Senate Bill sb0682er

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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



  1                                 

  2         An act relating to nursing facilities; amending

  3         s. 400.118, F.S.; revising the frequency of

  4         visits to nursing facilities by quality-of-care

  5         monitors from the Agency for Health Care

  6         Administration; amending s. 400.141, F.S.;

  7         authorizing certain licensed nursing facilities

  8         to develop a plan to provide certain training

  9         for nursing assistants; providing for rules

10         relating to agency approval of training

11         programs; amending s. 400.147, F.S.; redefining

12         the term "adverse incident"; deleting the

13         requirement that a nursing facility notify the

14         agency of an adverse incident; deleting

15         notification requirements; requiring that a

16         risk manager determine if an incident was an

17         adverse incident; amending s. 400.19, F.S.;

18         providing that the most recent survey is a

19         licensure survey under certain conditions for

20         purposes of future survey scheduling; amending

21         s. 400.195, F.S.; conforming a cross-reference;

22         amending s. 400.23, F.S.; requiring that

23         federal posting requirements for staffing

24         standards comply with state posting

25         requirements; providing an effective date.

26  

27  Be It Enacted by the Legislature of the State of Florida:

28  

29         Section 1.  Paragraph (a) of subsection (2) of section

30  400.118, Florida Statutes, is amended to read:

31  


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         400.118  Quality assurance; early warning system;

 2  monitoring; rapid response teams.--

 3         (2)(a)  The agency shall establish within each district

 4  office one or more quality-of-care monitors, based on the

 5  number of nursing facilities in the district, to monitor all

 6  nursing facilities in the district on a regular, unannounced,

 7  aperiodic basis, including nights, evenings, weekends, and

 8  holidays. Quality-of-care monitors shall visit each nursing

 9  facility annually, shall visit each conditionally licensed

10  nursing facility at least quarterly, and shall visit other

11  facilities as directed by the agency. However, upon the

12  request of a facility, the agency shall make quarterly visits

13  to a nursing home that is not conditionally licensed. The

14  request applies only to the current licensure period and must

15  be made again by the facility at the time of license renewal

16  in order to be continued. Priority for additional monitoring

17  visits shall be given to nursing facilities that have with a

18  history of resident care deficiencies. Quality-of-care

19  monitors shall be registered nurses who are trained and

20  experienced in nursing facility regulation, standards of

21  practice in long-term care, and evaluation of patient care.

22  Individuals in these positions may shall not be deployed by

23  the agency as a part of the district survey team in the

24  conduct of routine, scheduled surveys, but shall function

25  solely and independently as quality-of-care monitors.

26  Quality-of-care monitors shall assess the overall quality of

27  life in the nursing facility and shall assess specific

28  conditions in the facility directly related to resident care,

29  including the operations of internal quality improvement and

30  risk management programs and adverse incident reports. The

31  quality-of-care monitor shall include in an assessment visit


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    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  observation of the care and services rendered to residents and

 2  formal and informal interviews with residents, family members,

 3  facility staff, resident guests, volunteers, other regulatory

 4  staff, and representatives of a long-term care ombudsman

 5  council or Florida advocacy council.

 6         Section 2.  Section 400.141, Florida Statutes, is

 7  amended to read:

 8         400.141  Administration and management of nursing home

 9  facilities.--Every licensed facility shall comply with all

10  applicable standards and rules of the agency and shall:

11         (1)  Be under the administrative direction and charge

12  of a licensed administrator.

13         (2)  Appoint a medical director licensed pursuant to

14  chapter 458 or chapter 459. The agency may establish by rule

15  more specific criteria for the appointment of a medical

16  director.

17         (3)  Have available the regular, consultative, and

18  emergency services of physicians licensed by the state.

19         (4)  Provide for resident use of a community pharmacy

20  as specified in s. 400.022(1)(q). Any other law to the

21  contrary notwithstanding, a registered pharmacist licensed in

22  Florida, that is under contract with a facility licensed under

23  this chapter or chapter 429, shall repackage a nursing

24  facility resident's bulk prescription medication which has

25  been packaged by another pharmacist licensed in any state in

26  the United States into a unit dose system compatible with the

27  system used by the nursing facility, if the pharmacist is

28  requested to offer such service. In order to be eligible for

29  the repackaging, a resident or the resident's spouse must

30  receive prescription medication benefits provided through a

31  former employer as part of his or her retirement benefits, a


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    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  qualified pension plan as specified in s. 4972 of the Internal

 2  Revenue Code, a federal retirement program as specified under

 3  5 C.F.R. s. 831, or a long-term care policy as defined in s.

 4  627.9404(1). A pharmacist who correctly repackages and

 5  relabels the medication and the nursing facility which

 6  correctly administers such repackaged medication under the

 7  provisions of this subsection shall not be held liable in any

 8  civil or administrative action arising from the repackaging.

 9  In order to be eligible for the repackaging, a nursing

10  facility resident for whom the medication is to be repackaged

11  shall sign an informed consent form provided by the facility

12  which includes an explanation of the repackaging process and

13  which notifies the resident of the immunities from liability

14  provided herein. A pharmacist who repackages and relabels

15  prescription medications, as authorized under this subsection,

16  may charge a reasonable fee for costs resulting from the

17  implementation of this provision.

18         (5)  Provide for the access of the facility residents

19  to dental and other health-related services, recreational

20  services, rehabilitative services, and social work services

21  appropriate to their needs and conditions and not directly

22  furnished by the licensee.  When a geriatric outpatient nurse

23  clinic is conducted in accordance with rules adopted by the

24  agency, outpatients attending such clinic shall not be counted

25  as part of the general resident population of the nursing home

26  facility, nor shall the nursing staff of the geriatric

27  outpatient clinic be counted as part of the nursing staff of

28  the facility, until the outpatient clinic load exceeds 15 a

29  day.

30         (6)  Be allowed and encouraged by the agency to provide

31  other needed services under certain conditions. If the


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  facility has a standard licensure status, and has had no class

 2  I or class II deficiencies during the past 2 years or has been

 3  awarded a Gold Seal under the program established in s.

 4  400.235, it may be encouraged by the agency to provide

 5  services, including, but not limited to, respite and adult day

 6  services, which enable individuals to move in and out of the

 7  facility.  A facility is not subject to any additional

 8  licensure requirements for providing these services. Respite

 9  care may be offered to persons in need of short-term or

10  temporary nursing home services. Respite care must be provided

11  in accordance with this part and rules adopted by the agency.

12  However, the agency shall, by rule, adopt modified

13  requirements for resident assessment, resident care plans,

14  resident contracts, physician orders, and other provisions, as

15  appropriate, for short-term or temporary nursing home

16  services.  The agency shall allow for shared programming and

17  staff in a facility which meets minimum standards and offers

18  services pursuant to this subsection, but, if the facility is

19  cited for deficiencies in patient care, may require additional

20  staff and programs appropriate to the needs of service

21  recipients. A person who receives respite care may not be

22  counted as a resident of the facility for purposes of the

23  facility's licensed capacity unless that person receives

24  24-hour respite care. A person receiving either respite care

25  for 24 hours or longer or adult day services must be included

26  when calculating minimum staffing for the facility. Any costs

27  and revenues generated by a nursing home facility from

28  nonresidential programs or services shall be excluded from the

29  calculations of Medicaid per diems for nursing home

30  institutional care reimbursement.

31  


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         (7)  If the facility has a standard license or is a

 2  Gold Seal facility, exceeds the minimum required hours of

 3  licensed nursing and certified nursing assistant direct care

 4  per resident per day, and is part of a continuing care

 5  facility licensed under chapter 651 or a retirement community

 6  that offers other services pursuant to part III of this

 7  chapter or part I or part III of chapter 429 on a single

 8  campus, be allowed to share programming and staff. At the time

 9  of inspection and in the semiannual report required pursuant

10  to subsection (15), a continuing care facility or retirement

11  community that uses this option must demonstrate through

12  staffing records that minimum staffing requirements for the

13  facility were met. Licensed nurses and certified nursing

14  assistants who work in the nursing home facility may be used

15  to provide services elsewhere on campus if the facility

16  exceeds the minimum number of direct care hours required per

17  resident per day and the total number of residents receiving

18  direct care services from a licensed nurse or a certified

19  nursing assistant does not cause the facility to violate the

20  staffing ratios required under s. 400.23(3)(a). Compliance

21  with the minimum staffing ratios shall be based on total

22  number of residents receiving direct care services, regardless

23  of where they reside on campus. If the facility receives a

24  conditional license, it may not share staff until the

25  conditional license status ends. This subsection does not

26  restrict the agency's authority under federal or state law to

27  require additional staff if a facility is cited for

28  deficiencies in care which are caused by an insufficient

29  number of certified nursing assistants or licensed nurses. The

30  agency may adopt rules for the documentation necessary to

31  determine compliance with this provision.


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         (8)  Maintain the facility premises and equipment and

 2  conduct its operations in a safe and sanitary manner.

 3         (9)  If the licensee furnishes food service, provide a

 4  wholesome and nourishing diet sufficient to meet generally

 5  accepted standards of proper nutrition for its residents and

 6  provide such therapeutic diets as may be prescribed by

 7  attending physicians.  In making rules to implement this

 8  subsection, the agency shall be guided by standards

 9  recommended by nationally recognized professional groups and

10  associations with knowledge of dietetics.

11         (10)  Keep full records of resident admissions and

12  discharges; medical and general health status, including

13  medical records, personal and social history, and identity and

14  address of next of kin or other persons who may have

15  responsibility for the affairs of the residents; and

16  individual resident care plans including, but not limited to,

17  prescribed services, service frequency and duration, and

18  service goals.  The records shall be open to inspection by the

19  agency.

20         (11)  Keep such fiscal records of its operations and

21  conditions as may be necessary to provide information pursuant

22  to this part.

23         (12)  Furnish copies of personnel records for employees

24  affiliated with such facility, to any other facility licensed

25  by this state requesting this information pursuant to this

26  part.  Such information contained in the records may include,

27  but is not limited to, disciplinary matters and any reason for

28  termination. Any facility releasing such records pursuant to

29  this part shall be considered to be acting in good faith and

30  may not be held liable for information contained in such

31  


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    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  records, absent a showing that the facility maliciously

 2  falsified such records.

 3         (13)  Publicly display a poster provided by the agency

 4  containing the names, addresses, and telephone numbers for the

 5  state's abuse hotline, the State Long-Term Care Ombudsman, the

 6  Agency for Health Care Administration consumer hotline, the

 7  Advocacy Center for Persons with Disabilities, the Florida

 8  Statewide Advocacy Council, and the Medicaid Fraud Control

 9  Unit, with a clear description of the assistance to be

10  expected from each.

11         (14)  Submit to the agency the information specified in

12  s. 400.071(2)(e) for a management company within 30 days after

13  the effective date of the management agreement.

14         (15)  Submit semiannually to the agency, or more

15  frequently if requested by the agency, information regarding

16  facility staff-to-resident ratios, staff turnover, and staff

17  stability, including information regarding certified nursing

18  assistants, licensed nurses, the director of nursing, and the

19  facility administrator. For purposes of this reporting:

20         (a)  Staff-to-resident ratios must be reported in the

21  categories specified in s. 400.23(3)(a) and applicable rules.

22  The ratio must be reported as an average for the most recent

23  calendar quarter.

24         (b)  Staff turnover must be reported for the most

25  recent 12-month period ending on the last workday of the most

26  recent calendar quarter prior to the date the information is

27  submitted. The turnover rate must be computed quarterly, with

28  the annual rate being the cumulative sum of the quarterly

29  rates. The turnover rate is the total number of terminations

30  or separations experienced during the quarter, excluding any

31  employee terminated during a probationary period of 3 months


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  or less, divided by the total number of staff employed at the

 2  end of the period for which the rate is computed, and

 3  expressed as a percentage.

 4         (c)  The formula for determining staff stability is the

 5  total number of employees that have been employed for more

 6  than 12 months, divided by the total number of employees

 7  employed at the end of the most recent calendar quarter, and

 8  expressed as a percentage.

 9         (d)  A nursing facility that has failed to comply with

10  state minimum-staffing requirements for 2 consecutive days is

11  prohibited from accepting new admissions until the facility

12  has achieved the minimum-staffing requirements for a period of

13  6 consecutive days. For the purposes of this paragraph, any

14  person who was a resident of the facility and was absent from

15  the facility for the purpose of receiving medical care at a

16  separate location or was on a leave of absence is not

17  considered a new admission. Failure to impose such an

18  admissions moratorium constitutes a class II deficiency.

19         (e)  A nursing facility which does not have a

20  conditional license may be cited for failure to comply with

21  the standards in s. 400.23(3)(a)1.a. only if it has failed to

22  meet those standards on 2 consecutive days or if it has failed

23  to meet at least 97 percent of those standards on any one day.

24         (f)  A facility which has a conditional license must be

25  in compliance with the standards in s. 400.23(3)(a) at all

26  times.

27  

28  Nothing in this section shall limit the agency's ability to

29  impose a deficiency or take other actions if a facility does

30  not have enough staff to meet the residents' needs.

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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         (16)  Report monthly the number of vacant beds in the

 2  facility which are available for resident occupancy on the day

 3  the information is reported.

 4         (17)  Notify a licensed physician when a resident

 5  exhibits signs of dementia or cognitive impairment or has a

 6  change of condition in order to rule out the presence of an

 7  underlying physiological condition that may be contributing to

 8  such dementia or impairment. The notification must occur

 9  within 30 days after the acknowledgment of such signs by

10  facility staff. If an underlying condition is determined to

11  exist, the facility shall arrange, with the appropriate health

12  care provider, the necessary care and services to treat the

13  condition.

14         (18)  If the facility implements a dining and

15  hospitality attendant program, ensure that the program is

16  developed and implemented under the supervision of the

17  facility director of nursing. A licensed nurse, licensed

18  speech or occupational therapist, or a registered dietitian

19  must conduct training of dining and hospitality attendants. A

20  person employed by a facility as a dining and hospitality

21  attendant must perform tasks under the direct supervision of a

22  licensed nurse.

23         (19)  Report to the agency any filing for bankruptcy

24  protection by the facility or its parent corporation,

25  divestiture or spin-off of its assets, or corporate

26  reorganization within 30 days after the completion of such

27  activity.

28         (20)  Maintain general and professional liability

29  insurance coverage that is in force at all times. In lieu of

30  general and professional liability insurance coverage, a

31  state-designated teaching nursing home and its affiliated


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  assisted living facilities created under s. 430.80 may

 2  demonstrate proof of financial responsibility as provided in

 3  s. 430.80(3)(h).

 4         (21)  Maintain in the medical record for each resident

 5  a daily chart of certified nursing assistant services provided

 6  to the resident. The certified nursing assistant who is caring

 7  for the resident must complete this record by the end of his

 8  or her shift. This record must indicate assistance with

 9  activities of daily living, assistance with eating, and

10  assistance with drinking, and must record each offering of

11  nutrition and hydration for those residents whose plan of care

12  or assessment indicates a risk for malnutrition or

13  dehydration.

14         (22)  Before November 30 of each year, subject to the

15  availability of an adequate supply of the necessary vaccine,

16  provide for immunizations against influenza viruses to all its

17  consenting residents in accordance with the recommendations of

18  the United States Centers for Disease Control and Prevention,

19  subject to exemptions for medical contraindications and

20  religious or personal beliefs. Subject to these exemptions,

21  any consenting person who becomes a resident of the facility

22  after November 30 but before March 31 of the following year

23  must be immunized within 5 working days after becoming a

24  resident. Immunization shall not be provided to any resident

25  who provides documentation that he or she has been immunized

26  as required by this subsection. This subsection does not

27  prohibit a resident from receiving the immunization from his

28  or her personal physician if he or she so chooses. A resident

29  who chooses to receive the immunization from his or her

30  personal physician shall provide proof of immunization to the

31  


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  facility. The agency may adopt and enforce any rules necessary

 2  to comply with or implement this subsection.

 3         (23)  Assess all residents for eligibility for

 4  pneumococcal polysaccharide vaccination (PPV) and vaccinate

 5  residents when indicated within 60 days after the effective

 6  date of this act in accordance with the recommendations of the

 7  United States Centers for Disease Control and Prevention,

 8  subject to exemptions for medical contraindications and

 9  religious or personal beliefs. Residents admitted after the

10  effective date of this act shall be assessed within 5 working

11  days of admission and, when indicated, vaccinated within 60

12  days in accordance with the recommendations of the United

13  States Centers for Disease Control and Prevention, subject to

14  exemptions for medical contraindications and religious or

15  personal beliefs. Immunization shall not be provided to any

16  resident who provides documentation that he or she has been

17  immunized as required by this subsection. This subsection does

18  not prohibit a resident from receiving the immunization from

19  his or her personal physician if he or she so chooses. A

20  resident who chooses to receive the immunization from his or

21  her personal physician shall provide proof of immunization to

22  the facility. The agency may adopt and enforce any rules

23  necessary to comply with or implement this subsection.

24         (24)  Annually encourage and promote to its employees

25  the benefits associated with immunizations against influenza

26  viruses in accordance with the recommendations of the United

27  States Centers for Disease Control and Prevention. The agency

28  may adopt and enforce any rules necessary to comply with or

29  implement this subsection.

30  

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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  Facilities having a standard license that have been awarded a

 2  Gold Seal under the program established in s. 400.235 may

 3  develop a plan to provide certified nursing assistant training

 4  as prescribed by federal regulations and state rules and may

 5  apply to the agency for approval of their program. The agency

 6  may adopt rules relating to the approval, suspension, or

 7  termination of a certified nursing assistant training program.

 8         Section 3.  Subsections (5) through (15) of section

 9  400.147, Florida Statutes, are amended to read:

10         400.147  Internal risk management and quality assurance

11  program.--

12         (5)  For purposes of reporting to the agency under this

13  section, the term "adverse incident" means:

14         (a)  An event over which facility personnel could

15  exercise control and which is associated in whole or in part

16  with the facility's intervention, rather than the condition

17  for which such intervention occurred, and which results in one

18  of the following:

19         1.  Death;

20         2.  Brain or spinal damage;

21         3.  Permanent disfigurement;

22         4.  Fracture or dislocation of bones or joints;

23         5.  A limitation of neurological, physical, or sensory

24  function;

25         6.  Any condition that required medical attention to

26  which the resident has not given his or her informed consent,

27  including failure to honor advanced directives; or

28         7.  Any condition that required the transfer of the

29  resident, within or outside the facility, to a unit providing

30  a more acute level of care due to the adverse incident, rather

31  than the resident's condition prior to the adverse incident;


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    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         (b)  Abuse, neglect, or exploitation as defined in s.

 2  415.102;

 3         (c)  Abuse, neglect and harm as defined in s. 39.01;

 4         (d)  Resident elopement; or

 5         (e)  An event that is reported to a law enforcement

 6  agency for investigation.

 7         (6)  The internal risk manager of each licensed

 8  facility shall:

 9         (a)  Investigate every allegation of sexual misconduct

10  which is made against a member of the facility's personnel who

11  has direct patient contact when the allegation is that the

12  sexual misconduct occurred at the facility or at the grounds

13  of the facility;

14         (b)  Report every allegation of sexual misconduct to

15  the administrator of the licensed facility; and

16         (c)  Notify the resident representative or guardian of

17  the victim that an allegation of sexual misconduct has been

18  made and that an investigation is being conducted.

19         (7)(a)  The facility shall initiate an investigation

20  and shall notify the agency within 1 business day after the

21  risk manager or his or her designee has received a report

22  pursuant to paragraph (1)(d). The notification must be made in

23  writing and be provided electronically, by facsimile device or

24  overnight mail delivery. The notification must include

25  information regarding the identity of the affected resident,

26  the type of adverse incident, the initiation of an

27  investigation by the facility, and whether the events causing

28  or resulting in the adverse incident represent a potential

29  risk to any other resident. The notification is confidential

30  as provided by law and is not discoverable or admissible in

31  any civil or administrative action, except in disciplinary


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  proceedings by the agency or the appropriate regulatory board.

 2  The agency may investigate, as it deems appropriate, any such

 3  incident and prescribe measures that must or may be taken in

 4  response to the incident. The agency shall review each

 5  incident and determine whether it potentially involved conduct

 6  by the health care professional who is subject to disciplinary

 7  action, in which case the provisions of s. 456.073 shall

 8  apply.

 9         (b)(8)(a)  Each facility shall complete the

10  investigation and submit an adverse incident report to the

11  agency for each adverse incident within 15 calendar days after

12  its occurrence. If, after a complete investigation, the risk

13  manager determines that the incident was not an adverse

14  incident as defined in subsection (5), the facility shall

15  include this information in the report. The agency shall

16  develop a form for reporting this information.

17         (c)(b)  The information reported to the agency pursuant

18  to paragraph (b) (a) which relates to persons licensed under

19  chapter 458, chapter 459, chapter 461, or chapter 466 shall be

20  reviewed by the agency. The agency shall determine whether any

21  of the incidents potentially involved conduct by a health care

22  professional who is subject to disciplinary action, in which

23  case the provisions of s. 456.073 shall apply.

24         (d)(c)  The report submitted to the agency must also

25  contain the name of the risk manager of the facility.

26         (e)(d)  The adverse incident report is confidential as

27  provided by law and is not discoverable or admissible in any

28  civil or administrative action, except in disciplinary

29  proceedings by the agency or the appropriate regulatory board.

30         (8)(9)  By the 10th of each month, each facility

31  subject to this section shall report any notice received


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  pursuant to s. 400.0233(2) and each initial complaint that was

 2  filed with the clerk of the court and served on the facility

 3  during the previous month by a resident or a resident's family

 4  member, guardian, conservator, or personal legal

 5  representative. The report must include the name of the

 6  resident, the resident's date of birth and social security

 7  number, the Medicaid identification number for

 8  Medicaid-eligible persons, the date or dates of the incident

 9  leading to the claim or dates of residency, if applicable, and

10  the type of injury or violation of rights alleged to have

11  occurred.  Each facility shall also submit a copy of the

12  notices received pursuant to s. 400.0233(2) and complaints

13  filed with the clerk of the court. This report is confidential

14  as provided by law and is not discoverable or admissible in

15  any civil or administrative action, except in such actions

16  brought by the agency to enforce the provisions of this part.

17         (9)(10)  The agency shall review, as part of its

18  licensure inspection process, the internal risk management and

19  quality assurance program at each facility regulated by this

20  section to determine whether the program meets standards

21  established in statutory laws and rules, is being conducted in

22  a manner designed to reduce adverse incidents, and is

23  appropriately reporting incidents as required by this section.

24         (10)(11)  There is no monetary liability on the part

25  of, and a cause of action for damages may not arise against,

26  any risk manager for the implementation and oversight of the

27  internal risk management and quality assurance program in a

28  facility licensed under this part as required by this section,

29  or for any act or proceeding undertaken or performed within

30  the scope of the functions of such internal risk management

31  


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  and quality assurance program if the risk manager acts without

 2  intentional fraud.

 3         (11)(12)  If the agency, through its receipt of the

 4  adverse incident reports prescribed in subsection (7), or

 5  through any investigation, has a reasonable belief that

 6  conduct by a staff member or employee of a facility is grounds

 7  for disciplinary action by the appropriate regulatory board,

 8  the agency shall report this fact to the regulatory board.

 9         (12)(13)  The agency may adopt rules to administer this

10  section.

11         (13)(14)  The agency shall annually submit to the

12  Legislature a report on nursing home adverse incidents. The

13  report must include the following information arranged by

14  county:

15         (a)  The total number of adverse incidents.

16         (b)  A listing, by category, of the types of adverse

17  incidents, the number of incidents occurring within each

18  category, and the type of staff involved.

19         (c)  A listing, by category, of the types of injury

20  caused and the number of injuries occurring within each

21  category.

22         (d)  Types of liability claims filed based on an

23  adverse incident or reportable injury.

24         (e)  Disciplinary action taken against staff,

25  categorized by type of staff involved.

26         (14)(15)  Information gathered by a credentialing

27  organization under a quality assurance program is not

28  discoverable from the credentialing organization. This

29  subsection does not limit discovery of, access to, or use of

30  facility records, including those records from which the

31  credentialing organization gathered its information.


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         Section 4.  Subsection (3) of section 400.19, Florida

 2  Statutes, is amended to read:

 3         400.19  Right of entry and inspection.--

 4         (3)  The agency shall every 15 months conduct at least

 5  one unannounced inspection to determine compliance by the

 6  licensee with statutes, and with rules adopted promulgated

 7  under the provisions of those statutes, governing minimum

 8  standards of construction, quality and adequacy of care, and

 9  rights of residents. The survey shall be conducted every 6

10  months for the next 2-year period if the facility has been

11  cited for a class I deficiency, has been cited for two or more

12  class II deficiencies arising from separate surveys or

13  investigations within a 60-day period, or has had three or

14  more substantiated complaints within a 6-month period, each

15  resulting in at least one class I or class II deficiency. In

16  addition to any other fees or fines in this part, the agency

17  shall assess a fine for each facility that is subject to the

18  6-month survey cycle. The fine for the 2-year period shall be

19  $6,000, one-half to be paid at the completion of each survey.

20  The agency may adjust this fine by the change in the Consumer

21  Price Index, based on the 12 months immediately preceding the

22  increase, to cover the cost of the additional surveys. If such

23  deficiencies are overturned as the result of administrative

24  action but additional surveys have already been conducted

25  pursuant to this section, the most recent survey shall be

26  considered a licensure survey for purposes of scheduling

27  future surveys. The agency shall verify through subsequent

28  inspection that any deficiency identified during the annual

29  inspection is corrected.  However, the agency may verify the

30  correction of a class III or class IV deficiency unrelated to

31  resident rights or resident care without reinspecting the


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  facility if adequate written documentation has been received

 2  from the facility, which provides assurance that the

 3  deficiency has been corrected. The giving or causing to be

 4  given of advance notice of such unannounced inspections by an

 5  employee of the agency to any unauthorized person shall

 6  constitute cause for suspension of not fewer than 5 working

 7  days according to the provisions of chapter 110.

 8         Section 5.  Paragraph (d) of subsection (1) of section

 9  400.195, Florida Statutes, is amended to read:

10         400.195  Agency reporting requirements.--

11         (1)  For the period beginning June 30, 2001, and ending

12  June 30, 2005, the Agency for Health Care Administration shall

13  provide a report to the Governor, the President of the Senate,

14  and the Speaker of the House of Representatives with respect

15  to nursing homes.  The first report shall be submitted no

16  later than December 30, 2002, and subsequent reports shall be

17  submitted every 6 months thereafter.  The report shall

18  identify facilities based on their ownership characteristics,

19  size, business structure, for-profit or not-for-profit status,

20  and any other characteristics the agency determines useful in

21  analyzing the varied segments of the nursing home industry and

22  shall report:  

23         (d)  Information regarding deficiencies cited,

24  including information used to develop the Nursing Home Guide

25  WATCH LIST pursuant to s. 400.191, and applicable rules, a

26  summary of data generated on nursing homes by Centers for

27  Medicare and Medicaid Services Nursing Home Quality

28  Information Project, and information collected pursuant to s.

29  400.147(8) s. 400.147(9), relating to litigation.

30         Section 6.  Paragraph (a) of subsection (3) of section

31  400.23, Florida Statutes, is amended to read:


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    ENROLLED

    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1         400.23  Rules; evaluation and deficiencies; licensure

 2  status.--

 3         (3)(a)1.  The agency shall adopt rules providing

 4  minimum staffing requirements for nursing homes. These

 5  requirements shall include, for each nursing home facility:

 6         a.  A minimum certified nursing assistant staffing of

 7  2.6 hours of direct care per resident per day beginning

 8  January 1, 2003, and increasing to 2.7 hours of direct care

 9  per resident per day beginning January 1, 2007. Beginning

10  January 1, 2002, a no facility may not shall staff below one

11  certified nursing assistant per 20 residents, and must provide

12  a minimum licensed nursing staffing of 1.0 hour of direct care

13  per resident per day but never below one licensed nurse per 40

14  residents.

15         b.  Beginning January 1, 2007, a minimum weekly average

16  certified nursing assistant staffing of 2.9 hours of direct

17  care per resident per day. For the purpose of this

18  sub-subparagraph, a week is defined as Sunday through

19  Saturday.

20         2.  Nursing assistants employed under s. 400.211(2) may

21  be included in computing the staffing ratio for certified

22  nursing assistants only if their job responsibilities include

23  only nursing-assistant-related duties.

24         3.  Each nursing home must document compliance with

25  staffing standards as required under this paragraph and post

26  daily the names of staff on duty for the benefit of facility

27  residents and the public. Compliance with federal posting

28  requirements satisfies the posting requirements in this

29  subparagraph.

30         4.  The agency shall recognize the use of licensed

31  nurses for compliance with minimum staffing requirements for


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    2007 Legislature                  CS for SB 682, 3rd Engrossed



 1  certified nursing assistants, provided that the facility

 2  otherwise meets the minimum staffing requirements for licensed

 3  nurses and that the licensed nurses are performing the duties

 4  of a certified nursing assistant. Unless otherwise approved by

 5  the agency, licensed nurses counted toward the minimum

 6  staffing requirements for certified nursing assistants must

 7  exclusively perform the duties of a certified nursing

 8  assistant for the entire shift and not also be counted toward

 9  the minimum staffing requirements for licensed nurses. If the

10  agency approved a facility's request to use a licensed nurse

11  to perform both licensed nursing and certified nursing

12  assistant duties, the facility must allocate the amount of

13  staff time specifically spent on certified nursing assistant

14  duties for the purpose of documenting compliance with minimum

15  staffing requirements for certified and licensed nursing

16  staff. In no event may the hours of a licensed nurse with dual

17  job responsibilities be counted twice.

18         Section 7.  This act shall take effect July 1, 2007.

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