails to cease operation
728	after agency notification may be fined $1,000 for each day of
729	noncompliance.
730	(5)  When a controlling interest or licensee has an
731	interest in more than one provider and fails to license a
732	provider rendering services that require licensure, the agency
733	may revoke all licenses and impose actions under s. 408.814 and
734	a fine of $1,000 per day, unless otherwise specified by
735	authorizing statutes, against each licensee until such time as
736	the appropriate license is obtained for the unlicensed
737	operation.
738	(6)  In addition to granting injunctive relief pursuant to
739	subsection (2), if the agency determines that a person or entity
740	is operating or maintaining a provider without obtaining a
741	license and determines that a condition exists that poses a
742	threat to the health, safety, or welfare of a client of the
743	provider, the person or entity is subject to the same actions
744	and fines imposed against a licensee as specified in this part,
745	authorizing statutes, and agency rules.
746	(7)  Any person aware of the operation of an unlicensed
747	provider must report that provider to the agency.
748	408.813  Administrative fines.--As a penalty for any
749	violation of this part, authorizing statutes, or applicable
750	rules, the agency may impose an administrative fine. Unless the
751	amount or aggregate limitation of the fine is prescribed by
752	authorizing statutes or applicable rules, the agency may
753	establish criteria by rule for the amount or aggregate
754	limitation of administrative fines applicable to this part,
755	authorizing statutes, and applicable rules. Each day of
756	violation constitutes a separate violation and is subject to a
757	separate fine. For fines imposed by final order of the agency
758	and not subject to further appeal, the violator shall pay the
759	fine plus interest at the rate specified in s. 55.03 for each
760	day beyond the date set by the agency for payment of the fine.
761	408.814  Moratorium; emergency suspension.--
762	(1)  The agency may impose an immediate moratorium or
763	emergency suspension as defined in s. 120.60 on any provider if
764	the agency determines that any condition related to the provider
765	or licensee presents a threat to the health, safety, or welfare
766	of a client.
767	(2)  A provider or licensee, the license of which is denied
768	or revoked, may be subject to immediate imposition of a
769	moratorium or emergency suspension to run concurrently with
770	licensure denial, revocation, or injunction.
771	(3)  A moratorium or emergency suspension remains in effect
772	after a change of ownership, unless the agency has determined
773	that the conditions that created the moratorium, emergency
774	suspension, or denial of licensure have been corrected.
775	(4)  When a moratorium or emergency suspension is placed on
776	a provider or licensee, notice of the action shall be posted and
777	visible to the public at the location of the provider until the
778	action is lifted.
779	408.815  License or application denial; revocation.--
780	(1)  In addition to the grounds provided in authorizing
781	statutes, grounds that may be used by the agency for denying and
782	revoking a license or change of ownership application include
783	any of the following actions by a controlling interest:
784	(a)  False representation of a material fact in the license
785	application or omission of any material fact from the
786	application.
787	(b)  An intentional or negligent act materially affecting
788	the health or safety of a client of the provider.
789	(c)  A violation of this part, authorizing statutes, or
790	applicable rules.
791	(d)  A demonstrated pattern of deficient performance.
792	(e)  The applicant, licensee, or controlling interest has
793	been or is currently excluded, suspended, or terminated from
794	participation in the state Medicaid program, the Medicaid
795	program of any other state, or the Medicare program.
796	(2)  If a licensee lawfully continues to operate while a
797	denial or revocation is pending in litigation, the licensee must
798	continue to meet all other requirements of this part,
799	authorizing statutes, and applicable rules and must file
800	subsequent renewal applications for licensure and pay all
801	licensure fees. The provisions of ss. 120.60(1) and
802	408.806(3)(c) shall not apply to renewal applications filed
803	during the time period in which the litigation of the denial or
804	revocation is pending until that litigation is final.
805	(3)  An action under s. 408.814 or denial of the license of
806	the transferor may be grounds for denial of a change of
807	ownership application of the transferee.
808	408.816  Injunctions.--
809	(1)  In addition to the other powers provided by this part,
810	authorizing statutes, and applicable rules, the agency may
811	institute injunction proceedings in a court of competent
812	jurisdiction to:
813	(a)  Restrain or prevent the establishment or operation of
814	a provider that does not have a license or is in violation of
815	any provision of this part, authorizing statutes, or applicable
816	rules. The agency may also institute injunction proceedings in a
817	court of competent jurisdiction when a violation of this part,
818	authorizing statutes, or applicable rules constitutes an
819	emergency affecting the immediate health and safety of a client.
820	(b)  Enforce the provisions of this part, authorizing
821	statutes, or any minimum standard, rule, or order issued or
822	entered into pursuant thereto when the attempt by the agency to
823	correct a violation through administrative sanctions has failed
824	or when the violation materially affects the health, safety, or
825	welfare of clients or involves any operation of an unlicensed
826	provider.
827	(c)  Terminate the operation of a provider when a violation
828	of any provision of this part, authorizing statutes, or any
829	standard or rule adopted pursuant thereto exists that materially
830	affects the health, safety, or welfare of a client.
831
832	Such injunctive relief may be temporary or permanent.
833	(2)  If action is necessary to protect clients of providers
834	from immediate, life-threatening situations, the court may allow
835	a temporary injunction without bond upon proper proofs being
836	made. If it appears by competent evidence or a sworn,
837	substantiated affidavit that a temporary injunction should be
838	issued, the court, pending the determination on final hearing,
839	shall enjoin the operation of the provider.
840	408.817  Administrative proceedings.--Administrative
841	proceedings challenging agency licensure enforcement action
842	shall be reviewed on the basis of the facts and conditions that
843	resulted in the agency action.
844	408.818  Health Care Trust Fund.--Unless otherwise
845	prescribed by authorizing statutes, all fees and fines collected
846	under this part, authorizing statutes, and applicable rules
847	shall be deposited into the Health Care Trust Fund, created in
848	s. 408.16, and used to pay the costs of the agency in
849	administering the provider program paying the fees or fines.
850	408.819  Rules.--The agency is authorized to adopt rules as
851	necessary to administer this part. Any licensed provider that is
852	in operation at the time of adoption of any applicable rule
853	under this part or authorizing statutes shall be given a
854	reasonable time under the particular circumstances, not to
855	exceed 6 months after the date of such adoption, within which to
856	comply with such rule, unless otherwise specified by rule.
857	408.820  Exemptions.--Except as prescribed in authorizing
858	statutes, the following exemptions shall apply to specified
859	requirements of this part:
860	(1)  Laboratories authorized to perform testing under the
861	Drug-Free Workplace Act, as provided under ss. 112.0455 and
862	440.102, are exempt from s. 408.810(5)-(10).
863	(2)  Birth centers, as provided under chapter 383, are
864	exempt from s. 408.810(7)-(10).
865	(3)  Abortion clinics, as provided under chapter 390, are
866	exempt from s. 408.810(7)-(10).
867	(4)  Crisis stabilization units, as provided under parts I
868	and IV of chapter 394, are exempt from s. 408.810(8)-(10).
869	(5)  Short-term residential treatment facilities, as
870	provided under parts I and IV of chapter 394, are exempt from s.
871	408.810(8)-(10).
872	(6)  Residential treatment facilities, as provided under
873	part IV of chapter 394, are exempt from s. 408.810(8)-(10).
874	(7)  Residential treatment centers for children and
875	adolescents, as provided under part IV of chapter 394, are
876	exempt from s. 408.810(8)-(10).
877	(8)  Hospitals, as provided under part I of chapter 395,
878	are exempt from s. 408.810(7)-(9).
879	(9)  Ambulatory surgical centers, as provided under part I
880	of chapter 395, are exempt from s. 408.810(7)-(10).
881	(10)  Mobile surgical facilities, as provided under part I
882	of chapter 395, are exempt from s. 408.810(7)-(10).
883	(11)  Private review agents, as provided under part I of
884	chapter 395, are exempt from ss. 408.806(7), 408.810, and
885	408.811.
886	(12)  Health care risk managers, as provided under part I
887	of chapter 395, are exempt from ss. 408.806(7), 408.810, and
888	408.811.
889	(13)  Nursing homes, as provided under part II of chapter
890	400, are exempt from s. 408.810(7).
891	(14)  Assisted living facilities, as provided under part
892	III of chapter 400, are exempt from s. 408.810(10).
893	(15)  Home health agencies, as provided under part IV of
894	chapter 400, are exempt from s. 408.810(10).
895	(16)  Nurse registries, as provided under part IV of
896	chapter 400, are exempt from s. 408.810(6) and (10).
897	(17)  Companion services or homemaker services providers,
898	as provided under part IV of chapter 400, are exempt from s.
899	408.810(6)-(10).
900	(18)  Adult day care centers, as provided under part V of
901	chapter 400, are exempt from s. 408.810(10).
902	(19)  Adult family-care homes, as provided under part VII
903	of chapter 400, are exempt from s. 408.810(7)-(10).
904	(20)  Homes for special services, as provided under part
905	VIII of chapter 400, are exempt from s. 408.810(7)-(10).
906	(21)  Transitional living facilities, as provided under
907	part VIII of chapter 400, are exempt from s. 408.810(7)-(10).
908	(22)  Prescribed pediatric extended care centers, as
909	provided under part IX of chapter 400, are exempt from s.
910	408.810(10).
911	(23)  Home medical equipment providers, as provided under
912	part X of chapter 400, are exempt from s. 408.810(10).
913	(24)  Intermediate care facilities for persons with
914	developmental disabilities, as provided under part XI of chapter
915	400, are exempt from s. 408.810(7).
916	(25)  Health care services pools, as provided under part
917	XII of chapter 400, are exempt from s. 408.810(6)-(10).
918	(26)  Health care clinics, as provided under part XIII of
919	chapter 400, are exempt from ss. 408.809 and 408.810(1), (6),
920	(7), and (10).
921	(27)  Clinical laboratories, as provided under part I of
922	chapter 483, are exempt from s. 408.810(5)-(10).
923	(28)  Multiphasic health testing centers, as provided under
924	part II of chapter 483, are exempt from s. 408.810(5)-(10).
925	(29)  Organ and tissue procurement agencies, as provided
926	under chapter 765, are exempt from s. 408.810(5)-(10).
927	Section 6.  Paragraph (b) of subsection (1) of section
928	400.801, Florida Statutes, is amended to read:
929	400.801  Homes for special services.--
930	(1)  As used in this section, the term:
931	(b)  "Home for special services" means a site licensed by
932	the agency prior to January 1, 2006, where specialized health
933	care services are provided, including personal and custodial
934	care, but not continuous nursing services.
935	Section 7.  Paragraphs (e) and (i) of subsection (4) of
936	section 400.9905, Florida Statutes, are amended, and paragraph
937	(k) is added to that subsection, to read:
938	400.9905  Definitions.--
939	(4)  "Clinic" means an entity at which health care services
940	are provided to individuals and which tenders charges for
941	reimbursement for such services, including a mobile clinic and a
942	portable equipment provider. For purposes of this part, the term
943	does not include and the licensure requirements of this part do
944	not apply to:
945	(e)  An entity that is exempt from federal taxation under
946	26 U.S.C. s. 501(c)(3) or s. 501(c)(4), an employee stock
947	ownership plan under 26 U.S.C. s. 409 that has a board of
948	trustees not less than two-thirds of which are Florida-licensed
949	health care practitioners and provides only physical therapy
950	services under physician orders, any community college or
951	university clinic, and any entity owned or operated by the
952	federal or state government, including agencies, subdivisions,
953	or municipalities thereof.
954	(i)  Entities that provide only oncology or radiation
955	therapy services by physicians licensed under chapter 458 or
956	chapter 459 or entities that provide oncology or radiation
957	therapy services by physicians licensed under chapter 458 or
958	chapter 459 which are owned by a corporation whose shares are
959	publicly traded on a recognized stock exchange.
960	(k)  Entities that provide licensed practitioners to staff
961	emergency departments or to deliver anesthesia services in
962	facilities licensed under chapter 395 and that derive at least
963	90 percent of their gross annual revenues from the provision of
964	such services. Entities claiming an exemption from licensure
965	under this paragraph must provide documentation demonstrating
966	compliance.
967	Section 8.  Paragraphs (f) through (s) of subsection (3) of
968	section 408.036, Florida Statutes, are redesignated as
969	paragraphs (g) through (t), respectively, and a new paragraph
970	(f) is added to that subsection to read:
971	408.036  Projects subject to review; exemptions.--
972	(3)  EXEMPTIONS.--Upon request, the following projects are
973	subject to exemption from the provisions of subsection (1):
974	(f)  For the creation of a single nursing home within a
975	district by combining licensed beds from two or more licensed
976	nursing homes within such district, regardless of subdistrict
977	boundaries, if 50 percent of the beds in the created nursing
978	home are transferred from the only nursing home in a county and
979	its utilization data demonstrate that it had an occupancy rate
980	of less than 75 percent for the 12-month period ending 90 days
981	before the request for the exemption. This paragraph is repealed
982	upon the expiration of the moratorium established in s.
983	651.1185(1).
984	Section 9.  Subsections (1) and (3) of section 408.831,
985	Florida Statutes, are amended to read:
986	408.831  Denial, suspension, or revocation of a license,
987	registration, certificate, or application.--
988	(1)  In addition to any other remedies provided by law, the
989	agency may deny each application or suspend or revoke each
990	license, registration, or certificate of entities regulated or
991	licensed by it:
992	(a)  If the applicant, licensee, or a licensee subject to
993	this part which shares a common controlling interest with the
994	applicant registrant, or certificateholder, or, in the case of a
995	corporation, partnership, or other business entity, if any
996	officer, director, agent, or managing employee of that business
997	entity or any affiliated person, partner, or shareholder having
998	an ownership interest equal to 5 percent or greater in that
999	business entity, has failed to pay all outstanding fines, liens,
1000	or overpayments assessed by final order of the agency or final
1001	order of the Centers for Medicare and Medicaid Services, not
1002	subject to further appeal, unless a repayment plan is approved
1003	by the agency; or
1004	(b)  For failure to comply with any repayment plan.
1005	(3)  This section provides standards of enforcement
1006	applicable to all entities licensed or regulated by the Agency
1007	for Health Care Administration. This section controls over any
1008	conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
1009	394, 395, 400, 408, 468, 483, and 765 641 or rules adopted
1010	pursuant to those chapters.
1011	Section 10.  In case of conflict between the provisions of
1012	part II of chapter 408, Florida Statutes, and the authorizing
1013	statutes governing the licensure of health care providers by the
1014	Agency for Health Care Administration found in s. 112.0455 and
1015	chapters 383, 390, 394, 395, 400, 440, 483, and 765, Florida
1016	Statutes, the provisions of part II of chapter 408, Florida
1017	Statutes, shall prevail.
1018	Section 11.  All provisions that apply to the entities
1019	specified in s. 408.802, Florida Statutes, as created by this
1020	act, in effect on October 1, 2006, that provide for annual
1021	licensure fees are hereby adjusted to provide for biennial
1022	licensure fees with a corresponding doubling of the amount.
1023	Section 12.  The Legislature recognizes that there is a
1024	need to conform the Florida Statutes to the policy decisions
1025	reflected in this act and that there may be a need to resolve
1026	apparent conflicts between any changes or additions to the
1027	authorizing statutes, as defined in s. 408.803, Florida
1028	Statutes, or any other legislation that has been or may be
1029	enacted during 2006 and this chapter 408, Florida Statutes, as
1030	amended by this act. Therefore, in the interim between this act
1031	becoming a law and the 2007 Regular Session of the Legislature
1032	or an earlier special session addressing this issue, the
1033	Division of Statutory Revision shall provide the relevant
1034	substantive committees of the Senate and the House of
1035	Representatives with assistance, upon request, to enable such
1036	committees to prepare draft legislation to conform the Florida
1037	Statutes and any legislation enacted during 2006 to the
1038	provisions of this act.
1039	Section 13.  For the purpose of staggering license
1040	expiration dates, the Agency for Health Care Administration may
1041	issue a license for less than a 2-year period to those providers
1042	making the transition from annual to biennial licensure as
1043	authorized in this act. The agency shall charge a prorated
1044	licensure fee for this shortened period. This authority shall
1045	expire September 30, 2008.
1046	Section 14.  Section 395.4001, Florida Statutes, is amended
1047	to read:
1048	395.4001  Definitions.--As used in this part, the term:
1049	(1)  "Agency" means the Agency for Health Care
1050	Administration.
1051	(2)  "Charity care" or "uncompensated trauma care" means
1052	that portion of hospital charges reported to the agency for
1053	which there is no compensation, other than restricted or
1054	unrestricted revenues provided to a hospital by local
1055	governments or tax districts regardless of method of payment,
1056	for care provided to a patient whose family income for the 12
1057	months preceding the determination is less than or equal to 200
1058	percent of the federal poverty level, unless the amount of
1059	hospital charges due from the patient exceeds 25 percent of the
1060	annual family income. However, in no case shall the hospital
1061	charges for a patient whose family income exceeds four times the
1062	federal poverty level for a family of four be considered
1063	charity.
1064	(3)  "Department" means the Department of Health.
1065	(4)  "Interfacility trauma transfer" means the transfer of
1066	a trauma victim between two facilities licensed under this
1067	chapter, pursuant to this part.
1068	(5)  "International Classification Injury Severity Score"
1069	means the statistical method for computing the severity of
1070	injuries sustained by trauma patients. The International
1071	Classification Injury Severity Score shall be the methodology
1072	used by the department and trauma centers to report the severity
1073	of an injury.
1074	(6)(5)  "Level I trauma center" means a trauma center that:
1075	(a)  Has formal research and education programs for the
1076	enhancement of trauma care; is verified by the department to be
1077	in substantial compliance with Level I trauma center and
1078	pediatric trauma center standards; and has been approved by the
1079	department to operate as a Level I trauma center.
1080	(b)  Serves as a resource facility to Level II trauma
1081	centers, pediatric trauma centers, and general hospitals through
1082	shared outreach, education, and quality improvement activities.
1083	(c)  Participates in an inclusive system of trauma care,
1084	including providing leadership, system evaluation, and quality
1085	improvement activities.
1086	(7)(6)  "Level II trauma center" means a trauma center
1087	that:
1088	(a)  Is verified by the department to be in substantial
1089	compliance with Level II trauma center standards and has been
1090	approved by the department to operate as a Level II trauma
1091	center.
1092	(b)  Serves as a resource facility to general hospitals
1093	through shared outreach, education, and quality improvement
1094	activities.
1095	(c)  Participates in an inclusive system of trauma care.
1096	(8)  "Local funding contribution" means local municipal,
1097	county, or tax district funding exclusive of any patient-
1098	specific funds received pursuant to ss. 154.301-154.316, private
1099	foundation funding, or public or private grant funding of at
1100	least $150,000 received by a hospital or health care system that
1101	operates a trauma center.
1102	(9)(7)  "Pediatric trauma center" means a hospital that is
1103	verified by the department to be in substantial compliance with
1104	pediatric trauma center standards as established by rule of the
1105	department and has been approved by the department to operate as
1106	a pediatric trauma center.
1107	(10)(8)  "Provisional trauma center" means a hospital that
1108	has been verified by the department to be in substantial
1109	compliance with the requirements in s. 395.4025 and has been
1110	approved by the department to operate as a provisional Level I
1111	trauma center, Level II trauma center, or pediatric trauma
1112	center.
1113	(11)(9)  "Trauma agency" means a department-approved agency
1114	established and operated by one or more counties, or a
1115	department-approved entity with which one or more counties
1116	contract, for the purpose of administering an inclusive regional
1117	trauma system.
1118	(12)(10)  "Trauma alert victim" means a person who has
1119	incurred a single or multisystem injury due to blunt or
1120	penetrating means or burns, who requires immediate medical
1121	intervention or treatment, and who meets one or more of the
1122	adult or pediatric scorecard criteria established by the
1123	department by rule.
1124	(13)  "Trauma caseload volume" means the number of trauma
1125	patients reported by individual trauma centers to the Trauma
1126	Registry and validated by the department.
1127	(14)(11)  "Trauma center" means a hospital that has been
1128	verified by the department to be in substantial compliance with
1129	the requirements in s. 395.4025 and has been approved by the
1130	department to operate as a Level I trauma center, Level II
1131	trauma center, or pediatric trauma center.
1132	(15)  "Trauma patient" means a person who has incurred a
1133	physical injury or wound caused by trauma and has accessed a
1134	trauma center.
1135	(16)(12)  "Trauma scorecard" means a statewide methodology
1136	adopted by the department by rule under which a person who has
1137	incurred a traumatic injury is graded as to the severity of his
1138	or her injuries or illness and which methodology is used as the
1139	basis for making destination decisions.
1140	(17)(13)  "Trauma transport protocol" means a document
1141	which describes the policies, processes, and procedures
1142	governing the dispatch of vehicles, the triage, prehospital
1143	transport, and interfacility trauma transfer of trauma victims.
1144	(18)(14)  "Trauma victim" means any person who has incurred
1145	a single or multisystem injury due to blunt or penetrating means
1146	or burns and who requires immediate medical intervention or
1147	treatment.
1148	Section 15.  Section 395.4035, Florida Statutes, is
1149	repealed.
1150	Section 16.  Subsection (1) of section 395.4036, Florida
1151	Statutes, is amended to read:
1152	395.4036  Trauma payments.--
1153	(1)  Recognizing the Legislature's stated intent to provide
1154	financial support to the current verified trauma centers and to
1155	provide incentives for the establishment of additional trauma
1156	centers as part of a system of state-sponsored trauma centers,
1157	the department shall utilize funds collected under s.
1158	318.18(15)(14) and deposited into the Administrative Trust Fund
1159	of the department to ensure the availability and accessibility
1160	of trauma services throughout the state as provided in this
1161	subsection.
1162	(a)  Twenty percent of the total funds collected under this
1163	subsection during the state fiscal year shall be distributed to
1164	verified trauma centers located in a region that have has a
1165	local funding contribution as of December 31. Distribution of
1166	funds under this paragraph shall be based on trauma caseload
1167	volume for the most recent calendar year available.
1168	(b)  Forty percent of the total funds collected under this
1169	subsection shall be distributed to verified trauma centers based
1170	on trauma caseload volume for of the most recent previous
1171	calendar year available. The determination of caseload volume
1172	for distribution of funds under this paragraph shall be based on
1173	the department's Trauma Registry data.
1174	(c)  Forty percent of the total funds collected under this
1175	subsection shall be distributed to verified trauma centers based
1176	on severity of trauma patients for the most recent calendar year
1177	available. The determination of severity for distribution of
1178	funds under this paragraph shall be based on the department's
1179	International Classification Injury Severity Scores or another
1180	statistically valid and scientifically accepted method of
1181	stratifying a trauma patient's severity of injury, risk of
1182	mortality, and resource consumption as adopted by the department
1183	by rule, weighted based on the costs associated with and
1184	incurred by the trauma center in treating trauma patients. The
1185	weighting of scores shall be established by the department by
1186	rule scores of 1-14 and 15 plus.
1187
1188	Funds deposited in the department's Administrative Trust Fund
1189	for verified trauma centers may be used to maximize the receipt
1190	of federal funds that may be available for such trauma centers.
1191	Notwithstanding this section and s. 318.14, distributions to
1192	trauma centers may be adjusted in a manner to ensure that total
1193	payments to trauma centers represent the same proportional
1194	allocation as set forth in this section and s. 318.14. For
1195	purposes of this section and s. 318.14, total funds distributed
1196	to trauma centers may include revenue from the Administrative
1197	Trust Fund and federal funds for which revenue from the
1198	Administrative Trust Fund is used to meet state or local
1199	matching requirements. Funds collected under ss. 318.14 and
1200	318.18(15) and deposited in the Administrative Trust Fund of the
1201	department shall be distributed to trauma centers on a quarterly
1202	basis using the most recent calendar year data available. Such
1203	data shall not be used for more than four quarterly
1204	distributions unless there are extenuating circumstances as
1205	determined by the department, in which case the most recent
1206	calendar year data available shall continue to be used and
1207	appropriate adjustments shall be made as soon as the more recent
1208	data becomes available. Trauma centers may request that their
1209	distributions from the Administrative Trust Fund be used as
1210	intergovernmental transfer funds in the Medicaid program.
1211	Section 17.  Section 395.41, Florida Statutes, is created
1212	to read:
1213	395.41  Trauma center startup grant program.--There is
1214	established a trauma center startup grant program.
1215	(1)  The Legislature recognizes the need for a statewide,
1216	cohesive, uniform, and integrated trauma system, and the
1217	Legislature acknowledges that the state has been divided into
1218	trauma service areas. Each of the trauma service areas should
1219	have at least one trauma center; however, some trauma service
1220	areas do not have a trauma center because of the significant up-
1221	front investment of capital required for hospitals to develop
1222	the physical space, equipment, and qualified personnel necessary
1223	to provide quality trauma services.
1224	(2)  An acute care general hospital that has submitted a
1225	letter of intent and an application to become a trauma center
1226	pursuant to s. 395.4025 may apply to the department for a
1227	startup grant. The grant applicant must demonstrate that:
1228	(a)  There are currently no other trauma centers in the
1229	hospital's trauma service area as established under s. 395.402.
1230	(b)  There is not a trauma center within a 100-mile radius
1231	of the proposed trauma center.
1232	(c)  The hospital has received a local funding contribution
1233	as defined under s. 395.4001.
1234	(d)  The hospital has incurred startup costs in excess of
1235	the amount of grant funding requested.
1236	(e)  The hospital is pursuing the establishment of a
1237	residency program in internal medicine or emergency medicine.
1238	(3)  A hospital receiving startup grant funding that does
1239	not become a provisional trauma center within 24 months after
1240	submitting an application to become a trauma center must forfeit
1241	any state grant funds received pursuant to this section.
1242	(4)  A hospital that receives startup grant funding may not
1243	receive more than $500,000, must ensure that the startup grant
1244	funding is matched on a dollar-for-dollar basis with a local
1245	funding contribution, and shall receive startup grant funding
1246	only one time.
1247	Section 18.  This act shall take effect October 1, 2006,
1248	except that section 395.41, Florida Statutes, as created by this
1249	act, shall take effect subject to an appropriation for the
1250	trauma center startup grant program in the 2006-2007 General
1251	Appropriations Act.

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