HB 385

1	A bill to be entitled
2	An act relating to nursing home facilities; amending s.
3	400.118, F.S.; revising provisions relating to frequency
4	of quality-of-care monitoring of specified facilities;
5	amending s. 400.141, F.S.; authorizing facilities with a
6	standard license to provide certified nursing assistant
7	training; amending s. 400.147, F.S.; revising a
8	definition; revising reporting requirements under facility
9	internal risk management and quality assurance programs;
10	amending s. 400.19, F.S.; providing conditions for
11	scheduling surveys when certain deficiencies are
12	overturned; amending s. 400.195, F.S.; correcting a cross-
13	reference; amending s. 400.23, F.S.; revising conditions
14	for documentation of compliance with staffing standards;
15	directing the Agency for Health Care Administration to
16	assign standard licensure status to a facility that has
17	corrected specified deficiencies; revising provisions
18	relating to classification of facility deficiencies;
19	providing a definition; providing an effective date.
20
21	Be It Enacted by the Legislature of the State of Florida:
22
23	Section 1.  Paragraph (a) of subsection (2) of section
24	400.118, Florida Statutes, is amended to read:
25	400.118  Quality assurance; early warning system;
26	monitoring; rapid response teams.--
27	(2)(a)  The agency shall establish within each district
28	office one or more quality-of-care monitors, based on the number
29	of nursing facilities in the district, to monitor all nursing
30	facilities in the district on a regular, unannounced, aperiodic
31	basis, including nights, evenings, weekends, and holidays.
32	Quality-of-care monitors shall visit each nursing facility
33	annually, shall visit each conditionally licensed nursing
34	facility at least quarterly, and shall visit other nursing
35	facilities as directed by the agency. Priority for additional
36	monitoring visits shall be given to nursing facilities with a
37	history of resident care deficiencies. Quality-of-care monitors
38	shall be registered nurses who are trained and experienced in
39	nursing facility regulation, standards of practice in long-term
40	care, and evaluation of patient care. Individuals in these
41	positions shall not be deployed by the agency as a part of the
42	district survey team in the conduct of routine, scheduled
43	surveys, but shall function solely and independently as quality-
44	of-care monitors. Quality-of-care monitors shall assess the
45	overall quality of life in the nursing facility and shall assess
46	specific conditions in the facility directly related to resident
47	care, including the operations of internal quality improvement
48	and risk management programs and adverse incident reports. The
49	quality-of-care monitor shall include in an assessment visit
50	observation of the care and services rendered to residents and
51	formal and informal interviews with residents, family members,
52	facility staff, resident guests, volunteers, other regulatory
53	staff, and representatives of a long-term care ombudsman council
54	or Florida advocacy council.
55	Section 2.  Section 400.141, Florida Statutes, is amended
56	to read:
57	400.141  Administration and management of nursing home
58	facilities.--Every licensed facility shall comply with all
59	applicable standards and rules of the agency and shall:
60	(1)  Be under the administrative direction and charge of a
61	licensed administrator.
62	(2)  Appoint a medical director licensed pursuant to
63	chapter 458 or chapter 459. The agency may establish by rule
64	more specific criteria for the appointment of a medical
65	director.
66	(3)  Have available the regular, consultative, and
67	emergency services of physicians licensed by the state.
68	(4)  Provide for resident use of a community pharmacy as
69	specified in s. 400.022(1)(q). Any other law to the contrary
70	notwithstanding, a registered pharmacist licensed in Florida,
71	that is under contract with a facility licensed under this
72	chapter or chapter 429, shall repackage a nursing facility
73	resident's bulk prescription medication which has been packaged
74	by another pharmacist licensed in any state in the United States
75	into a unit dose system compatible with the system used by the
76	nursing facility, if the pharmacist is requested to offer such
77	service. In order to be eligible for the repackaging, a resident
78	or the resident's spouse must receive prescription medication
79	benefits provided through a former employer as part of his or
80	her retirement benefits, a qualified pension plan as specified
81	in s. 4972 of the Internal Revenue Code, a federal retirement
82	program as specified under 5 C.F.R. s. 831, or a long-term care
83	policy as defined in s. 627.9404(1). A pharmacist who correctly
84	repackages and relabels the medication and the nursing facility
85	which correctly administers such repackaged medication under the
86	provisions of this subsection shall not be held liable in any
87	civil or administrative action arising from the repackaging. In
88	order to be eligible for the repackaging, a nursing facility
89	resident for whom the medication is to be repackaged shall sign
90	an informed consent form provided by the facility which includes
91	an explanation of the repackaging process and which notifies the
92	resident of the immunities from liability provided herein. A
93	pharmacist who repackages and relabels prescription medications,
94	as authorized under this subsection, may charge a reasonable fee
95	for costs resulting from the implementation of this provision.
96	(5)  Provide for the access of the facility residents to
97	dental and other health-related services, recreational services,
98	rehabilitative services, and social work services appropriate to
99	their needs and conditions and not directly furnished by the
100	licensee. When a geriatric outpatient nurse clinic is conducted
101	in accordance with rules adopted by the agency, outpatients
102	attending such clinic shall not be counted as part of the
103	general resident population of the nursing home facility, nor
104	shall the nursing staff of the geriatric outpatient clinic be
105	counted as part of the nursing staff of the facility, until the
106	outpatient clinic load exceeds 15 a day.
107	(6)  Be allowed and encouraged by the agency to provide
108	other needed services under certain conditions. If the facility
109	has a standard licensure status, and has had no class I or class
110	II deficiencies during the past 2 years or has been awarded a
111	Gold Seal under the program established in s. 400.235, it may be
112	encouraged by the agency to provide services, including, but not
113	limited to, respite and adult day services, which enable
114	individuals to move in and out of the facility. A facility is
115	not subject to any additional licensure requirements for
116	providing these services. Respite care may be offered to persons
117	in need of short-term or temporary nursing home services.
118	Respite care must be provided in accordance with this part and
119	rules adopted by the agency. However, the agency shall, by rule,
120	adopt modified requirements for resident assessment, resident
121	care plans, resident contracts, physician orders, and other
122	provisions, as appropriate, for short-term or temporary nursing
123	home services. The agency shall allow for shared programming and
124	staff in a facility which meets minimum standards and offers
125	services pursuant to this subsection, but, if the facility is
126	cited for deficiencies in patient care, may require additional
127	staff and programs appropriate to the needs of service
128	recipients. A person who receives respite care may not be
129	counted as a resident of the facility for purposes of the
130	facility's licensed capacity unless that person receives 24-hour
131	respite care. A person receiving either respite care for 24
132	hours or longer or adult day services must be included when
133	calculating minimum staffing for the facility. Any costs and
134	revenues generated by a nursing home facility from
135	nonresidential programs or services shall be excluded from the
136	calculations of Medicaid per diems for nursing home
137	institutional care reimbursement.
138	(7)  If the facility has a standard license or is a Gold
139	Seal facility, exceeds the minimum required hours of licensed
140	nursing and certified nursing assistant direct care per resident
141	per day, and is part of a continuing care facility licensed
142	under chapter 651 or a retirement community that offers other
143	services pursuant to part III of this chapter or part I or part
144	III of chapter 429 on a single campus, be allowed to share
145	programming and staff. At the time of inspection and in the
146	semiannual report required pursuant to subsection (15), a
147	continuing care facility or retirement community that uses this
148	option must demonstrate through staffing records that minimum
149	staffing requirements for the facility were met. Licensed nurses
150	and certified nursing assistants who work in the nursing home
151	facility may be used to provide services elsewhere on campus if
152	the facility exceeds the minimum number of direct care hours
153	required per resident per day and the total number of residents
154	receiving direct care services from a licensed nurse or a
155	certified nursing assistant does not cause the facility to
156	violate the staffing ratios required under s. 400.23(3)(a).
157	Compliance with the minimum staffing ratios shall be based on
158	total number of residents receiving direct care services,
159	regardless of where they reside on campus. If the facility
160	receives a conditional license, it may not share staff until the
161	conditional license status ends. This subsection does not
162	restrict the agency's authority under federal or state law to
163	require additional staff if a facility is cited for deficiencies
164	in care which are caused by an insufficient number of certified
165	nursing assistants or licensed nurses. The agency may adopt
166	rules for the documentation necessary to determine compliance
167	with this provision.
168	(8)  Maintain the facility premises and equipment and
169	conduct its operations in a safe and sanitary manner.
170	(9)  If the licensee furnishes food service, provide a
171	wholesome and nourishing diet sufficient to meet generally
172	accepted standards of proper nutrition for its residents and
173	provide such therapeutic diets as may be prescribed by attending
174	physicians. In making rules to implement this subsection, the
175	agency shall be guided by standards recommended by nationally
176	recognized professional groups and associations with knowledge
177	of dietetics.
178	(10)  Keep full records of resident admissions and
179	discharges; medical and general health status, including medical
180	records, personal and social history, and identity and address
181	of next of kin or other persons who may have responsibility for
182	the affairs of the residents; and individual resident care plans
183	including, but not limited to, prescribed services, service
184	frequency and duration, and service goals. The records shall be
185	open to inspection by the agency.
186	(11)  Keep such fiscal records of its operations and
187	conditions as may be necessary to provide information pursuant
188	to this part.
189	(12)  Furnish copies of personnel records for employees
190	affiliated with such facility, to any other facility licensed by
191	this state requesting this information pursuant to this part.
192	Such information contained in the records may include, but is
193	not limited to, disciplinary matters and any reason for
194	termination. Any facility releasing such records pursuant to
195	this part shall be considered to be acting in good faith and may
196	not be held liable for information contained in such records,
197	absent a showing that the facility maliciously falsified such
198	records.
199	(13)  Publicly display a poster provided by the agency
200	containing the names, addresses, and telephone numbers for the
201	state's abuse hotline, the State Long-Term Care Ombudsman, the
202	Agency for Health Care Administration consumer hotline, the
203	Advocacy Center for Persons with Disabilities, the Florida
204	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
205	with a clear description of the assistance to be expected from
206	each.
207	(14)  Submit to the agency the information specified in s.
208	400.071(2)(e) for a management company within 30 days after the
209	effective date of the management agreement.
210	(15)  Submit semiannually to the agency, or more frequently
211	if requested by the agency, information regarding facility
212	staff-to-resident ratios, staff turnover, and staff stability,
213	including information regarding certified nursing assistants,
214	licensed nurses, the director of nursing, and the facility
215	administrator. For purposes of this reporting:
216	(a)  Staff-to-resident ratios must be reported in the
217	categories specified in s. 400.23(3)(a) and applicable rules.
218	The ratio must be reported as an average for the most recent
219	calendar quarter.
220	(b)  Staff turnover must be reported for the most recent
221	12-month period ending on the last workday of the most recent
222	calendar quarter prior to the date the information is submitted.
223	The turnover rate must be computed quarterly, with the annual
224	rate being the cumulative sum of the quarterly rates. The
225	turnover rate is the total number of terminations or separations
226	experienced during the quarter, excluding any employee
227	terminated during a probationary period of 3 months or less,
228	divided by the total number of staff employed at the end of the
229	period for which the rate is computed, and expressed as a
230	percentage.
231	(c)  The formula for determining staff stability is the
232	total number of employees that have been employed for more than
233	12 months, divided by the total number of employees employed at
234	the end of the most recent calendar quarter, and expressed as a
235	percentage.
236	(d)  A nursing facility that has failed to comply with
237	state minimum-staffing requirements for 2 consecutive days is
238	prohibited from accepting new admissions until the facility has
239	achieved the minimum-staffing requirements for a period of 6
240	consecutive days. For the purposes of this paragraph, any person
241	who was a resident of the facility and was absent from the
242	facility for the purpose of receiving medical care at a separate
243	location or was on a leave of absence is not considered a new
244	admission. Failure to impose such an admissions moratorium
245	constitutes a class II deficiency.
246	(e)  A nursing facility which does not have a conditional
247	license may be cited for failure to comply with the standards in
248	s. 400.23(3)(a)1.a. only if it has failed to meet those
249	standards on 2 consecutive days or if it has failed to meet at
250	least 97 percent of those standards on any one day.
251	(f)  A facility which has a conditional license must be in
252	compliance with the standards in s. 400.23(3)(a) at all times.
253
254	Nothing in this section shall limit the agency's ability to
255	impose a deficiency or take other actions if a facility does not
256	have enough staff to meet the residents' needs.
257	(16)  Report monthly the number of vacant beds in the
258	facility which are available for resident occupancy on the day
259	the information is reported.
260	(17)  Notify a licensed physician when a resident exhibits
261	signs of dementia or cognitive impairment or has a change of
262	condition in order to rule out the presence of an underlying
263	physiological condition that may be contributing to such
264	dementia or impairment. The notification must occur within 30
265	days after the acknowledgment of such signs by facility staff.
266	If an underlying condition is determined to exist, the facility
267	shall arrange, with the appropriate health care provider, the
268	necessary care and services to treat the condition.
269	(18)  If the facility implements a dining and hospitality
270	attendant program, ensure that the program is developed and
271	implemented under the supervision of the facility director of
272	nursing. A licensed nurse, licensed speech or occupational
273	therapist, or a registered dietitian must conduct training of
274	dining and hospitality attendants. A person employed by a
275	facility as a dining and hospitality attendant must perform
276	tasks under the direct supervision of a licensed nurse.
277	(19)  Report to the agency any filing for bankruptcy
278	protection by the facility or its parent corporation,
279	divestiture or spin-off of its assets, or corporate
280	reorganization within 30 days after the completion of such
281	activity.
282	(20)  Maintain general and professional liability insurance
283	coverage that is in force at all times. In lieu of general and
284	professional liability insurance coverage, a state-designated
285	teaching nursing home and its affiliated assisted living
286	facilities created under s. 430.80 may demonstrate proof of
287	financial responsibility as provided in s. 430.80(3)(h).
288	(21)  Maintain in the medical record for each resident a
289	daily chart of certified nursing assistant services provided to
290	the resident. The certified nursing assistant who is caring for
291	the resident must complete this record by the end of his or her
292	shift. This record must indicate assistance with activities of
293	daily living, assistance with eating, and assistance with
294	drinking, and must record each offering of nutrition and
295	hydration for those residents whose plan of care or assessment
296	indicates a risk for malnutrition or dehydration.
297	(22)  Before November 30 of each year, subject to the
298	availability of an adequate supply of the necessary vaccine,
299	provide for immunizations against influenza viruses to all its
300	consenting residents in accordance with the recommendations of
301	the United States Centers for Disease Control and Prevention,
302	subject to exemptions for medical contraindications and
303	religious or personal beliefs. Subject to these exemptions, any
304	consenting person who becomes a resident of the facility after
305	November 30 but before March 31 of the following year must be
306	immunized within 5 working days after becoming a resident.
307	Immunization shall not be provided to any resident who provides
308	documentation that he or she has been immunized as required by
309	this subsection. This subsection does not prohibit a resident
310	from receiving the immunization from his or her personal
311	physician if he or she so chooses. A resident who chooses to
312	receive the immunization from his or her personal physician
313	shall provide proof of immunization to the facility. The agency
314	may adopt and enforce any rules necessary to comply with or
315	implement this subsection.
316	(23)  Assess all residents for eligibility for pneumococcal
317	polysaccharide vaccination (PPV) and vaccinate residents when
318	indicated within 60 days after the effective date of this act in
319	accordance with the recommendations of the United States Centers
320	for Disease Control and Prevention, subject to exemptions for
321	medical contraindications and religious or personal beliefs.
322	Residents admitted after the effective date of this act shall be
323	assessed within 5 working days of admission and, when indicated,
324	vaccinated within 60 days in accordance with the recommendations
325	of the United States Centers for Disease Control and Prevention,
326	subject to exemptions for medical contraindications and
327	religious or personal beliefs. Immunization shall not be
328	provided to any resident who provides documentation that he or
329	she has been immunized as required by this subsection. This
330	subsection does not prohibit a resident from receiving the
331	immunization from his or her personal physician if he or she so
332	chooses. A resident who chooses to receive the immunization from
333	his or her personal physician shall provide proof of
334	immunization to the facility. The agency may adopt and enforce
335	any rules necessary to comply with or implement this subsection.
336	(24)  Annually encourage and promote to its employees the
337	benefits associated with immunizations against influenza viruses
338	in accordance with the recommendations of the United States
339	Centers for Disease Control and Prevention. The agency may adopt
340	and enforce any rules necessary to comply with or implement this
341	subsection.
342
343	Every facility with a standard license Facilities that have been
344	awarded a Gold Seal under the program established in s. 400.235
345	may develop a plan to provide certified nursing assistant
346	training as prescribed by federal regulations and state rules
347	and may apply to the agency for approval of its their program.
348	Section 3.  Subsections (9) through (15) of section
349	400.147, Florida Statutes, are renumbered as subsections (8)
350	through (14), respectively, and paragraph (e) of subsection (5),
351	subsection (7), and present subsection (8) of that section are
352	amended to read:
353	400.147  Internal risk management and quality assurance
354	program.--
355	(5)  For purposes of reporting to the agency under this
356	section, the term "adverse incident" means:
357	(e)  An event that is reported to law enforcement for
358	investigation.
359	(7)(a)  The facility shall initiate an investigation and
360	shall notify the agency within 1 business day after the risk
361	manager or his or her designee has received a report pursuant to
362	paragraph (1)(d). The notification must be made in writing and
363	be provided electronically, by facsimile device or overnight
364	mail delivery. The notification must include information
365	regarding the identity of the affected resident, the type of
366	adverse incident, the initiation of an investigation by the
367	facility, and whether the events causing or resulting in the
368	adverse incident represent a potential risk to any other
369	resident. The notification is confidential as provided by law
370	and is not discoverable or admissible in any civil or
371	administrative action, except in disciplinary proceedings by the
372	agency or the appropriate regulatory board. The agency may
373	investigate, as it deems appropriate, any such incident and
374	prescribe measures that must or may be taken in response to the
375	incident. The agency shall review each incident and determine
376	whether it potentially involved conduct by the health care
377	professional who is subject to disciplinary action, in which
378	case the provisions of s. 456.073 shall apply.
379	(b)(8)(a)  Each facility shall complete the investigation
380	and submit an adverse incident report to the agency for each
381	adverse incident within 15 calendar days after its occurrence.
382	If, after a complete investigation, the risk manager determines
383	that the incident was not an adverse incident as defined in
384	subsection (5), the facility shall include this information in
385	the report. The agency shall develop a form for reporting this
386	information.
387	(c)(b)  The information reported to the agency pursuant to
388	paragraph (b) that (a) which relates to persons licensed under
389	chapter 458, chapter 459, chapter 461, or chapter 466 shall be
390	reviewed by the agency. The agency shall determine whether any
391	of the incidents potentially involved conduct by a health care
392	professional who is subject to disciplinary action, in which
393	case the provisions of s. 456.073 shall apply.
394	(d)(c)  The report submitted to the agency must also
395	contain the name of the risk manager of the facility.
396	(e)(d)  The adverse incident report is confidential as
397	provided by law and is not discoverable or admissible in any
398	civil or administrative action, except in disciplinary
399	proceedings by the agency or the appropriate regulatory board.
400	Section 4.  Subsection (3) of section 400.19, Florida
401	Statutes, is amended to read:
402	400.19  Right of entry and inspection.--
403	(3)  The agency shall every 15 months conduct at least one
404	unannounced inspection to determine compliance by the licensee
405	with statutes, and with rules promulgated under the provisions
406	of those statutes, governing minimum standards of construction,
407	quality and adequacy of care, and rights of residents. The
408	survey shall be conducted every 6 months for the next 2-year
409	period if the facility has been cited for a class I deficiency,
410	has been cited for two or more class II deficiencies arising
411	from separate surveys or investigations within a 60-day period,
412	or has had three or more substantiated complaints within a 6-
413	month period, each resulting in at least one class I or class II
414	deficiency. In addition to any other fees or fines in this part,
415	the agency shall assess a fine for each facility that is subject
416	to the 6-month survey cycle. The fine for the 2-year period
417	shall be $6,000, one-half to be paid at the completion of each
418	survey. The agency may adjust this fine by the change in the
419	Consumer Price Index, based on the 12 months immediately
420	preceding the increase, to cover the cost of the additional
421	surveys. In the event such deficiencies are overturned as the
422	result of administrative action but additional surveys have
423	already been conducted pursuant to this section, the most recent
424	survey shall be considered an annual survey for purposes of
425	future survey scheduling. The agency shall verify through
426	subsequent inspection that any deficiency identified during the
427	annual inspection is corrected. However, the agency may verify
428	the correction of a class III or class IV deficiency unrelated
429	to resident rights or resident care without reinspecting the
430	facility if adequate written documentation has been received
431	from the facility, which provides assurance that the deficiency
432	has been corrected. The giving or causing to be given of advance
433	notice of such unannounced inspections by an employee of the
434	agency to any unauthorized person shall constitute cause for
435	suspension of not fewer than 5 working days according to the
436	provisions of chapter 110.
437	Section 5.  Paragraph (d) of subsection (1) of section
438	400.195, Florida Statutes, is amended to read:
439	400.195  Agency reporting requirements.--
440	(1)  For the period beginning June 30, 2001, and ending
441	June 30, 2005, the Agency for Health Care Administration shall
442	provide a report to the Governor, the President of the Senate,
443	and the Speaker of the House of Representatives with respect to
444	nursing homes. The first report shall be submitted no later than
445	December 30, 2002, and subsequent reports shall be submitted
446	every 6 months thereafter. The report shall identify facilities
447	based on their ownership characteristics, size, business
448	structure, for-profit or not-for-profit status, and any other
449	characteristics the agency determines useful in analyzing the
450	varied segments of the nursing home industry and shall report:
451	(d)  Information regarding deficiencies cited, including
452	information used to develop the Nursing Home Guide WATCH LIST
453	pursuant to s. 400.191, and applicable rules, a summary of data
454	generated on nursing homes by Centers for Medicare and Medicaid
455	Services Nursing Home Quality Information Project, and
456	information collected pursuant to s. 400.147(8)(9), relating to
457	litigation.
458	Section 6.  Paragraph (a) of subsection (3), paragraphs (b)
459	and (e) of subsection (7), and subsection (8) of section 400.23,
460	Florida Statutes, are amended to read:
461	400.23  Rules; evaluation and deficiencies; licensure
462	status.--
463	(3)(a)1.  The agency shall adopt rules providing minimum
464	staffing requirements for nursing homes. These requirements
465	shall include, for each nursing home facility:
466	a.  A minimum certified nursing assistant staffing of 2.6
467	hours of direct care per resident per day beginning January 1,
468	2003, and increasing to 2.7 hours of direct care per resident
469	per day beginning January 1, 2007. Beginning January 1, 2002, no
470	facility shall staff below one certified nursing assistant per
471	20 residents, and a minimum licensed nursing staffing of 1.0
472	hour of direct care per resident per day but never below one
473	licensed nurse per 40 residents.
474	b.  Beginning January 1, 2007, a minimum weekly average
475	certified nursing assistant staffing of 2.9 hours of direct care
476	per resident per day. For the purpose of this sub-subparagraph,
477	a week is defined as Sunday through Saturday.
478	2.  Nursing assistants employed under s. 400.211(2) may be
479	included in computing the staffing ratio for certified nursing
480	assistants only if their job responsibilities include only
481	nursing-assistant-related duties.
482	3.  Each nursing home must document compliance with
483	staffing standards as required under this paragraph and post
484	daily the names of staff on duty for the benefit of facility
485	residents and the public. Compliance with federal posting
486	requirements shall satisfy the posting requirements of this
487	subparagraph.
488	4.  The agency shall recognize the use of licensed nurses
489	for compliance with minimum staffing requirements for certified
490	nursing assistants, provided that the facility otherwise meets
491	the minimum staffing requirements for licensed nurses and that
492	the licensed nurses are performing the duties of a certified
493	nursing assistant. Unless otherwise approved by the agency,
494	licensed nurses counted toward the minimum staffing requirements
495	for certified nursing assistants must exclusively perform the
496	duties of a certified nursing assistant for the entire shift and
497	not also be counted toward the minimum staffing requirements for
498	licensed nurses. If the agency approved a facility's request to
499	use a licensed nurse to perform both licensed nursing and
500	certified nursing assistant duties, the facility must allocate
501	the amount of staff time specifically spent on certified nursing
502	assistant duties for the purpose of documenting compliance with
503	minimum staffing requirements for certified and licensed nursing
504	staff. In no event may the hours of a licensed nurse with dual
505	job responsibilities be counted twice.
506	(7)  The agency shall, at least every 15 months, evaluate
507	all nursing home facilities and make a determination as to the
508	degree of compliance by each licensee with the established rules
509	adopted under this part as a basis for assigning a licensure
510	status to that facility. The agency shall base its evaluation on
511	the most recent inspection report, taking into consideration
512	findings from other official reports, surveys, interviews,
513	investigations, and inspections. The agency shall assign a
514	licensure status of standard or conditional to each nursing
515	home.
516	(b)  A conditional licensure status means that a facility,
517	due to the presence of one or more class I or class II
518	deficiencies, or class III deficiencies not corrected within the
519	time established by the agency, is not in substantial compliance
520	at the time of the survey with criteria established under this
521	part or with rules adopted by the agency. If the facility has no
522	class I, class II, or uncorrected class III deficiencies at the
523	time of the followup survey, a standard licensure status shall
524	may be assigned.
525	(e)  Each licensee shall post its license issued pursuant
526	to final agency action in a prominent place that is in clear and
527	unobstructed public view at or near the place where residents
528	are being admitted to the facility.
529	(8)  The agency shall adopt rules to provide that, when the
530	criteria established under subsection (2) are not met, such
531	deficiencies shall be classified according to the nature and the
532	scope of the deficiency. The scope shall be cited as isolated,
533	patterned, or widespread. An isolated deficiency is a deficiency
534	affecting one or a very limited number of residents, or
535	involving one or a very limited number of staff, or a situation
536	that occurred only occasionally or in a very limited number of
537	locations. A patterned deficiency is a deficiency where more
538	than a very limited number of residents are affected, or more
539	than a very limited number of staff are involved, or the
540	situation has occurred in several locations, or the same
541	resident or residents have been affected by repeated occurrences
542	of the same deficient practice but the effect of the deficient
543	practice is not found to be pervasive throughout the facility. A
544	widespread deficiency is a deficiency in which the problems
545	causing the deficiency are pervasive in the facility or
546	represent systemic failure that has affected or has the
547	potential to affect a large portion of the facility's residents.
548	The agency shall indicate the classification on the face of the
549	notice of deficiencies as follows:
550	(a)  A class I deficiency is a deficiency that the agency
551	determines presents a situation in which immediate corrective
552	action is necessary because the facility's noncompliance creates
553	immediate jeopardy to the health or safety of a resident. For
554	purposes of this subsection, "immediate jeopardy" means that the
555	licensee's noncompliance has caused, or is likely to cause,
556	serious injury, harm, impairment, or death to a resident
557	receiving care in a facility. The condition or practice
558	constituting a class I violation shall be abated or eliminated
559	immediately, unless a fixed period of time, as determined by the
560	agency, is required for correction. A class I deficiency is
561	subject to a civil penalty of $10,000 for an isolated
562	deficiency, $12,500 for a patterned deficiency, and $15,000 for
563	a widespread deficiency. The fine amount shall be doubled for
564	each deficiency if the facility was previously cited for one or
565	more class I or class II deficiencies during the last annual
566	inspection or any inspection or complaint investigation since
567	the last annual inspection. A fine must be levied
568	notwithstanding the correction of the deficiency.
569	(b)  A class II deficiency is a deficiency that the agency
570	determines has caused actual harm to a resident but did not
571	create immediate jeopardy compromised the resident's ability to
572	maintain or reach his or her highest practicable physical,
573	mental, and psychosocial well-being, as defined by an accurate
574	and comprehensive resident assessment, plan of care, and
575	provision of services. A class II deficiency is subject to a
576	civil penalty of $2,500 for an isolated deficiency, $5,000 for a
577	patterned deficiency, and $7,500 for a widespread deficiency.
578	The fine amount shall be doubled for each deficiency if the
579	facility was previously cited for one or more class I or class
580	II deficiencies during the last annual inspection or any
581	inspection or complaint investigation since the last annual
582	inspection. A fine shall be levied notwithstanding the
583	correction of the deficiency.
584	(c)  A class III deficiency is a deficiency that the agency
585	determines has not caused actual harm to a resident and did not
586	create immediate jeopardy but presents the potential for more
587	than minimal harm will result in no more than minimal physical,
588	mental, or psychosocial discomfort to the resident or has the
589	potential to compromise the resident's ability to maintain or
590	reach his or her highest practical physical, mental, or
591	psychosocial well-being, as defined by an accurate and
592	comprehensive resident assessment, plan of care, and provision
593	of services. A class III deficiency is subject to a civil
594	penalty of $1,000 for an isolated deficiency, $2,000 for a
595	patterned deficiency, and $3,000 for a widespread deficiency.
596	The fine amount shall be doubled for each deficiency if the
597	facility was previously cited for one or more class I or class
598	II deficiencies during the last annual inspection or any
599	inspection or complaint investigation since the last annual
600	inspection. A citation for a class III deficiency must specify
601	the time within which the deficiency is required to be
602	corrected. If a class III deficiency is corrected within the
603	time specified, no civil penalty shall be imposed.
604	(d)  A class IV deficiency is a deficiency that the agency
605	determines has the potential for causing no more than minimal
606	harm to a minor negative impact on the resident. If the class IV
607	deficiency is isolated, no plan of correction is required.
608	Section 7.  This act shall take effect July 1, 2007.

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