Senate Bill sb0992

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    Florida Senate - 2007                                   SB 992

    By the Committee on Health Regulation





    588-371D-07

  1                      A bill to be entitled

  2         An act conforming the Florida Statutes to

  3         legislation enacted during the 2006 Regular

  4         Session relating to the licensure of health

  5         care providers regulated by the Agency for

  6         Health Care Administration; amending s.

  7         112.0455, F.S.; providing applicability of

  8         licensure requirements under pt. II of ch. 408,

  9         F.S., to drug-testing standards of

10         laboratories; authorizing the Agency for Health

11         Care Administration to adopt rules to implement

12         pt. II of ch. 408, F.S., relating to the

13         Drug-Free Workplace Act; revising a license

14         fee; amending s. 381.78, F.S.; conforming a

15         cross-reference; amending s. 383.301, F.S.;

16         providing applicability of licensure

17         requirements under pt. II of ch. 408, F.S., to

18         birth centers; repealing s. 383.304, F.S.,

19         relating to the licensure requirement for birth

20         centers; amending s. 383.305, F.S.; providing

21         applicability of licensure requirements under

22         pt. II of ch. 408, F.S., to birth centers;

23         providing for licensure fees to be established

24         by rule; amending s. 383.309, F.S.; authorizing

25         the agency to adopt and enforce rules to

26         administer pt. II of ch. 408, F.S., relating to

27         standards for birth centers; amending s.

28         383.315, F.S.; revising a provision relating to

29         consultation agreements for birth centers;

30         amending s. 383.324, F.S.; revising provisions

31         relating to inspections and investigations of

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    Florida Senate - 2007                                   SB 992
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 1         birth center facilities; amending s. 383.33,

 2         F.S.; revising provisions relating to

 3         administrative fines, penalties, emergency

 4         orders, and moratoriums on admissions;

 5         repealing s. 383.331, F.S., relating to

 6         injunctive relief; amending s. 383.332, F.S.;

 7         providing applicability of licensure

 8         requirements under pt. II of ch. 408, F.S.;

 9         amending s. 383.335, F.S.; providing an

10         exemption from pt. II of ch. 408, F.S., for

11         specified birth centers; amending s. 383.50,

12         F.S.; conforming a cross-reference; amending s.

13         390.011, F.S.; revising a definition; amending

14         s. 390.012, F.S.; revising rulemaking authority

15         of the agency for abortion clinics; repealing

16         s. 390.013, F.S., relating to effective date of

17         rules applicable to abortion clinics; amending

18         s. 390.014, F.S.; providing applicability of

19         licensure requirements under pt. II of ch. 408,

20         F.S., to abortion clinics; amending s. 390.015,

21         F.S.; revising provisions to applications for a

22         license; repealing s. 390.016, F.S., relating

23         to expiration and renewal of a license;

24         repealing s. 390.017, F.S., relating to grounds

25         for suspension or revocation of a license;

26         amending s. 390.018, F.S.; providing

27         applicability of licensure requirements under

28         pt. II of ch. 408, F.S., to administrative

29         fines; repealing s. 390.019, F.S., relating an

30         to administrative penalty in lieu of revocation

31         or suspension of a license to operate an

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    Florida Senate - 2007                                   SB 992
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 1         abortion clinic; repealing s. 390.021, F.S.,

 2         relating to instituting injunction proceedings

 3         against an abortion clinic; amending s.

 4         394.455, F.S.; revising a definition; amending

 5         s. 394.4787, F.S.; conforming a

 6         cross-reference; amending s. 394.67, F.S.;

 7         deleting, revising, and providing definitions;

 8         amending ss. 394.74 and 394.82, F.S.;

 9         conforming cross-references; amending s.

10         394.875, F.S.; providing the purpose of

11         short-term residential treatment facilities;

12         providing applicability of licensure

13         requirements under pt. II of ch. 408, F.S., to

14         crisis stabilization units, short-term

15         residential treatment facilities, residential

16         treatment facilities, and residential treatment

17         centers for children and adolescents; providing

18         an exemption from licensure requirements for

19         hospitals licensed under ch. 395, F.S., and

20         certain programs operated therein; amending s.

21         394.876, F.S.; revising provisions relating to

22         an application for licensure to provide

23         community substance abuse and mental health

24         services; amending s. 394.877, F.S.; providing

25         applicability of pt. II of ch. 408, F.S., to

26         license fees; repealing s. 394.878, F.S.,

27         relating to issuance and renewal of licenses;

28         amending s. 394.879, F.S.; providing rulemaking

29         authority to the Department of Children and

30         Family Services; deleting a reference to

31         deposit of certain fines in the Mental Health

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    Florida Senate - 2007                                   SB 992
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 1         Facility Trust Fund; amending s. 394.90, F.S.;

 2         revising provisions relating to inspections of

 3         crisis stabilization units and residential

 4         treatment facilities; amending s. 394.902,

 5         F.S.; revising provisions relating to the

 6         moratorium on admissions for unsafe or unlawful

 7         provision of community substance abuse and

 8         mental health services; amending s. 394.907,

 9         F.S., relating to access to records of

10         community mental health centers; providing for

11         the department to determine licensee compliance

12         with quality assurance programs; amending s.

13         395.002, F.S.; deleting a definition;

14         conforming cross-references; amending ss.

15         395.003, 395.004, and 395.0161, F.S.; providing

16         applicability of licensure requirements under

17         pt. II of ch. 408, F.S., to hospitals,

18         ambulatory surgical centers, and mobile

19         surgical facilities; repealing s. 395.0055,

20         F.S., relating to background screening of

21         personnel of hospitals and other licensed

22         facilities; amending s. 395.0163, F.S.;

23         deleting a provision requiring the deposit of

24         fees charged for review of plans for

25         construction of hospitals and other licensed

26         facilities in the Planning and Regulation Trust

27         Fund; amending ss. 395.0193 and 395.0197, F.S.;

28         providing for the applicability of the

29         reporting requirements of pt. II of ch. 408,

30         F.S., to hospitals and other licensed

31         facilities; conforming cross-references;

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 1         amending ss. 395.0199 and 395.1046, F.S.;

 2         providing applicability of licensure

 3         requirements under pt. II of ch. 408, F.S., to

 4         health care utilization review and complaint

 5         investigation procedures; amending s. 395.1055,

 6         F.S.; providing applicability of licensure

 7         requirements under pt. II of ch. 408, F.S., to

 8         the adoption and enforcement of rules; amending

 9         ss. 395.1065, 395.10973, and 395.10974, F.S.;

10         providing applicability of licensure

11         requirements under pt. II of ch. 408, F.S., to

12         administrative penalties and injunctions,

13         rulemaking, and health care risk managers;

14         amending ss. 395.602, 395.701, 400.0073, and

15         400.0074, F.S.; conforming cross-references;

16         amending s. 400.021, F.S.; deleting

17         definitions; amending s. 400.022, F.S.;

18         providing applicability of licensure

19         requirements under pt. II of ch. 408, F.S., to

20         grounds for action for a violation of

21         residents' rights; amending s. 400.051, F.S.;

22         conforming a cross-reference; amending s.

23         400.062, F.S.; providing applicability of

24         licensure requirements under pt. II of ch. 408,

25         F.S., to nursing homes and related health care

26         facilities; revising provisions relating to

27         license fees; amending s. 400.063, F.S.;

28         conforming a cross-reference; amending ss.

29         400.071 and 400.0712, F.S.; providing

30         applicability of licensure requirements under

31         pt. II of ch. 408, F.S., to license

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 1         applications; revising provisions governing

 2         inactive licenses; amending s. 400.102, F.S.;

 3         providing applicability of licensure

 4         requirements under pt. II of ch. 408, F.S., to

 5         grounds for action by the agency against a

 6         licensee; amending s. 400.111, F.S.; providing

 7         applicability of licensure requirements under

 8         pt. II of ch. 408, F.S., to the disclosure of a

 9         controlling interest of a nursing home

10         facility; requiring a licensee to disclose

11         certain holdings of a controlling interest;

12         amending s. 400.1183, F.S.; revising grievance

13         procedures for nursing home residents; deleting

14         a provision relating to an administrative fine;

15         amending s. 400.121, F.S.; providing

16         applicability of licensure requirements under

17         pt. II of ch. 408, F.S., to the denial,

18         suspension, or revocation of a nursing home

19         facility license, fines imposed, and procedures

20         for conducting hearings; repealing s. 400.125,

21         F.S., relating to instituting injunction

22         proceedings against a nursing home; amending s.

23         400.141, F.S.; conforming a cross-reference;

24         amending s. 400.179, F.S.; revising provisions

25         relating to liability for Medicaid

26         underpayments and overpayments; requiring that

27         certain licensure fees be paid annually;

28         amending s. 400.18, F.S.; revising provisions

29         relating to the closing of a nursing home

30         facility; amending s. 400.19, F.S.; providing

31         applicability of licensure requirements under

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    Florida Senate - 2007                                   SB 992
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 1         pt. II of ch. 408, F.S., to nursing home

 2         facility inspections; amending s. 400.191,

 3         F.S.; revising provisions relating to the

 4         availability, distribution, and posting of

 5         reports and records; amending s. 400.23, F.S.;

 6         providing applicability of pt. II of ch. 408,

 7         F.S., to rulemaking for nursing home

 8         facilities; amending s. 400.241, F.S.; deleting

 9         provisions relating to prohibited acts

10         involving the establishment, operation, or

11         advertisement of nursing home facilities;

12         amending ss. 400.464, 400.471, 400.474, and

13         400.484, F.S.; providing applicability of

14         licensure requirements under pt. II of ch. 408,

15         F.S., to home health agencies; repealing s.

16         400.495, F.S., relating to the notice of a

17         toll-free telephone number for the central

18         abuse hotline; amending ss. 400.497, 400.506,

19         400.509, 400.602, 400.605, 400.606, 400.6065,

20         400.607, 400.801, 400.805, 400.903, 400.905,

21         400.907, 400.908, 400.912, 400.914, and

22         400.915, F.S.; providing applicability of

23         licensure requirements under pt. II of ch. 408,

24         F.S., to the toll-free central abuse hotline,

25         rules establishing minimum standards for home

26         health aides, nurse registries, the

27         registration of companion or homemaker service

28         providers that are exempt from licensure,

29         hospices, homes for special services,

30         transitional living facilities, and prescribed

31         pediatric extended care (PPEC) centers;

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    Florida Senate - 2007                                   SB 992
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 1         amending s. 400.512, F.S.; revising provisions

 2         relating to the screening of home health

 3         agency, nurse registry, companion, and

 4         homemaker personnel; repealing s. 400.515,

 5         F.S., relating to instituting injunction

 6         proceedings against a home health agency or

 7         nurse registry; amending s. 400.6095, F.S.;

 8         clarifying provisions relating to protection

 9         from liability for hospice staff; amending s.

10         400.902, F.S.; revising a definition; amending

11         s. 400.906, F.S.; revising provisions relating

12         to applications for a license to operate a PPEC

13         center; repealing s. 400.910, F.S., relating to

14         expiration and renewal of a license and the

15         issuance of a conditional license or permit to

16         operate a PPEC center; repealing s. 400.911,

17         F.S., relating to instituting injunction

18         proceedings against a PPEC center; repealing s.

19         400.913, F.S., relating to right to enter and

20         inspect a PPEC center; amending s. 400.916,

21         F.S.; revising provisions relating to

22         prohibited acts and penalties applicable to a

23         PPEC center; repealing s. 400.917, F.S.,

24         relating to disposition of moneys from fines

25         and fees imposed on a PPEC center; amending s.

26         400.925, F.S.; deleting and revising

27         definitions; amending ss. 400.93, 400.931,

28         400.932, 400.933, 400.935, and 400.955, F.S.;

29         providing applicability of licensure

30         requirements under pt. II of ch. 408, F.S., to

31         home medical equipment providers; repealing s.

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    Florida Senate - 2007                                   SB 992
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 1         400.95, F.S., relating to notice of the

 2         toll-free telephone number for the central

 3         abuse hotline; repealing s. 400.956, F.S.,

 4         relating to instituting injunction proceedings

 5         against a home medical equipment provider;

 6         amending ss. 400.962, 400.967, 400.968, and

 7         400.969, F.S.; providing applicability of

 8         licensure requirements under pt. II of ch. 408,

 9         F.S., to intermediate care facilities for

10         developmentally disabled persons; repealing s.

11         400.963, F.S., relating to instituting

12         injunction proceedings against an intermediate

13         care facility for developmentally disabled

14         persons; repealing s. 400.965, F.S., relating

15         to agency action against an intermediate care

16         facility for developmentally disabled persons;

17         amending s. 400.980, F.S.; providing

18         applicability of licensure requirements under

19         pt. II of ch. 408, F.S., to health care

20         services pools; amending ss. 400.991, 400.9915,

21         400.9925, 400.993, 400.9935, and 400.995, F.S.;

22         providing applicability of licensure

23         requirements under pt. II of ch. 408, F.S., to

24         health care clinics; repealing s. 400.992,

25         F.S., relating to license renewal, transfer of

26         ownership, and provisional license of a health

27         care clinic; repealing s. 400.994, F.S.,

28         relating to instituting injunctive proceedings

29         against a health care clinic; repealing s.

30         400.9945, F.S., relating to review of agency

31         licensure enforcement actions; amending ss.

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    Florida Senate - 2007                                   SB 992
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 1         408.802 and 408.832, F.S.; revising provisions

 2         to conform to changes made by the act; amending

 3         ss. 409.221, 409.815, 409.905, and 409.907,

 4         F.S.; conforming cross-references; amending ss.

 5         429.02, 429.07, 429.075, 429.08, 429.11,

 6         429.12, 429.14, 429.17, 429.174, 429.176,

 7         429.18, 429.19, 429.22, 429.26, 429.31, 429.34,

 8         429.35, 429.41, and 429.47, F.S.; providing

 9         applicability of licensure requirements under

10         pt. II of ch. 408, F.S., to assisted living

11         facilities; repealing s. 429.15, F.S., relating

12         to imposing a moratorium on admissions to an

13         assisted living facility and notice thereof;

14         repealing s. 429.21, F.S., relating to

15         instituting injunctive proceedings against an

16         assisted living facility; repealing s. 429.51,

17         F.S., relating to the time for an existing

18         assisted living facility to comply with newly

19         adopted rules and standards; amending ss.

20         429.67, 429.69, 429.71, and 429.73, F.S.;

21         providing applicability of licensure

22         requirements under pt. II of ch. 408, F.S., to

23         adult family-care homes; repealing s. 429.77,

24         F.S., relating to instituting injunctive

25         proceedings against an adult family-care home;

26         amending ss. 429.901, 429.907, 429.909,

27         429.911, 429.913, 429.915, 429.919, 429.925,

28         429.927, and 429.929, F.S.; providing

29         applicability of licensure requirements under

30         pt. II of ch. 408, F.S., to adult day care

31         centers; repealing s. 429.921, F.S., relating

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 1         to the disposition of fees and administrative

 2         fines imposed on adult day care centers;

 3         repealing s. 429.923, F.S., relating to

 4         instituting injunctive proceedings against an

 5         adult day care center; repealing s. 429.933,

 6         F.S., relating to prohibited acts and penalties

 7         applicable to adult day care centers; amending

 8         s. 440.102, F.S.; providing applicability of

 9         licensure requirements under pt. II of ch. 408,

10         F.S., to drug-testing laboratories; amending

11         ss. 468.505 and 483.106, F.S.; conforming

12         cross-references; amending ss. 483.035,

13         483.051, 483.061, 483.091, 483.101, 483.111,

14         483.172, 483.201, and 483.221, F.S.; providing

15         applicability of licensure requirements under

16         pt. II of ch. 408, F.S., to certain clinical

17         laboratories; repealing s. 483.131, F.S.,

18         relating to display of the clinical laboratory

19         license; repealing s. 483.25, F.S., relating to

20         instituting injunctive proceedings against a

21         clinical laboratory; amending ss. 483.291,

22         483.294, 483.30, 483.302, 483.317, 483.32, and

23         483.322, F.S.; providing applicability of

24         licensure requirements under pt. II of ch. 408,

25         F.S., to multiphasic health testing centers;

26         repealing s. 483.311, F.S., relating to the

27         display of a multiphasic health testing center

28         license; amending s. 483.317, F.S.; repealing

29         s. 483.328, F.S., relating to instituting

30         injunctive proceedings against a multiphasic

31         health testing center; amending s. 765.541,

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 1         F.S.; conforming provisions relating to

 2         cadaveric organ and tissue procurement;

 3         amending s. 765.542, F.S.; providing

 4         applicability of licensure requirements under

 5         pt. II of ch. 408, F.S., to organ procurement

 6         organizations and tissue and eye banks;

 7         amending s. 765.544, F.S.; conforming

 8         provisions relating to application fees from

 9         organizations and tissue and eye banks;

10         amending ss. 766.118, 766.316, and 812.014,

11         F.S.; conforming cross-references; providing an

12         effective date.

13  

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

15  

16         Section 1.  Subsections (12) and (17) and paragraph (a)

17  of subsection (13) of section 112.0455, Florida Statutes, are

18  amended to read:

19         112.0455  Drug-Free Workplace Act.--

20         (12)  DRUG-TESTING STANDARDS; LABORATORIES.--

21         (a)  The requirements of part II of chapter 408 apply

22  to the provision of services that require licensure pursuant

23  to this section and part II of chapter 408 and to entities

24  licensed by or applying for such licensure from the Agency for

25  Health Care Administration pursuant to this section. A license

26  issued by the agency is required in order to operate a

27  laboratory.

28         (b)(a)  A laboratory may analyze initial or

29  confirmation drug specimens only if:

30         1.  The laboratory is licensed and approved by the

31  Agency for Health Care Administration using criteria

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 1  established by the United States Department of Health and

 2  Human Services as general guidelines for modeling the state

 3  drug testing program and in accordance with part II of chapter

 4  408. Each applicant for licensure and licensee must comply

 5  with all requirements of part II of chapter 408. the following

 6  requirements:

 7         a.  Upon receipt of a completed, signed, and dated

 8  application, the agency shall require background screening, in

 9  accordance with the level 2 standards for screening set forth

10  in chapter 435, of the managing employee, or other similarly

11  titled individual responsible for the daily operation of the

12  laboratory, and of the financial officer, or other similarly

13  titled individual who is responsible for the financial

14  operation of the laboratory, including billings for services.

15  The applicant must comply with the procedures for level 2

16  background screening as set forth in chapter 435, as well as

17  the requirements of s. 435.03(3).

18         b.  The agency may require background screening of any

19  other individual who is an applicant if the agency has

20  probable cause to believe that he or she has been convicted of

21  an offense prohibited under the level 2 standards for

22  screening set forth in chapter 435.

23         c.  Proof of compliance with the level 2 background

24  screening requirements of chapter 435 which has been submitted

25  within the previous 5 years in compliance with any other

26  health care licensure requirements of this state is acceptable

27  in fulfillment of screening requirements.

28         d.  A provisional license may be granted to an

29  applicant when each individual required by this section to

30  undergo background screening has met the standards for the

31  Department of Law Enforcement background check, but the agency

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 1  has not yet received background screening results from the

 2  Federal Bureau of Investigation, or a request for a

 3  disqualification exemption has been submitted to the agency as

 4  set forth in chapter 435, but a response has not yet been

 5  issued. A license may be granted to the applicant upon the

 6  agency's receipt of a report of the results of the Federal

 7  Bureau of Investigation background screening for each

 8  individual required by this section to undergo background

 9  screening which confirms that all standards have been met, or

10  upon the granting of a disqualification exemption by the

11  agency as set forth in chapter 435. Any other person who is

12  required to undergo level 2 background screening may serve in

13  his or her capacity pending the agency's receipt of the report

14  from the Federal Bureau of Investigation. However, the person

15  may not continue to serve if the report indicates any

16  violation of background screening standards and a

17  disqualification exemption has not been requested of and

18  granted by the agency as set forth in chapter 435.

19         e.  Each applicant must submit to the agency, with its

20  application, a description and explanation of any exclusions,

21  permanent suspensions, or terminations of the applicant from

22  the Medicare or Medicaid programs. Proof of compliance with

23  the requirements for disclosure of ownership and control

24  interests under the Medicaid or Medicare programs shall be

25  accepted in lieu of this submission.

26         f.  Each applicant must submit to the agency a

27  description and explanation of any conviction of an offense

28  prohibited under the level 2 standards of chapter 435 by a

29  member of the board of directors of the applicant, its

30  officers, or any individual owning 5 percent or more of the

31  applicant. This requirement does not apply to a director of a

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 1  not-for-profit corporation or organization if the director

 2  serves solely in a voluntary capacity for the corporation or

 3  organization, does not regularly take part in the day-to-day

 4  operational decisions of the corporation or organization,

 5  receives no remuneration for his or her services on the

 6  corporation or organization's board of directors, and has no

 7  financial interest and has no family members with a financial

 8  interest in the corporation or organization, provided that the

 9  director and the not-for-profit corporation or organization

10  include in the application a statement affirming that the

11  director's relationship to the corporation satisfies the

12  requirements of this sub-subparagraph.

13         g.  A license may not be granted to any applicant if

14  the applicant or managing employee has been found guilty of,

15  regardless of adjudication, or has entered a plea of nolo

16  contendere or guilty to, any offense prohibited under the

17  level 2 standards for screening set forth in chapter 435,

18  unless an exemption from disqualification has been granted by

19  the agency as set forth in chapter 435.

20         h.  The agency may deny or revoke licensure if the

21  applicant:

22         (I)  Has falsely represented a material fact in the

23  application required by sub-subparagraph e. or

24  sub-subparagraph f., or has omitted any material fact from the

25  application required by sub-subparagraph e. or

26  sub-subparagraph f.; or

27         (II)  Has had prior action taken against the applicant

28  under the Medicaid or Medicare program as set forth in

29  sub-subparagraph e.

30         i.  An application for license renewal must contain the

31  information required under sub-subparagraphs e. and f.

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 1         2.  The laboratory has written procedures to ensure

 2  chain of custody.

 3         3.  The laboratory follows proper quality control

 4  procedures, including, but not limited to:

 5         a.  The use of internal quality controls including the

 6  use of samples of known concentrations which are used to check

 7  the performance and calibration of testing equipment, and

 8  periodic use of blind samples for overall accuracy.

 9         b.  An internal review and certification process for

10  drug test results, conducted by a person qualified to perform

11  that function in the testing laboratory.

12         c.  Security measures implemented by the testing

13  laboratory to preclude adulteration of specimens and drug test

14  results.

15         d.  Other necessary and proper actions taken to ensure

16  reliable and accurate drug test results.

17         (c)(b)  A laboratory shall disclose to the employer a

18  written test result report within 7 working days after receipt

19  of the sample. All laboratory reports of a drug test result

20  shall, at a minimum, state:

21         1.  The name and address of the laboratory which

22  performed the test and the positive identification of the

23  person tested.

24         2.  Positive results on confirmation tests only, or

25  negative results, as applicable.

26         3.  A list of the drugs for which the drug analyses

27  were conducted.

28         4.  The type of tests conducted for both initial and

29  confirmation tests and the minimum cutoff levels of the tests.

30  

31  

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 1         5.  Any correlation between medication reported by the

 2  employee or job applicant pursuant to subparagraph (8)(b)2.

 3  and a positive confirmed drug test result.

 4  

 5  No report shall disclose the presence or absence of any drug

 6  other than a specific drug and its metabolites listed pursuant

 7  to this section.

 8         (d)(c)  The laboratory shall submit to the Agency for

 9  Health Care Administration a monthly report with statistical

10  information regarding the testing of employees and job

11  applicants. The reports shall include information on the

12  methods of analyses conducted, the drugs tested for, the

13  number of positive and negative results for both initial and

14  confirmation tests, and any other information deemed

15  appropriate by the Agency for Health Care Administration. No

16  monthly report shall identify specific employees or job

17  applicants.

18         (e)(d)  Laboratories shall provide technical assistance

19  to the employer, employee, or job applicant for the purpose of

20  interpreting any positive confirmed test results which could

21  have been caused by prescription or nonprescription medication

22  taken by the employee or job applicant.

23         (13)  RULES.--

24         (a)  The Agency for Health Care Administration may

25  adopt additional rules to support this law and part II of

26  chapter 408, using criteria established by the United States

27  Department of Health and Human Services as general guidelines

28  for modeling drug-free workplace laboratories the state

29  drug-testing program, concerning, but not limited to:

30         1.  Standards for drug-testing laboratory licensing and

31  denial, suspension, and revocation of a license.

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 1         2.  Urine, hair, blood, and other body specimens and

 2  minimum specimen amounts which are appropriate for drug

 3  testing, not inconsistent with other provisions established by

 4  law.

 5         3.  Methods of analysis and procedures to ensure

 6  reliable drug-testing results, including standards for initial

 7  tests and confirmation tests, not inconsistent with other

 8  provisions established by law.

 9         4.  Minimum cutoff detection levels for drugs or their

10  metabolites for the purposes of determining a positive test

11  result, not inconsistent with other provisions established by

12  law.

13         5.  Chain-of-custody procedures to ensure proper

14  identification, labeling, and handling of specimens being

15  tested, not inconsistent with other provisions established by

16  law.

17         6.  Retention, storage, and transportation procedures

18  to ensure reliable results on confirmation tests and retests.

19         7.  A list of the most common medications by brand name

20  or common name, as applicable, as well as by chemical name,

21  which may alter or affect a drug test.

22  

23  This section shall not be construed to eliminate the

24  bargainable rights as provided in the collective bargaining

25  process where applicable.

26         (17)  LICENSE FEE.--Fees from licensure of drug-testing

27  laboratories shall be sufficient to carry out the

28  responsibilities of the Agency for Health Care Administration

29  for the regulation of drug-testing laboratories. In accordance

30  with s. 408.805, applicants and licensees shall pay a fee for

31  each license application submitted under this part, part II of

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 1  chapter 408, and applicable rules. The fee shall be not less

 2  than $16,000 or more than $20,000 per biennium and shall be

 3  established by rule. The Agency for Health Care Administration

 4  shall collect fees for all licenses issued under this part.

 5  Each nonrefundable fee shall be due at the time of application

 6  and shall be payable to the Agency for Health Care

 7  Administration to be deposited in a trust fund administered by

 8  the Agency for Health Care Administration and used only for

 9  the purposes of this section. The fee schedule is as

10  follows:  For licensure as a drug-testing laboratory, an

11  annual fee of not less than $8,000 or more than $10,000 per

12  fiscal year; for late filing of an application for renewal, an

13  additional fee of $500 per day shall be charged.

14         Section 2.  Paragraph (b) of subsection (4) of section

15  381.78, Florida Statutes, is amended to read:

16         381.78  Advisory council on brain and spinal cord

17  injuries.--

18         (4)  The council shall:

19         (b)  Annually appoint a five-member committee composed

20  of one individual who has a brain injury or has a family

21  member with a brain injury, one individual who has a spinal

22  cord injury or has a family member with a spinal cord injury,

23  and three members who shall be chosen from among these

24  representative groups: physicians, other allied health

25  professionals, administrators of brain and spinal cord injury

26  programs, and representatives from support groups with

27  expertise in areas related to the rehabilitation of

28  individuals who have brain or spinal cord injuries, except

29  that one and only one member of the committee shall be an

30  administrator of a transitional living facility. Membership on

31  

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 1  the council is not a prerequisite for membership on this

 2  committee.

 3         1.  The committee shall perform onsite visits to those

 4  transitional living facilities identified by the Agency for

 5  Health Care Administration as being in possible violation of

 6  the statutes and rules regulating such facilities. The

 7  committee members have the same rights of entry and inspection

 8  granted under s. 400.805(4) s. 400.805(8) to designated

 9  representatives of the agency.

10         2.  Factual findings of the committee resulting from an

11  onsite investigation of a facility pursuant to subparagraph 1.

12  shall be adopted by the agency in developing its

13  administrative response regarding enforcement of statutes and

14  rules regulating the operation of the facility.

15         3.  Onsite investigations by the committee shall be

16  funded by the Health Care Trust Fund.

17         4.  Travel expenses for committee members shall be

18  reimbursed in accordance with s. 112.061.

19         5.  Members of the committee shall recuse themselves

20  from participating in any investigation that would create a

21  conflict of interest under state law, and the council shall

22  replace the member, either temporarily or permanently.

23         Section 3.  Section 383.301, Florida Statutes, is

24  amended to read:

25         383.301  Licensure and regulation of birth centers;

26  legislative intent.--It is the intent of the Legislature to

27  provide for the protection of public health and safety in the

28  establishment, maintenance, and operation of birth centers by

29  providing for licensure of birth centers and for the

30  development, establishment, and enforcement of minimum

31  standards with respect to birth centers. The requirements of

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 1  part II of chapter 408 shall apply to the provision of

 2  services that require licensure pursuant to ss. 383.30-383.335

 3  and part II of chapter 408 and to entities licensed by or

 4  applying for such licensure from the Agency for Health Care

 5  Administration pursuant to ss. 383.30-383.335. A license

 6  issued by the agency is required in order to operate a birth

 7  center in this state.

 8         Section 4.  Section 383.304, Florida Statutes, is

 9  repealed.

10         Section 5.  Section 383.305, Florida Statutes, is

11  amended to read:

12         383.305  Licensure; issuance, renewal, denial,

13  suspension, revocation; fees; background screening.--

14         (1)(a)  In accordance with s. 408.805, an applicant or

15  a licensee shall pay a fee for each license application

16  submitted under ss. 383.30-383.335 and part II of chapter 408.

17  The amount of the fee shall be established by rule. Upon

18  receipt of an application for a license and the license fee,

19  the agency shall issue a license if the applicant and facility

20  have received all approvals required by law and meet the

21  requirements established under ss. 383.30-383.335 and by rules

22  promulgated hereunder.

23         (b)  A provisional license may be issued to any birth

24  center that is in substantial compliance with ss.

25  383.30-383.335 and with the rules of the agency. A provisional

26  license may be granted for a period of no more than 1 year

27  from the effective date of rules adopted by the agency, shall

28  expire automatically at the end of its term, and may not be

29  renewed.

30         (c)  A license, unless sooner suspended or revoked,

31  automatically expires 1 year from its date of issuance and is

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 1  renewable upon application for renewal and payment of the fee

 2  prescribed, provided the applicant and the birth center meet

 3  the requirements established under ss. 383.30-383.335 and by

 4  rules promulgated hereunder. A complete application for

 5  renewal of a license shall be made 90 days prior to expiration

 6  of the license on forms provided by the agency.

 7         (2)  An application for a license, or renewal thereof,

 8  shall be made to the agency upon forms provided by it and

 9  shall contain such information as the agency reasonably

10  requires, which may include affirmative evidence of ability to

11  comply with applicable laws and rules.

12         (3)(a)  Each application for a birth center license, or

13  renewal thereof, shall be accompanied by a license fee. Fees

14  shall be established by rule of the agency. Such fees are

15  payable to the agency and shall be deposited in a trust fund

16  administered by the agency, to be used for the sole purpose of

17  carrying out the provisions of ss. 383.30-383.335.

18         (b)  The fees established pursuant to ss.

19  383.30-383.335 shall be based on actual costs incurred by the

20  agency in the administration of its duties under such

21  sections.

22         (4)  Each license is valid only for the person or

23  governmental unit to whom or which it is issued; is not

24  subject to sale, assignment, or other transfer, voluntary or

25  involuntary; and is not valid for any premises other than

26  those for which it was originally issued.

27         (5)  Each license shall be posted in a conspicuous

28  place on the licensed premises.

29         (6)  Whenever the agency finds that there has been a

30  substantial failure to comply with the requirements

31  established under ss. 383.30-383.335 or in rules adopted under

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 1  those sections, it is authorized to deny, suspend, or revoke a

 2  license.

 3         (2)(7)  Each applicant for licensure and each licensee

 4  must comply with the following requirements of this chapter

 5  and part II of chapter 408.:

 6         (a)  Upon receipt of a completed, signed, and dated

 7  application, the agency shall require background screening, in

 8  accordance with the level 2 standards for screening set forth

 9  in chapter 435, of the managing employee, or other similarly

10  titled individual who is responsible for the daily operation

11  of the center, and of the financial officer, or other

12  similarly titled individual who is responsible for the

13  financial operation of the center, including billings for

14  patient care and services. The applicant must comply with the

15  procedures for level 2 background screening as set forth in

16  chapter 435 as well as the requirements of s. 435.03(3).

17         (b)  The agency may require background screening of any

18  other individual who is an applicant if the agency has

19  probable cause to believe that he or she has been convicted of

20  a crime or has committed any other offense prohibited under

21  the level 2 standards for screening set forth in chapter 435.

22         (c)  Proof of compliance with the level 2 background

23  screening requirements of chapter 435 which has been submitted

24  within the previous 5 years in compliance with any other

25  health care licensure requirements of this state is acceptable

26  in fulfillment of the requirements of paragraph (a).

27         (d)  A provisional license may be granted to an

28  applicant when each individual required by this section to

29  undergo background screening has met the standards for the

30  Department of Law Enforcement background check, but the agency

31  has not yet received background screening results from the

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 1  Federal Bureau of Investigation, or a request for a

 2  disqualification exemption has been submitted to the agency as

 3  set forth in chapter 435 but a response has not yet been

 4  issued. A standard license may be granted to the applicant

 5  upon the agency's receipt of a report of the results of the

 6  Federal Bureau of Investigation background screening for each

 7  individual required by this section to undergo background

 8  screening which confirms that all standards have been met, or

 9  upon the granting of a disqualification exemption by the

10  agency as set forth in chapter 435. Any other person who is

11  required to undergo level 2 background screening may serve in

12  his or her capacity pending the agency's receipt of the report

13  from the Federal Bureau of Investigation. However, the person

14  may not continue to serve if the report indicates any

15  violation of background screening standards and a

16  disqualification exemption has not been requested of and

17  granted by the agency as set forth in chapter 435.

18         (e)  Each applicant must submit to the agency, with its

19  application, a description and explanation of any exclusions,

20  permanent suspensions, or terminations of the applicant from

21  the Medicare or Medicaid programs. Proof of compliance with

22  the requirements for disclosure of ownership and control

23  interests under the Medicaid or Medicare programs shall be

24  accepted in lieu of this submission.

25         (f)  Each applicant must submit to the agency a

26  description and explanation of any conviction of an offense

27  prohibited under the level 2 standards of chapter 435 by a

28  member of the board of directors of the applicant, its

29  officers, or any individual owning 5 percent or more of the

30  applicant. This requirement does not apply to a director of a

31  not-for-profit corporation or organization if the director

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 1  serves solely in a voluntary capacity for the corporation or

 2  organization, does not regularly take part in the day-to-day

 3  operational decisions of the corporation or organization,

 4  receives no remuneration for his or her services on the

 5  corporation or organization's board of directors, and has no

 6  financial interest and has no family members with a financial

 7  interest in the corporation or organization, provided that the

 8  director and the not-for-profit corporation or organization

 9  include in the application a statement affirming that the

10  director's relationship to the corporation satisfies the

11  requirements of this paragraph.

12         (g)  A license may not be granted to an applicant if

13  the applicant or managing employee has been found guilty of,

14  regardless of adjudication, or has entered a plea of nolo

15  contendere or guilty to, any offense prohibited under the

16  level 2 standards for screening set forth in chapter 435,

17  unless an exemption from disqualification has been granted by

18  the agency as set forth in chapter 435.

19         (h)  The agency may deny or revoke licensure if the

20  applicant:

21         1.  Has falsely represented a material fact in the

22  application required by paragraph (e) or paragraph (f), or has

23  omitted any material fact from the application required by

24  paragraph (e) or paragraph (f); or

25         2.  Has had prior action taken against the applicant

26  under the Medicaid or Medicare program as set forth in

27  paragraph (e).

28         (i)  An application for license renewal must contain

29  the information required under paragraphs (e) and (f).

30         Section 6.  Section 383.309, Florida Statutes, is

31  amended to read:

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 1         383.309  Minimum standards for birth centers; rules and

 2  enforcement.--

 3         (1)  The agency shall adopt and enforce rules to

 4  administer ss. 383.30-383.335 and part II of chapter 408,

 5  which rules shall include, but are not limited to, reasonable

 6  and fair minimum standards for ensuring that:

 7         (a)  Sufficient numbers and qualified types of

 8  personnel and occupational disciplines are available at all

 9  times to provide necessary and adequate patient care and

10  safety.

11         (b)  Infection control, housekeeping, sanitary

12  conditions, disaster plan, and medical record procedures that

13  will adequately protect patient care and provide safety are

14  established and implemented.

15         (c)  Licensed facilities are established, organized,

16  and operated consistent with established programmatic

17  standards.

18         (2)  Any licensed facility that is in operation at the

19  time of adoption of any applicable rule under ss.

20  383.30-383.335 shall be given a reasonable time under the

21  particular circumstances, not to exceed 1 year after the date

22  of such adoption, within which to comply with such rule.

23         (2)(3)  The agency may not establish any rule governing

24  the design, construction, erection, alteration, modification,

25  repair, or demolition of birth centers. It is the intent of

26  the Legislature to preempt that function to the Florida

27  Building Commission and the State Fire Marshal through

28  adoption and maintenance of the Florida Building Code and the

29  Florida Fire Prevention Code. However, the agency shall

30  provide technical assistance to the commission and the State

31  Fire Marshal in updating the construction standards of the

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 1  Florida Building Code and the Florida Fire Prevention Code

 2  which govern birth centers. In addition, the agency may

 3  enforce the special-occupancy provisions of the Florida

 4  Building Code and the Florida Fire Prevention Code which apply

 5  to birth centers in conducting any inspection authorized under

 6  this chapter or part II of chapter 408.

 7         Section 7.  Subsection (1) of section 383.315, Florida

 8  Statutes, is amended to read:

 9         383.315  Agreements with consultants for advice or

10  services; maintenance.--

11         (1)  A birth center shall maintain in writing a

12  consultation agreement, signed within the current license

13  period year, with each consultant who has agreed to provide

14  advice and services to the birth center as requested.

15         Section 8.  Section 383.324, Florida Statutes, is

16  amended to read:

17         383.324  Inspections and investigations; inspection

18  fees.--

19         (1)  The agency shall make or cause to be made such

20  inspections and investigations as it deems necessary.

21         (2)  Each facility licensed under s. 383.305 shall pay

22  to the agency, at the time of inspection, an inspection fee

23  established by rule of the agency. In addition to the

24  requirements of part II of chapter 408,

25         (3)  the agency shall coordinate all periodic

26  inspections for licensure made by the agency to ensure that

27  the cost to the facility of such inspections and the

28  disruption of services by such inspections is minimized.

29         Section 9.  Section 383.33, Florida Statutes, is

30  amended to read:

31  

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 1         383.33  Administrative penalties; emergency orders;

 2  moratorium on admissions.--

 3         (1)(a)  In addition to the requirements of part II of

 4  chapter 408, the agency may deny, revoke, or suspend a

 5  license, or impose an administrative fine not to exceed $500

 6  per violation per day, for the violation of any provision of

 7  ss. 383.30-383.335, part II of chapter 408, or applicable

 8  rules or any rule adopted under ss. 383.30-383.335. Each day

 9  of violation constitutes a separate violation and is subject

10  to a separate fine.

11         (2)(b)  In determining the amount of the fine to be

12  levied for a violation, as provided in this section paragraph

13  (a), the following factors shall be considered:

14         (a)1.  The severity of the violation, including the

15  probability that death or serious harm to the health or safety

16  of any person will result or has resulted; the severity of the

17  actual or potential harm; and the extent to which the

18  provisions of ss. 383.30-383.335, part II of chapter 408, or

19  applicable rules were violated.

20         (b)2.  Actions taken by the licensee to correct the

21  violations or to remedy complaints.

22         (c)3.  Any previous violations by the licensee.

23         (c)  All amounts collected pursuant to this section

24  shall be deposited into a trust fund administered by the

25  agency to be used for the sole purpose of carrying out the

26  provisions of ss.383.30-383.335.

27         (2)  The agency may issue an emergency order

28  immediately suspending or revoking a license when it

29  determines that any condition in the licensed facility

30  presents a clear and present danger to the public health and

31  safety.

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 1         (2)(3)  In accordance with part II of chapter 408, the

 2  agency may impose an immediate moratorium on elective

 3  admissions to any licensed facility, building or portion

 4  thereof, or service when the agency determines that any

 5  condition in the facility presents a threat to the public

 6  health or safety.

 7         Section 10.  Section 383.331, Florida Statutes, is

 8  repealed.

 9         Section 11.  Section 383.332, Florida Statutes, is

10  amended to read:

11         383.332  Establishing, managing, or operating a birth

12  center without a license; penalty.--Any person who

13  establishes, conducts, manages, or operates any birth center

14  facility without a license issued under s. 383.305 and part II

15  of chapter 408 commits is guilty of a misdemeanor and, upon

16  conviction, shall be fined not more than $100 for the first

17  offense and not more than $500 for each subsequent offense;

18  and each day of continuing violation after conviction shall be

19  considered a separate offense.

20         Section 12.  Subsection (1) of section 383.335, Florida

21  Statutes, is amended to read:

22         383.335  Partial exemptions.--

23         (1)  Any facility that which was providing obstetrical

24  and gynecological surgical services and was owned and operated

25  by a board-certified obstetrician on June 15, 1984, and that

26  would which is otherwise be subject to licensure under ss.

27  383.30-383.335 as a birth center, is exempt from the

28  provisions of ss. 383.30-383.335 and part II of chapter 408

29  which restrict the provision of surgical services and outlet

30  forceps delivery and the administration of anesthesia at birth

31  centers. The agency shall adopt rules specifically related to

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 1  the performance of such services and the administration of

 2  anesthesia at such facilities.

 3         Section 13.  Subsection (4) of section 383.50, Florida

 4  Statutes, is amended to read:

 5         383.50  Treatment of abandoned newborn infant.--

 6         (4)  Each hospital of this state subject to s. 395.1041

 7  shall, and any other hospital may, admit and provide all

 8  necessary emergency services and care, as defined in s.

 9  395.002(9)(10), to any newborn infant left with the hospital

10  in accordance with this section. The hospital or any of its

11  licensed health care professionals shall consider these

12  actions as implied consent for treatment, and a hospital

13  accepting physical custody of a newborn infant has implied

14  consent to perform all necessary emergency services and care.

15  The hospital or any of its licensed health care professionals

16  is immune from criminal or civil liability for acting in good

17  faith in accordance with this section. Nothing in this

18  subsection limits liability for negligence.

19         Section 14.  Subsection (5) of section 390.011, Florida

20  Statutes, is amended to read:

21         390.011  Definitions.--As used in this chapter, the

22  term:

23         (5)  "Hospital" means a facility as defined in s.

24  395.002(12) and licensed under chapter 395 and part II of

25  chapter 408.

26         Section 15.  Subsection (1) of section 390.012, Florida

27  Statutes, is amended to read:

28         390.012  Powers of agency; rules; disposal of fetal

29  remains.--

30         (1)  The agency may shall have the authority to develop

31  and enforce rules pursuant to ss. 390.001-390.018 and part II

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 1  of chapter 408 for the health, care, and treatment of persons

 2  in abortion clinics and for the safe operation of such

 3  clinics.

 4         (a)  The rules shall be reasonably related to the

 5  preservation of maternal health of the clients.

 6         (b)  The rules shall be in accordance with s. 797.03

 7  and may not impose an unconstitutional burden on a woman's

 8  freedom to decide whether to terminate her pregnancy.

 9         (c)  The rules shall provide for:

10         1.  The performance of pregnancy termination procedures

11  only by a licensed physician.

12         2.  The making, protection, and preservation of patient

13  records, which shall be treated as medical records under

14  chapter 458.

15         Section 16.  Section 390.013, Florida Statutes, is

16  repealed.

17         Section 17.  Section 390.014, Florida Statutes, is

18  amended to read:

19         390.014  Licenses; fees, display, etc.--

20         (1)  The requirements of part II of chapter 408 shall

21  apply to the provision of services that require licensure

22  pursuant to ss. 390.011-390.018 and part II of chapter 408 and

23  to entities licensed by or applying for such licensure from

24  the Agency for Health Care Administration pursuant to ss.

25  390.011-390.018. A license issued by the agency is required in

26  order to operate a clinic in this state. No abortion clinic

27  shall operate in this state without a currently effective

28  license issued by the agency.

29         (2)  A separate license shall be required for each

30  clinic maintained on separate premises, even though it is

31  operated by the same management as another clinic; but a

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 1  separate license shall not be required for separate buildings

 2  on the same premises.

 3         (3)  In accordance with s. 408.805, an applicant or

 4  licensee shall pay a fee for each license application

 5  submitted under this part and part II of chapter 408. The

 6  amount of the fee shall be established by rule and The annual

 7  license fee required for a clinic shall be nonrefundable and

 8  shall be reasonably calculated to cover the cost of regulation

 9  under this chapter, but may not be less than $70 or $35 nor

10  more than $500 $250.

11         (4)  Counties and municipalities applying for licenses

12  under this act shall be exempt from the payment of the license

13  fees.

14         (5)  The license shall be displayed in a conspicuous

15  place inside the clinic.

16         (6)  A license shall be valid only for the clinic to

17  which it is issued, and it shall not be subject to sale,

18  assignment, or other transfer, voluntary or involuntary. No

19  license shall be valid for any premises other than those for

20  which it was originally issued.

21         Section 18.  Section 390.015, Florida Statutes, is

22  amended to read:

23         390.015  Application for license.--

24         (1)  In addition to the requirements of part II of

25  chapter 408, an application for a license to operate an

26  abortion clinic shall be made to the agency and must include

27  on a form furnished by it for that purpose.  The application

28  shall be accompanied by the applicable license fee.

29         (2)  The application, which shall be made under oath,

30  shall contain, among other things, the following:

31  

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 1         (a)  The name and address of the applicant if the

 2  applicant is an individual; or if the applicant is a firm,

 3  partnership, or association, the name and address of each

 4  member thereof; or if the applicant is a corporation, its name

 5  and address and the name and address of each of its officers.

 6         (b)  The name by which the clinic is to be known.

 7         (c)  the location of the clinic for which application

 8  is made and a statement that local zoning ordinances permit

 9  such location.

10         (d)  The name of the person or persons under whose

11  management or supervision the clinic will be operated.

12         (3)  Each applicant for licensure must comply with the

13  following requirements:

14         (a)  Upon receipt of a completed, signed, and dated

15  application, the agency shall require background screening, in

16  accordance with the level 2 standards for screening set forth

17  in chapter 435, of the managing employee, or other similarly

18  titled individual who is responsible for the daily operation

19  of the clinic, and financial officer, or other similarly

20  titled individual who is responsible for the financial

21  operation of the clinic, including billings for patient care

22  and services. The applicant must comply with the procedures

23  for level 2 background screening as set forth in chapter 435,

24  as well as the requirements of s. 435.03(3).

25         (b)  The agency may require background screening of any

26  other individual who is an applicant if the agency has

27  probable cause to believe that he or she has been convicted of

28  a crime or has committed any other offense prohibited under

29  the level 2 standards for screening set forth in chapter 435.

30         (c)  Proof of compliance with the level 2 background

31  screening requirements of chapter 435 which has been submitted

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 1  within the previous 5 years in compliance with any other

 2  health care licensure requirements of this state is acceptable

 3  in fulfillment of the requirements of paragraph (a).

 4         (d)  A provisional license may be granted to an

 5  applicant when each individual required by this section to

 6  undergo background screening has met the standards for the

 7  Department of Law Enforcement background check, but the agency

 8  has not yet received background screening results from the

 9  Federal Bureau of Investigation, or a request for a

10  disqualification exemption has been submitted to the agency as

11  set forth in chapter 435 but a response has not yet been

12  issued. A standard license may be granted to the applicant

13  upon the agency's receipt of a report of the results of the

14  Federal Bureau of Investigation background screening for each

15  individual required by this section to undergo background

16  screening which confirms that all standards have been met, or

17  upon the granting of a disqualification exemption by the

18  agency as set forth in chapter 435. Any other person who is

19  required to undergo level 2 background screening may serve in

20  his or her capacity pending the agency's receipt of the report

21  from the Federal Bureau of Investigation. However, the person

22  may not continue to serve if the report indicates any

23  violation of background screening standards and a

24  disqualification exemption has not been requested of and

25  granted by the agency as set forth in chapter 435.

26         (e)  Each applicant must submit to the agency, with its

27  application, a description and explanation of any exclusions,

28  permanent suspensions, or terminations of the applicant from

29  the Medicare or Medicaid programs. Proof of compliance with

30  the requirements for disclosure of ownership and control

31  

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 1  interests under the Medicaid or Medicare programs shall be

 2  accepted in lieu of this submission.

 3         (f)  Each applicant must submit to the agency a

 4  description and explanation of any conviction of an offense

 5  prohibited under the level 2 standards of chapter 435 by a

 6  member of the board of directors of the applicant, its

 7  officers, or any individual owning 5 percent or more of the

 8  applicant. This requirement does not apply to a director of a

 9  not-for-profit corporation or organization if the director

10  serves solely in a voluntary capacity for the corporation or

11  organization, does not regularly take part in the day-to-day

12  operational decisions of the corporation or organization,

13  receives no remuneration for his or her services on the

14  corporation or organization's board of directors, and has no

15  financial interest and has no family members with a financial

16  interest in the corporation or organization, provided that the

17  director and the not-for-profit corporation or organization

18  include in the application a statement affirming that the

19  director's relationship to the corporation satisfies the

20  requirements of this paragraph.

21         (g)  A license may not be granted to an applicant if

22  the applicant or managing employee has been found guilty of,

23  regardless of adjudication, or has entered a plea of nolo

24  contendere or guilty to, any offense prohibited under the

25  level 2 standards for screening set forth in chapter 435,

26  unless an exemption from disqualification has been granted by

27  the agency as set forth in chapter 435.

28         (h)  The agency may deny or revoke licensure if the

29  applicant:

30         1.  Has falsely represented a material fact in the

31  application required by paragraph (e) or paragraph (f), or has

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 1  omitted any material fact from the application required by

 2  paragraph (e) or paragraph (f); or

 3         2.  Has had prior action taken against the applicant

 4  under the Medicaid or Medicare program as set forth in

 5  paragraph (e).

 6         (i)  An application for license renewal must contain

 7  the information required under paragraphs (e) and (f).

 8         Section 19.  Section 390.016, Florida Statutes, is

 9  repealed.

10         Section 20.  Section 390.017, Florida Statutes, is

11  repealed.

12         Section 21.  Section 390.018, Florida Statutes, is

13  amended to read:

14         390.018  Administrative fine penalty in lieu of

15  revocation or suspension.--In addition to the requirements of

16  part II of chapter 408 If the agency finds that one or more

17  grounds exist for the revocation or suspension of a license

18  issued to an abortion clinic, the agency may, in lieu of such

19  suspension or revocation, impose a fine upon the clinic in an

20  amount not to exceed $1,000 for each violation of any

21  provision of this part, part II of chapter 408, or applicable

22  rules. The fine shall be paid to the agency within 60 days

23  from the date of entry of the administrative order. If the

24  licensee fails to pay the fine in its entirety to the agency

25  within the period allowed, the license of the licensee shall

26  stand suspended, revoked, or renewal or continuation may be

27  refused, as the case may be, upon expiration of such period

28  and without any further administrative or judicial

29  proceedings.

30         Section 22.  Section 390.019, Florida Statutes, is

31  repealed.

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 1         Section 23.  Section 390.021, Florida Statutes, is

 2  repealed.

 3         Section 24.  Subsection (13) of section 394.455,

 4  Florida Statutes, is amended to read:

 5         394.455  Definitions.--As used in this part, unless the

 6  context clearly requires otherwise, the term:

 7         (13)  "Hospital" means a facility as defined in s.

 8  395.002 and licensed under chapter 395 and part II of chapter

 9  408.

10         Section 25.  Subsection (7) of section 394.4787,

11  Florida Statutes, is amended to read:

12         394.4787  Definitions; ss. 394.4786, 394.4787,

13  394.4788, and 394.4789.--As used in this section and ss.

14  394.4786, 394.4788, and 394.4789:

15         (7)  "Specialty psychiatric hospital" means a hospital

16  licensed by the agency pursuant to s. 395.002(28) and part II

17  of chapter 408 s. 395.002(29) as a specialty psychiatric

18  hospital.

19         Section 26.  Subsections (3) through (25) of section

20  394.67, Florida Statutes, are renumbered as subsections (2)

21  through (24), respectively, and present subsections (2) and

22  (4) of that section are amended to read:

23         394.67  Definitions.--As used in this part, the term:

24         (2)  "Applicant" means an individual applicant, or any

25  officer, director, agent, managing employee, or affiliated

26  person, or any partner or shareholder having an ownership

27  interest equal to a 5-percent or greater interest in the

28  corporation, partnership, or other business entity.

29         (3)(4)  "Crisis services" means short-term evaluation,

30  stabilization, and brief intervention services provided to a

31  person who is experiencing an acute mental or emotional

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 1  crisis, as defined in subsection (17) (18), or an acute

 2  substance abuse crisis, as defined in subsection (18) (19), to

 3  prevent further deterioration of the person's mental health.

 4  Crisis services are provided in settings such as a crisis

 5  stabilization unit, an inpatient unit, a short-term

 6  residential treatment program, a detoxification facility, or

 7  an addictions receiving facility; at the site of the crisis by

 8  a mobile crisis response team; or at a hospital on an

 9  outpatient basis.

10         Section 27.  Subsection (3) of section 394.74, Florida

11  Statutes, is amended to read:

12         394.74  Contracts for provision of local substance

13  abuse and mental health programs.--

14         (3)  Contracts shall include, but are not limited to:

15         (a)  A provision that, within the limits of available

16  resources, substance abuse and mental health crisis services,

17  as defined in s. 394.67(3)(4), shall be available to any

18  individual residing or employed within the service area,

19  regardless of ability to pay for such services, current or

20  past health condition, or any other factor;

21         (b)  A provision that such services be available with

22  priority of attention being given to individuals who exhibit

23  symptoms of chronic or acute substance abuse or mental illness

24  and who are unable to pay the cost of receiving such services;

25         (c)  A provision that every reasonable effort to

26  collect appropriate reimbursement for the cost of providing

27  substance abuse and mental health services to persons able to

28  pay for services, including first-party payments and

29  third-party payments, shall be made by facilities providing

30  services pursuant to this act;

31  

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 1         (d)  A program description and line-item operating

 2  budget by program service component for substance abuse and

 3  mental health services, provided the entire proposed operating

 4  budget for the service provider will be displayed;

 5         (e)  A provision that client demographic, service, and

 6  outcome information required for the department's Mental

 7  Health and Substance Abuse Data System be submitted to the

 8  department by a date specified in the contract. The department

 9  may not pay the provider unless the required information has

10  been submitted by the specified date; and

11         (f)  A requirement that the contractor must conform to

12  department rules and the priorities established thereunder.

13         Section 28.  Subsections (1) and (4) of section 394.82,

14  Florida Statutes, are amended to read:

15         394.82  Funding of expanded services.--

16         (1)  Pursuant to the General Appropriations Acts for

17  the 2001-2002 and 2002-2003 fiscal years, funds appropriated

18  to the Department of Children and Family Services for the

19  purpose of expanding community mental health services must be

20  used to implement programs that emphasize crisis services as

21  defined in s. 394.67(3)(4) and treatment services,

22  rehabilitative services, support services, and case management

23  services, as defined in s. 394.67(15)(16). Following the

24  2002-2003 fiscal year, the Department of Children and Family

25  Services must continue to expand the provision of these

26  community mental health services.

27         (4)  By January 1, 2004, the crisis services defined in

28  s. 394.67(3)(4) shall be implemented, as appropriate, in the

29  state's public community mental health system to serve

30  children and adults who are experiencing an acute mental or

31  emotional crisis, as defined in s. 394.67(17)(18). By January

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 1  1, 2006, the mental health services defined in s.

 2  394.67(15)(16) shall be implemented, as appropriate, in the

 3  state's public community mental health system to serve adults

 4  and older adults who have a severe and persistent mental

 5  illness and to serve children who have a serious emotional

 6  disturbance or mental illness, as defined in s. 394.492(6).

 7         Section 29.  Section 394.875, Florida Statutes, is

 8  amended to read:

 9         394.875  Crisis stabilization units, residential

10  treatment facilities, and residential treatment centers for

11  children and adolescents; authorized services; license

12  required; penalties.--

13         (1)(a)  The purpose of a crisis stabilization unit is

14  to stabilize and redirect a client to the most appropriate and

15  least restrictive community setting available, consistent with

16  the client's needs. Crisis stabilization units may screen,

17  assess, and admit for stabilization persons who present

18  themselves to the unit and persons who are brought to the unit

19  under s. 394.463. Clients may be provided 24-hour observation,

20  medication prescribed by a physician or psychiatrist, and

21  other appropriate services. Crisis stabilization units shall

22  provide services regardless of the client's ability to pay and

23  shall be limited in size to a maximum of 30 beds.

24         (b)  The purpose of a residential treatment facility is

25  to be a part of a comprehensive treatment program for mentally

26  ill individuals in a community-based residential setting.

27         (c)  The purpose of a residential treatment center for

28  children and adolescents is to provide mental health

29  assessment and treatment services pursuant to ss. 394.491,

30  394.495, and 394.496 to children and adolescents who meet the

31  

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 1  target population criteria specified in s. 394.493(1)(a), (b),

 2  or (c).

 3         (2)  The requirements of part II of chapter 408 apply

 4  to the provision of services that require licensure under ss.

 5  394.455-394.904 and part II of chapter 408 and to entities

 6  licensed by or applying for such licensure from the Agency for

 7  Health Care Administration pursuant to ss. 394.455-394.904. A

 8  license issued by the agency is required in order to operate

 9  It is unlawful for any entity to hold itself out as a crisis

10  stabilization unit, a residential treatment facility, or a

11  residential treatment center for children and adolescents, or

12  to act as a crisis stabilization unit, a residential treatment

13  facility, or a residential treatment center for children and

14  adolescents in this state, unless it is licensed by the agency

15  pursuant to this chapter.

16         (3)  Any person who violates subsection (2) is guilty

17  of a misdemeanor of the first degree, punishable as provided

18  in s. 775.082 or s. 775.083.

19         (4)  The agency may maintain an action in circuit court

20  to enjoin the unlawful operation of a crisis stabilization

21  unit, a residential treatment facility, or a residential

22  treatment center for children and adolescents if the agency

23  first gives the violator 14 days' notice of its intention to

24  maintain such action and if the violator fails to apply for

25  licensure within such 14-day period.

26         (3)(5)  The following are exempt from licensure as

27  required in ss. 394.455-394.904 Subsection (2) does not apply

28  to:

29         (a)  Homes for special services licensed under chapter

30  400.; or

31         (b)  Nursing homes licensed under chapter 400.

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 1         (c)  Comprehensive transitional education programs

 2  licensed under s. 393.067.

 3         (4)(6)  The department, in consultation with the

 4  agency, may establish multiple license classifications for

 5  residential treatment facilities.

 6         (5)(7)  The agency may not issue a license to a crisis

 7  stabilization unit unless the unit receives state mental

 8  health funds and is affiliated with a designated public

 9  receiving facility.

10         (6)(8)  The agency may issue a license for a crisis

11  stabilization unit or short-term residential treatment

12  facility, certifying the number of authorized beds for such

13  facility as indicated by existing need and available

14  appropriations. The agency may disapprove an application for

15  such a license if it determines that a facility should not be

16  licensed pursuant to the provisions of this chapter. Any

17  facility operating beds in excess of those authorized by the

18  agency shall, upon demand of the agency, reduce the number of

19  beds to the authorized number, forfeit its license, or provide

20  evidence of a license issued pursuant to chapter 395 for the

21  excess beds.

22         (7)(9)  A children's crisis stabilization unit which

23  does not exceed 20 licensed beds and which provides separate

24  facilities or a distinct part of a facility, separate

25  staffing, and treatment exclusively for minors may be located

26  on the same premises as a crisis stabilization unit serving

27  adults. The department, in consultation with the agency, shall

28  adopt rules governing facility construction, staffing and

29  licensure requirements, and the operation of such units for

30  minors.

31  

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 1         (8)(10)  The department, in consultation with the

 2  agency, must adopt rules governing a residential treatment

 3  center for children and adolescents which specify licensure

 4  standards for:  admission; length of stay; program and

 5  staffing; discharge and discharge planning; treatment

 6  planning; seclusion, restraints, and time-out; rights of

 7  patients under s. 394.459; use of psychotropic medications;

 8  and standards for the operation of such centers.

 9         (9)(11)  Notwithstanding the provisions of subsection

10  (6) (8), crisis stabilization units may not exceed their

11  licensed capacity by more than 10 percent, nor may they exceed

12  their licensed capacity for more than 3 consecutive working

13  days or for more than 7 days in 1 month.

14         (10)(12)  Notwithstanding the other provisions of this

15  section, any facility licensed under former chapter 396 and

16  chapter 397 for detoxification, residential level I care, and

17  outpatient treatment may elect to license concurrently all of

18  the beds at such facility both for that purpose and as a

19  long-term residential treatment facility pursuant to this

20  section, if all of the following conditions are met:

21         (a)  The licensure application is received by the

22  department prior to January 1, 1993.

23         (b)  On January 1, 1993, the facility was licensed

24  under former chapter 396 and chapter 397 as a facility for

25  detoxification, residential level I care, and outpatient

26  treatment of substance abuse.

27         (c)  The facility restricted its practice to the

28  treatment of law enforcement personnel for a period of at

29  least 12 months beginning after January 1, 1992.

30         (d)  The number of beds to be licensed under this

31  chapter is equal to or less than the number of beds licensed

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 1  under former chapter 396 and chapter 397 as of January 1,

 2  1993.

 3         (e)  The licensee agrees in writing to a condition

 4  placed upon the license that the facility will limit its

 5  treatment exclusively to law enforcement personnel and their

 6  immediate families who are seeking admission on a voluntary

 7  basis and who are exhibiting symptoms of posttraumatic stress

 8  disorder or other mental health problems, including drug or

 9  alcohol abuse, which are directly related to law enforcement

10  work and which are amenable to verbal treatment therapies; the

11  licensee agrees to coordinate the provision of appropriate

12  postresidential care for discharged individuals; and the

13  licensee further agrees in writing that a failure to meet any

14  condition specified in this paragraph shall constitute grounds

15  for a revocation of the facility's license as a residential

16  treatment facility.

17         (f)  The licensee agrees that the facility will meet

18  all licensure requirements for a residential treatment

19  facility, including minimum standards for compliance with

20  lifesafety requirements, except those licensure requirements

21  which are in express conflict with the conditions and other

22  provisions specified in this subsection.

23         (g)  The licensee agrees that the conditions stated in

24  this subsection must be agreed to in writing by any person

25  acquiring the facility by any means.

26  

27  Any facility licensed under this subsection is not required to

28  provide any services to any persons except those included in

29  the specified conditions of licensure, and is exempt from any

30  requirements related to the 60-day or greater average length

31  

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 1  of stay imposed on community-based residential treatment

 2  facilities otherwise licensed under this chapter.

 3         (13)  Each applicant for licensure must comply with the

 4  following requirements:

 5         (a)  Upon receipt of a completed, signed, and dated

 6  application, the agency shall require background screening, in

 7  accordance with the level 2 standards for screening set forth

 8  in chapter 435, of the managing employee and financial

 9  officer, or other similarly titled individual who is

10  responsible for the financial operation of the facility,

11  including billings for client care and services. The applicant

12  must comply with the procedures for level 2 background

13  screening as set forth in chapter 435, as well as the

14  requirements of s. 435.03(3).

15         (b)  The agency may require background screening of any

16  other individual who is an applicant if the agency has

17  probable cause to believe that he or she has been convicted of

18  a crime or has committed any other offense prohibited under

19  the level 2 standards for screening set forth in chapter 435.

20         (c)  Proof of compliance with the level 2 background

21  screening requirements of chapter 435 which has been submitted

22  within the previous 5 years in compliance with any other

23  health care licensure requirements of this state is acceptable

24  in fulfillment of the requirements of paragraph (a).

25         (d)  A provisional license may be granted to an

26  applicant when each individual required by this section to

27  undergo background screening has met the standards for the

28  Department of Law Enforcement background check, but the agency

29  has not yet received background screening results from the

30  Federal Bureau of Investigation, or a request for a

31  disqualification exemption has been submitted to the agency as

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 1  set forth in chapter 435, but a response has not yet been

 2  issued. A standard license may be granted to the applicant

 3  upon the agency's receipt of a report of the results of the

 4  Federal Bureau of Investigation background screening for each

 5  individual required by this section to undergo background

 6  screening which confirms that all standards have been met, or

 7  upon the granting of a disqualification exemption by the

 8  agency as set forth in chapter 435. Any other person who is

 9  required to undergo level 2 background screening may serve in

10  his or her capacity pending the agency's receipt of the report

11  from the Federal Bureau of Investigation. However, the person

12  may not continue to serve if the report indicates any

13  violation of background screening standards and a

14  disqualification exemption has not been requested of and

15  granted by the agency as set forth in chapter 435.

16         (e)  Each applicant must submit to the agency, with its

17  application, a description and explanation of any exclusions,

18  permanent suspensions, or terminations of the applicant from

19  the Medicare or Medicaid programs. Proof of compliance with

20  the requirements for disclosure of ownership and control

21  interests under the Medicaid or Medicare programs shall be

22  accepted in lieu of this submission.

23         (f)  Each applicant must submit to the agency a

24  description and explanation of any conviction of an offense

25  prohibited under the level 2 standards of chapter 435 by a

26  member of the board of directors of the applicant, its

27  officers, or any individual owning 5 percent or more of the

28  applicant. This requirement does not apply to a director of a

29  not-for-profit corporation or organization if the director

30  serves solely in a voluntary capacity for the corporation or

31  organization, does not regularly take part in the day-to-day

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 1  operational decisions of the corporation or organization,

 2  receives no remuneration for his or her services on the

 3  corporation or organization's board of directors, and has no

 4  financial interest and has no family members with a financial

 5  interest in the corporation or organization, provided that the

 6  director and the not-for-profit corporation or organization

 7  include in the application a statement affirming that the

 8  director's relationship to the corporation satisfies the

 9  requirements of this paragraph.

10         (g)  A license may not be granted to an applicant if

11  the applicant or managing employee has been found guilty of,

12  regardless of adjudication, or has entered a plea of nolo

13  contendere or guilty to, any offense prohibited under the

14  level 2 standards for screening set forth in chapter 435,

15  unless an exemption from disqualification has been granted by

16  the agency as set forth in chapter 435.

17         (h)  The agency may deny or revoke licensure if the

18  applicant:

19         1.  Has falsely represented a material fact in the

20  application required by paragraph (e) or paragraph (f), or has

21  omitted any material fact from the application required by

22  paragraph (e) or paragraph (f); or

23         2.  Has had prior action taken against the applicant

24  under the Medicaid or Medicare program as set forth in

25  paragraph (e).

26         (i)  An application for license renewal must contain

27  the information required under paragraphs (e) and (f).

28         Section 30.  Section 394.876, Florida Statutes, is

29  amended to read:

30         394.876  Applications.--

31  

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 1         (1)  In addition to the requirements of part II of

 2  chapter 408, any person desiring to be licensed under this

 3  chapter shall apply to the agency and on forms provided by the

 4  agency. the application must shall contain the following:

 5         (a)  The name and address of the applicant, the name of

 6  the unit or facility, and the address of the unit or facility.

 7         (b)1.  If the applicant is a partnership, association,

 8  or other form of entity other than an individual or a

 9  corporation, the name and address of each member or owner of

10  the entity.

11         2.  If the applicant is a corporation, the name and

12  address of each director or officer and the name and address

13  of each person holding at least 5 percent ownership interest

14  in the corporation.

15         (c)  such information as the department and the agency

16  find necessary to determine the ability of the applicant to

17  carry out its responsibilities under this chapter.

18         (2)  The applicant shall furnish proof satisfactory to

19  the agency of its financial ability to operate the unit or

20  facility in accordance with this chapter.  An applicant for an

21  original license shall submit a balance sheet and a statement

22  projecting revenues, expenses, taxes, extraordinary items, and

23  other credits and charges for the first 6 months of operation.

24         (2)(3)  The applicant shall provide proof of liability

25  insurance coverage in amounts set by the department and the

26  agency by rule.

27         (4)  The agency shall accept proof of accreditation by

28  the Joint Commission on Accreditation of Hospitals in lieu of

29  the information required by subsection (1).

30         Section 31.  Section 394.877, Florida Statutes, is

31  amended to read:

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 1         394.877  Fees.--

 2         (1)  In accordance with s. 408.805, an applicant or

 3  licensee shall pay a fee for each license application

 4  submitted under this part, part II of chapter 408, and

 5  applicable rules. The amount of the fee shall be established

 6  by rule. Each application for licensure or renewal must be

 7  accompanied by a fee set by the department, in consultation

 8  with the agency, by rule. Such fees shall be reasonably

 9  calculated to cover only the cost of regulation under this

10  chapter.

11         (2)  All fees collected under this section shall be

12  deposited in the Health Care Trust Fund.

13         Section 32.  Section 394.878, Florida Statutes, is

14  repealed.

15         Section 33.  Subsections (1), (3), (4), and (5) of

16  section 394.879, Florida Statutes, are amended to read:

17         394.879  Rules; enforcement.--

18         (1)  The agency, in consultation with the department,

19  may adopt rules to administer the requirements of part II of

20  chapter 408. The department, in consultation with the agency,

21  shall adopt rules pursuant to ss. 120.536(1) and 120.54 to

22  administer implement the provisions of this chapter,

23  including, at a minimum, rules providing standards to ensure

24  that:

25         (a)  Sufficient numbers and types of qualified

26  personnel are on duty and available at all times to provide

27  necessary and adequate client safety and care.

28         (b)  Adequate space is provided each client of a

29  licensed facility.

30         (c)  Licensed facilities are limited to an appropriate

31  number of beds.

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 1         (d)  Each licensee establishes and implements adequate

 2  infection control, housekeeping, sanitation, disaster

 3  planning, and medical recordkeeping.

 4         (e)  Licensed facilities are established, organized,

 5  and operated in accordance with programmatic standards of the

 6  department.

 7         (f)  The operation and purposes of these facilities

 8  assure individuals' health, safety, and welfare.

 9         (g)  The use of restraint and seclusion is consistent

10  with recognized best practices and professional judgment; that

11  inherently dangerous restraint or seclusion procedures are

12  prohibited; that limitations are established on the use and

13  duration of restraint and seclusion; that measures are

14  established to ensure the safety of program participants and

15  staff during an incident of restraint or seclusion; that

16  procedures are created for staff to follow before, during, and

17  after incidents of restraint or seclusion; that professional

18  qualifications and training are established for staff who may

19  order or be engaged in the use of restraint or seclusion; and

20  that mandatory reporting, data collection, and data

21  dissemination procedures and requirements are instituted.

22  Rules adopted under this section must require that any

23  instance of the use of restraint or seclusion shall be

24  documented in the record of the client.

25         (3)  The department, in consultation with the agency,

26  shall allow any licensed facility in operation at the time of

27  adoption of any rule a reasonable period, not to exceed 1

28  year, to bring itself into compliance with department rules

29  such rule.

30         (4)  In accordance with part II of chapter 408, the

31  agency may impose an administrative penalty of no more than

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 1  $500 per day against any licensee that violates any rule

 2  adopted pursuant to this section and may suspend and or revoke

 3  the license and or deny the renewal application of such

 4  licensee. In imposing such penalty, the agency shall consider

 5  the severity of the violation, actions taken by the licensee

 6  to correct the violation, and previous violations by the

 7  licensee. Fines collected under this subsection shall be

 8  deposited in the Mental Health Facility Licensing Trust Fund.

 9         (5)  The agency or the department may not adopt any

10  rule governing the design, construction, erection, alteration,

11  modification, repair, or demolition of crisis stabilization

12  units. It is the intent of the Legislature to preempt that

13  function to the Florida Building Commission and the State Fire

14  Marshal through adoption and maintenance of the Florida

15  Building Code and the Florida Fire Prevention Code. However,

16  the agency shall provide technical assistance to the

17  commission and the State Fire Marshal in updating the

18  construction standards of the Florida Building Code and the

19  Florida Fire Prevention Code which govern crisis stabilization

20  units. In addition, the agency may enforce the

21  special-occupancy provisions of the Florida Building Code and

22  the Florida Fire Prevention Code which apply to crisis

23  stabilization units in conducting any inspection authorized

24  under this part or part II of chapter 408.

25         Section 34.  Paragraph (a) of subsection (1) of section

26  394.90, Florida Statutes, is amended to read:

27         394.90  Inspection; right of entry; records.--

28         (1)(a)  The department and the agency, in accordance

29  with s. 408.811, and the department may enter and inspect at

30  any time a licensed facility to determine whether the facility

31  

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 1  is in compliance with this chapter, part II of chapter 408,

 2  and applicable the rules of the department.

 3         Section 35.  Section 394.902, Florida Statutes, is

 4  amended to read:

 5         394.902  Moratorium on admissions Denial, suspension,

 6  and revocation; other remedies.--

 7         (1)  The agency may issue an emergency order suspending

 8  or revoking a license if the agency determines that the

 9  continued operation of the licensed facility presents a clear

10  and present danger to the public health or safety.

11         (2)  In accordance with part II of chapter 408, the

12  agency may impose a moratorium on elective admissions to a

13  licensee or any program or portion of a licensed facility if

14  the agency determines that any condition in the facility

15  presents a threat to the public health or safety.

16         (3)  If the agency determines that an applicant or

17  licensee is not in compliance with this chapter or the rules

18  adopted under this chapter, the agency may deny, suspend, or

19  revoke the license or application or may suspend, revoke, or

20  impose reasonable restrictions on any portion of the license.

21  If a license is revoked, the licensee is barred from

22  submitting any application for licensure to the agency for a

23  period of 6 months following revocation.

24         (4)  The agency may maintain an action in circuit court

25  to enjoin the operation of any licensed or unlicensed facility

26  in violation of this chapter or the rules adopted under this

27  chapter.

28         (5)  License denial, suspension, or revocation

29  procedures shall be in accordance with chapter 120.

30         Section 36.  Subsection (7) of section 394.907, Florida

31  Statutes, is amended to read:

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 1         394.907  Community mental health centers; quality

 2  assurance programs.--

 3         (7)  The department shall have access to all records

 4  necessary to determine licensee agency compliance with the

 5  provisions of this section. The records of quality assurance

 6  programs which relate solely to actions taken in carrying out

 7  the provisions of this section, and records obtained by the

 8  department to determine licensee agency compliance with this

 9  section, are confidential and exempt from s. 119.07(1). Such

10  records are not admissible in any civil or administrative

11  action, except in disciplinary proceedings by the Department

12  of Business and Professional Regulation and the appropriate

13  regulatory board, nor shall such records be available to the

14  public as part of the record of investigation for, and

15  prosecution in disciplinary proceedings made available to the

16  public by the Department of Business and Professional

17  Regulation or the appropriate regulatory board. Meetings or

18  portions of meetings of quality assurance program committees

19  that relate solely to actions taken pursuant to this section

20  are exempt from s. 286.011.

21         Section 37.  Subsections (5) through (33) of section

22  395.002, Florida Statutes, are renumbered as subsections (4)

23  through (32), respectively, and present subsections (4), (11),

24  and (29) of that section are amended to read:

25         395.002  Definitions.--As used in this chapter:

26         (4)  "Applicant" means an individual applicant, or any

27  officer, director, or agent, or any partner or shareholder

28  having an ownership interest equal to a 5-percent or greater

29  interest in the corporation, partnership, or other business

30  entity.

31  

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 1         (10)(11)  "General hospital" means any facility which

 2  meets the provisions of subsection (12) (13) and which

 3  regularly makes its facilities and services available to the

 4  general population.

 5         (28)(29)  "Specialty hospital" means any facility which

 6  meets the provisions of subsection (12) (13), and which

 7  regularly makes available either:

 8         (a)  The range of medical services offered by general

 9  hospitals, but restricted to a defined age or gender group of

10  the population;

11         (b)  A restricted range of services appropriate to the

12  diagnosis, care, and treatment of patients with specific

13  categories of medical or psychiatric illnesses or disorders;

14  or

15         (c)  Intensive residential treatment programs for

16  children and adolescents as defined in subsection (15) (16).

17         Section 38.  Section 395.003, Florida Statutes, is

18  amended to read:

19         395.003  Licensure; issuance, renewal, denial,

20  modification, suspension, and revocation.--

21         (1)(a)  The requirements of part II of chapter 408

22  apply to the provision of services that require licensure

23  pursuant to ss. 395.001-395.1065 and part II of chapter 408

24  and to entities licensed by or applying for such licensure

25  from the Agency for Health Care Administration pursuant to ss.

26  395.001-395.1065. A license issued by the agency is required

27  in order to operate A person may not establish, conduct, or

28  maintain a hospital, ambulatory surgical center, or mobile

29  surgical facility in this state without first obtaining a

30  license under this part.

31  

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 1         (b)1.  It is unlawful for a person to use or advertise

 2  to the public, in any way or by any medium whatsoever, any

 3  facility as a "hospital," "ambulatory surgical center," or

 4  "mobile surgical facility" unless such facility has first

 5  secured a license under the provisions of this part.

 6         2.  This part does not apply to veterinary hospitals or

 7  to commercial business establishments using the word

 8  "hospital," "ambulatory surgical center," or "mobile surgical

 9  facility" as a part of a trade name if no treatment of human

10  beings is performed on the premises of such establishments.

11         (c)3.  Until July 1, 2006, additional emergency

12  departments located off the premises of licensed hospitals may

13  not be authorized by the agency.

14         (2)(a)  Upon the receipt of an application for a

15  license and the license fee, the agency shall issue a license

16  if the applicant and facility have received all approvals

17  required by law and meet the requirements established under

18  this part and in rules. Such license shall include all beds

19  and services located on the premises of the facility.

20         (b)  A provisional license may be issued to a new

21  facility or a facility that is in substantial compliance with

22  this part and with the rules of the agency. A provisional

23  license shall be granted for a period of no more than 1 year

24  and shall expire automatically at the end of its term. A

25  provisional license may not be renewed.

26         (c)  A license, unless sooner suspended or revoked,

27  shall automatically expire 2 years from the date of issuance

28  and shall be renewable biennially upon application for renewal

29  and payment of the fee prescribed by s. 395.004(2), provided

30  the applicant and licensed facility meet the requirements

31  established under this part and in rules. An application for

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 1  renewal of a license shall be made 90 days prior to expiration

 2  of the license, on forms provided by the agency.

 3         (a)(d)  In addition to the requirements in part II of

 4  chapter 408, the agency shall, at the request of a licensee,

 5  issue a single license to a licensee for facilities located on

 6  separate premises. Such a license shall specifically state the

 7  location of the facilities, the services, and the licensed

 8  beds available on each separate premises. If a licensee

 9  requests a single license, the licensee shall designate which

10  facility or office is responsible for receipt of information,

11  payment of fees, service of process, and all other activities

12  necessary for the agency to carry out the provisions of this

13  part.

14         (b)(e)  The agency shall, at the request of a licensee

15  that is a teaching hospital as defined in s. 408.07(45), issue

16  a single license to a licensee for facilities that have been

17  previously licensed as separate premises, provided such

18  separately licensed facilities, taken together, constitute the

19  same premises as defined in s. 395.002(23)(24). Such license

20  for the single premises shall include all of the beds,

21  services, and programs that were previously included on the

22  licenses for the separate premises. The granting of a single

23  license under this paragraph shall not in any manner reduce

24  the number of beds, services, or programs operated by the

25  licensee.

26         (c)(f)  Intensive residential treatment programs for

27  children and adolescents which have received accreditation

28  from an accrediting organization as defined in s. 395.002(1)

29  and which meet the minimum standards developed by rule of the

30  agency for such programs shall be licensed by the agency under

31  this part.

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 1         (3)(a)  Each license shall be valid only for the person

 2  to whom it is issued and shall not be sold, assigned, or

 3  otherwise transferred, voluntarily or involuntarily. A license

 4  is only valid for the premises for which it was originally

 5  issued.

 6         (b)1.  An application for a new license is required if

 7  ownership, a majority of the ownership, or controlling

 8  interest of a licensed facility is transferred or assigned and

 9  when a lessee agrees to undertake or provide services to the

10  extent that legal liability for operation of the facility

11  rests with the lessee. The application for a new license

12  showing such change shall be made at least 60 days prior to

13  the date of the sale, transfer, assignment, or lease.

14         (3)2.  In addition to the requirements of s. 408.807,

15  after a change of ownership has been approved by the agency,

16  the transferee shall be liable for any liability to the state,

17  regardless of when identified, resulting from changes to

18  allowable costs affecting provider reimbursement for Medicaid

19  participation or Public Medical Assistance Trust Fund

20  Assessments, and related administrative fines. The transferee,

21  simultaneously with the transfer of ownership, shall pay or

22  make arrangements to pay to the agency or the department any

23  amount owed to the agency or the department; payment

24  assurances may be in the form of an irrevocable credit

25  instrument or payment bond acceptable to the agency or the

26  department provided by or on behalf of the transferor. The

27  issuance of a license to the transferee shall be delayed

28  pending payment or until arrangement for payment acceptable to

29  the agency or the department is made.

30         (4)  The agency shall issue a license which specifies

31  the service categories and the number of hospital beds in each

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 1  bed category for which a license is received. Such information

 2  shall be listed on the face of the license. All beds which are

 3  not covered by any specialty-bed-need methodology shall be

 4  specified as general beds. A licensed facility shall not

 5  operate a number of hospital beds greater than the number

 6  indicated by the agency on the face of the license without

 7  approval from the agency under conditions established by rule.

 8         (5)(a)  Adherence to patient rights, standards of care,

 9  and examination and placement procedures provided under part I

10  of chapter 394 shall be a condition of licensure for hospitals

11  providing voluntary or involuntary medical or psychiatric

12  observation, evaluation, diagnosis, or treatment.

13         (b)  Any hospital that provides psychiatric treatment

14  to persons under 18 years of age who have emotional

15  disturbances shall comply with the procedures pertaining to

16  the rights of patients prescribed in part I of chapter 394.

17         (c)  A hospital that provides birthing services shall

18  affirm in writing as part of the application for a new,

19  provisional, or renewal license that the hospital shall comply

20  with s. 382.013(2)(c), which includes assisting unmarried

21  parents who request assistance in executing a voluntary

22  acknowledgment of paternity. No fine or other sanction under

23  s. 395.1065 may be imposed on a hospital for noncompliance

24  with s. 382.013(2)(c).

25         (6)  No specialty hospital shall provide any service or

26  regularly serve any population group beyond those services or

27  groups specified in its license.

28         (7)  Licenses shall be posted in a conspicuous place on

29  each of the licensed premises.

30         (7)(8)  In addition to the requirements of part II of

31  chapter 408, whenever the agency finds that there has been a

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 1  substantial failure to comply with the requirements

 2  established under this part or in rules, the agency is

 3  authorized to deny, modify, suspend, and or revoke:

 4         (a)  A license;

 5         (b)  That part of a license which is limited to a

 6  separate premises, as designated on the license; or

 7         (c)  Licensure approval limited to a facility,

 8  building, or portion thereof, or a service, within a given

 9  premises.

10         (8)(9)  A hospital may not be licensed or relicensed

11  if:

12         (a)  The diagnosis-related groups for 65 percent or

13  more of the discharges from the hospital, in the most recent

14  year for which data is available to the Agency for Health Care

15  Administration pursuant to s. 408.061, are for diagnosis,

16  care, and treatment of patients who have:

17         1.  Cardiac-related diseases and disorders classified

18  as diagnosis-related groups 103-145, 478-479, 514-518, or

19  525-527;

20         2.  Orthopedic-related diseases and disorders

21  classified as diagnosis-related groups 209-256, 471, 491,

22  496-503, or 519-520;

23         3.  Cancer-related diseases and disorders classified as

24  diagnosis-related groups 64, 82, 172, 173, 199, 200, 203,

25  257-260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346,

26  347, 363, 366, 367, 400-414, 473, or 492; or

27         4.  Any combination of the above discharges.

28         (b)  The hospital restricts its medical and surgical

29  services to primarily or exclusively cardiac, orthopedic,

30  surgical, or oncology specialties.

31  

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 1         (9)(10)  A hospital licensed as of June 1, 2004, shall

 2  be exempt from subsection (8) (9) as long as the hospital

 3  maintains the same ownership, facility street address, and

 4  range of services that were in existence on June 1, 2004. Any

 5  transfer of beds, or other agreements that result in the

 6  establishment of a hospital or hospital services within the

 7  intent of this section, shall be subject to subsection (8)

 8  (9). Unless the hospital is otherwise exempt under subsection

 9  (8) (9), the agency shall deny or revoke the license of a

10  hospital that violates any of the criteria set forth in that

11  subsection.

12         (10)(11)  The agency may adopt rules implementing the

13  licensure requirements set forth in subsection (8) (9). Within

14  14 days after rendering its decision on a license application

15  or revocation, the agency shall publish its proposed decision

16  in the Florida Administrative Weekly. Within 21 days after

17  publication of the agency's decision, any authorized person

18  may file a request for an administrative hearing. In

19  administrative proceedings challenging the approval, denial,

20  or revocation of a license pursuant to subsection (8) (9), the

21  hearing must be based on the facts and law existing at the

22  time of the agency's proposed agency action. Existing

23  hospitals may initiate or intervene in an administrative

24  hearing to approve, deny, or revoke licensure under subsection

25  (8) (9) based upon a showing that an established program will

26  be substantially affected by the issuance or renewal of a

27  license to a hospital within the same district or service

28  area.

29         Section 39.  Section 395.004, Florida Statutes, is

30  amended to read:

31         395.004  Application for license;, fees; expenses.--

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 1         (1)  In accordance with s. 408.805, an applicant or

 2  licensee shall pay a fee for each license application

 3  submitted under this part, part II of chapter 408, and

 4  applicable rules. The amount of the fee shall be established

 5  by rule. An application for a license or renewal thereof shall

 6  be made under oath to the agency, upon forms provided by it,

 7  and shall contain such information as the agency reasonably

 8  requires, which may include affirmative evidence of ability to

 9  comply with applicable laws and rules.

10         (2)  Each application for a general hospital license,

11  specialty hospital license, ambulatory surgical center

12  license, or mobile surgical facility license, or renewal

13  thereof, shall be accompanied by a license fee, in accordance

14  with the following schedule:

15         (a)  The biennial license, provisional license, and

16  license renewal fee required of a facility licensed under this

17  part shall be reasonably calculated to cover the cost of

18  regulation under this part and shall be established by rule at

19  the rate of not less than $9.50 per hospital bed, nor more

20  than $30 per hospital bed, except that the minimum license fee

21  shall be $1,500 and the total fees collected from all licensed

22  facilities may not exceed the cost of properly carrying out

23  the provisions of this part.

24         (b)  Such fees shall be paid to the agency and shall be

25  deposited in the Planning and Regulation Trust Fund of the

26  agency, which is hereby created, for the sole purpose of

27  carrying out the provisions of this part.

28         Section 40.  Section 395.0055, Florida Statutes, is

29  repealed.

30         Section 41.  Section 395.0161, Florida Statutes, is

31  amended to read:

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 1         395.0161  Licensure inspection.--

 2         (1)  In addition to the requirement of s. 408.811, the

 3  agency shall make or cause to be made such inspections and

 4  investigations as it deems necessary, including:

 5         (a)  Inspections directed by the federal Centers for

 6  Medicare and Medicaid Services Health Care Financing

 7  Administration.

 8         (b)  Validation inspections.

 9         (c)  Lifesafety inspections.

10         (d)  Licensure complaint investigations, including full

11  licensure investigations with a review of all licensure

12  standards as outlined in the administrative rules. Complaints

13  received by the agency from individuals, organizations, or

14  other sources are subject to review and investigation by the

15  agency.

16         (e)  Emergency access complaint investigations.

17         (f)  Inspections of mobile surgical facilities at each

18  time a facility establishes a new location, prior to the

19  admission of patients. However, such inspections shall not be

20  required when a mobile surgical facility is moved temporarily

21  to a location where medical treatment will not be provided.

22         (2)  The agency shall accept, in lieu of its own

23  periodic inspections for licensure, the survey or inspection

24  of an accrediting organization, provided the accreditation of

25  the licensed facility is not provisional and provided the

26  licensed facility authorizes release of, and the agency

27  receives the report of, the accrediting organization. The

28  agency shall develop, and adopt by rule, criteria for

29  accepting survey reports of accrediting organizations in lieu

30  of conducting a state licensure inspection.

31  

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 1         (3)  In accordance with s. 408.805, an applicant or

 2  licensee shall pay a fee for each license application

 3  submitted under this part, part II of chapter 408, and

 4  applicable rules. With the exception of state-operated

 5  licensed facilities, each facility licensed under this part

 6  shall pay to the agency, at the time of inspection, the

 7  following fees:

 8         (a)  Inspection for licensure.--A fee shall be paid

 9  which is not less than $8 per hospital bed, nor more than $12

10  per hospital bed, except that the minimum fee shall be $400

11  per facility.

12         (b)  Inspection for lifesafety only.--A fee shall be

13  paid which is not less than 75 cents per hospital bed, nor

14  more than $1.50 per hospital bed, except that the minimum fee

15  shall be $40 per facility.

16         (4)  The agency shall coordinate all periodic

17  inspections for licensure made by the agency to ensure that

18  the cost to the facility of such inspections and the

19  disruption of services by such inspections is minimized.

20         Section 42.  Subsections (2) and (3) of section

21  395.0163, Florida Statutes, are amended to read:

22         395.0163  Construction inspections; plan submission and

23  approval; fees.--

24         (2)(a)  The agency is authorized to charge an initial

25  fee of $2,000 for review of plans and construction on all

26  projects, no part of which is refundable. The agency may also

27  collect a fee, not to exceed 1 percent of the estimated

28  construction cost or the actual cost of review, whichever is

29  less, for the portion of the review which encompasses initial

30  review through the initial revised construction document

31  review. The agency is further authorized to collect its actual

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 1  costs on all subsequent portions of the review and

 2  construction inspections. The initial fee payment shall

 3  accompany the initial submission of plans and specifications.

 4  Any subsequent payment that is due is payable upon receipt of

 5  the invoice from the agency.

 6         (b)  Notwithstanding any other provisions of law to the

 7  contrary, all moneys received by the agency pursuant to the

 8  provisions of this section shall be deposited in the Planning

 9  and Regulation Trust Fund, as created by s. 395.004, to be

10  held and applied solely for the operations required under this

11  section.

12         (3)  In addition to the requirements of s. 408.811, the

13  agency shall inspect a mobile surgical facility at initial

14  licensure and at each time the facility establishes a new

15  location, prior to admission of patients. However, such

16  inspections shall not be required when a mobile surgical

17  facility is moved temporarily to a location where medical

18  treatment will not be provided.

19         Section 43.  Subsection (6) of section 395.0193,

20  Florida Statutes, is amended to read:

21         395.0193  Licensed facilities; peer review;

22  disciplinary powers; agency or partnership with physicians.--

23         (6)  For a single incident or series of isolated

24  incidents that are nonwillful violations of the reporting

25  requirements of this section or part II of chapter 408, the

26  agency shall first seek to obtain corrective action by the

27  facility. If correction is not demonstrated within the

28  timeframe established by the agency or if there is a pattern

29  of nonwillful violations of this section or part II of chapter

30  408, the agency may impose an administrative fine, not to

31  exceed $5,000 for any violation of the reporting requirements

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 1  of this section or part II of chapter 408. The administrative

 2  fine for repeated nonwillful violations may shall not exceed

 3  $10,000 for any violation. The administrative fine for each

 4  intentional and willful violation may not exceed $25,000 per

 5  violation, per day. The fine for an intentional and willful

 6  violation of this section or part II of chapter 408 may not

 7  exceed $250,000. In determining the amount of fine to be

 8  levied, the agency shall be guided by s. 395.1065(2)(b).

 9         Section 44.  Subsection (12) of section 395.0197,

10  Florida Statutes, is amended to read:

11         395.0197  Internal risk management program.--

12         (12)  In addition to any penalty imposed pursuant to

13  this section or part II of chapter 408, the agency shall

14  require a written plan of correction from the facility. For a

15  single incident or series of isolated incidents that are

16  nonwillful violations of the reporting requirements of this

17  section or part II of chapter 408, the agency shall first seek

18  to obtain corrective action by the facility. If the correction

19  is not demonstrated within the timeframe established by the

20  agency or if there is a pattern of nonwillful violations of

21  this section or part II of chapter 408, the agency may impose

22  an administrative fine, not to exceed $5,000 for any violation

23  of the reporting requirements of this section or part II of

24  chapter 408. The administrative fine for repeated nonwillful

25  violations may shall not exceed $10,000 for any violation. The

26  administrative fine for each intentional and willful violation

27  may not exceed $25,000 per violation, per day. The fine for an

28  intentional and willful violation of this section or part II

29  of chapter 408 may not exceed $250,000. In determining the

30  amount of fine to be levied, the agency shall be guided by s.

31  395.1065(2)(b).

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 1         Section 45.  Section 395.0199, Florida Statutes, is

 2  amended to read:

 3         395.0199  Private utilization review.--

 4         (1)  The purpose of this section is to:

 5         (a)  Promote the delivery of quality health care in a

 6  cost-effective manner.

 7         (b)  Foster greater coordination between providers and

 8  health insurers performing utilization review.

 9         (c)  Protect patients and insurance providers by

10  ensuring that private review agents are qualified to perform

11  utilization review activities and to make informed decisions

12  on the appropriateness of medical care.

13         (d)  This section does not regulate the activities of

14  private review agents, health insurers, health maintenance

15  organizations, or hospitals, except as expressly provided

16  herein, or authorize regulation or intervention as to the

17  correctness of utilization review decisions of insurers or

18  private review agents.

19         (2)  The requirements of part II of chapter 408 apply

20  to the provision of services that require registration or

21  licensure pursuant to this section and part II of chapter 408

22  and to persons registered by or applying for such registration

23  from the Agency for Health Care Administration pursuant to

24  this section. Registration or a license issued by the agency

25  is required in order to perform as a private review agent

26  conducting utilization review as to health care services in

27  this state performed or proposed to be performed in this state

28  shall register with the agency in accordance with this

29  section.

30         (3)  In accordance with s. 408.805, an applicant for

31  registration or the registrant shall pay a fee for each

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 1  registration application submitted under this section, part II

 2  of chapter 408, and applicable rules. The amount of the fee

 3  shall be established by rule and Registration shall be made

 4  annually with the agency on forms furnished by the agency and

 5  shall be accompanied by the appropriate registration fee as

 6  set by the agency. The fee shall be sufficient to pay for the

 7  administrative costs of registering the agent, but may shall

 8  not exceed $500 $250. The agency may also charge reasonable

 9  fees, reflecting actual costs, to persons requesting copies of

10  registration.

11         (4)  Each applicant for registration must comply with

12  the following requirements:

13         (a)  Upon receipt of a completed, signed, and dated

14  application, the agency shall require background screening, in

15  accordance with the level 2 standards for screening set forth

16  in chapter 435, of the managing employee or other similarly

17  titled individual who is responsible for the operation of the

18  entity. The applicant must comply with the procedures for

19  level 2 background screening as set forth in chapter 435, as

20  well as the requirements of s. 435.03(3).

21         (b)  The agency may require background screening of any

22  other individual who is an applicant, if the agency has

23  probable cause to believe that he or she has been convicted of

24  a crime or has committed any other offense prohibited under

25  the level 2 standards for screening set forth in chapter 435.

26         (c)  Proof of compliance with the level 2 background

27  screening requirements of chapter 435 which has been submitted

28  within the previous 5 years in compliance with any other

29  health care licensure requirements of this state is acceptable

30  in fulfillment of the requirements of paragraph (a).

31  

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 1         (d)  A provisional registration may be granted to an

 2  applicant when each individual required by this section to

 3  undergo background screening has met the standards for the

 4  Department of Law Enforcement background check, but the agency

 5  has not yet received background screening results from the

 6  Federal Bureau of Investigation, or a request for a

 7  disqualification exemption has been submitted to the agency as

 8  set forth in chapter 435 but a response has not yet been

 9  issued. A standard registration may be granted to the

10  applicant upon the agency's receipt of a report of the results

11  of the Federal Bureau of Investigation background screening

12  for each individual required by this section to undergo

13  background screening which confirms that all standards have

14  been met, or upon the granting of a disqualification exemption

15  by the agency as set forth in chapter 435. Any other person

16  who is required to undergo level 2 background screening may

17  serve in his or her capacity pending the agency's receipt of

18  the report from the Federal Bureau of Investigation. However,

19  the person may not continue to serve if the report indicates

20  any violation of background screening standards and a

21  disqualification exemption has not been requested of and

22  granted by the agency as set forth in chapter 435.

23         (e)  Each applicant must submit to the agency, with its

24  application, a description and explanation of any exclusions,

25  permanent suspensions, or terminations of the applicant from

26  the Medicare or Medicaid programs. Proof of compliance with

27  the requirements for disclosure of ownership and control

28  interests under the Medicaid or Medicare programs shall be

29  accepted in lieu of this submission.

30         (f)  Each applicant must submit to the agency a

31  description and explanation of any conviction of an offense

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 1  prohibited under the level 2 standards of chapter 435 by a

 2  member of the board of directors of the applicant, its

 3  officers, or any individual owning 5 percent or more of the

 4  applicant. This requirement does not apply to a director of a

 5  not-for-profit corporation or organization if the director

 6  serves solely in a voluntary capacity for the corporation or

 7  organization, does not regularly take part in the day-to-day

 8  operational decisions of the corporation or organization,

 9  receives no remuneration for his or her services on the

10  corporation or organization's board of directors, and has no

11  financial interest and has no family members with a financial

12  interest in the corporation or organization, provided that the

13  director and the not-for-profit corporation or organization

14  include in the application a statement affirming that the

15  director's relationship to the corporation satisfies the

16  requirements of this paragraph.

17         (g)  A registration may not be granted to an applicant

18  if the applicant or managing employee has been found guilty

19  of, regardless of adjudication, or has entered a plea of nolo

20  contendere or guilty to, any offense prohibited under the

21  level 2 standards for screening set forth in chapter 435,

22  unless an exemption from disqualification has been granted by

23  the agency as set forth in chapter 435.

24         (h)  The agency may deny or revoke the registration if

25  any applicant:

26         1.  Has falsely represented a material fact in the

27  application required by paragraph (e) or paragraph (f), or has

28  omitted any material fact from the application required by

29  paragraph (e) or paragraph (f); or

30  

31  

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 1         2.  Has had prior action taken against the applicant

 2  under the Medicaid or Medicare program as set forth in

 3  paragraph (e).

 4         (i)  An application for registration renewal must

 5  contain the information required under paragraphs (e) and (f).

 6         (4)(5)  In addition to the requirements of part II of

 7  chapter 408, registration shall include the following:

 8         (a)  A description of the review policies and

 9  procedures to be used in evaluating proposed or delivered

10  hospital care.

11         (b)  The name, address, and telephone number of the

12  utilization review agent performing utilization review, who

13  shall be at least:

14         1.  A licensed practical nurse or licensed registered

15  nurse, or other similarly qualified medical records or health

16  care professionals, for performing initial review when

17  information is necessary from the physician or hospital to

18  determine the medical necessity or appropriateness of hospital

19  services; or

20         2.  A licensed physician, or a licensed physician

21  practicing in the field of psychiatry for review of mental

22  health services, for an initial denial determination prior to

23  a final denial determination by the health insurer and which

24  shall include the written evaluation and findings of the

25  reviewing physician.

26         (c)  A description of an appeal procedure for patients

27  or health care providers whose services are under review, who

28  may appeal an initial denial determination prior to a final

29  determination by the health insurer with whom the private

30  review agent has contracted. The appeal procedure shall

31  provide for review by a licensed physician, or by a licensed

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 1  physician practicing in the field of psychiatry for review of

 2  mental health services, and shall include the written

 3  evaluation and findings of the reviewing physician.

 4         (d)  A designation of the times when the staff of the

 5  utilization review agent will be available by toll-free

 6  telephone, which shall include at least 40 hours per week

 7  during the normal business hours of the agent.

 8         (e)  An acknowledgment and agreement that any private

 9  review agent which, as a general business practice, fails to

10  adhere to the policies, procedures, and representations made

11  in its application for registration shall have its

12  registration revoked.

13         (f)  Disclosure of any incentive payment provision or

14  quota provision which is contained in the agent's contract

15  with a health insurer and is based on reduction or denial of

16  services, reduction of length of stay, or selection of

17  treatment setting.

18         (g)  Updates of any material changes to review policies

19  or procedures.

20         (6)  The agency may impose fines or suspend or revoke

21  the registration of any private review agent in violation of

22  this section. Any private review agent failing to register or

23  update registration as required by this section shall be

24  deemed to be within the jurisdiction of the agency and subject

25  to an administrative penalty not to exceed $1,000. The agency

26  may bring actions to enjoin activities of private review

27  agents in violation of this section.

28         (5)(7)  No insurer shall knowingly contract with or

29  utilize a private review agent which has failed to register as

30  required by this section or which has had a registration

31  revoked by the agency.

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 1         (6)(8)  A private review agent which operates under

 2  contract with the federal or state government for utilization

 3  review of patients eligible for hospital or other services

 4  under Title XVIII or Title XIX of the Social Security Act is

 5  exempt from the provisions of this section for services

 6  provided under such contract. A private review agent which

 7  provides utilization review services to the federal or state

 8  government and a private insurer shall not be exempt for

 9  services provided to nonfederally funded patients. This

10  section shall not apply to persons who perform utilization

11  review services for medically necessary hospital services

12  provided to injured workers pursuant to chapter 440 and shall

13  not apply to self-insurance funds or service companies

14  authorized pursuant to chapter 440 or part VII of chapter 626.

15         (7)(9)  Facilities licensed under this chapter shall

16  promptly comply with the requests of utilization review agents

17  or insurers which are reasonably necessary to facilitate

18  prompt accomplishment of utilization review activities.

19         (8)(10)  The agency shall adopt rules to implement the

20  provisions of this section.

21         Section 46.  Subsection (1) of section 395.1046,

22  Florida Statutes, is amended to read:

23         395.1046  Complaint investigation procedures.--

24         (1)  In addition to the requirements of s. 408.811, the

25  agency shall investigate any complaint against a hospital for

26  any violation of s. 395.1041 which that the agency reasonably

27  believes to be legally sufficient. A complaint is legally

28  sufficient if it contains ultimate facts showing which show

29  that a violation of this chapter, or any rule adopted under

30  this chapter by the agency, has occurred. The agency may

31  investigate, or continue to investigate, and may take

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 1  appropriate final action on a complaint, even though the

 2  original complainant withdraws his or her complaint or

 3  otherwise indicates his or her desire not to cause it to be

 4  investigated to completion. When an investigation of any

 5  person or facility is undertaken, the agency shall notify such

 6  person in writing of the investigation and inform the person

 7  or facility in writing of the substance, the facts showing

 8  which show that a violation has occurred, and the source of

 9  any complaint filed against him or her. The agency may conduct

10  an investigation without notification to any person if the act

11  under investigation is a criminal offense. The agency shall

12  have access to all records necessary for the investigation of

13  the complaint.

14         Section 47.  Paragraph (f) of subsection (1) of section

15  395.1055, Florida Statutes, is amended, and subsection (9) is

16  added to that section, to read:

17         395.1055  Rules and enforcement.--

18         (1)  The agency shall adopt rules pursuant to ss.

19  120.536(1) and 120.54 to implement the provisions of this

20  part, which shall include reasonable and fair minimum

21  standards for ensuring that:

22         (f)  All hospitals submit such data as necessary to

23  conduct certificate-of-need reviews required under part I of

24  chapter 408 ss. 408.031-408.045. Such data shall include, but

25  shall not be limited to, patient origin data, hospital

26  utilization data, type of service reporting, and facility

27  staffing data. The agency may shall not collect data that

28  identifies or could disclose the identity of individual

29  patients. The agency shall utilize existing uniform statewide

30  data sources when available and shall minimize reporting costs

31  to hospitals.

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 1         (9)  The agency may adopt rules to administer the

 2  requirements of part II of chapter 408.

 3         Section 48.  Section 395.1065, Florida Statutes, is

 4  amended to read:

 5         395.1065  Criminal and administrative penalties;

 6  injunctions; emergency orders; moratorium.--

 7         (1)  In addition to s. 408.812, any person

 8  establishing, conducting, managing, or operating any facility

 9  without a license under this part commits is guilty of a

10  misdemeanor and, upon conviction, shall be fined not more than

11  $500 for the first offense and not more than $1,000 for each

12  subsequent offense, and each day of continuing violation after

13  conviction shall be considered a separate offense.

14         (2)(a)  The agency may deny, revoke, or suspend a

15  license or impose an administrative fine, not to exceed $1,000

16  per violation, per day, for the violation of any provision of

17  this part, part II of chapter 408, or applicable rules adopted

18  under this part. Each day of violation constitutes a separate

19  violation and is subject to a separate fine.

20         (b)  In determining the amount of fine to be levied for

21  a violation, as provided in paragraph (a), the following

22  factors shall be considered:

23         1.  The severity of the violation, including the

24  probability that death or serious harm to the health or safety

25  of any person will result or has resulted, the severity of the

26  actual or potential harm, and the extent to which the

27  provisions of this part were violated.

28         2.  Actions taken by the licensee to correct the

29  violations or to remedy complaints.

30         3.  Any previous violations of the licensee.

31  

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 1         (c)  All amounts collected pursuant to this section

 2  shall be deposited into the Planning and Regulation Trust

 3  Fund, as created by s. 395.004.

 4         (c)(d)  The agency may impose an administrative fine

 5  for the violation of s. 641.3154 or, if sufficient claims due

 6  to a provider from a health maintenance organization do not

 7  exist to enable the take-back of an overpayment, as provided

 8  under s. 641.3155(5), for the violation of s. 641.3155(5). The

 9  administrative fine for a violation cited in this paragraph

10  shall be in the amounts specified in s. 641.52(5), and the

11  provisions of paragraph (a) do not apply.

12         (3)  Notwithstanding the existence or pursuit of any

13  other remedy, the agency may maintain an action in the name of

14  the state for injunction or other process to enforce the

15  provisions of this part and rules promulgated hereunder.

16         (4)  The agency may issue an emergency order

17  immediately suspending or revoking a license when it

18  determines that any condition in the licensed facility

19  presents a clear and present danger to public health and

20  safety.

21         (3)(5)  In accordance with part II of chapter 408, the

22  agency may impose an immediate moratorium on elective

23  admissions to any licensed facility, building, or portion

24  thereof, or service, when the agency determines that any

25  condition in the facility presents a threat to public health

26  or safety.

27         (4)(6)  In seeking to impose penalties against a

28  facility as defined in s. 394.455 for a violation of part I of

29  chapter 394, the agency is authorized to rely on the

30  investigation and findings by the Department of Health in lieu

31  of conducting its own investigation.

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 1         (5)(7)  The agency shall impose a fine of $500 for each

 2  instance of the facility's failure to provide the information

 3  required by rules adopted pursuant to s. 395.1055(1)(h).

 4         Section 49.  Subsections (1) and (8) of section

 5  395.10973, Florida Statutes, are amended to read:

 6         395.10973  Powers and duties of the agency.--It is the

 7  function of the agency to:

 8         (1)  Adopt rules pursuant to ss. 120.536(1) and 120.54

 9  to implement the provisions of this part and part II of

10  chapter 408 conferring duties upon it.

11         (8)  Enforce the special-occupancy provisions of the

12  Florida Building Code which apply to hospitals, intermediate

13  residential treatment facilities, and ambulatory surgical

14  centers in conducting any inspection authorized by this

15  chapter and part II of chapter 408.

16         Section 50.  Section 395.10974, Florida Statutes, is

17  amended to read:

18         395.10974  Health care risk managers; qualifications,

19  licensure, fees.--

20         (1)  The requirements of part II of chapter 408 apply

21  to the provision of services that require licensure pursuant

22  to ss. 395.10971-395.10975, and part II of chapter 408 and to

23  entities licensed by or applying for such licensure from the

24  Agency for Health Care Administration pursuant to ss.

25  395.10971-395.10975. A license issued by the agency is

26  required in order to perform as a health care risk manager in

27  this state. Any person desiring to be licensed as a health

28  care risk manager shall submit an application on a form

29  provided by the agency. In order to qualify for licensure, the

30  applicant shall submit evidence satisfactory to the agency

31  

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 1  which demonstrates the applicant's competence, by education or

 2  experience, in the following areas:

 3         (a)  Applicable standards of health care risk

 4  management.

 5         (b)  Applicable federal, state, and local health and

 6  safety laws and rules.

 7         (c)  General risk management administration.

 8         (d)  Patient care.

 9         (e)  Medical care.

10         (f)  Personal and social care.

11         (g)  Accident prevention.

12         (h)  Departmental organization and management.

13         (i)  Community interrelationships.

14         (j)  Medical terminology.

15  

16  Each applicant for licensure and each licensee must comply

17  with all provisions of part II of chapter 408. The agency may

18  require such additional information, from the applicant or any

19  other person, as may be reasonably required to verify the

20  information contained in the application.

21         (2)  The agency shall not grant or issue a license as a

22  health care risk manager to any individual unless from the

23  application it affirmatively appears that the applicant:

24         (a)  Is 18 years of age or over;

25         (b)  Is a high school graduate or equivalent; and

26         (c)1.  Has fulfilled the requirements of a 1-year

27  program or its equivalent in health care risk management

28  training which may be developed or approved by the agency;

29         2.  Has completed 2 years of college-level studies

30  which would prepare the applicant for health care risk

31  management, to be further defined by rule; or

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 1         3.  Has obtained 1 year of practical experience in

 2  health care risk management.

 3         (3)  The agency shall issue a license to practice

 4  health care risk management to any applicant who qualifies

 5  under this section. In accordance with s. 408.805, an

 6  applicant or licensee shall pay a fee for each license

 7  application submitted under this part, part II of chapter 408,

 8  and applicable rules. The amount of the fee shall be

 9  established by rule as follows: and submits an application fee

10  of not more than $75, a background-screening fingerprinting

11  fee of not more than $75, and a license fee of not more than

12  $100. The agency shall by rule establish fees and procedures

13  for the issuance and cancellation of licenses.

14         (4)  The agency shall renew a health care risk manager

15  license upon receipt of a biennial renewal application and

16  fees. The agency shall by rule establish a procedure for the

17  biennial renewal of licenses.

18         Section 51.  Paragraph (c) of subsection (2) of section

19  395.602, Florida Statutes, is amended to read:

20         395.602  Rural hospitals.--

21         (2)  DEFINITIONS.--As used in this part:

22         (c)  "Inactive rural hospital bed" means a licensed

23  acute care hospital bed, as defined in s. 395.002(13)(14),

24  that is inactive in that it cannot be occupied by acute care

25  inpatients.

26         Section 52.  Paragraph (c) of subsection (1) of section

27  395.701, Florida Statutes, is amended to read:

28         395.701  Annual assessments on net operating revenues

29  for inpatient and outpatient services to fund public medical

30  assistance; administrative fines for failure to pay

31  assessments when due; exemption.--

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 1         (1)  For the purposes of this section, the term:

 2         (c)  "Hospital" means a health care institution as

 3  defined in s. 395.002(12)(13), but does not include any

 4  hospital operated by the agency or the Department of

 5  Corrections.

 6         Section 53.  Subsection (4) of section 400.0073,

 7  Florida Statutes, is amended to read:

 8         400.0073  State and local ombudsman council

 9  investigations.--

10         (4)  If the ombudsman or any state or local council

11  member is not allowed to enter a long-term care facility, the

12  administrator of the facility shall be considered to have

13  interfered with a representative of the office, the state

14  council, or the local council in the performance of official

15  duties as described in s. 400.0083(1) and to have committed a

16  violation of this part. The ombudsman shall report a

17  facility's refusal to allow entry to the agency, and the

18  agency shall record the report and take it into consideration

19  when determining actions allowable under s. 400.102, s.

20  400.121, s. 429.14 400.414, s. 429.19 400.419, s. 429.69

21  400.6194, or s.429.71 400.6196.

22         Section 54.  Subsection (4) of section 400.0074,

23  Florida Statutes, is amended to read:

24         400.0074  Local ombudsman council onsite administrative

25  assessments.--

26         (4)  An onsite administrative assessment may not be

27  accomplished by forcible entry. However, if the ombudsman or a

28  state or local council member is not allowed to enter a

29  long-term care facility, the administrator of the facility

30  shall be considered to have interfered with a representative

31  of the office, the state council, or the local council in the

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 1  performance of official duties as described in s. 400.0083(1)

 2  and to have committed a violation of this part. The ombudsman

 3  shall report the refusal by a facility to allow entry to the

 4  agency, and the agency shall record the report and take it

 5  into consideration when determining actions allowable under s.

 6  400.102, s. 400.121, s. 429.14 400.414, s. 429.19 400.419, s.

 7  429.69 400.6194, or s. 429.71 400.6196.

 8         Section 55.  Subsections (6) through (19) of section

 9  400.021, Florida Statutes, are renumbered as subsections (5)

10  through (18), respectively, and present subsections (5) and

11  (20) of that section are amended to read:

12         400.021  Definitions.--When used in this part, unless

13  the context otherwise requires, the term:

14         (5)  "Controlling interest" means:

15         (a)  The applicant for licensure or a licensee;

16         (b)  A person or entity that serves as an officer of,

17  is on the board of directors of, or has a 5 percent or greater

18  ownership interest in the management company or other entity,

19  related or unrelated, which the applicant or licensee may

20  contract with to operate the facility; or

21         (c)  A person or entity that serves as an officer of,

22  is on the board of directors of, or has a 5 percent or greater

23  ownership interest in the applicant or licensee.

24  

25  The term does not include a voluntary board member.

26         (20)  "Voluntary board member" means a director of a

27  not-for-profit corporation or organization who serves solely

28  in a voluntary capacity for the corporation or organization,

29  does not receive any remuneration for his or her services on

30  the board of directors, and has no financial interest in the

31  corporation or organization. The agency shall recognize a

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 1  person as a voluntary board member following submission of a

 2  statement to the agency by the director and the not-for-profit

 3  corporation or organization which affirms that the director

 4  conforms to this definition. The statement affirming the

 5  status of the director must be submitted to the agency on a

 6  form provided by the agency.

 7         Section 56.  Subsection (3) of section 400.022, Florida

 8  Statutes, is amended to read:

 9         400.022  Residents' rights.--

10         (3)  Any violation of the resident's rights set forth

11  in this section shall constitute grounds for action by the

12  agency under the provisions of s. 400.102, s. 400.121, or part

13  II of chapter 408. In order to determine whether the licensee

14  is adequately protecting residents' rights, the licensure

15  annual inspection of the facility shall include private

16  informal conversations with a sample of residents to discuss

17  residents' experiences within the facility with respect to

18  rights specified in this section and general compliance with

19  standards, and consultation with the ombudsman council in the

20  local planning and service area of the Department of Elderly

21  Affairs in which the nursing home is located.

22         Section 57.  Paragraph (b) of subsection (1) of section

23  400.051, Florida Statutes, is amended to read:

24         400.051  Homes or institutions exempt from the

25  provisions of this part.--

26         (1)  The following shall be exempt from the provisions

27  of this part:

28         (b)  Any hospital, as defined in s. 395.002(11), that

29  is licensed under chapter 395.

30         Section 58.  Section 400.062, Florida Statutes, is

31  amended to read:

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 1         400.062  License required; fee; disposition; display;

 2  transfer.--

 3         (1)  The requirements of part II of chapter 408 apply

 4  to the provision of services that require licensure pursuant

 5  to this part and part II of chapter 408 and to entities

 6  licensed by or applying for such licensure from the Agency for

 7  Health Care Administration pursuant to this part. A license

 8  issued by the agency is required for the operation of a

 9  nursing home in this state. It is unlawful to operate or

10  maintain a facility without first obtaining from the agency a

11  license authorizing such operation.

12         (2)  Separate licenses shall be required for facilities

13  maintained in separate premises, even though operated under

14  the same management. However, a separate license shall not be

15  required for separate buildings on the same grounds.

16         (3)  In accordance with s. 408.805, an applicant or

17  licensee shall pay a fee for each license application

18  submitted under this part, part II of chapter 408, and

19  applicable rules. The annual license fee required for each

20  license issued under this part shall be comprised of two

21  parts. Part I of the license fee shall be the basic license

22  fee. The rate per bed for the basic license fee shall be

23  established biennially annually and shall be $100 $50 per bed

24  unless modified by rule. The agency may adjust the per bed

25  licensure fees by the Consumer Price Index based on the 12

26  months immediately preceding the increase to cover the cost of

27  regulation under this part. Part II of the license fee shall

28  be the resident protection fee, which shall be at the rate of

29  not less than 50 25 cents per bed. The rate per bed shall be

30  the minimum rate per bed, and such rate shall remain in effect

31  until the effective date of a rate per bed adopted by rule by

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 1  the agency pursuant to this part. At such time as the amount

 2  on deposit in the Resident Protection Trust Fund is less than

 3  $1 million, the agency may adopt rules to establish a rate

 4  which may not exceed $20 $10 per bed. The rate per bed shall

 5  revert back to the minimum rate per bed when the amount on

 6  deposit in the Resident Protection Trust Fund reaches $1

 7  million, except that any rate established by rule shall remain

 8  in effect until such time as the rate has been equally

 9  required for each license issued under this part. Any amount

10  in the fund in excess of $2 million shall revert to the Health

11  Care Trust Fund and may not be expended without prior approval

12  of the Legislature. The agency may prorate the biennial annual

13  license fee for those licenses which it issues under this part

14  for less than 2 years 1 year. Funds generated by license fees

15  collected in accordance with this section shall be deposited

16  in the following manner:

17         (a)  The basic license fee collected shall be deposited

18  in the Health Care Trust Fund, established for the sole

19  purpose of carrying out this part. When the balance of the

20  account established in the Health Care Trust Fund for the

21  deposit of fees collected as authorized under this section

22  exceeds one-third of the annual cost of regulation under this

23  part, the excess shall be used to reduce the licensure fees in

24  the next year.

25         (b)  The resident protection fee collected shall be

26  deposited in the Resident Protection Trust Fund for the sole

27  purpose of paying, in accordance with the provisions of s.

28  400.063, for the appropriate alternate placement, care, and

29  treatment of a resident removed from a nursing home facility

30  on a temporary, emergency basis or for the maintenance and

31  

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 1  care of residents in a nursing home facility pending removal

 2  and alternate placement.

 3         (4)  Counties or municipalities applying for licenses

 4  under this part are exempt from license fees authorized under

 5  this section.

 6         (5)  The license shall be displayed in a conspicuous

 7  place inside the facility.

 8         (6)  A license shall be valid only in the hands of the

 9  individual, firm, partnership, association, or corporation to

10  whom it is issued and shall not be subject to sale,

11  assignment, or other transfer, voluntary or involuntary, nor

12  shall a license be valid for any premises other than those for

13  which originally issued.

14         Section 59.  Subsection (1) of section 400.063, Florida

15  Statutes, is amended to read:

16         400.063  Resident Protection Trust Fund.--

17         (1)  A Resident Protection Trust Fund shall be

18  established for the purpose of collecting and disbursing funds

19  generated from the license fees and administrative fines as

20  provided for in ss. 393.0673(2), 400.062(3)(b), 400.111(1),

21  400.121(2), and 400.23(8). Such funds shall be for the sole

22  purpose of paying for the appropriate alternate placement,

23  care, and treatment of residents who are removed from a

24  facility licensed under this part or a facility specified in

25  s. 393.0678(1) in which the agency determines that existing

26  conditions or practices constitute an immediate danger to the

27  health, safety, or security of the residents. If the agency

28  determines that it is in the best interest of the health,

29  safety, or security of the residents to provide for an orderly

30  removal of the residents from the facility, the agency may

31  utilize such funds to maintain and care for the residents in

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 1  the facility pending removal and alternative placement. The

 2  maintenance and care of the residents shall be under the

 3  direction and control of a receiver appointed pursuant to s.

 4  393.0678(1) or s. 400.126(1). However, funds may be expended

 5  in an emergency upon a filing of a petition for a receiver,

 6  upon the declaration of a state of local emergency pursuant to

 7  s. 252.38(3)(a)5., or upon a duly authorized local order of

 8  evacuation of a facility by emergency personnel to protect the

 9  health and safety of the residents.

10         Section 60.  Section 400.071, Florida Statutes, is

11  amended to read:

12         400.071  Application for license.--

13         (1)  An application for a license as required by s.

14  400.062 shall be made to the agency on forms furnished by it

15  and shall be accompanied by the appropriate license fee.

16         (1)(2)  In addition to the requirements of part II of

17  chapter 408, the application for a license shall be under oath

18  and must shall contain the following:

19         (a)  The name, address, and social security number of

20  the applicant if an individual; if the applicant is a firm,

21  partnership, or association, its name, address, and employer

22  identification number (EIN), and the name and address of any

23  controlling interest; and the name by which the facility is to

24  be known.

25         (b)  The name of any person whose name is required on

26  the application under the provisions of paragraph (a) and who

27  owns at least a 10-percent interest in any professional

28  service, firm, association, partnership, or corporation

29  providing goods, leases, or services to the facility for which

30  the application is made, and the name and address of the

31  

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 1  professional service, firm, association, partnership, or

 2  corporation in which such interest is held.

 3         (a)(c)  The location of the facility for which a

 4  license is sought and an indication, as in the original

 5  application, that such location conforms to the local zoning

 6  ordinances.

 7         (d)  The name of the person or persons under whose

 8  management or supervision the facility will be conducted and

 9  the name of the administrator.

10         (b)(e)  A signed affidavit disclosing any financial or

11  ownership interest that a controlling interest as defined in

12  part II of chapter 408 person or entity described in paragraph

13  (a) or paragraph (d) has held in the last 5 years in any

14  entity licensed by this state or any other state to provide

15  health or residential care which has closed voluntarily or

16  involuntarily; has filed for bankruptcy; has had a receiver

17  appointed; has had a license denied, suspended, or revoked; or

18  has had an injunction issued against it which was initiated by

19  a regulatory agency. The affidavit must disclose the reason

20  any such entity was closed, whether voluntarily or

21  involuntarily.

22         (c)(f)  The total number of beds and the total number

23  of Medicare and Medicaid certified beds.

24         (d)(g)  Information relating to the number, experience,

25  and training of the employees of the facility and of the moral

26  character of the applicant and employees which the agency

27  requires by rule, including the name and address of any

28  nursing home with which the applicant or employees have been

29  affiliated through ownership or employment within 5 years of

30  the date of the application for a license and the record of

31  any criminal convictions involving the applicant and any

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 1  criminal convictions involving an employee if known by the

 2  applicant after inquiring of the employee. The applicant must

 3  demonstrate that sufficient numbers of qualified staff, by

 4  training or experience, will be employed to properly care for

 5  the type and number of residents who will reside in the

 6  facility.

 7         (e)(h)  Copies of any civil verdict or judgment

 8  involving the applicant rendered within the 10 years preceding

 9  the application, relating to medical negligence, violation of

10  residents' rights, or wrongful death. As a condition of

11  licensure, the licensee agrees to provide to the agency copies

12  of any new verdict or judgment involving the applicant,

13  relating to such matters, within 30 days after filing with the

14  clerk of the court. The information required in this paragraph

15  shall be maintained in the facility's licensure file and in an

16  agency database which is available as a public record.

17         (3)  The applicant shall submit evidence which

18  establishes the good moral character of the applicant,

19  manager, supervisor, and administrator. No applicant, if the

20  applicant is an individual; no member of a board of directors

21  or officer of an applicant, if the applicant is a firm,

22  partnership, association, or corporation; and no licensed

23  nursing home administrator shall have been convicted, or found

24  guilty, regardless of adjudication, of a crime in any

25  jurisdiction which affects or may potentially affect residents

26  in the facility.

27         (4)  Each applicant for licensure must comply with the

28  following requirements:

29         (a)  Upon receipt of a completed, signed, and dated

30  application, the agency shall require background screening of

31  the applicant, in accordance with the level 2 standards for

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 1  screening set forth in chapter 435. As used in this

 2  subsection, the term "applicant" means the facility

 3  administrator, or similarly titled individual who is

 4  responsible for the day-to-day operation of the licensed

 5  facility, and the facility financial officer, or similarly

 6  titled individual who is responsible for the financial

 7  operation of the licensed facility.

 8         (b)  The agency may require background screening for a

 9  member of the board of directors of the licensee or an officer

10  or an individual owning 5 percent or more of the licensee if

11  the agency has probable cause to believe that such individual

12  has been convicted of an offense prohibited under the level 2

13  standards for screening set forth in chapter 435.

14         (c)  Proof of compliance with the level 2 background

15  screening requirements of chapter 435 which has been submitted

16  within the previous 5 years in compliance with any other

17  health care or assisted living licensure requirements of this

18  state is acceptable in fulfillment of paragraph (a). Proof of

19  compliance with background screening which has been submitted

20  within the previous 5 years to fulfill the requirements of the

21  Financial Services Commission and the Office of Insurance

22  Regulation pursuant to chapter 651 as part of an application

23  for a certificate of authority to operate a continuing care

24  retirement community is acceptable in fulfillment of the

25  Department of Law Enforcement and Federal Bureau of

26  Investigation background check.

27         (d)  A provisional license may be granted to an

28  applicant when each individual required by this section to

29  undergo background screening has met the standards for the

30  Department of Law Enforcement background check, but the agency

31  has not yet received background screening results from the

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 1  Federal Bureau of Investigation, or a request for a

 2  disqualification exemption has been submitted to the agency as

 3  set forth in chapter 435, but a response has not yet been

 4  issued. A license may be granted to the applicant upon the

 5  agency's receipt of a report of the results of the Federal

 6  Bureau of Investigation background screening for each

 7  individual required by this section to undergo background

 8  screening which confirms that all standards have been met, or

 9  upon the granting of a disqualification exemption by the

10  agency as set forth in chapter 435. Any other person who is

11  required to undergo level 2 background screening may serve in

12  his or her capacity pending the agency's receipt of the report

13  from the Federal Bureau of Investigation; however, the person

14  may not continue to serve if the report indicates any

15  violation of background screening standards and a

16  disqualification exemption has not been requested of and

17  granted by the agency as set forth in chapter 435.

18         (e)  Each applicant must submit to the agency, with its

19  application, a description and explanation of any exclusions,

20  permanent suspensions, or terminations of the applicant from

21  the Medicare or Medicaid programs. Proof of compliance with

22  disclosure of ownership and control interest requirements of

23  the Medicaid or Medicare programs shall be accepted in lieu of

24  this submission.

25         (f)  Each applicant must submit to the agency a

26  description and explanation of any conviction of an offense

27  prohibited under the level 2 standards of chapter 435 by a

28  member of the board of directors of the applicant, its

29  officers, or any individual owning 5 percent or more of the

30  applicant. This requirement shall not apply to a director of a

31  not-for-profit corporation or organization if the director

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 1  serves solely in a voluntary capacity for the corporation or

 2  organization, does not regularly take part in the day-to-day

 3  operational decisions of the corporation or organization,

 4  receives no remuneration for his or her services on the

 5  corporation or organization's board of directors, and has no

 6  financial interest and has no family members with a financial

 7  interest in the corporation or organization, provided that the

 8  director and the not-for-profit corporation or organization

 9  include in the application a statement affirming that the

10  director's relationship to the corporation satisfies the

11  requirements of this paragraph.

12         (g)  An application for license renewal must contain

13  the information required under paragraphs (e) and (f).

14         (5)  The applicant shall furnish satisfactory proof of

15  financial ability to operate and conduct the nursing home in

16  accordance with the requirements of this part and all rules

17  adopted under this part, and the agency shall establish

18  standards for this purpose, including information reported

19  under paragraph (2)(e). The agency also shall establish

20  documentation requirements, to be completed by each applicant,

21  that show anticipated facility revenues and expenditures, the

22  basis for financing the anticipated cash-flow requirements of

23  the facility, and an applicant's access to contingency

24  financing.

25         (6)  If the applicant offers continuing care agreements

26  as defined in chapter 651, proof shall be furnished that such

27  applicant has obtained a certificate of authority as required

28  for operation under that chapter.

29         (2)(7)  As a condition of licensure, each licensee,

30  except one offering continuing care agreements as defined in

31  chapter 651, must agree to accept recipients of Title XIX of

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 1  the Social Security Act on a temporary, emergency basis. The

 2  persons whom the agency may require such licensees to accept

 3  are those recipients of Title XIX of the Social Security Act

 4  who are residing in a facility in which existing conditions

 5  constitute an immediate danger to the health, safety, or

 6  security of the residents of the facility.

 7         (3)(8)  The agency may not issue a license to a nursing

 8  home that fails to receive a certificate of need under the

 9  provisions of ss. 408.031-408.045. It is the intent of the

10  Legislature that, in reviewing a certificate-of-need

11  application to add beds to an existing nursing home facility,

12  preference be given to the application of a licensee who has

13  been awarded a Gold Seal as provided for in s. 400.235, if the

14  applicant otherwise meets the review criteria specified in s.

15  408.035.

16         (4)(9)  The agency may develop an abbreviated survey

17  for licensure renewal applicable to a licensee that has

18  continuously operated as a nursing facility since 1991 or

19  earlier, has operated under the same management for at least

20  the preceding 30 months, and has had during the preceding 30

21  months no class I or class II deficiencies.

22         (5)(10)  As a condition of licensure, each facility

23  must establish and submit with its application a plan for

24  quality assurance and for conducting risk management.

25         (11)  The applicant must provide the agency with proof

26  of a legal right to occupy the property before a license may

27  be issued. Proof may include, but is not limited to, copies of

28  warranty deeds, lease or rental agreements, contracts for

29  deeds, or quitclaim deeds.

30         Section 61.  Section 400.0712, Florida Statutes, is

31  amended to read:

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 1         400.0712  Application for inactive license.--

 2         (1)  As specified in s. 408.321(4) and this section,

 3  the agency may issue an inactive license to a nursing home

 4  facility for all or a portion of its beds. Any request by a

 5  licensee that a nursing home or portion of a nursing home

 6  become inactive must be submitted to the agency in the

 7  approved format. The facility may not initiate any suspension

 8  of services, notify residents, or initiate inactivity facility

 9  closure before receiving approval from the agency; and a

10  licensee facility that violates this provision may shall not

11  be issued an inactive license. Upon agency approval of an

12  inactive license, the nursing home shall notify residents of

13  any necessary discharge or transfer as provided in s.

14  400.0255.

15         (2)  The agency may issue an inactive license to a

16  nursing home that chooses to use an unoccupied contiguous

17  portion of the facility for an alternative use to meet the

18  needs of elderly persons through the use of less restrictive,

19  less institutional services.

20         (a)  An inactive license issued under this subsection

21  may be granted for a period not to exceed the current

22  licensure expiration date 12 months but may be renewed

23  annually by the agency at the time of licensure renewal for 12

24  months.

25         (b)  A request to extend the inactive license must be

26  submitted to the agency in the approved format and approved by

27  the agency in writing.

28         (c)  Nursing homes that receive an inactive license to

29  provide alternative services shall not receive preference for

30  participation in the Assisted Living for the Elderly Medicaid

31  waiver.

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 1         (3)  The agency may issue an inactive license to a

 2  nursing home that will be temporarily unable to provide

 3  services but is reasonably expected to resume services.

 4         (a)  An inactive license issued under this subsection

 5  may be issued for a period not to exceed 12 months and may be

 6  renewed by the agency for an additional 6 months upon

 7  demonstration of progress toward reopening.

 8         (b)  All licensure fees must be current and paid in

 9  full, and may be prorated as provided by agency rule, before

10  the inactive license is issued.

11         (c)  Reactivation of an inactive license requires that

12  the applicant pay all licensure fees and be inspected by the

13  agency to confirm that all of the requirements of this part

14  and applicable rules are met.

15         (3)(4)  The agency shall adopt rules pursuant to ss.

16  120.536(1) and 120.54 necessary to implement this section.

17         Section 62.  Section 400.102, Florida Statutes, is

18  amended to read:

19         400.102  Action by agency against licensee; grounds.--

20         (1)  In addition to the grounds listed in part II of

21  chapter 408, any of the following conditions shall be grounds

22  for action by the agency against a licensee:

23         (1)(a)  An intentional or negligent act materially

24  affecting the health or safety of residents of the facility;

25         (2)(b)  Misappropriation or conversion of the property

26  of a resident of the facility;

27         (3)(c)  Failure to follow the criteria and procedures

28  provided under part I of chapter 394 relating to the

29  transportation, voluntary admission, and involuntary

30  examination of a nursing home resident; or

31  

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 1         (d)  Violation of provisions of this part or rules

 2  adopted under this part;

 3         (4)(e)  Fraudulent altering, defacing, or falsifying

 4  any medical or nursing home records, or causing or procuring

 5  any of these offenses to be committed. ; or

 6         (f)  Any act constituting a ground upon which

 7  application for a license may be denied.

 8         (2)  If the agency has reasonable belief that any of

 9  such conditions exist, it shall take the following action:

10         (a)  In the case of an applicant for original

11  licensure, denial action as provided in s. 400.121.

12         (b)  In the case of an applicant for relicensure or a

13  current licensee, administrative action as provided in s.

14  400.121 or injunctive action as authorized by s. 400.125.

15         (c)  In the case of a facility operating without a

16  license, injunctive action as authorized in s. 400.125.

17         Section 63.  Section 400.111, Florida Statutes, is

18  amended to read:

19         400.111  Disclosure of controlling interest Expiration

20  of license; renewal.--

21         (1)  A license issued for the operation of a facility,

22  unless sooner suspended or revoked, shall expire on the date

23  set forth by the agency on the face of the license or 1 year

24  from the date of issuance, whichever occurs first. Ninety days

25  prior to the expiration date, an application for renewal shall

26  be submitted to the agency. A license shall be renewed upon

27  the filing of an application on forms furnished by the agency

28  if the applicant has first met the requirements established

29  under this part and all rules adopted under this part. The

30  failure to file an application within the period established

31  in this subsection shall result in a late fee charged to the

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 1  licensee by the agency in an amount equal to 50 percent of the

 2  fee in effect on the last preceding regular renewal date. A

 3  late fee shall be levied for each and every day the filing of

 4  the license application is delayed, but in no event shall such

 5  fine aggregate more than $5,000. If an application is received

 6  after the required filing date and exhibits a hand-canceled

 7  postmark obtained from a United States Post Office dated on or

 8  before the required filing date, no fine will be levied.

 9         (2)  A licensee against whom a revocation or suspension

10  proceeding, or any judicial proceeding instituted by the

11  agency under this part, is pending at the time of license

12  renewal may be issued a temporary license effective until

13  final disposition by the agency of such proceeding. If

14  judicial relief is sought from the aforesaid administrative

15  order, the court having jurisdiction may issue such orders

16  regarding the issuance of a temporary permit during the

17  pendency of the judicial proceeding.

18         (3)  The agency may not renew a license if the

19  applicant has failed to pay any fines assessed by final order

20  of the agency or final order of the Health Care Financing

21  Administration under requirements for federal certification.

22  The agency may renew the license of an applicant following the

23  assessment of a fine by final order if such fine has been paid

24  into an escrow account pending an appeal of a final order.

25         (4)  In addition to the requirements of part II of

26  chapter 408, the licensee shall submit a signed affidavit

27  disclosing any financial or ownership interest that a

28  controlling interest licensee has held within the last 5 years

29  in any entity licensed by the state or any other state to

30  provide health or residential care which entity has closed

31  voluntarily or involuntarily; has filed for bankruptcy; has

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 1  had a receiver appointed; has had a license denied, suspended,

 2  or revoked; or has had an injunction issued against it which

 3  was initiated by a regulatory agency. The affidavit must

 4  disclose the reason such entity was closed, whether

 5  voluntarily or involuntarily.

 6         Section 64.  Subsections (2) and (5) of section

 7  400.1183, Florida Statutes, are amended to read:

 8         400.1183  Resident grievance procedures.--

 9         (2)  Each facility shall maintain records of all

10  grievances and shall report annually to the agency at the time

11  of relicensure the total number of grievances handled during

12  the prior licensure period, a categorization of the cases

13  underlying the grievances, and the final disposition of the

14  grievances.

15         (5)  The agency may impose an administrative fine, in

16  accordance with s. 400.121, against a nursing home facility

17  for noncompliance with this section.

18         Section 65.  Section 400.121, Florida Statutes, is

19  amended to read:

20         400.121  Denial, suspension, revocation of license;

21  moratorium on admissions; administrative fines; procedure;

22  order to increase staffing.--

23         (1)  The agency may deny an application, revoke or

24  suspend a license, and or impose an administrative fine, not

25  to exceed $500 per violation per day for the violation of any

26  provision of this part, part II of chapter 408, or applicable

27  rules, against any applicant or licensee for the following

28  violations by the applicant, licensee, or other controlling

29  interest:

30         (a)  A violation of any provision of this part, part II

31  of chapter 408, or applicable rules s. 400.102(1); or

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 1         (b)  A demonstrated pattern of deficient practice;

 2         (c)  Failure to pay any outstanding fines assessed by

 3  final order of the agency or final order of the Health Care

 4  Financing Administration pursuant to requirements for federal

 5  certification. The agency may renew or approve the license of

 6  an applicant following the assessment of a fine by final order

 7  if such fine has been paid into an escrow account pending an

 8  appeal of a final order;

 9         (d)  Exclusion from the Medicare or Medicaid program;

10  or

11         (b)(e)  An adverse action by a regulatory agency

12  against any other licensed facility that has a common

13  controlling interest with the licensee or applicant against

14  whom the action under this section is being brought. If the

15  adverse action involves solely the management company, the

16  applicant or licensee shall be given 30 days to remedy before

17  final action is taken. If the adverse action is based solely

18  upon actions by a controlling interest, the applicant or

19  licensee may present factors in mitigation of any proposed

20  penalty based upon a showing that such penalty is

21  inappropriate under the circumstances.

22  

23  All hearings shall be held within the county in which the

24  licensee or applicant operates or applies for a license to

25  operate a facility as defined herein.

26         (2)  Except as provided in s. 400.23(8), a $500 fine

27  shall be imposed for each violation. Each day a violation of

28  this part or part II of chapter 408 occurs constitutes a

29  separate violation and is subject to a separate fine, but in

30  no event may any fine aggregate more than $5,000. A fine may

31  be levied pursuant to this section in lieu of and

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 1  notwithstanding the provisions of s. 400.23. Fines paid shall

 2  be deposited in the Resident Protection Trust Fund and

 3  expended as provided in s. 400.063.

 4         (3)  The agency shall revoke or deny a nursing home

 5  license if the licensee or controlling interest operates a

 6  facility in this state that:

 7         (a)  Has had two moratoria issued pursuant to this part

 8  or part II of chapter 408 which are imposed by final order for

 9  substandard quality of care, as defined by 42 C.F.R. part 483,

10  within any 30-month period;

11         (b)  Is conditionally licensed for 180 or more

12  continuous days;

13         (c)  Is cited for two class I deficiencies arising from

14  unrelated circumstances during the same survey or

15  investigation; or

16         (d)  Is cited for two class I deficiencies arising from

17  separate surveys or investigations within a 30-month period.

18  

19  The licensee may present factors in mitigation of revocation,

20  and the agency may make a determination not to revoke a

21  license based upon a showing that revocation is inappropriate

22  under the circumstances.

23         (4)  The agency may issue an order immediately

24  suspending or revoking a license when it determines that any

25  condition in the facility presents a danger to the health,

26  safety, or welfare of the residents in the facility.

27         (5)(a)  The agency may impose an immediate moratorium

28  on admissions to any facility when the agency determines that

29  any condition in the facility presents a threat to the health,

30  safety, or welfare of the residents in the facility.

31  

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 1         (4)(b)  If Where the agency has placed a moratorium

 2  pursuant to this part or part II of chapter 408 on admissions

 3  on any facility two times within a 7-year period, the agency

 4  may suspend the nursing home license of the nursing home and

 5  the facility's management company, if any. During the

 6  suspension, the agency shall take the facility into

 7  receivership and shall operate the facility.

 8         (5)(6)  An action taken by the agency to deny, suspend,

 9  or revoke a facility's license under this part or part II of

10  chapter 408 shall be heard by the Division of Administrative

11  Hearings of the Department of Management Services within 60

12  days after the assignment of an administrative law judge,

13  unless the time limitation is waived by both parties. The

14  administrative law judge must render a decision within 30 days

15  after receipt of a proposed recommended order.

16         (6)(7)  The agency is authorized to require a facility

17  to increase staffing beyond the minimum required by law, if

18  the agency has taken administrative action against the

19  facility for care-related deficiencies directly attributable

20  to insufficient staff. Under such circumstances, the facility

21  may request an expedited interim rate increase. The agency

22  shall process the request within 10 days after receipt of all

23  required documentation from the facility. A facility that

24  fails to maintain the required increased staffing is subject

25  to a fine of $500 per day for each day the staffing is below

26  the level required by the agency.

27         (8)  An administrative proceeding challenging an action

28  taken by the agency pursuant to this section shall be reviewed

29  on the basis of the facts and conditions that resulted in such

30  agency action.

31  

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 1         (7)(9)  Notwithstanding any other provision of law to

 2  the contrary, agency action in an administrative proceeding

 3  under this section may be overcome by the licensee upon a

 4  showing by a preponderance of the evidence to the contrary.

 5         (8)(10)  In addition to any other sanction imposed

 6  under this part or part II of chapter 408, in any final order

 7  that imposes sanctions, the agency may assess costs related to

 8  the investigation and prosecution of the case. Payment of

 9  agency costs shall be deposited into the Health Care Trust

10  Fund.

11         Section 66.  Section 400.125, Florida Statutes, is

12  repealed.

13         Section 67.  Subsection (14) of section 400.141,

14  Florida Statutes, is amended to read:

15         400.141  Administration and management of nursing home

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

17  applicable standards and rules of the agency and shall:

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

19  s. 400.071(1)(b)(2)(e) for a management company within 30 days

20  after the effective date of the management agreement.

21  

22  Facilities that have been awarded a Gold Seal under the

23  program established in s. 400.235 may develop a plan to

24  provide certified nursing assistant training as prescribed by

25  federal regulations and state rules and may apply to the

26  agency for approval of their program.

27         Section 68.  Section 400.179, Florida Statutes, is

28  amended to read:

29         400.179  Sale or transfer of ownership of a nursing

30  facility; Liability for Medicaid underpayments and

31  overpayments.--

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 1         (1)  It is the intent of the Legislature to protect the

 2  rights of nursing home residents and the security of public

 3  funds when a nursing facility is sold or the ownership is

 4  transferred.

 5         (2)  Whenever a nursing facility is sold or the

 6  ownership is transferred, including leasing, the transferee

 7  shall make application to the agency for a new license at

 8  least 90 days prior to the date of transfer of ownership.

 9         (3)  The transferor shall notify the agency in writing

10  at least 90 days prior to the date of transfer of ownership.

11  The transferor shall be responsible and liable for the lawful

12  operation of the nursing facility and the welfare of the

13  residents domiciled in the facility until the date the

14  transferee is licensed by the agency. The transferor shall be

15  liable for any and all penalties imposed against the facility

16  for violations occurring prior to the date of transfer of

17  ownership.

18         (4)  The transferor shall, prior to transfer of

19  ownership, repay or make arrangements to repay to the agency

20  or the Department of Children and Family Services any amounts

21  owed to the agency or the department. Should the transferor

22  fail to repay or make arrangements to repay the amounts owed

23  to the agency or the department prior to the transfer of

24  ownership, the issuance of a license to the transferee shall

25  be delayed until repayment or until arrangements for repayment

26  are made.

27         (2)(5)  Because any transfer of a nursing facility may

28  expose the fact that Medicaid may have underpaid or overpaid

29  the transferor, and because in most instances, any such

30  underpayment or overpayment can only be determined following a

31  

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 1  formal field audit, the liabilities for any such underpayments

 2  or overpayments shall be as follows:

 3         (a)  The Medicaid program shall be liable to the

 4  transferor for any underpayments owed during the transferor's

 5  period of operation of the facility.

 6         (b)  Without regard to whether the transferor had

 7  leased or owned the nursing facility, the transferor shall

 8  remain liable to the Medicaid program for all Medicaid

 9  overpayments received during the transferor's period of

10  operation of the facility, regardless of when determined.

11         (c)  Where the facility transfer takes any form of a

12  sale of assets, in addition to the transferor's continuing

13  liability for any such overpayments, if the transferor fails

14  to meet these obligations, the transferee shall be liable for

15  all liabilities that can be readily identifiable 90 days in

16  advance of the transfer. Such liability shall continue in

17  succession until the debt is ultimately paid or otherwise

18  resolved. It shall be the burden of the transferee to

19  determine the amount of all such readily identifiable

20  overpayments from the Agency for Health Care Administration,

21  and the agency shall cooperate in every way with the

22  identification of such amounts. Readily identifiable

23  overpayments shall include overpayments that will result from,

24  but not be limited to:

25         1.  Medicaid rate changes or adjustments;

26         2.  Any depreciation recapture;

27         3.  Any recapture of fair rental value system indexing;

28  or

29         4.  Audits completed by the agency.

30  

31  

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 1  The transferor shall remain liable for any such Medicaid

 2  overpayments that were not readily identifiable 90 days in

 3  advance of the nursing facility transfer.

 4         (d)  Where the transfer involves a facility that has

 5  been leased by the transferor:

 6         1.  The transferee shall, as a condition to being

 7  issued a license by the agency, acquire, maintain, and provide

 8  proof to the agency of a bond with a term of 30 months,

 9  renewable annually, in an amount not less than the total of 3

10  months' Medicaid payments to the facility computed on the

11  basis of the preceding 12-month average Medicaid payments to

12  the facility.

13         2.  A leasehold licensee may meet the requirements of

14  subparagraph 1. by payment of a nonrefundable fee, paid at

15  initial licensure, paid at the time of any subsequent change

16  of ownership, and paid annually thereafter at the time of any

17  subsequent annual license renewal, in the amount of 1 percent

18  of the total of 3 months' Medicaid payments to the facility

19  computed on the basis of the preceding 12-month average

20  Medicaid payments to the facility. If a preceding 12-month

21  average is not available, projected Medicaid payments may be

22  used. The fee shall be deposited into the Health Care Trust

23  Fund and shall be accounted for separately as a Medicaid

24  nursing home overpayment account. These fees shall be used at

25  the sole discretion of the agency to repay nursing home

26  Medicaid overpayments. Payment of this fee shall not release

27  the licensee from any liability for any Medicaid overpayments,

28  nor shall payment bar the agency from seeking to recoup

29  overpayments from the licensee and any other liable party. As

30  a condition of exercising this lease bond alternative,

31  licensees paying this fee must maintain an existing lease bond

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 1  through the end of the 30-month term period of that bond. The

 2  agency is herein granted specific authority to promulgate all

 3  rules pertaining to the administration and management of this

 4  account, including withdrawals from the account, subject to

 5  federal review and approval. This provision shall take effect

 6  upon becoming law and shall apply to any leasehold license

 7  application. The financial viability of the Medicaid nursing

 8  home overpayment account shall be determined by the agency

 9  through annual review of the account balance and the amount of

10  total outstanding, unpaid Medicaid overpayments owing from

11  leasehold licensees to the agency as determined by final

12  agency audits.

13         3.  The leasehold licensee may meet the bond

14  requirement through other arrangements acceptable to the

15  agency. The agency is herein granted specific authority to

16  promulgate rules pertaining to lease bond arrangements.

17         4.  All existing nursing facility licensees, operating

18  the facility as a leasehold, shall acquire, maintain, and

19  provide proof to the agency of the 30-month bond required in

20  subparagraph 1., above, on and after July 1, 1993, for each

21  license renewal.

22         5.  It shall be the responsibility of all nursing

23  facility operators, operating the facility as a leasehold, to

24  renew the 30-month bond and to provide proof of such renewal

25  to the agency annually at the time of application for license

26  renewal.

27         6.  Any failure of the nursing facility operator to

28  acquire, maintain, renew annually, or provide proof to the

29  agency shall be grounds for the agency to deny, cancel,

30  revoke, and or suspend the facility license to operate such

31  facility and to take any further action, including, but not

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 1  limited to, enjoining the facility, asserting a moratorium

 2  pursuant to part II of chapter 408, or applying for a

 3  receiver, deemed necessary to ensure compliance with this

 4  section and to safeguard and protect the health, safety, and

 5  welfare of the facility's residents. A lease agreement

 6  required as a condition of bond financing or refinancing under

 7  s. 154.213 by a health facilities authority or required under

 8  s. 159.30 by a county or municipality is not a leasehold for

 9  purposes of this paragraph and is not subject to the bond

10  requirement of this paragraph.

11         Section 69.  Subsections (1) and (4) of section 400.18,

12  Florida Statutes, are amended to read:

13         400.18  Closing of nursing facility.--

14         (1)  In addition to the requirements of part II of

15  chapter 408, Whenever a licensee voluntarily discontinues

16  operation, and during the period when it is preparing for such

17  discontinuance, it shall inform the agency not less than 90

18  days prior to the discontinuance of operation. the licensee

19  also shall inform each the resident or the next of kin, legal

20  representative, or agency acting on behalf of the resident of

21  the fact, and the proposed time, of such discontinuance of

22  operation and give at least 90 days' notice so that suitable

23  arrangements may be made for the transfer and care of the

24  resident. In the event any resident has no such person to

25  represent him or her, the licensee shall be responsible for

26  securing a suitable transfer of the resident before the

27  discontinuance of operation. The agency shall be responsible

28  for arranging for the transfer of those residents requiring

29  transfer who are receiving assistance under the Medicaid

30  program.

31  

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 1         (4)  Immediately upon discontinuance of operation of a

 2  facility, the licensee shall surrender the license therefor to

 3  the agency, and the license shall be canceled.

 4         Section 70.  Subsections (1), (2), and (3) of section

 5  400.19, Florida Statutes, are amended to read:

 6         400.19  Right of entry and inspection.--

 7         (1)  In accordance with part II of chapter 408, the

 8  agency and any duly designated officer or employee thereof or

 9  a member of the State Long-Term Care Ombudsman Council or the

10  local long-term care ombudsman council shall have the right to

11  enter upon and into the premises of any facility licensed

12  pursuant to this part, or any distinct nursing home unit of a

13  hospital licensed under chapter 395 or any freestanding

14  facility licensed under chapter 395 that provides extended

15  care or other long-term care services, at any reasonable time

16  in order to determine the state of compliance with the

17  provisions of this part, part II of chapter 408, and

18  applicable rules in force pursuant thereto. The right of entry

19  and inspection shall also extend to any premises which the

20  agency has reason to believe is being operated or maintained

21  as a facility without a license, but no such entry or

22  inspection of any premises shall be made without the

23  permission of the owner or person in charge thereof, unless a

24  warrant is first obtained from the circuit court authorizing

25  same. Any application for a facility license or renewal

26  thereof, made pursuant to this part, shall constitute

27  permission for and complete acquiescence in any entry or

28  inspection of the premises for which the license is sought, in

29  order to facilitate verification of the information submitted

30  on or in connection with the application; to discover,

31  investigate, and determine the existence of abuse or neglect;

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 1  or to elicit, receive, respond to, and resolve complaints. The

 2  agency shall, within 60 days after receipt of a complaint made

 3  by a resident or resident's representative, complete its

 4  investigation and provide to the complainant its findings and

 5  resolution.

 6         (2)  The agency shall coordinate nursing home facility

 7  licensing activities and responsibilities of any duly

 8  designated officer or employee involved in nursing home

 9  facility inspection to assure necessary, equitable, and

10  consistent supervision of inspection personnel without

11  unnecessary duplication of inspections, consultation services,

12  or complaint investigations. To facilitate such coordination,

13  all rules promulgated by the agency pursuant to this part

14  shall be distributed to nursing homes licensed under s.

15  400.062 30 days prior to implementation. This requirement does

16  not apply to emergency rules.

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

18  one unannounced inspection to determine compliance by the

19  licensee with statutes, and with rules promulgated under the

20  provisions of those statutes, governing minimum standards of

21  construction, quality and adequacy of care, and rights of

22  residents. The survey shall be conducted every 6 months for

23  the next 2-year period if the facility has been cited for a

24  class I deficiency, has been cited for two or more class II

25  deficiencies arising from separate surveys or investigations

26  within a 60-day period, or has had three or more substantiated

27  complaints within a 6-month period, each resulting in at least

28  one class I or class II deficiency. In addition to any other

29  fees or fines in this part, the agency shall assess a fine for

30  each facility that is subject to the 6-month survey cycle. The

31  fine for the 2-year period shall be $6,000, one-half to be

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 1  paid at the completion of each survey. The agency may adjust

 2  this fine by the change in the Consumer Price Index, based on

 3  the 12 months immediately preceding the increase, to cover the

 4  cost of the additional surveys. The agency shall verify

 5  through subsequent inspection that any deficiency identified

 6  during the annual inspection is corrected. However, the agency

 7  may verify the correction of a class III or class IV

 8  deficiency unrelated to resident rights or resident care

 9  without reinspecting the facility if adequate written

10  documentation has been received from the facility, which

11  provides assurance that the deficiency has been corrected. The

12  giving or causing to be given of advance notice of such

13  unannounced inspections by an employee of the agency to any

14  unauthorized person shall constitute cause for suspension of

15  not fewer than 5 working days according to the provisions of

16  chapter 110.

17         Section 71.  Subsection (1) of section 400.191, Florida

18  Statutes, is amended to read:

19         400.191  Availability, distribution, and posting of

20  reports and records.--

21         (1)  The agency shall provide information to the public

22  about all of the licensed nursing home facilities operating in

23  the state. The agency shall, within 60 days after a licensure

24  an annual inspection visit or within 30 days after any interim

25  visit to a facility, send copies of the inspection reports to

26  the local long-term care ombudsman council, the agency's local

27  office, and a public library or the county seat for the county

28  in which the facility is located. The agency may provide

29  electronic access to inspection reports as a substitute for

30  sending copies.

31  

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 1         Section 72.  Subsections (1), (2), (7), and (8) of

 2  section 400.23, Florida Statutes, are amended to read:

 3         400.23  Rules; evaluation and deficiencies; licensure

 4  status.--

 5         (1)  It is the intent of the Legislature that rules

 6  published and enforced pursuant to this part and part II of

 7  chapter 408 shall include criteria by which a reasonable and

 8  consistent quality of resident care may be ensured and the

 9  results of such resident care can be demonstrated and by which

10  safe and sanitary nursing homes can be provided.  It is

11  further intended that reasonable efforts be made to

12  accommodate the needs and preferences of residents to enhance

13  the quality of life in a nursing home.  In addition, efforts

14  shall be made to minimize the paperwork associated with the

15  reporting and documentation requirements of these rules.

16         (2)  Pursuant to the intention of the Legislature, the

17  agency, in consultation with the Department of Health and the

18  Department of Elderly Affairs, shall adopt and enforce rules

19  to implement this part and part II of chapter 408, which shall

20  include reasonable and fair criteria in relation to:

21         (a)  The location of the facility and housing

22  conditions that will ensure the health, safety, and comfort of

23  residents, including an adequate call system. In making such

24  rules, the agency shall be guided by criteria recommended by

25  nationally recognized reputable professional groups and

26  associations with knowledge of such subject matters. The

27  agency shall update or revise such criteria as the need

28  arises. The agency may require alterations to a building if it

29  determines that an existing condition constitutes a distinct

30  hazard to life, health, or safety. In performing any

31  inspections of facilities authorized by this part or part II

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 1  of chapter 408, the agency may enforce the special-occupancy

 2  provisions of the Florida Building Code and the Florida Fire

 3  Prevention Code which apply to nursing homes. Residents or

 4  their representatives shall be able to request a change in the

 5  placement of the bed in their room, provided that at admission

 6  they are presented with a room that meets requirements of the

 7  Florida Building Code. The location of a bed may be changed if

 8  the requested placement does not infringe on the resident's

 9  roommate or interfere with the resident's care or safety as

10  determined by the care planning team in accordance with

11  facility policies and procedures. In addition, the bed

12  placement may not be used as a restraint. Each facility shall

13  maintain a log of resident rooms with beds that are not in

14  strict compliance with the Florida Building Code in order for

15  such log to be used by surveyors and nurse monitors during

16  inspections and visits. A resident or resident representative

17  who requests that a bed be moved shall sign a statement

18  indicating that he or she understands the room will not be in

19  compliance with the Florida Building Code, but they would

20  prefer to exercise their right to self-determination. The

21  statement must be retained as part of the resident's care

22  plan. Any facility that offers this option must submit a

23  letter signed by the nursing home administrator of record to

24  the agency notifying it of this practice with a copy of the

25  policies and procedures of the facility. The agency is

26  directed to provide assistance to the Florida Building

27  Commission in updating the construction standards of the code

28  relative to nursing homes.

29         (b)  The number and qualifications of all personnel,

30  including management, medical, nursing, and other professional

31  personnel, and nursing assistants, orderlies, and support

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 1  personnel, having responsibility for any part of the care

 2  given residents.

 3         (c)  All sanitary conditions within the facility and

 4  its surroundings, including water supply, sewage disposal,

 5  food handling, and general hygiene which will ensure the

 6  health and comfort of residents.

 7         (d)  The equipment essential to the health and welfare

 8  of the residents.

 9         (e)  A uniform accounting system.

10         (f)  The care, treatment, and maintenance of residents

11  and measurement of the quality and adequacy thereof, based on

12  rules developed under this chapter and the Omnibus Budget

13  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,

14  1987), Title IV (Medicare, Medicaid, and Other Health-Related

15  Programs), Subtitle C (Nursing Home Reform), as amended.

16         (g)  The preparation and annual update of a

17  comprehensive emergency management plan.  The agency shall

18  adopt rules establishing minimum criteria for the plan after

19  consultation with the Department of Community Affairs.  At a

20  minimum, the rules must provide for plan components that

21  address emergency evacuation transportation; adequate

22  sheltering arrangements; postdisaster activities, including

23  emergency power, food, and water; postdisaster transportation;

24  supplies; staffing; emergency equipment; individual

25  identification of residents and transfer of records; and

26  responding to family inquiries.  The comprehensive emergency

27  management plan is subject to review and approval by the local

28  emergency management agency.  During its review, the local

29  emergency management agency shall ensure that the following

30  agencies, at a minimum, are given the opportunity to review

31  the plan:  the Department of Elderly Affairs, the Department

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 1  of Health, the Agency for Health Care Administration, and the

 2  Department of Community Affairs.  Also, appropriate volunteer

 3  organizations must be given the opportunity to review the

 4  plan.  The local emergency management agency shall complete

 5  its review within 60 days and either approve the plan or

 6  advise the facility of necessary revisions.

 7         (h)  The availability, distribution, and posting of

 8  reports and records pursuant to s. 400.191 and the Gold Seal

 9  Program pursuant to s. 400.235.

10         (7)  The agency shall, at least every 15 months,

11  evaluate all nursing home facilities and make a determination

12  as to the degree of compliance by each licensee with the

13  established rules adopted under this part as a basis for

14  assigning a licensure status to that facility.  The agency

15  shall base its evaluation on the most recent inspection

16  report, taking into consideration findings from other official

17  reports, surveys, interviews, investigations, and inspections.

18  In addition to license categories authorized under part II of

19  chapter 408, the agency shall assign a licensure status of

20  standard or conditional to each nursing home.

21         (a)  A standard licensure status means that a facility

22  has no class I or class II deficiencies and has corrected all

23  class III deficiencies within the time established by the

24  agency.

25         (b)  A conditional licensure status means that a

26  facility, due to the presence of one or more class I or class

27  II deficiencies, or class III deficiencies not corrected

28  within the time established by the agency, is not in

29  substantial compliance at the time of the survey with criteria

30  established under this part or with rules adopted by the

31  agency.  If the facility has no class I, class II, or class

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 1  III deficiencies at the time of the followup survey, a

 2  standard licensure status may be assigned.

 3         (c)  In evaluating the overall quality of care and

 4  services and determining whether the facility will receive a

 5  conditional or standard license, the agency shall consider the

 6  needs and limitations of residents in the facility and the

 7  results of interviews and surveys of a representative sampling

 8  of residents, families of residents, ombudsman council members

 9  in the planning and service area in which the facility is

10  located, guardians of residents, and staff of the nursing home

11  facility.

12         (d)  The current licensure status of each facility must

13  be indicated in bold print on the face of the license.  A list

14  of the deficiencies of the facility shall be posted in a

15  prominent place that is in clear and unobstructed public view

16  at or near the place where residents are being admitted to

17  that facility. Licensees receiving a conditional licensure

18  status for a facility shall prepare, within 10 working days

19  after receiving notice of deficiencies, a plan for correction

20  of all deficiencies and shall submit the plan to the agency

21  for approval.

22         (e)  Each licensee shall post its license in a

23  prominent place that is in clear and unobstructed public view

24  at or near the place where residents are being admitted to the

25  facility.

26         (e)(f)  The agency shall adopt rules that:

27         1.  Establish uniform procedures for the evaluation of

28  facilities.

29         2.  Provide criteria in the areas referenced in

30  paragraph (c).

31  

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 1         3.  Address other areas necessary for carrying out the

 2  intent of this section.

 3         (8)  The agency shall adopt rules pursuant to this part

 4  and part II of chapter 408 to provide that, when the criteria

 5  established under subsection (2) are not met, such

 6  deficiencies shall be classified according to the nature and

 7  the scope of the deficiency. The scope shall be cited as

 8  isolated, patterned, or widespread. An isolated deficiency is

 9  a deficiency affecting one or a very limited number of

10  residents, or involving one or a very limited number of staff,

11  or a situation that occurred only occasionally or in a very

12  limited number of locations. A patterned deficiency is a

13  deficiency where more than a very limited number of residents

14  are affected, or more than a very limited number of staff are

15  involved, or the situation has occurred in several locations,

16  or the same resident or residents have been affected by

17  repeated occurrences of the same deficient practice but the

18  effect of the deficient practice is not found to be pervasive

19  throughout the facility. A widespread deficiency is a

20  deficiency in which the problems causing the deficiency are

21  pervasive in the facility or represent systemic failure that

22  has affected or has the potential to affect a large portion of

23  the facility's residents. The agency shall indicate the

24  classification on the face of the notice of deficiencies as

25  follows:

26         (a)  A class I deficiency is a deficiency that the

27  agency determines presents a situation in which immediate

28  corrective action is necessary because the facility's

29  noncompliance has caused, or is likely to cause, serious

30  injury, harm, impairment, or death to a resident receiving

31  care in a facility. The condition or practice constituting a

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 1  class I violation shall be abated or eliminated immediately,

 2  unless a fixed period of time, as determined by the agency, is

 3  required for correction. A class I deficiency is subject to a

 4  civil penalty of $10,000 for an isolated deficiency, $12,500

 5  for a patterned deficiency, and $15,000 for a widespread

 6  deficiency. The fine amount shall be doubled for each

 7  deficiency if the facility was previously cited for one or

 8  more class I or class II deficiencies during the last

 9  licensure annual inspection or any inspection or complaint

10  investigation since the last licensure annual inspection. A

11  fine must be levied notwithstanding the correction of the

12  deficiency.

13         (b)  A class II deficiency is a deficiency that the

14  agency determines has compromised the resident's ability to

15  maintain or reach his or her highest practicable physical,

16  mental, and psychosocial well-being, as defined by an accurate

17  and comprehensive resident assessment, plan of care, and

18  provision of services. A class II deficiency is subject to a

19  civil penalty of $2,500 for an isolated deficiency, $5,000 for

20  a patterned deficiency, and $7,500 for a widespread

21  deficiency. The fine amount shall be doubled for each

22  deficiency if the facility was previously cited for one or

23  more class I or class II deficiencies during the last

24  licensure annual inspection or any inspection or complaint

25  investigation since the last licensure annual inspection. A

26  fine shall be levied notwithstanding the correction of the

27  deficiency.

28         (c)  A class III deficiency is a deficiency that the

29  agency determines will result in no more than minimal

30  physical, mental, or psychosocial discomfort to the resident

31  or has the potential to compromise the resident's ability to

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 1  maintain or reach his or her highest practical physical,

 2  mental, or psychosocial well-being, as defined by an accurate

 3  and comprehensive resident assessment, plan of care, and

 4  provision of services. A class III deficiency is subject to a

 5  civil penalty of $1,000 for an isolated deficiency, $2,000 for

 6  a patterned deficiency, and $3,000 for a widespread

 7  deficiency. The fine amount shall be doubled for each

 8  deficiency if the facility was previously cited for one or

 9  more class I or class II deficiencies during the last

10  licensure annual inspection or any inspection or complaint

11  investigation since the last licensure annual inspection. A

12  citation for a class III deficiency must specify the time

13  within which the deficiency is required to be corrected.  If a

14  class III deficiency is corrected within the time specified, a

15  no civil penalty may not shall be imposed.

16         (d)  A class IV deficiency is a deficiency that the

17  agency determines has the potential for causing no more than a

18  minor negative impact on the resident. If the class IV

19  deficiency is isolated, no plan of correction is required.

20         Section 73.  Section 400.241, Florida Statutes, is

21  amended to read:

22         400.241  Prohibited acts; penalties for violations.--

23         (1)  It is unlawful for any person or public body to

24  establish, conduct, manage, or operate a home as defined in

25  this part without obtaining a valid current license.

26         (2)  It is unlawful for any person or public body to

27  offer or advertise to the public, in any way by any medium

28  whatever, nursing home care or service or custodial services

29  without obtaining a valid current license. It is unlawful for

30  any holder of a license issued pursuant to the provisions of

31  this part to advertise or hold out to the public that it holds

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 1  a license for a facility other than that for which it actually

 2  holds a license.

 3         (1)(3)  It is unlawful for any person, long-term care

 4  facility, or other entity to willfully interfere with the

 5  unannounced inspections mandated by s. 400.19(3) or part II of

 6  chapter 408. Alerting or advising a facility of the actual or

 7  approximate date of such inspection shall be a per se

 8  violation of this subsection.

 9         (2)(4)  A violation of any provision of this part or of

10  any minimum standard, rule, or regulation adopted pursuant

11  thereto constitutes a misdemeanor of the second degree,

12  punishable as provided in s. 775.082 or s. 775.083.  Each day

13  of a continuing violation is shall be considered a separate

14  offense.

15         Section 74.  Subsection (1) and paragraphs (a) and (c)

16  of subsection (4) of section 400.464, Florida Statutes, are

17  amended to read:

18         400.464  Home health agencies to be licensed;

19  expiration of license; exemptions; unlawful acts; penalties.--

20         (1)  The requirements of part II of chapter 408 apply

21  to the provision of services that require licensure pursuant

22  to this part and part II of chapter 408 and entities licensed

23  or registered by or applying for such licensure or

24  registration from the Agency for Health Care Administration

25  pursuant to this part. A license issued by the agency is

26  required in order to operate a home health agency in this

27  state. Any home health agency must be licensed by the agency

28  to operate in this state. A license issued to a home health

29  agency, unless sooner suspended or revoked, expires 2 years

30  after its date of issuance.

31  

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 1         (4)(a)  An organization may not provide, offer, or

 2  advertise home health services to the public unless the

 3  organization has a valid license or is specifically exempted

 4  under this part. An organization that offers or advertises to

 5  the public any service for which licensure or registration is

 6  required under this part must include in the advertisement the

 7  license number or registration number issued to the

 8  organization by the agency. The agency shall assess a fine of

 9  not less than $100 to any licensee or registrant who fails to

10  include the license or registration number when submitting the

11  advertisement for publication, broadcast, or printing. The

12  fine for a second or subsequent offense is $500. The holder of

13  a license issued under this part may not advertise or indicate

14  to the public that it holds a home health agency or nurse

15  registry license other than the one it has been issued.

16         (c)  A person who violates paragraph (a) is subject to

17  an injunctive proceeding under s. 408.816 s. 400.515. A

18  violation of paragraph (a) or s. 408.812 is a deceptive and

19  unfair trade practice and constitutes a violation of the

20  Florida Deceptive and Unfair Trade Practices Act under part II

21  of chapter 501.

22         Section 75.  Section 400.471, Florida Statutes, is

23  amended to read:

24         400.471  Application for license; fee; provisional

25  license; temporary permit.--

26         (1)  Each applicant for licensure must comply with all

27  provisions of this part and part II of chapter 408.

28  Application for an initial license or for renewal of an

29  existing license must be made under oath to the agency on

30  forms furnished by it and must be accompanied by the

31  appropriate license fee as provided in subsection (10). The

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 1  agency must take final action on an initial licensure

 2  application within 60 days after receipt of all required

 3  documentation.

 4         (2)  In addition to the requirements of part II of

 5  chapter 408, the initial applicant must file with the

 6  application satisfactory proof that the home health agency is

 7  in compliance with this part and applicable rules, including:

 8         (a)  A listing of services to be provided, either

 9  directly by the applicant or through contractual arrangements

10  with existing providers.

11         (b)  The number and discipline of professional staff to

12  be employed.

13         (c)  Proof of financial ability to operate.

14         (c)(d)  Completion of questions concerning volume data

15  on the renewal application as determined by rule.

16         (3)  An applicant for initial licensure must

17  demonstrate financial ability to operate by submitting a

18  balance sheet and income and expense statement for the first 2

19  years of operation which provide evidence of having sufficient

20  assets, credit, and projected revenues to cover liabilities

21  and expenses. The applicant shall have demonstrated financial

22  ability to operate if the applicant's assets, credit, and

23  projected revenues meet or exceed projected liabilities and

24  expenses. All documents required under this subsection must be

25  prepared in accordance with generally accepted accounting

26  principles and must be compiled by a certified public

27  accountant.

28         (4)  Each applicant for licensure must comply with the

29  following requirements:

30         (a)  Upon receipt of a completed, signed, and dated

31  application, the agency shall require background screening of

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 1  the applicant, in accordance with the level 2 standards for

 2  screening set forth in chapter 435. As used in this

 3  subsection, the term "applicant" means the administrator, or a

 4  similarly titled person who is responsible for the day-to-day

 5  operation of the licensed home health agency, and the

 6  financial officer, or similarly titled individual who is

 7  responsible for the financial operation of the licensed home

 8  health agency.

 9         (b)  The agency may require background screening for a

10  member of the board of directors of the licensee or an officer

11  or an individual owning 5 percent or more of the licensee if

12  the agency reasonably suspects that such individual has been

13  convicted of an offense prohibited under the level 2 standards

14  for screening set forth in chapter 435.

15         (c)  Proof of compliance with the level 2 background

16  screening requirements of chapter 435 which has been submitted

17  within the previous 5 years in compliance with any other

18  health care or assisted living licensure requirements of this

19  state is acceptable in fulfillment of paragraph (a). Proof of

20  compliance with background screening which has been submitted

21  within the previous 5 years to fulfill the requirements of the

22  Financial Services Commission and the Office of Insurance

23  Regulation pursuant to chapter 651 as part of an application

24  for a certificate of authority to operate a continuing care

25  retirement community is acceptable in fulfillment of the

26  Department of Law Enforcement and Federal Bureau of

27  Investigation background check.

28         (d)  A provisional license may be granted to an

29  applicant when each individual required by this section to

30  undergo background screening has met the standards for the

31  Department of Law Enforcement background check, but the agency

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 1  has not yet received background screening results from the

 2  Federal Bureau of Investigation. A standard license may be

 3  granted to the licensee upon the agency's receipt of a report

 4  of the results of the Federal Bureau of Investigation

 5  background screening for each individual required by this

 6  section to undergo background screening which confirms that

 7  all standards have been met, or upon the granting of a

 8  disqualification exemption by the agency as set forth in

 9  chapter 435. Any other person who is required to undergo level

10  2 background screening may serve in his or her capacity

11  pending the agency's receipt of the report from the Federal

12  Bureau of Investigation. However, the person may not continue

13  to serve if the report indicates any violation of background

14  screening standards and a disqualification exemption has not

15  been requested of and granted by the agency as set forth in

16  chapter 435.

17         (e)  Each applicant must submit to the agency, with its

18  application, a description and explanation of any exclusions,

19  permanent suspensions, or terminations of the licensee or

20  potential licensee from the Medicare or Medicaid programs.

21  Proof of compliance with the requirements for disclosure of

22  ownership and control interest under the Medicaid or Medicare

23  programs may be accepted in lieu of this submission.

24         (f)  Each applicant must submit to the agency a

25  description and explanation of any conviction of an offense

26  prohibited under the level 2 standards of chapter 435 by a

27  member of the board of directors of the applicant, its

28  officers, or any individual owning 5 percent or more of the

29  applicant. This requirement does not apply to a director of a

30  not-for-profit corporation or organization if the director

31  serves solely in a voluntary capacity for the corporation or

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 1  organization, does not regularly take part in the day-to-day

 2  operational decisions of the corporation or organization,

 3  receives no remuneration for his or her services on the

 4  corporation or organization's board of directors, and has no

 5  financial interest and has no family members with a financial

 6  interest in the corporation or organization, provided that the

 7  director and the not-for-profit corporation or organization

 8  include in the application a statement affirming that the

 9  director's relationship to the corporation satisfies the

10  requirements of this paragraph.

11         (g)  A license may not be granted to an applicant if

12  the applicant, administrator, or financial officer has been

13  found guilty of, regardless of adjudication, or has entered a

14  plea of nolo contendere or guilty to, any offense prohibited

15  under the level 2 standards for screening set forth in chapter

16  435, unless an exemption from disqualification has been

17  granted by the agency as set forth in chapter 435.

18         (h)  The agency may deny or revoke licensure if the

19  applicant has been or is currently excluded, suspended,

20  terminated from, or has involuntarily withdrawn from

21  participation in any governmental or private health care or

22  health insurance program.

23         (i)  An application for license renewal must contain

24  the information required under paragraphs (e) and (f).

25         (5)  The agency may deny or revoke licensure if the

26  applicant has falsely represented a material fact, or has

27  omitted any material fact, from the application required by

28  this section.

29         (3)(6)  In addition to the requirements of s. 408.810,

30  the home health agency must also obtain and maintain the

31  following insurance coverage in an amount of not less than

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 1  $250,000 per claim, and the home health agency must submit

 2  proof of coverage with an initial application for licensure

 3  and with each application for license renewal:

 4         (a)  Malpractice insurance as defined in s.

 5  624.605(1)(k).;

 6         (b)  Liability insurance as defined in s.

 7  624.605(1)(b).

 8         (7)  Sixty days before the expiration date, an

 9  application for renewal must be submitted to the agency under

10  oath on forms furnished by it, and a license must be renewed

11  if the applicant has met the requirements established under

12  this part and applicable rules. The home health agency must

13  file with the application satisfactory proof that it is in

14  compliance with this part and applicable rules. If there is

15  evidence of financial instability, the home health agency must

16  submit satisfactory proof of its financial ability to comply

17  with the requirements of this part. The agency shall impose an

18  administrative fine of $50 per day for each day the home

19  health agency fails to file an application within the

20  timeframe specified in this subsection. Each day of continuing

21  violation is a separate violation; however, the aggregate of

22  such fines may not exceed $500.

23         (8)  When transferring the ownership of a home health

24  agency, the transferee must submit an application for a

25  license at least 60 days before the effective date of the

26  transfer. If the application is filed late, an administrative

27  fine shall be imposed in the amount of $50 per day. Each day

28  of continuing violation is a separate violation; however, the

29  aggregate of such fines may not exceed $500. If the home

30  health agency is being leased, a copy of the lease agreement

31  must be filed with the application.

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 1         (4)(9)  The agency shall accept, in lieu of its own

 2  periodic licensure survey, submission of the survey of an

 3  accrediting organization that is recognized by the agency if

 4  the accreditation of the licensed home health agency is not

 5  provisional and if the licensed home health agency authorizes

 6  release of, and the agency receives the report of, the

 7  accrediting organization.

 8         (5)(10)  In accordance with s. 408.805, an applicant or

 9  licensee shall pay a fee for each license application

10  submitted under this part, part II of chapter 408, and

11  applicable rules. The amount of the fee shall be established

12  by rule and shall be set at The license fee and renewal fee

13  required of a home health agency are nonrefundable. The agency

14  shall set the license fees in an amount that is sufficient to

15  cover the agency's its costs in carrying out its

16  responsibilities under this part, but not to exceed $2,000 per

17  biennium. However, state, county, or municipal governments

18  applying for licenses under this part are exempt from the

19  payment of license fees. All fees collected under this part

20  must be deposited in the Health Care Trust Fund for the

21  administration of this part.

22         (11)  The license must be displayed in a conspicuous

23  place in the administrative office of the home health agency

24  and is valid only while in the possession of the person to

25  which it is issued. The license may not be sold, assigned, or

26  otherwise transferred, voluntarily or involuntarily, and is

27  valid only for the home health agency and location for which

28  originally issued.

29         (12)  A home health agency against whom a revocation or

30  suspension proceeding is pending at the time of license

31  renewal may be issued a provisional license effective until

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 1  final disposition by the agency of such proceedings. If

 2  judicial relief is sought from the final disposition, the

 3  court that has jurisdiction may issue a temporary permit for

 4  the duration of the judicial proceeding.

 5         (6)(13)  The agency may not issue a license designated

 6  as certified to a home health agency that fails to satisfy the

 7  requirements of a Medicare certification survey from the

 8  agency.

 9         (14)  The agency may not issue a license to a home

10  health agency that has any unpaid fines assessed under this

11  part.

12         Section 76.  Section 400.474, Florida Statutes, is

13  amended to read:

14         400.474  Administrative Denial, suspension, revocation

15  of license; injunction; grounds; penalties.--

16         (1)  The agency may deny, revoke, and or suspend a

17  license and, or impose an administrative fine in the manner

18  provided in chapter 120, or initiate injunctive proceedings

19  under s. 400.515.

20         (2)  Any of the following actions by a home health

21  agency or its employee is grounds for disciplinary action by

22  the agency:

23         (a)  Violation of this part, part II of chapter 408, or

24  of applicable rules.

25         (b)  An intentional, reckless, or negligent act that

26  materially affects the health or safety of a patient.

27         (c)  Knowingly providing home health services in an

28  unlicensed assisted living facility or unlicensed adult

29  family-care home, unless the home health agency or employee

30  reports the unlicensed facility or home to the agency within

31  72 hours after providing the services.

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 1         (3)  The agency may impose the following penalties for

 2  operating without a license upon an applicant or owner who has

 3  in the past operated, or who currently operates, a licensed

 4  home health agency.

 5         (a)  If a home health agency that is found to be

 6  operating without a license wishes to apply for a license, the

 7  home health agency may submit an application only after the

 8  agency has verified that the home health agency no longer

 9  operates an unlicensed home health agency.

10         (a)(b)  In addition to the requirements of s. 408.813,

11  any person, partnership, or corporation that violates s.

12  408.813 paragraph (a) and that previously operated a licensed

13  home health agency or concurrently operates both a licensed

14  home health agency and an unlicensed home health agency

15  commits a felony of the third degree punishable as provided in

16  s. 775.082, s. 775.083, or s. 775.084. If an owner has an

17  interest in more than one home health agency and fails to

18  license any one of those home health agencies, the agency must

19  issue a cease and desist order for the activities of the

20  unlicensed home health agency and impose a moratorium on any

21  or all of the licensed related home health agencies until the

22  unlicensed home health agency is licensed.

23         (b)(c)  If any home health agency is found to be

24  operating without a license meets the criteria in paragraph

25  (a) or paragraph (b) and that home health agency has received

26  any government reimbursement for services provided by an

27  unlicensed home health agency, the agency shall make a fraud

28  referral to the appropriate government reimbursement program.

29         (4)  The agency may deny, revoke, or suspend the

30  license of a home health agency, or may impose on a home

31  

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 1  health agency administrative fines not to exceed the aggregate

 2  sum of $5,000 if:

 3         (a)  The agency is unable to obtain entry to the home

 4  health agency to conduct a licensure survey, complaint

 5  investigation, surveillance visit, or monitoring visit.

 6         (b)  An applicant or a licensed home health agency has

 7  falsely represented a material fact in the application, or has

 8  omitted from the application any material fact, including, but

 9  not limited to, the fact that the controlling or ownership

10  interest is held by any officer, director, agent, manager,

11  employee, affiliated person, partner, or shareholder who is

12  not eligible to participate.

13         (c)  An applicant, owner, or person who has a 5 percent

14  or greater interest in a licensed entity:

15         1.  Has been previously found by any licensing,

16  certifying, or professional standards board or agency to have

17  violated the standards or conditions that relate to home

18  health-related licensure or certification, or to the quality

19  of home health-related services provided; or

20         2.  Has been or is currently excluded, suspended,

21  terminated from, or has involuntarily withdrawn from,

22  participation in the Medicaid program of this state or any

23  other state, the Medicare program, or any other governmental

24  health care or health insurance program.

25         Section 77.  Subsection (1) and paragraphs (a) and (b)

26  of subsection (2) of section 400.484, Florida Statutes, are

27  amended to read:

28         400.484  Right of inspection; deficiencies; fines.--

29         (1)  In addition to the requirements of s. 408.811, Any

30  duly authorized officer or employee of the agency may make

31  such inspections and investigations as are necessary in order

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 1  to determine the state of compliance with this part, part II

 2  of chapter 408, and with applicable rules. The right of

 3  inspection extends to any business that the agency has reason

 4  to believe is being operated as a home health agency without a

 5  license, but such inspection of any such business may not be

 6  made without the permission of the owner or person in charge

 7  unless a warrant is first obtained from a circuit court. Any

 8  application for a license issued under this part or for

 9  license renewal constitutes permission for an appropriate

10  inspection to verify the information submitted on or in

11  connection with the application.

12         (2)  The agency shall impose fines for various classes

13  of deficiencies in accordance with the following schedule:

14         (a)  A class I deficiency is any act, omission, or

15  practice that results in a patient's death, disablement, or

16  permanent injury, or places a patient at imminent risk of

17  death, disablement, or permanent injury. Upon finding a class

18  I deficiency, the agency may impose an administrative fine in

19  the amount of $5,000 for each occurrence and each day that the

20  deficiency exists. In addition, the agency may immediately

21  revoke the license, or impose a moratorium on the admission of

22  new patients, until the factors causing the deficiency have

23  been corrected.

24         (b)  A class II deficiency is any act, omission, or

25  practice that has a direct adverse effect on the health,

26  safety, or security of a patient. Upon finding a class II

27  deficiency, the agency may impose an administrative fine in

28  the amount of $1,000 for each occurrence and each day that the

29  deficiency exists. In addition, the agency may suspend the

30  license, or impose a moratorium on the admission of new

31  patients, until the deficiency has been corrected.

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 1         Section 78.  Section 400.495, Florida Statutes, is

 2  repealed.

 3         Section 79.  Section 400.497, Florida Statutes, is

 4  amended to read:

 5         400.497  Rules establishing minimum standards.--The

 6  agency shall adopt, publish, and enforce rules to implement

 7  part II of chapter 408 and this part, including, as

 8  applicable, ss. 400.506 and 400.509, which must provide

 9  reasonable and fair minimum standards relating to:

10         (1)  The home health aide competency test and home

11  health aide training. The agency shall create the home health

12  aide competency test and establish the curriculum and

13  instructor qualifications for home health aide training.

14  Licensed home health agencies may provide this training and

15  shall furnish documentation of such training to other licensed

16  home health agencies upon request. Successful passage of the

17  competency test by home health aides may be substituted for

18  the training required under this section and any rule adopted

19  pursuant thereto.

20         (2)  Shared staffing. The agency shall allow shared

21  staffing if the home health agency is part of a retirement

22  community that provides multiple levels of care, is located on

23  one campus, is licensed under this chapter or chapter 429, and

24  otherwise meets the requirements of law and rule.

25         (3)  The criteria for the frequency of onsite licensure

26  surveys.

27         (4)  Licensure application and renewal.

28         (5)  The requirements for onsite and electronic

29  accessibility of supervisory personnel of home health

30  agencies.

31         (6)  Information to be included in patients' records.

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 1         (7)  Geographic service areas.

 2         (8)  Preparation of a comprehensive emergency

 3  management plan pursuant to s. 400.492.

 4         (a)  The Agency for Health Care Administration shall

 5  adopt rules establishing minimum criteria for the plan and

 6  plan updates, with the concurrence of the Department of Health

 7  and in consultation with the Department of Community Affairs.

 8         (b)  The rules must address the requirements in s.

 9  400.492. In addition, the rules shall provide for the

10  maintenance of patient-specific medication lists that can

11  accompany patients who are transported from their homes.

12         (c)  The plan is subject to review and approval by the

13  county health department. During its review, the county health

14  department shall contact state and local health and medical

15  stakeholders when necessary. The county health department

16  shall complete its review to ensure that the plan is in

17  accordance with the criteria in the Agency for Health Care

18  Administration rules within 90 days after receipt of the plan

19  and shall approve the plan or advise the home health agency of

20  necessary revisions. If the home health agency fails to submit

21  a plan or fails to submit the requested information or

22  revisions to the county health department within 30 days after

23  written notification from the county health department, the

24  county health department shall notify the Agency for Health

25  Care Administration. The agency shall notify the home health

26  agency that its failure constitutes a deficiency, subject to a

27  fine of $5,000 per occurrence. If the plan is not submitted,

28  information is not provided, or revisions are not made as

29  requested, the agency may impose the fine.

30         (d)  For any home health agency that operates in more

31  than one county, the Department of Health shall review the

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 1  plan, after consulting with state and local health and medical

 2  stakeholders when necessary. The department shall complete its

 3  review within 90 days after receipt of the plan and shall

 4  approve the plan or advise the home health agency of necessary

 5  revisions. The department shall make every effort to avoid

 6  imposing differing requirements on a home health agency that

 7  operates in more than one county as a result of differing or

 8  conflicting comprehensive plan requirements of the counties in

 9  which the home health agency operates.

10         (e)  The requirements in this subsection do not apply

11  to:

12         1.  A facility that is certified under chapter 651 and

13  has a licensed home health agency used exclusively by

14  residents of the facility; or

15         2.  A retirement community that consists of residential

16  units for independent living and either a licensed nursing

17  home or an assisted living facility, and has a licensed home

18  health agency used exclusively by the residents of the

19  retirement community, provided the comprehensive emergency

20  management plan for the facility or retirement community

21  provides for continuous care of all residents with special

22  needs during an emergency.

23         Section 80.  Section 400.506, Florida Statutes, is

24  amended to read:

25         400.506  Licensure of nurse registries; requirements;

26  penalties.--

27         (1)  A nurse registry is exempt from the licensing

28  requirements of a home health agency but must be licensed as a

29  nurse registry. The requirements of part II of chapter 408

30  apply to the provision of services that require licensure

31  pursuant to ss. 400.506-400.518 and part II of chapter 408 and

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 1  to entities licensed by or applying for such license from the

 2  Agency for Health Care Administration pursuant to ss.

 3  400.506-400.518. A license issued by the agency is required

 4  for the operation of a nurse registry. Each operational site

 5  of the nurse registry must be licensed, unless there is more

 6  than one site within a county. If there is more than one site

 7  within a county, only one license per county is required. Each

 8  operational site must be listed on the license.

 9         (2)  Each applicant for licensure and each licensee

10  must comply with all provisions of part II of chapter 408 and

11  this section. the following requirements:

12         (a)  Upon receipt of a completed, signed, and dated

13  application, the agency shall require background screening, in

14  accordance with the level 2 standards for screening set forth

15  in chapter 435, of the managing employee, or other similarly

16  titled individual who is responsible for the daily operation

17  of the nurse registry, and of the financial officer, or other

18  similarly titled individual who is responsible for the

19  financial operation of the registry, including billings for

20  patient care and services. The applicant shall comply with the

21  procedures for level 2 background screening as set forth in

22  chapter 435.

23         (b)  The agency may require background screening of any

24  other individual who is an applicant if the agency has

25  probable cause to believe that he or she has been convicted of

26  a crime or has committed any other offense prohibited under

27  the level 2 standards for screening set forth in chapter 435.

28         (c)  Proof of compliance with the level 2 background

29  screening requirements of chapter 435 which has been submitted

30  within the previous 5 years in compliance with any other

31  health care or assisted living licensure requirements of this

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 1  state is acceptable in fulfillment of the requirements of

 2  paragraph (a).

 3         (d)  A provisional license may be granted to an

 4  applicant when each individual required by this section to

 5  undergo background screening has met the standards for the

 6  Department of Law Enforcement background check but the agency

 7  has not yet received background screening results from the

 8  Federal Bureau of Investigation. A standard license may be

 9  granted to the applicant upon the agency's receipt of a report

10  of the results of the Federal Bureau of Investigation

11  background screening for each individual required by this

12  section to undergo background screening which confirms that

13  all standards have been met, or upon the granting of a

14  disqualification exemption by the agency as set forth in

15  chapter 435. Any other person who is required to undergo level

16  2 background screening may serve in his or her capacity

17  pending the agency's receipt of the report from the Federal

18  Bureau of Investigation. However, the person may not continue

19  to serve if the report indicates any violation of background

20  screening standards and a disqualification exemption has not

21  been requested of and granted by the agency as set forth in

22  chapter 435.

23         (e)  Each applicant must submit to the agency, with its

24  application, a description and explanation of any exclusions,

25  permanent suspensions, or terminations of the applicant from

26  the Medicare or Medicaid programs. Proof of compliance with

27  the requirements for disclosure of ownership and control

28  interests under the Medicaid or Medicare programs may be

29  accepted in lieu of this submission.

30         (f)  Each applicant must submit to the agency a

31  description and explanation of any conviction of an offense

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 1  prohibited under the level 2 standards of chapter 435 by a

 2  member of the board of directors of the applicant, its

 3  officers, or any individual owning 5 percent or more of the

 4  applicant. This requirement does not apply to a director of a

 5  not-for-profit corporation or organization if the director

 6  serves solely in a voluntary capacity for the corporation or

 7  organization, does not regularly take part in the day-to-day

 8  operational decisions of the corporation or organization,

 9  receives no remuneration for his or her services on the

10  corporation or organization's board of directors, and has no

11  financial interest and has no family members with a financial

12  interest in the corporation or organization, provided that the

13  director and the not-for-profit corporation or organization

14  include in the application a statement affirming that the

15  director's relationship to the corporation satisfies the

16  requirements of this paragraph.

17         (g)  A license may not be granted to an applicant if

18  the applicant or managing employee has been found guilty of,

19  regardless of adjudication, or has entered a plea of nolo

20  contendere or guilty to, any offense prohibited under the

21  level 2 standards for screening set forth in chapter 435,

22  unless an exemption from disqualification has been granted by

23  the agency as set forth in chapter 435.

24         (h)  The agency may deny or revoke the license if any

25  applicant:

26         1.  Has falsely represented a material fact in the

27  application required by paragraph (e) or paragraph (f), or has

28  omitted any material fact from the application required by

29  paragraph (e) or paragraph (f); or

30  

31  

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 1         2.  Has had prior action taken against the applicant

 2  under the Medicaid or Medicare program as set forth in

 3  paragraph (e).

 4         (i)  An application for license renewal must contain

 5  the information required under paragraphs (e) and (f).

 6         (3)  In accordance with s. 408.805, an applicant or

 7  licensee shall pay a fee for each license application

 8  submitted under ss. 400.508-400.518, part II of chapter 408,

 9  and applicable rules. The amount of the fee shall be

10  established by rule and may not exceed $2,000 per biennium.

11  Application for license must be made to the Agency for Health

12  Care Administration on forms furnished by it and must be

13  accompanied by the appropriate licensure fee, as established

14  by rule and not to exceed the cost of regulation under this

15  part. The licensure fee for nurse registries may not exceed

16  $2,000 and must be deposited in the Health Care Trust Fund.

17         (4)  The Agency for Health Care Administration may

18  deny, revoke, or suspend a license or impose an administrative

19  fine in the manner provided in chapter 120 against a nurse

20  registry that:

21         (a)  Fails to comply with this section or applicable

22  rules.

23         (b)  Commits an intentional, reckless, or negligent act

24  that materially affects the health or safety of a person

25  receiving services.

26         (5)  A license issued for the operation of a nurse

27  registry, unless sooner suspended or revoked, expires 2 years

28  after its date of issuance. Sixty days before the expiration

29  date, an application for renewal must be submitted to the

30  Agency for Health Care Administration on forms furnished by

31  it. The Agency for Health Care Administration shall renew the

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 1  license if the applicant has met the requirements of this

 2  section and applicable rules. A nurse registry against which a

 3  revocation or suspension proceeding is pending at the time of

 4  license renewal may be issued a conditional license effective

 5  until final disposition by the Agency for Health Care

 6  Administration of such proceedings. If judicial relief is

 7  sought from the final disposition, the court having

 8  jurisdiction may issue a conditional license for the duration

 9  of the judicial proceeding.

10         (6)  The Agency for Health Care Administration may

11  institute injunctive proceedings under s. 400.515.

12         (4)(7)  A person that provides, offers, or advertises

13  to the public any service for which licensure is required

14  under this section must include in such advertisement the

15  license number issued to it by the Agency for Health Care

16  Administration. The agency shall assess a fine of not less

17  than $100 against any licensee who fails to include the

18  license number when submitting the advertisement for

19  publication, broadcast, or printing. The fine for a second or

20  subsequent offense is $500.

21         (8)(a)  It is unlawful for a person to provide, offer,

22  or advertise to the public services as defined by rule without

23  obtaining a valid license from the Agency for Health Care

24  Administration. It is unlawful for any holder of a license to

25  advertise or hold out to the public that he or she holds a

26  license for other than that for which he or she actually holds

27  a license. A person who violates this subsection is subject to

28  injunctive proceedings under s. 400.515.

29         (b)  A person who violates the provisions of paragraph

30  (a) commits a misdemeanor of the second degree, punishable as

31  

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 1  provided in s. 775.082 or s. 775.083. Each day of continuing

 2  violation is a separate offense.

 3         (5)(a)(c)  In addition to the requirements of s.

 4  408.812, any person who owns, operates, or maintains an

 5  unlicensed nurse registry and who, within 10 working days

 6  after receiving notification from the agency, fails to cease

 7  operation and apply for a license under this part commits a

 8  misdemeanor of the second degree, punishable as provided in s.

 9  775.082 or s. 775.083. Each day of continued operation is a

10  separate offense.

11         (b)(d)  If a nurse registry fails to cease operation

12  after agency notification, the agency may impose a fine of

13  $500 for each day of noncompliance.

14         (9)  Any duly authorized officer or employee of the

15  Agency for Health Care Administration may make such

16  inspections and investigations as are necessary to respond to

17  complaints or to determine the state of compliance with this

18  section and applicable rules.

19         (a)  If, in responding to a complaint, an agent or

20  employee of the Agency for Health Care Administration has

21  reason to believe that a crime has been committed, he or she

22  shall notify the appropriate law enforcement agency.

23         (b)  If, in responding to a complaint, an agent or

24  employee of the Agency for Health Care Administration has

25  reason to believe that abuse, neglect, or exploitation has

26  occurred, according to the definitions in chapter 415, he or

27  she shall file a report under chapter 415.

28         (6)(10)(a)  A nurse registry may refer for contract in

29  private residences registered nurses and licensed practical

30  nurses registered and licensed under part I of chapter 464,

31  certified nursing assistants certified under part II of

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 1  chapter 464, home health aides who present documented proof of

 2  successful completion of the training required by rule of the

 3  agency, and companions or homemakers for the purposes of

 4  providing those services authorized under s. 400.509(1). Each

 5  person referred by a nurse registry must provide current

 6  documentation that he or she is free from communicable

 7  diseases.

 8         (b)  A certified nursing assistant or home health aide

 9  may be referred for a contract to provide care to a patient in

10  his or her home only if that patient is under a physician's

11  care. A certified nursing assistant or home health aide

12  referred for contract in a private residence shall be limited

13  to assisting a patient with bathing, dressing, toileting,

14  grooming, eating, physical transfer, and those normal daily

15  routines the patient could perform for himself or herself were

16  he or she physically capable. A certified nursing assistant or

17  home health aide may not provide medical or other health care

18  services that require specialized training and that may be

19  performed only by licensed health care professionals. The

20  nurse registry shall obtain the name and address of the

21  attending physician and send written notification to the

22  physician within 48 hours after a contract is concluded that a

23  certified nursing assistant or home health aide will be

24  providing care for that patient.

25         (c)  When a certified nursing assistant or home health

26  aide is referred to a patient's home by a nurse registry, the

27  nurse registry shall advise the patient, the patient's family,

28  or any other person acting on behalf of the patient at the

29  time the contract for services is made that registered nurses

30  are available to make visits to the patient's home for an

31  additional cost.

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 1         (7)(11)  A person who is referred by a nurse registry

 2  for contract in private residences and who is not a nurse

 3  licensed under part I of chapter 464 may perform only those

 4  services or care to clients that the person has been certified

 5  to perform or trained to perform as required by law or rules

 6  of the Agency for Health Care Administration or the Department

 7  of Business and Professional Regulation. Providing services

 8  beyond the scope authorized under this subsection constitutes

 9  the unauthorized practice of medicine or a violation of the

10  Nurse Practice Act and is punishable as provided under chapter

11  458, chapter 459, or part I of chapter 464.

12         (8)(12)  Each nurse registry must require every

13  applicant for contract to complete an application form

14  providing the following information:

15         (a)  The name, address, date of birth, and social

16  security number of the applicant.

17         (b)  The educational background and employment history

18  of the applicant.

19         (c)  The number and date of the applicable license or

20  certification.

21         (d)  When appropriate, information concerning the

22  renewal of the applicable license, registration, or

23  certification.

24         (9)(13)  Each nurse registry must comply with the

25  procedures set forth in s. 400.512 for maintaining records of

26  the work history of all persons referred for contract and is

27  subject to the standards and conditions set forth in that

28  section. However, an initial screening may not be required for

29  persons who have been continuously registered with the nurse

30  registry since October 1, 2000.

31  

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 1         (10)(14)  The nurse registry must maintain the

 2  application on file, and that file must be open to the

 3  inspection of the Agency for Health Care Administration. The

 4  nurse registry must maintain on file the name and address of

 5  the patient or client to whom nurse registry personnel are

 6  referred for contract and the amount of the fee received by

 7  the nurse registry. A nurse registry must maintain the file

 8  that includes the application and other applicable

 9  documentation for 3 years after the date of the last file

10  entry of patient-related or client-related information.

11         (11)(15)  Nurse registries shall assist persons who

12  would need assistance and sheltering during evacuations

13  because of physical, mental, or sensory disabilities in

14  registering with the appropriate local emergency management

15  agency pursuant to s. 252.355.

16         (12)(16)  Each nurse registry shall prepare and

17  maintain a comprehensive emergency management plan that is

18  consistent with the criteria in this subsection and with the

19  local special needs plan. The plan shall be updated annually.

20  The plan shall include the means by which the nurse registry

21  will continue to provide the same type and quantity of

22  services to its patients who evacuate to special needs

23  shelters which were being provided to those patients prior to

24  evacuation. The plan shall specify how the nurse registry

25  shall facilitate the provision of continuous care by persons

26  referred for contract to persons who are registered pursuant

27  to s. 252.355 during an emergency that interrupts the

28  provision of care or services in private residences

29  residencies. Nurse registries may establish links to local

30  emergency operations centers to determine a mechanism by which

31  to approach specific areas within a disaster area in order for

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 1  a provider to reach its clients. Nurse registries shall

 2  demonstrate a good faith effort to comply with the

 3  requirements of this subsection by documenting attempts of

 4  staff to follow procedures outlined in the nurse registry's

 5  comprehensive emergency management plan which support a

 6  finding that the provision of continuing care has been

 7  attempted for patients identified as needing care by the nurse

 8  registry and registered under s. 252.355 in the event of an

 9  emergency under subsection (1).

10         (a)  All persons referred for contract who care for

11  persons registered pursuant to s. 252.355 must include in the

12  patient record a description of how care will be continued

13  during a disaster or emergency that interrupts the provision

14  of care in the patient's home. It shall be the responsibility

15  of the person referred for contract to ensure that continuous

16  care is provided.

17         (b)  Each nurse registry shall maintain a current

18  prioritized list of patients in private residences who are

19  registered pursuant to s. 252.355 and are under the care of

20  persons referred for contract and who need continued services

21  during an emergency. This list shall indicate, for each

22  patient, if the client is to be transported to a special needs

23  shelter and if the patient is receiving skilled nursing

24  services. Nurse registries shall make this list available to

25  county health departments and to local emergency management

26  agencies upon request.

27         (c)  Each person referred for contract who is caring

28  for a patient who is registered pursuant to s. 252.355 shall

29  provide a list of the patient's medication and equipment needs

30  to the nurse registry. Each person referred for contract shall

31  

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 1  make this information available to county health departments

 2  and to local emergency management agencies upon request.

 3         (d)  Each person referred for contract shall not be

 4  required to continue to provide care to patients in emergency

 5  situations that are beyond the person's control and that make

 6  it impossible to provide services, such as when roads are

 7  impassable or when patients do not go to the location

 8  specified in their patient records.

 9         (e)  The comprehensive emergency management plan

10  required by this subsection is subject to review and approval

11  by the county health department. During its review, the county

12  health department shall contact state and local health and

13  medical stakeholders when necessary. The county health

14  department shall complete its review to ensure that the plan

15  complies with the criteria in the Agency for Health Care

16  Administration rules within 90 days after receipt of the plan

17  and shall either approve the plan or advise the nurse registry

18  of necessary revisions. If a nurse registry fails to submit a

19  plan or fails to submit requested information or revisions to

20  the county health department within 30 days after written

21  notification from the county health department, the county

22  health department shall notify the Agency for Health Care

23  Administration. The agency shall notify the nurse registry

24  that its failure constitutes a deficiency, subject to a fine

25  of $5,000 per occurrence. If the plan is not submitted,

26  information is not provided, or revisions are not made as

27  requested, the agency may impose the fine.

28         (f)  The Agency for Health Care Administration shall

29  adopt rules establishing minimum criteria for the

30  comprehensive emergency management plan and plan updates

31  required by this subsection, with the concurrence of the

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 1  Department of Health and in consultation with the Department

 2  of Community Affairs.

 3         (13)(17)  All persons referred for contract in private

 4  residences by a nurse registry must comply with the following

 5  requirements for a plan of treatment:

 6         (a)  When, in accordance with the privileges and

 7  restrictions imposed upon a nurse under part I of chapter 464,

 8  the delivery of care to a patient is under the direction or

 9  supervision of a physician or when a physician is responsible

10  for the medical care of the patient, a medical plan of

11  treatment must be established for each patient receiving care

12  or treatment provided by a licensed nurse in the home. The

13  original medical plan of treatment must be timely signed by

14  the physician, physician assistant, or advanced registered

15  nurse practitioner, acting within his or her respective scope

16  of practice, and reviewed in consultation with the licensed

17  nurse at least every 2 months. Any additional order or change

18  in orders must be obtained from the physician, physician

19  assistant, or advanced registered nurse practitioner and

20  reduced to writing and timely signed by the physician,

21  physician assistant, or advanced registered nurse

22  practitioner. The delivery of care under a medical plan of

23  treatment must be substantiated by the appropriate nursing

24  notes or documentation made by the nurse in compliance with

25  nursing practices established under part I of chapter 464.

26         (b)  Whenever a medical plan of treatment is

27  established for a patient, the initial medical plan of

28  treatment, any amendment to the plan, additional order or

29  change in orders, and copy of nursing notes must be filed in

30  the office of the nurse registry.

31  

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 1         (14)(18)  The nurse registry must comply with the

 2  notice requirements of s. 408.810(5) s. 400.495, relating to

 3  abuse reporting.

 4         (15)(19)  In addition to any other penalties imposed

 5  pursuant to this section or part, the agency may assess costs

 6  related to an investigation that results in a successful

 7  prosecution, excluding costs associated with an attorney's

 8  time. If the agency imposes such an assessment and the

 9  assessment is not paid, and if challenged is not the subject

10  of a pending appeal, prior to the renewal of the license, the

11  license shall not be issued until the assessment is paid or

12  arrangements for payment of the assessment are made.

13         (16)(20)  The Agency for Health Care Administration

14  shall adopt rules to implement this section and part II of

15  chapter 408.

16         Section 81.  Section 400.509, Florida Statutes, is

17  amended to read:

18         400.509  Registration of particular service providers

19  exempt from licensure; certificate of registration; regulation

20  of registrants.--

21         (1)  Any organization that provides companion services

22  or homemaker services and does not provide a home health

23  service to a person is exempt from licensure under this part.

24  However, any organization that provides companion services or

25  homemaker services must register with the agency.

26         (2)  The requirements of part II of chapter 408 apply

27  to the provision of services that require registration or

28  licensure pursuant to this section and part II of chapter 408

29  and entities registered by or applying for such registration

30  from the Agency for Health Care Administration pursuant to

31  this section. Each applicant for registration and each

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 1  registrant must comply with all provisions of part II of

 2  chapter 408. Registration or a license issued by the agency is

 3  required for the operation of an organization that provides

 4  companion services or homemaker services. Registration

 5  consists of annually filing with the agency, under oath, on

 6  forms provided by it, the following information:

 7         (a)  If the registrant is a firm or partnership, the

 8  name, address, date of birth, and social security number of

 9  every member.

10         (b)  If the registrant is a corporation or association,

11  its name and address; the name, address, date of birth, and

12  social security number of each of its directors and officers;

13  and the name and address of each person having at least a 5

14  percent interest in the corporation or association.

15         (c)  The name, address, date of birth, and social

16  security number of each person employed by or under contract

17  with the organization.

18         (3)  In accordance with s. 408.805, applicants and

19  registrants shall pay fees for all registrations issued under

20  this part, part II of chapter 408, and applicable rules. The

21  amount of the fee shall be $50 per biennium. The agency shall

22  charge a registration fee of $25 to be submitted with the

23  information required under subsection (2).

24         (4)  Each applicant for registration must comply with

25  the following requirements:

26         (a)  Upon receipt of a completed, signed, and dated

27  application, the agency shall require background screening, in

28  accordance with the level 1 standards for screening set forth

29  in chapter 435, of every individual who will have contact with

30  the client. The agency shall require background screening of

31  the managing employee or other similarly titled individual who

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 1  is responsible for the operation of the entity, and of the

 2  financial officer or other similarly titled individual who is

 3  responsible for the financial operation of the entity,

 4  including billings for client services in accordance with the

 5  level 2 standards for background screening as set forth in

 6  chapter 435.

 7         (b)  The agency may require background screening of any

 8  other individual who is affiliated with the applicant if the

 9  agency has a reasonable basis for believing that he or she has

10  been convicted of a crime or has committed any other offense

11  prohibited under the level 2 standards for screening set forth

12  in chapter 435.

13         (c)  Proof of compliance with the level 2 background

14  screening requirements of chapter 435 which has been submitted

15  within the previous 5 years in compliance with any other

16  health care or assisted living licensure requirements of this

17  state is acceptable in fulfillment of paragraph (a).

18         (d)  A provisional registration may be granted to an

19  applicant when each individual required by this section to

20  undergo background screening has met the standards for the

21  abuse-registry background check through the agency and the

22  Department of Law Enforcement background check, but the agency

23  has not yet received background screening results from the

24  Federal Bureau of Investigation. A standard registration may

25  be granted to the applicant upon the agency's receipt of a

26  report of the results of the Federal Bureau of Investigation

27  background screening for each individual required by this

28  section to undergo background screening which confirms that

29  all standards have been met, or upon the granting of a

30  disqualification exemption by the agency as set forth in

31  chapter 435. Any other person who is required to undergo level

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 1  2 background screening may serve in his or her capacity

 2  pending the agency's receipt of the report from the Federal

 3  Bureau of Investigation. However, the person may not continue

 4  to serve if the report indicates any violation of background

 5  screening standards and if a disqualification exemption has

 6  not been requested of and granted by the agency as set forth

 7  in chapter 435.

 8         (e)  Each applicant must submit to the agency, with its

 9  application, a description and explanation of any exclusions,

10  permanent suspensions, or terminations of the applicant from

11  the Medicare or Medicaid programs. Proof of compliance with

12  the requirements for disclosure of ownership and control

13  interests under the Medicaid or Medicare programs may be

14  accepted in lieu of this submission.

15         (f)  Each applicant must submit to the agency a

16  description and explanation of any conviction of an offense

17  prohibited under the level 2 standards of chapter 435 which

18  was committed by a member of the board of directors of the

19  applicant, its officers, or any individual owning 5 percent or

20  more of the applicant. This requirement does not apply to a

21  director of a not-for-profit corporation or organization who

22  serves solely in a voluntary capacity for the corporation or

23  organization, does not regularly take part in the day-to-day

24  operational decisions of the corporation or organization,

25  receives no remuneration for his or her services on the

26  corporation's or organization's board of directors, and has no

27  financial interest and no family members having a financial

28  interest in the corporation or organization, if the director

29  and the not-for-profit corporation or organization include in

30  the application a statement affirming that the director's

31  

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 1  relationship to the corporation satisfies the requirements of

 2  this paragraph.

 3         (g)  A registration may not be granted to an applicant

 4  if the applicant or managing employee has been found guilty

 5  of, regardless of adjudication, or has entered a plea of nolo

 6  contendere or guilty to, any offense prohibited under the

 7  level 2 standards for screening set forth in chapter 435,

 8  unless an exemption from disqualification has been granted by

 9  the agency as set forth in chapter 435.

10         (h)  The agency may deny or revoke the registration of

11  any applicant who:

12         1.  Has falsely represented a material fact in the

13  application required by paragraph (e) or paragraph (f), or has

14  omitted any material fact from the application required by

15  paragraph (e) or paragraph (f); or

16         2.  Has had prior action taken against the applicant

17  under the Medicaid or Medicare program as set forth in

18  paragraph (e).

19         (i)  An application for licensure renewal must contain

20  the information required under paragraphs (e) and (f).

21         (4)(5)  Each registrant must obtain the employment or

22  contract history of persons who are employed by or under

23  contract with the organization and who will have contact at

24  any time with patients or clients in their homes by:

25         (a)  Requiring such persons to submit an employment or

26  contractual history to the registrant; and

27         (b)  Verifying the employment or contractual history,

28  unless through diligent efforts such verification is not

29  possible. The agency shall prescribe by rule the minimum

30  requirements for establishing that diligent efforts have been

31  made.

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 1  

 2  There is no monetary liability on the part of, and no cause of

 3  action for damages arises against, a former employer of a

 4  prospective employee of or prospective independent contractor

 5  with a registrant who reasonably and in good faith

 6  communicates his or her honest opinions about the former

 7  employee's or contractor's job performance. This subsection

 8  does not affect the official immunity of an officer or

 9  employee of a public corporation.

10         (6)  On or before the first day on which services are

11  provided to a patient or client, any registrant under this

12  part must inform the patient or client and his or her

13  immediate family, if appropriate, of the right to report

14  abusive, neglectful, or exploitative practices. The statewide

15  toll-free telephone number for the central abuse hotline must

16  be provided to patients or clients in a manner that is clearly

17  legible and must include the words: "To report abuse, neglect,

18  or exploitation, please call toll-free      (phone number)  ."

19  Registrants must establish appropriate policies and

20  procedures for providing such notice to patients or clients.

21         (7)  The provisions of s. 400.512 regarding screening

22  apply to any person or business entity registered under this

23  section on or after October 1, 1994.

24         (8)  Upon verification that all requirements for

25  registration have been met, the Agency for Health Care

26  Administration shall issue a certificate of registration valid

27  for no more than 1 year.

28         (9)  The Agency for Health Care Administration may

29  deny, suspend, or revoke the registration of a person that:

30         (a)  Fails to comply with this section or applicable

31  rules.

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 1         (b)  Commits an intentional, reckless, or negligent act

 2  that materially affects the health or safety of a person

 3  receiving services.

 4         (10)  The Agency for Health Care Administration may

 5  institute injunctive proceedings under s. 400.515.

 6         (5)(11)  A person that offers or advertises to the

 7  public a service for which registration is required must

 8  include in its advertisement the registration number issued by

 9  the Agency for Health Care Administration.

10         (12)  It is unlawful for a person to offer or advertise

11  to the public services, as defined by rule, without obtaining

12  a certificate of registration from the Agency for Health Care

13  Administration. It is unlawful for any holder of a certificate

14  of registration to advertise or hold out to the public that he

15  or she holds a certificate of registration for other than that

16  for which he or she actually holds a certificate of

17  registration. Any person who violates this subsection is

18  subject to injunctive proceedings under s. 400.515.

19         (13)  Any duly authorized officer or employee of the

20  Agency for Health Care Administration has the right to make

21  such inspections and investigations as are necessary in order

22  to respond to complaints or to determine the state of

23  compliance with this section and applicable rules.

24         (a)  If, in responding to a complaint, an officer or

25  employee of the Agency for Health Care Administration has

26  reason to believe that a crime has been committed, he or she

27  shall notify the appropriate law enforcement agency.

28         (b)  If, in responding to a complaint, an officer or

29  employee of the Agency for Health Care Administration has

30  reason to believe that abuse, neglect, or exploitation has

31  

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 1  occurred, according to the definitions in chapter 415, he or

 2  she shall file a report under chapter 415.

 3         (6)(14)  In addition to any other penalties imposed

 4  pursuant to this section or part, the agency may assess costs

 5  related to an investigation that results in a successful

 6  prosecution, excluding costs associated with an attorney's

 7  time. If the agency imposes such an assessment and the

 8  assessment is not paid, and if challenged is not the subject

 9  of a pending appeal, prior to the renewal of the registration,

10  the registration shall not be issued until the assessment is

11  paid or arrangements for payment of the assessment are made.

12         (7)(15)  The Agency for Health Care Administration

13  shall adopt rules to administer this section and part II of

14  chapter 408.

15         Section 82.  Subsection (7) of section 400.512, Florida

16  Statutes, is amended to read:

17         400.512  Screening of home health agency personnel;

18  nurse registry personnel; and companions and homemakers.--The

19  agency shall require employment or contractor screening as

20  provided in chapter 435, using the level 1 standards for

21  screening set forth in that chapter, for home health agency

22  personnel; persons referred for employment by nurse

23  registries; and persons employed by companion or homemaker

24  services registered under s. 400.509.

25         (7)(a)  It is a misdemeanor of the first degree,

26  punishable under s. 775.082 or s. 775.083, for any person

27  willfully, knowingly, or intentionally to:

28         1.  Fail, by false statement, misrepresentation,

29  impersonation, or other fraudulent means, to disclose in any

30  application for voluntary or paid employment a material fact

31  

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 1  used in making a determination as to such person's

 2  qualifications to be an employee under this section;

 3         2.  Operate or attempt to operate an entity licensed or

 4  registered under this part with persons who do not meet the

 5  minimum standards for good moral character as contained in

 6  this section; or

 7         3.  Use information from the criminal records obtained

 8  under this section for any purpose other than screening that

 9  person for employment as specified in this section or release

10  such information to any other person for any purpose other

11  than screening for employment under this section.

12         (b)  It is a felony of the third degree, punishable

13  under s. 775.082, s. 775.083, or s. 775.084, for any person

14  willfully, knowingly, or intentionally to use information from

15  the juvenile records of a person obtained under this section

16  for any purpose other than screening for employment under this

17  section.

18         Section 83.  Section 400.515, Florida Statutes, is

19  repealed.

20         Section 84.  Section 400.602, Florida Statutes, is

21  amended to read:

22         400.602  Licensure required; prohibited acts;

23  exemptions; display, transferability of license.--

24         (1)(a)  The requirements of part II of chapter 408

25  apply to the provision of services that require licensure

26  pursuant to this part and part II of chapter 408 and to

27  entities licensed by or applying for such licensure from the

28  agency pursuant to this part. A license issued by the agency

29  is required in order to operate a hospice in this state It is

30  unlawful to operate or maintain a hospice without first

31  obtaining a license from the agency.

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 1         (b)  It is unlawful for Any person or legal entity that

 2  is not licensed as a hospice under this part may not to use

 3  the word "hospice" in its name, or to offer or advertise

 4  hospice services or hospice-like services in such a way as to

 5  mislead a person to believe that the offeror is a hospice

 6  licensed under this part.

 7         (b)(c)  It is unlawful for any person or legal entity

 8  offering, describing, or advertising hospice services or

 9  hospice-like services or otherwise holding itself out as a

10  hospice to do so without stating the year of initial licensure

11  as a hospice in the state or the year of initial licensure of

12  the hospice entity or affiliate based in the state that owns

13  the hospice. At a minimum, the year of initial licensure must

14  be stated directly beneath the name of the licensed entity in

15  a type no less than 25 percent of the size of the type used

16  for the name or other indication of hospice services or

17  hospice-like services and must be prominently stated at least

18  one time on any document, item, or other medium offering,

19  describing, or advertising hospice services or hospice-like

20  services. This requirement excludes any materials relating to

21  the care and treatment of an existing hospice patient.

22         (2)  Services provided by a hospital, nursing home, or

23  other health care facility, health care provider, or

24  caregiver, or under the Community Care for the Elderly Act, do

25  not constitute a hospice unless the facility, provider, or

26  caregiver establishes a separate and distinct administrative

27  program to provide home, residential, and homelike inpatient

28  hospice services.

29         (3)(a)  A separately licensed hospice may not use a

30  name which is substantially the same as the name of another

31  hospice licensed under this part.

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 1         (b)  A licensed hospice which intends to change its

 2  name or address must notify the agency at least 60 days before

 3  making the change.

 4         (4)  The license shall be displayed in a conspicuous

 5  place inside the hospice program office; shall be valid only

 6  in the possession of the person or public agency to which it

 7  is issued; shall not be subject to sale, assignment, or other

 8  transfer, voluntary or involuntary; and shall not be valid for

 9  any hospice other than the hospice for which originally

10  issued.

11         Section 85.  Section 400.605, Florida Statutes, is

12  amended to read:

13         400.605  Administration; forms; fees; rules;

14  inspections; fines.--

15         (1)  The agency, in consultation with the department,

16  may adopt rules to administer the requirements of part II of

17  chapter 408. The department, in consultation with the agency,

18  shall by rule establish minimum standards and procedures for a

19  hospice pursuant to this part. The rules must include:

20         (a)  License application procedures and requirements.

21         (a)(b)  The qualifications of professional and

22  ancillary personnel to ensure the provision of appropriate and

23  adequate hospice care.

24         (b)(c)  Standards and procedures for the administrative

25  management of a hospice.

26         (c)(d)  Standards for hospice services that ensure the

27  provision of quality patient care.

28         (d)(e)  Components of a patient plan of care.

29         (e)(f)  Procedures relating to the implementation of

30  advanced directives and do-not-resuscitate orders.

31  

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 1         (f)(g)  Procedures for maintaining and ensuring

 2  confidentiality of patient records.

 3         (g)(h)  Standards for hospice care provided in

 4  freestanding inpatient facilities that are not otherwise

 5  licensed medical facilities and in residential care facilities

 6  such as nursing homes, assisted living facilities, adult

 7  family care homes, and hospice residential units and

 8  facilities.

 9         (h)(i)  Components of a comprehensive emergency

10  management plan, developed in consultation with the Department

11  of Health, the Department of Elderly Affairs, and the

12  Department of Community Affairs.

13         (i)(j)  Standards and procedures relating to the

14  establishment and activities of a quality assurance and

15  utilization review committee.

16         (j)(k)  Components and procedures relating to the

17  collection of patient demographic data and other information

18  on the provision of hospice care in this state.

19         (2)  In accordance with s. 408.805, an applicant or

20  licensee shall pay a fee for each license application

21  submitted under this part, part II of chapter 408, and

22  applicable rules. The amount of the fee shall be established

23  by rule and may not exceed $1,200 per biennium. The agency

24  shall:

25         (a)  Prepare and furnish all forms necessary under the

26  provisions of this part in relation to applications for

27  licensure or licensure renewals.

28         (b)  Collect from the applicant at the time of filing

29  an application for a license or at the time of renewal of a

30  license a fee which must be reasonably calculated to cover the

31  cost of regulation under this part, but may not exceed $600

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 1  per program. All fees collected under this part shall be

 2  deposited in the Health Care Trust Fund for the administration

 3  of this part.

 4         (c)  Issue hospice licenses to all applicants which

 5  meet the provisions of this part and applicable rules.

 6         (3)(d)  In accordance with s. 408.811, the agency shall

 7  conduct annual licensure inspections of all licensees, except

 8  that licensure inspections may be conducted biennially for

 9  hospices having a 3-year record of substantial compliance.

10         (e)  The agency shall conduct such inspections and

11  investigations as are necessary in order to determine the

12  state of compliance with the provisions of this part, part II

13  of chapter 408, and applicable adopted rules. The right of

14  inspection also extends to any program that the agency has

15  reason to believe is offering or advertising itself as a

16  hospice without a license, but no inspection may be made

17  without the permission of the owner or person in charge

18  thereof unless a warrant is first obtained from a circuit

19  court authorizing such inspection. An application for a

20  license or license renewal made pursuant to this part

21  constitutes permission for an inspection of the hospice for

22  which the license is sought in order to facilitate

23  verification of the information submitted on or in connection

24  with the application.

25         (4)(f)  In accordance with part II of chapter 408, the

26  agency may impose an administrative fine for any violation of

27  the provisions of this part, part II of chapter 408, or

28  applicable rules.

29         Section 86.  Section 400.606, Florida Statutes, is

30  amended to read:

31  

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 1         400.606  License; application; renewal; conditional

 2  license or permit; certificate of need.--

 3         (1)  In addition to the requirements of part II of

 4  chapter 408, A license application must be filed on a form

 5  provided by the agency and must be accompanied by the

 6  appropriate license fee as well as satisfactory proof that the

 7  hospice is in compliance with this part and any rules adopted

 8  by the department and proof of financial ability to operate

 9  and conduct the hospice in accordance with the requirements of

10  this part. the initial application and change of ownership

11  application must be accompanied by a plan for the delivery of

12  home, residential, and homelike inpatient hospice services to

13  terminally ill persons and their families. Such plan must

14  contain, but need not be limited to:

15         (a)  The estimated average number of terminally ill

16  persons to be served monthly.

17         (b)  The geographic area in which hospice services will

18  be available.

19         (c)  A listing of services which are or will be

20  provided, either directly by the applicant or through

21  contractual arrangements with existing providers.

22         (d)  Provisions for the implementation of hospice home

23  care within 3 months after licensure.

24         (e)  Provisions for the implementation of hospice

25  homelike inpatient care within 12 months after licensure.

26         (f)  The number and disciplines of professional staff

27  to be employed.

28         (g)  The name and qualifications of any existing or

29  potential contractee.

30         (h)  A plan for attracting and training volunteers.

31  

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 1         (i)  The projected annual operating cost of the

 2  hospice.

 3         (j)  A statement of financial resources and personnel

 4  available to the applicant to deliver hospice care.

 5  

 6  If the applicant is an existing licensed health care provider,

 7  the application must be accompanied by a copy of the most

 8  recent profit-loss statement and, if applicable, the most

 9  recent licensure inspection report.

10         (2)  Each applicant must submit to the agency with its

11  application a description and explanation of any exclusions,

12  permanent suspensions, or terminations from the Medicaid or

13  Medicare programs of the owner, if an individual; of any

14  officer or board member of the hospice, if the owner is a

15  firm, corporation, partnership, or association; or of any

16  person owning 5 percent or more of the hospice. Proof of

17  compliance with disclosure of ownership and control interest

18  requirements of the Medicaid or Medicare programs may be

19  accepted in lieu of this submission.

20         (2)(3)  In addition to the requirements of part II of

21  chapter 408, A license issued for the operation of a hospice,

22  unless sooner suspended or revoked, shall expire automatically

23  1 year from the date of issuance. Sixty days prior to the

24  expiration date, a hospice wishing to renew its license shall

25  submit an application for renewal to the agency on forms

26  furnished by the agency. The agency shall renew the license if

27  the applicant has first met the requirements established under

28  this part and all applicable rules and has provided the

29  information described under this section in addition to the

30  application. However, the application for license renewal

31  shall be accompanied by an update of the plan for delivery of

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 1  hospice care only if information contained in the plan

 2  submitted pursuant to subsection (1) is no longer applicable.

 3         (4)  A hospice against which a revocation or suspension

 4  proceeding is pending at the time of license renewal may be

 5  issued a conditional license by the agency effective until

 6  final disposition of such proceeding. If judicial relief is

 7  sought from the final agency action, the court having

 8  jurisdiction may issue a conditional permit for the duration

 9  of the judicial proceeding.

10         (3)(5)  The agency shall not issue a license to a

11  hospice that fails to receive a certificate of need under the

12  provisions of part I of chapter 408 ss. 408.031-408.045. A

13  licensed hospice is a health care facility as that term is

14  used in s. 408.039(5) and is entitled to initiate or intervene

15  in an administrative hearing.

16         (4)(6)  A freestanding hospice facility that is

17  primarily engaged in providing inpatient and related services

18  and that is not otherwise licensed as a health care facility

19  shall be required to obtain a certificate of need. However, a

20  freestanding hospice facility with six or fewer beds shall not

21  be required to comply with institutional standards such as,

22  but not limited to, standards requiring sprinkler systems,

23  emergency electrical systems, or special lavatory devices.

24         (5)(7)  The agency may deny a license to an applicant

25  that fails to meet any condition for the provision of hospice

26  care or services imposed by the agency on a certificate of

27  need by final agency action, unless the applicant can

28  demonstrate that good cause exists for the applicant's failure

29  to meet such condition.

30         Section 87.  Section 400.6065, Florida Statutes, is

31  amended to read:

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 1         400.6065  Background screening.--

 2         (1)  Upon receipt of a completed application under s.

 3  400.606, the agency shall require level 2 background screening

 4  on each of the following persons, who shall be considered

 5  employees for the purposes of conducting screening under

 6  chapter 435:

 7         (a)  The hospice administrator and financial officer.

 8         (b)  An officer or board member if the hospice is a

 9  firm, corporation, partnership, or association, or any person

10  owning 5 percent or more of the hospice if the agency has

11  probable cause to believe that such officer, board member, or

12  owner has been convicted of any offense prohibited by s.

13  435.04. For each officer, board member, or person owning 5

14  percent or more who has been convicted of any such offense,

15  the hospice shall submit to the agency a description and

16  explanation of the conviction at the time of license

17  application. This paragraph does not apply to a board member

18  of a not-for-profit corporation or organization if the board

19  member serves solely in a voluntary capacity, does not

20  regularly take part in the day-to-day operational decisions of

21  the corporation or organization, receives no remuneration for

22  his or her services, and has no financial interest and has no

23  family members with a financial interest in the corporation or

24  organization, provided that the board member and the

25  corporation or organization submit a statement affirming that

26  the board member's relationship to the corporation or

27  organization satisfies the requirements of this paragraph.

28         (2)  Proof of compliance with level 2 screening

29  standards which has been submitted within the previous 5 years

30  to meet any facility or professional licensure requirements of

31  

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 1  the agency or the Department of Health satisfies the

 2  requirements of this section.

 3         (3)  The agency may grant a provisional license to a

 4  hospice applying for an initial license when each individual

 5  required by this section to undergo screening has completed

 6  the Department of Law Enforcement background check, but has

 7  not yet received results from the Federal Bureau of

 8  Investigation.

 9         (4)  The agency shall require employment or contractor

10  screening as provided in chapter 435, using the level 1

11  standards for screening set forth in that chapter, for hospice

12  personnel.

13         (5)  The agency may grant exemptions from

14  disqualification from employment under this section as

15  provided in s. 435.07.

16         (6)  The administration of each hospice must sign an

17  affidavit annually, under penalty of perjury, stating that all

18  personnel employed or contracted with on or after October 1,

19  1998, who provide hospice services in a facility, or who enter

20  the home of a patient in their service capacity, have been

21  screened.

22         (7)  Proof of compliance with the screening

23  requirements of chapter 435 shall be accepted in lieu of the

24  requirements of this section if the person has been

25  continuously employed or registered without a breach in

26  service that exceeds 180 days, the proof of compliance is not

27  more than 2 years old, and the person has been screened, at

28  the discretion of the hospice.

29         (8)(a)  It is a misdemeanor of the first degree,

30  punishable under s. 775.082 or s. 775.083, for any person

31  willfully, knowingly, or intentionally to:

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 1         1.  Fail, by false statement, misrepresentation,

 2  impersonation, or other fraudulent means, to disclose in any

 3  application for voluntary or paid employment a material fact

 4  used in making a determination as to such person's

 5  qualifications to be employed or contracted with under this

 6  section;

 7         2.  Operate or attempt to operate an entity licensed

 8  under this part with persons who do not meet the minimum

 9  standards for good moral character as contained in this

10  section; or

11         3.  Use information from the criminal records obtained

12  under this section for any purpose other than screening as

13  specified in this section, or release such information to any

14  other person for any purpose other than screening under this

15  section.

16         (b)  It is a felony of the third degree, punishable

17  under s. 775.082, s. 775.083, or s. 775.084, for any person

18  willfully, knowingly, or intentionally to use information from

19  the juvenile records of a person obtained under this section

20  for any purpose other than screening for employment under this

21  section.

22         Section 88.  Section 400.607, Florida Statutes, is

23  amended to read:

24         400.607  Denial, suspension, or revocation of license;

25  emergency actions; imposition of administrative fine; grounds;

26  injunctions.--

27         (1)  The agency may deny, revoke, and or suspend a

28  license, impose an action under s. 408.814, and or impose an

29  administrative fine, which may not exceed $5,000 per

30  violation, for the violation of any provision of this part,

31  

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 1  part II of chapter 408, or applicable rules in the manner

 2  provided in chapter 120.

 3         (2)  Any of the following actions by a licensed hospice

 4  or any of its employees shall be grounds for action by the

 5  agency against a hospice:

 6         (a)  A violation of the provisions of this part, part

 7  II of chapter 408, or applicable rules.

 8         (b)  An intentional or negligent act materially

 9  affecting the health or safety of a patient.

10         (3)  The agency may deny or revoke a license upon a

11  determination that:

12         (a)  Persons subject to level 2 background screening

13  under s. 400.6065 do not meet the screening standards of s.

14  435.04, and exemptions from disqualification have not been

15  provided by the agency.

16         (b)  An officer, board member, or person owning 5

17  percent or more of the hospice has been excluded, permanently

18  suspended, or terminated from the Medicare or Medicaid

19  programs.

20         (3)(4)  If, 3 months after the date of obtaining a

21  license, or at any time thereafter, a hospice does not have in

22  operation the home-care component of hospice care, the agency

23  shall immediately revoke the license of such hospice.

24         (4)(5)  If, 12 months after the date of obtaining a

25  license pursuant to s. 400.606, or at any time thereafter, a

26  hospice does not have in operation the inpatient components of

27  hospice care, the agency shall immediately revoke the license

28  of such hospice.

29         (6)  The agency may institute a civil action in a court

30  of competent jurisdiction to seek injunctive relief to enforce

31  

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 1  compliance with this part or any rule adopted pursuant to this

 2  part.

 3         (5)(7)  The remedies set forth in this section are

 4  independent of and cumulative to other remedies provided by

 5  law.

 6         Section 89.  Subsection (8) of section 400.6095,

 7  Florida Statutes, is amended to read:

 8         400.6095  Patient admission; assessment; plan of care;

 9  discharge; death.--

10         (8)  The hospice care team may withhold or withdraw

11  cardiopulmonary resuscitation if presented with an order not

12  to resuscitate executed pursuant to s. 401.45. The department

13  shall adopt rules providing for the implementation of such

14  orders. Hospice staff shall not be subject to criminal

15  prosecution or civil liability, nor be considered to have

16  engaged in negligent or unprofessional conduct, for

17  withholding or withdrawing cardiopulmonary resuscitation

18  pursuant to such an order and applicable rules adopted by the

19  department. The absence of an order to resuscitate executed

20  pursuant to s. 401.45 does not preclude a physician from

21  withholding or withdrawing cardiopulmonary resuscitation as

22  otherwise permitted by law.

23         Section 90.  Section 400.801, Florida Statutes, is

24  amended to read:

25         400.801  Homes for special services.--

26         (1)  As used in this section, the term:

27         (a)  "Agency" means the "Agency for Health Care

28  Administration."

29         (b)  "Home for special services" means a site licensed

30  by the agency prior to January 1, 2006, where specialized

31  

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 1  health care services are provided, including personal and

 2  custodial care, but not continuous nursing services.

 3         (2)  The requirements of part II of chapter 408 apply

 4  to the provision of services that require licensure pursuant

 5  to this section and part II of chapter 408 and entities

 6  licensed by or applying for such licensure from the agency

 7  pursuant to this section. A license issued by the agency is

 8  required in order to operate a home for special services in

 9  this state. A person must obtain a license from the agency to

10  operate a home for special services. A license is valid for 1

11  year.

12         (3)  In accordance with s. 408.805, an applicant or

13  licensee shall pay a fee for each license application

14  submitted under this part, part II of chapter 408, and

15  applicable rules. The amount of the fee shall be established

16  by rule and may not be more than $2,000 per biennium. The

17  application for a license under this section must be made on a

18  form provided by the agency. A nonrefundable license fee of

19  not more than $1,000 must be submitted with the license

20  application.

21         (4)  Each applicant for licensure must comply with the

22  following requirements:

23         (a)  Upon receipt of a completed, signed, and dated

24  application, the agency shall require background screening, in

25  accordance with the level 2 standards for screening set forth

26  in chapter 435, of the managing employee, or other similarly

27  titled individual who is responsible for the daily operation

28  of the facility, and of the financial officer, or other

29  similarly titled individual who is responsible for the

30  financial operation of the facility, including billings for

31  client care and services, in accordance with the level 2

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 1  standards for screening set forth in chapter 435. The

 2  applicant must comply with the procedures for level 2

 3  background screening as set forth in chapter 435.

 4         (b)  The agency may require background screening of any

 5  other individual who is an applicant if the agency has

 6  probable cause to believe that he or she has been convicted of

 7  a crime or has committed any other offense prohibited under

 8  the level 2 standards for screening set forth in chapter 435.

 9         (c)  Proof of compliance with the level 2 background

10  screening requirements of chapter 435 which has been submitted

11  within the previous 5 years in compliance with any other

12  health care or assisted living licensure requirements of this

13  state is acceptable in fulfillment of the requirements of

14  paragraph (a).

15         (d)  A provisional license may be granted to an

16  applicant when each individual required by this section to

17  undergo background screening has met the standards for the

18  Department of Law Enforcement background check, but the agency

19  has not yet received background screening results from the

20  Federal Bureau of Investigation, or a request for a

21  disqualification exemption has been submitted to the agency as

22  set forth in chapter 435, but a response has not yet been

23  issued. A standard license may be granted to the applicant

24  upon the agency's receipt of a report of the results of the

25  Federal Bureau of Investigation background screening for each

26  individual required by this section to undergo background

27  screening which confirms that all standards have been met, or

28  upon the granting of a disqualification exemption by the

29  agency as set forth in chapter 435. Any other person who is

30  required to undergo level 2 background screening may serve in

31  his or her capacity pending the agency's receipt of the report

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 1  from the Federal Bureau of Investigation. However, the person

 2  may not continue to serve if the report indicates any

 3  violation of background screening standards and a

 4  disqualification exemption has not been requested of and

 5  granted by the agency as set forth in chapter 435.

 6         (e)  Each applicant must submit to the agency, with its

 7  application, a description and explanation of any exclusions,

 8  permanent suspensions, or terminations of the applicant from

 9  the Medicare or Medicaid programs. Proof of compliance with

10  the requirements for disclosure of ownership and control

11  interests under the Medicaid or Medicare programs may be

12  accepted in lieu of this submission.

13         (f)  Each applicant must submit to the agency a

14  description and explanation of any conviction of an offense

15  prohibited under the level 2 standards of chapter 435 by a

16  member of the board of directors of the applicant, its

17  officers, or any individual owning 5 percent or more of the

18  applicant. This requirement does not apply to a director of a

19  not-for-profit corporation or organization if the director

20  serves solely in a voluntary capacity for the corporation or

21  organization, does not regularly take part in the day-to-day

22  operational decisions of the corporation or organization,

23  receives no remuneration for his or her services on the

24  corporation or organization's board of directors, and has no

25  financial interest and has no family members with a financial

26  interest in the corporation or organization, provided that the

27  director and the not-for-profit corporation or organization

28  include in the application a statement affirming that the

29  director's relationship to the corporation satisfies the

30  requirements of this paragraph.

31  

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 1         (g)  A license may not be granted to an applicant if

 2  the applicant or managing employee has been found guilty of,

 3  regardless of adjudication, or has entered a plea of nolo

 4  contendere or guilty to, any offense prohibited under the

 5  level 2 standards for screening set forth in chapter 435,

 6  unless an exemption from disqualification has been granted by

 7  the agency as set forth in chapter 435.

 8         (h)  The agency may deny or revoke licensure if the

 9  applicant:

10         1.  Has falsely represented a material fact in the

11  application required by paragraph (e) or paragraph (f), or has

12  omitted any material fact from the application required by

13  paragraph (e) or paragraph (f); or

14         2.  Has had prior action taken against the applicant

15  under the Medicaid or Medicare program as set forth in

16  paragraph (e).

17         (i)  An application for license renewal must contain

18  the information required under paragraphs (e) and (f).

19         (5)  Application for license renewal must be submitted

20  90 days before the expiration of the license.

21         (6)  A change of ownership or control of a home for

22  special services must be reported to the agency in writing at

23  least 60 days before the change is scheduled to take effect.

24         (4)(7)  The agency may shall adopt rules for

25  implementing and enforcing this section and part II of chapter

26  408.

27         (8)(a)  It is unlawful for any person to establish,

28  conduct, manage, or operate a home for special services

29  without obtaining a license from the agency.

30         (b)  It is unlawful for any person to offer or

31  advertise to the public, in any medium whatever, specialized

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 1  health care services without obtaining a license from the

 2  agency.

 3         (c)  It is unlawful for a holder of a license issued

 4  under this section to advertise or represent to the public

 5  that it holds a license for a type of facility other than the

 6  facility for which its license is issued.

 7         (5)(9)(a)  In addition to the requirements of part II

 8  of chapter 408, a violation of any provision of this section,

 9  part II of chapter 408, or applicable rules adopted by the

10  agency for implementing this section is punishable by payment

11  of an administrative fine not to exceed $5,000.

12         (b)  A violation of s. 408.812 subsection (8) or rules

13  adopted under that section subsection is a misdemeanor of the

14  first degree, punishable as provided in s. 775.082 or s.

15  775.083. Each day of continuing violation is a separate

16  offense.

17         Section 91.  Section 400.805, Florida Statutes, is

18  amended to read:

19         400.805  Transitional living facilities.--

20         (1)  As used in this section, the term:

21         (a)  "Agency" means the Agency for Health Care

22  Administration.

23         (b)  "Department" means the Department of Health.

24         (c)  "Transitional living facility" means a site where

25  specialized health care services are provided, including, but

26  not limited to, rehabilitative services, community reentry

27  training, aids for independent living, and counseling to

28  spinal-cord-injured persons and head-injured persons. This

29  term does not include a hospital licensed under chapter 395 or

30  any federally operated hospital or facility.

31  

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 1         (2)(a)  The requirements of part II of chapter 408

 2  apply to the provision of services that require licensure

 3  pursuant to this section and part II of chapter 408 and to

 4  entities licensed by or applying for such licensure from the

 5  agency pursuant to this section. A license issued by the

 6  agency is required for the operation of a transitional living

 7  facility in this state. A person must obtain a license from

 8  the agency to operate a transitional living facility. A

 9  license issued under this section is valid for 1 year.

10         (b)  In accordance with this section, an applicant or a

11  licensee shall pay a fee for each license application

12  submitted under this part, part II of chapter 408, and

13  applicable rules. The fee shall consist of a $4,000 license

14  fee and a $78.50 per bed fee per biennium. The application for

15  a license must be made on a form provided by the agency. A

16  nonrefundable license fee of $2,000 and a fee of up to $39.25

17  per bed must be submitted with the license application.

18         (c)  The agency may not issue a license to an applicant

19  until the agency receives notice from the department as

20  provided in paragraph (3)(6)(b).

21         (3)  Each applicant for licensure must comply with the

22  following requirements:

23         (a)  Upon receipt of a completed, signed, and dated

24  application, the agency shall require background screening, in

25  accordance with the level 2 standards for screening set forth

26  in chapter 435, of the managing employee, or other similarly

27  titled individual who is responsible for the daily operation

28  of the facility, and of the financial officer, or other

29  similarly titled individual who is responsible for the

30  financial operation of the facility, including billings for

31  client care and services. The applicant must comply with the

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 1  procedures for level 2 background screening as set forth in

 2  chapter 435.

 3         (b)  The agency may require background screening of any

 4  other individual who is an applicant if the agency has

 5  probable cause to believe that he or she has been convicted of

 6  a crime or has committed any other offense prohibited under

 7  the level 2 standards for screening set forth in chapter 435.

 8         (c)  Proof of compliance with the level 2 background

 9  screening requirements of chapter 435 which has been submitted

10  within the previous 5 years in compliance with any other

11  health care or assisted living licensure requirements of this

12  state is acceptable in fulfillment of the requirements of

13  paragraph (a).

14         (d)  A provisional license may be granted to an

15  applicant when each individual required by this section to

16  undergo background screening has met the standards for the

17  Department of Law Enforcement background check, but the agency

18  has not yet received background screening results from the

19  Federal Bureau of Investigation, or a request for a

20  disqualification exemption has been submitted to the agency as

21  set forth in chapter 435, but a response has not yet been

22  issued. A standard license may be granted to the applicant

23  upon the agency's receipt of a report of the results of the

24  Federal Bureau of Investigation background screening for each

25  individual required by this section to undergo background

26  screening which confirms that all standards have been met, or

27  upon the granting of a disqualification exemption by the

28  agency as set forth in chapter 435. Any other person who is

29  required to undergo level 2 background screening may serve in

30  his or her capacity pending the agency's receipt of the report

31  from the Federal Bureau of Investigation. However, the person

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 1  may not continue to serve if the report indicates any

 2  violation of background screening standards and a

 3  disqualification exemption has not been requested of and

 4  granted by the agency as set forth in chapter 435.

 5         (e)  Each applicant must submit to the agency, with its

 6  application, a description and explanation of any exclusions,

 7  permanent suspensions, or terminations of the applicant from

 8  the Medicare or Medicaid programs. Proof of compliance with

 9  the requirements for disclosure of ownership and control

10  interests under the Medicaid or Medicare programs may be

11  accepted in lieu of this submission.

12         (f)  Each applicant must submit to the agency a

13  description and explanation of any conviction of an offense

14  prohibited under the level 2 standards of chapter 435 by a

15  member of the board of directors of the applicant, its

16  officers, or any individual owning 5 percent or more of the

17  applicant. This requirement does not apply to a director of a

18  not-for-profit corporation or organization if the director

19  serves solely in a voluntary capacity for the corporation or

20  organization, does not regularly take part in the day-to-day

21  operational decisions of the corporation or organization,

22  receives no remuneration for his or her services on the

23  corporation or organization's board of directors, and has no

24  financial interest and has no family members with a financial

25  interest in the corporation or organization, provided that the

26  director and the not-for-profit corporation or organization

27  include in the application a statement affirming that the

28  director's relationship to the corporation satisfies the

29  requirements of this paragraph.

30         (g)  A license may not be granted to an applicant if

31  the applicant or managing employee has been found guilty of,

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 1  regardless of adjudication, or has entered a plea of nolo

 2  contendere or guilty to, any offense prohibited under the

 3  level 2 standards for screening set forth in chapter 435,

 4  unless an exemption from disqualification has been granted by

 5  the agency as set forth in chapter 435.

 6         (h)  The agency may deny or revoke licensure if the

 7  applicant:

 8         1.  Has falsely represented a material fact in the

 9  application required by paragraph (e) or paragraph (f), or has

10  omitted any material fact from the application required by

11  paragraph (e) or paragraph (f); or

12         2.  Has had prior action taken against the applicant

13  under the Medicaid or Medicare program as set forth in

14  paragraph (e).

15         (i)  An application for license renewal must contain

16  the information required under paragraphs (e) and (f).

17         (4)  An application for renewal of license must be

18  submitted 90 days before the expiration of the license. Upon

19  renewal of licensure, each applicant must submit to the

20  agency, under penalty of perjury, an affidavit as set forth in

21  paragraph (3)(d).

22         (5)  A change of ownership or control of a transitional

23  living facility must be reported to the agency in writing at

24  least 60 days before the change is scheduled to take effect.

25         (3)(6)(a)  The agency shall adopt rules in consultation

26  with the department governing the physical plant of

27  transitional living facilities and the fiscal management of

28  transitional living facilities.

29         (b)  The department shall adopt rules in consultation

30  with the agency governing the services provided to clients of

31  transitional living facilities. The department shall enforce

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 1  all requirements for providing services to the facility's

 2  clients. The department must notify the agency when it

 3  determines that an applicant for licensure meets the service

 4  requirements adopted by the department.

 5         (c)  The agency and the department shall enforce

 6  requirements under this section and part II of chapter 408, as

 7  such requirements relate to them respectively, and their

 8  respective adopted rules.

 9         (7)(a)  It is unlawful for any person to establish,

10  conduct, manage, or operate a transitional living facility

11  without obtaining a license from the agency.

12         (b)  It is unlawful for any person to offer or

13  advertise to the public, in any medium whatever, services or

14  care defined in paragraph (1)(c) without obtaining a license

15  from the agency.

16         (c)  It is unlawful for a holder of a license issued

17  under this section to advertise or represent to the public

18  that it holds a license for a type of facility other than the

19  facility for which its license is issued.

20         (4)(8)  In accordance with s. 408.811, any designated

21  officer or employee of the agency, of the state, or of the

22  local fire marshal may enter unannounced upon and into the

23  premises of any facility licensed under this section in order

24  to determine the state of compliance with this section, part

25  II of chapter 408, and applicable rules and the rules or

26  standards in force under this section. The right of entry and

27  inspection also extends to any premises that the agency has

28  reason to believe are being operated or maintained as a

29  facility without a license; but such an entry or inspection

30  may not be made without the permission of the owner or person

31  in charge of the facility unless a warrant that authorizes the

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 1  entry is first obtained from the circuit court. The warrant

 2  requirement extends only to a facility that the agency has

 3  reason to believe is being operated or maintained as a

 4  facility without a license. An application for a license or

 5  renewal thereof which is made under this section constitutes

 6  permission for, and acquiescence in, any entry or inspection

 7  of the premises for which the license is sought, in order to

 8  facilitate verification of the information submitted on or in

 9  connection with the application; to discover, investigate, and

10  determine the existence of abuse or neglect; or to elicit,

11  receive, respond to, and resolve complaints. A current valid

12  license constitutes unconditional permission for, and

13  acquiescence in, any entry or inspection of the premises by

14  authorized personnel. The agency retains the right of entry

15  and inspection of facilities that have had a license revoked

16  or suspended within the previous 24 months, to ensure that the

17  facility is not operating unlawfully. However, before the

18  facility is entered, a statement of probable cause must be

19  filed with the director of the agency, who must approve or

20  disapprove the action within 48 hours. Probable cause

21  includes, but is not limited to, evidence that the facility

22  holds itself out to the public as a provider of personal

23  assistance services, or the receipt by the advisory council on

24  brain and spinal cord injuries of a complaint about the

25  facility.

26         (9)  The agency may institute injunctive proceedings in

27  a court of competent jurisdiction for temporary or permanent

28  relief to:

29         (a)  Enforce this section or any minimum standard,

30  rule, or order issued pursuant thereto if the agency's effort

31  to correct a violation through administrative fines has failed

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 1  or when the violation materially affects the health, safety,

 2  or welfare of residents; or

 3         (b)  Terminate the operation of a facility if a

 4  violation of this section or of any standard or rule adopted

 5  pursuant thereto exists which materially affects the health,

 6  safety, or welfare of residents.

 7  

 8  The Legislature recognizes that, in some instances, action is

 9  necessary to protect residents of facilities from immediately

10  life-threatening situations. If it appears by competent

11  evidence or a sworn, substantiated affidavit that a temporary

12  injunction should issue, the court, pending the determination

13  on final hearing, shall enjoin operation of the facility.

14         (10)  The agency may impose an immediate moratorium on

15  admissions to a facility when the agency determines that any

16  condition in the facility presents a threat to the health,

17  safety, or welfare of the residents in the facility. If a

18  facility's license is denied, revoked, or suspended, the

19  facility may be subject to the immediate imposition of a

20  moratorium on admissions to run concurrently with licensure

21  denial, revocation, or suspension.

22         (5)(11)(a)  In accordance with part II of chapter 408,

23  a violation of any provision of this section, part II of

24  chapter 408, or applicable rules adopted by the agency or

25  department under this section is punishable by payment of an

26  administrative or a civil penalty fine not to exceed $5,000.

27         (b)  Unlicensed activity pursuant to s. 408.812 A

28  violation of subsection (7) or rules adopted under that

29  subsection is a misdemeanor of the first degree, punishable as

30  provided in s. 775.082 or s. 775.083. Each day of a continuing

31  violation is a separate offense.

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 1         (6)  The agency may adopt rules to administer the

 2  requirements of part II of chapter 408.

 3         Section 92.  Subsection (4) of section 400.902, Florida

 4  Statutes, is amended to read:

 5         400.902  Definitions.--As used in this part, the term:

 6         (4)  "Owner or operator" means a licensee any

 7  individual who has general administrative charge of a PPEC

 8  center.

 9         Section 93.  Subsection (3) is added to section

10  400.903, Florida Statutes, to read:

11         400.903  PPEC centers to be licensed; exemptions.--

12         (3)  The requirements of part II of chapter 408 apply

13  to the provision of services that require licensure pursuant

14  to this part and part II of chapter 408 and to entities

15  licensed by or applying for such licensure from the agency

16  pursuant to this part. A license issued by the agency is

17  required for the operation of a PPEC center in this state.

18         Section 94.  Section 400.905, Florida Statutes, is

19  amended to read:

20         400.905  License required; fee; exemption; display.--

21         (1)(a)  It is unlawful to operate or maintain a PPEC

22  center without first obtaining from the agency a license

23  authorizing such operation. The agency is responsible for

24  licensing PPEC centers in accordance with the provisions of

25  this part.

26         (b)  Any person who violates paragraph (a) is guilty of

27  a felony of the third degree, punishable as provided in s.

28  775.082, s. 775.083, or s. 775.084.

29         (1)(2)  In addition to the requirements of part II of

30  chapter 408, separate licenses are required for PPEC centers

31  maintained on separate premises, even though they are operated

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 1  under the same management. Separate licenses are not required

 2  for separate buildings on the same grounds.

 3         (2)(3)  In accordance with s. 408.805, an applicant or

 4  licensee shall pay a fee for each license application

 5  submitted under this part, part II of chapter 408, and

 6  applicable rules. The amount of the fee shall be established

 7  by rule and may not be less than $1,000 or more than $3,000

 8  per biennium. The annual license fee required of a PPEC center

 9  shall be in an amount determined by the agency to be

10  sufficient to cover the agency's costs in carrying out its

11  responsibilities under this part, but shall not be less than

12  $500 or more than $1,500.

13         (3)(4)  County-operated or municipally operated PPEC

14  centers applying for licensure under this part are exempt from

15  the payment of license fees.

16         (5)  The license shall be displayed in a conspicuous

17  place inside the PPEC center.

18         (6)  A license shall be valid only in the possession of

19  the individual, firm, partnership, association, or corporation

20  to whom it is issued and shall not be subject to sale,

21  assignment, or other transfer, voluntary or involuntary; nor

22  shall a license be valid for any premises other than that for

23  which originally issued.

24         (7)  Any license granted by the agency shall state the

25  maximum capacity of the facility, the date the license was

26  issued, the expiration date of the license, and any other

27  information deemed necessary by the agency.

28         Section 95.  Section 400.906, Florida Statutes, is

29  amended to read:

30         400.906  Initial application for license; zoning.--

31  

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 1         (1)  Application for a license shall be made to the

 2  agency on forms furnished by it and shall be accompanied by

 3  the appropriate license fee unless the applicant is exempt

 4  from payment of the fee as provided in s. 400.905.

 5         (2)  In addition to the requirements of part II of

 6  chapter 408, the application must shall be under oath and

 7  shall contain the following:

 8         (a)  The name and address of the applicant and the name

 9  by which the facility is to be known. Pursuant thereto:

10         1.  If the applicant is a firm, partnership, or

11  association, the application shall contain the name and

12  address of every member thereof.

13         2.  If the applicant is a corporation, the application

14  shall contain its name and address, the names and addresses of

15  its directors and officers, and the name and address of each

16  person having at least a 10 percent interest in the

17  corporation.

18         (b)  Information which provides a source to establish

19  the suitable character and competency of the applicant in

20  accordance with the provisions of s. 402.305(2) and, if

21  applicable, of the owner or operator, including the name and

22  address of any licensed facility with which the applicant or

23  owner or operator has been affiliated through ownership or

24  employment within 5 years of the date of the application for a

25  license.

26         (c)  The names and addresses of other persons of whom

27  the agency may inquire as to the character and reputation of

28  the applicant and, if applicable, of the owner or operator.

29         (d)  The names and addresses of other persons of whom

30  the agency may inquire as to the financial responsibility of

31  the applicant.

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 1         (e)  Such other reasonable information as may be

 2  required by the agency to evaluate the ability of the

 3  applicant to meet the responsibilities entailed under this

 4  part.

 5         (f)  The location of the facility for which a license

 6  is sought and documentation, signed by the appropriate local

 7  government official, which states that the applicant has met

 8  local zoning requirements.

 9         (3)  The applicant for licensure shall furnish

10  satisfactory proof of financial ability to operate and conduct

11  the PPEC center in accordance with the requirements of this

12  part.

13         (4)  The applicant for licensure shall furnish proof of

14  adequate liability insurance coverage or protection.

15         (5)  Each applicant for licensure must comply with the

16  following requirements:

17         (a)  Upon receipt of a completed, signed, and dated

18  application, the agency shall require background screening, in

19  accordance with the level 2 standards for screening set forth

20  in chapter 435, of the operator, and of the financial officer,

21  or other similarly titled individual who is responsible for

22  the financial operation of the center, including billings for

23  patient care and services.  The applicant must comply with the

24  procedures for level 2 background screening as set forth in

25  chapter 435, as well as the requirements of s. 435.03(3).

26         (b)  The agency may require background screening of any

27  other individual who is an applicant if the agency has a

28  reasonable basis for believing that he or she has been

29  convicted of a crime or has committed any other offense

30  prohibited under the level 2 standards for screening set forth

31  in chapter 435.

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 1         (c)  Proof of compliance with the level 2 background

 2  screening requirements of chapter 435 which has been submitted

 3  within the previous 5 years in compliance with any other

 4  health care licensure requirements of this state is acceptable

 5  in fulfillment of the requirements of paragraph (a).

 6         (d)  A provisional license may be granted to an

 7  applicant when each individual required by this section to

 8  undergo background screening has met the standards for the

 9  Department of Law Enforcement background check, but the agency

10  has not yet received background screening results from the

11  Federal Bureau of Investigation, or a request for a

12  disqualification exemption has been submitted to the agency as

13  set forth in chapter 435, but a response has not yet been

14  issued. A standard license may be granted to the applicant

15  upon the agency's receipt of a report of the results of the

16  Federal Bureau of Investigation background screening for each

17  individual required by this section to undergo background

18  screening which confirms that all standards have been met, or

19  upon the granting of a disqualification exemption by the

20  agency as set forth in chapter 435. Any other person who is

21  required to undergo level 2 background screening may serve in

22  his or her capacity pending the agency's receipt of the report

23  from the Federal Bureau of Investigation. However, the person

24  may not continue to serve if the report indicates any

25  violation of background screening standards and a

26  disqualification exemption has not been requested of and

27  granted by the agency as set forth in chapter 435.

28         (e)  Each applicant must submit to the agency, with its

29  application, a description and explanation of any exclusions,

30  permanent suspensions, or terminations of the applicant from

31  the Medicare or Medicaid programs. Proof of compliance with

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 1  the requirements for disclosure of ownership and control

 2  interests under the Medicaid or Medicare programs shall be

 3  accepted in lieu of this submission.

 4         (f)  Each applicant must submit to the agency a

 5  description and explanation of any conviction of an offense

 6  prohibited under the level 2 standards of chapter 435 by a

 7  member of the board of directors of the applicant, its

 8  officers, or any individual owning 5 percent or more of the

 9  applicant. This requirement does not apply to a director of a

10  not-for-profit corporation or organization if the director

11  serves solely in a voluntary capacity for the corporation or

12  organization, does not regularly take part in the day-to-day

13  operational decisions of the corporation or organization,

14  receives no remuneration for his or her services on the

15  corporation or organization's board of directors, and has no

16  financial interest and has no family members with a financial

17  interest in the corporation or organization, provided that the

18  director and the not-for-profit corporation or organization

19  include in the application a statement affirming that the

20  director's relationship to the corporation satisfies the

21  requirements of this paragraph.

22         (g)  A license may not be granted to an applicant if

23  the applicant or managing employee has been found guilty of,

24  regardless of adjudication, or has entered a plea of nolo

25  contendere or guilty to, any offense prohibited under the

26  level 2 standards for screening set forth in chapter 435,

27  unless an exemption from disqualification has been granted by

28  the agency as set forth in chapter 435.

29         (h)  The agency may deny or revoke licensure if the

30  applicant:

31  

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 1         1.  Has falsely represented a material fact in the

 2  application required by paragraph (e) or paragraph (f), or has

 3  omitted any material fact from the application required by

 4  paragraph (e) or paragraph (f); or

 5         2.  Has had prior action taken against the applicant

 6  under the Medicaid or Medicare program as set forth in

 7  paragraph (e).

 8         (i)  An application for license renewal must contain

 9  the information required under paragraphs (e) and (f).

10         Section 96.  Section 400.907, Florida Statutes, is

11  amended to read:

12         400.907  Denial, suspension, revocation of licensure;

13  administrative fines; grounds.--

14         (1)  In accordance with part II of chapter 408, the

15  agency may deny, revoke, and or suspend a license and or

16  impose an administrative fine for the violation of any

17  provision of this part, part II of chapter 408, or applicable

18  rules in the manner provided in chapter 120.

19         (2)  Any of the following actions by a PPEC center or

20  its employee is grounds for action by the agency against a

21  PPEC center or its employee:

22         (a)  An intentional or negligent act materially

23  affecting the health or safety of children in the PPEC center.

24         (b)  A violation of the provisions of this part, part

25  II of chapter 408, or applicable rules or of any standards or

26  rules adopted pursuant to this part.

27         (c)  Multiple and repeated violations of this part or

28  part II of chapter 408 or of minimum standards or rules

29  adopted pursuant to this part or part II of chapter 408.

30  

31  

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 1         (3)  The agency shall be responsible for all

 2  investigations and inspections conducted pursuant to this

 3  part.

 4         Section 97.  Section 400.908, Florida Statutes, is

 5  amended to read:

 6         400.908  Administrative fines; disposition of fees and

 7  fines.--

 8         (1)(a)  If the agency determines that a PPEC center is

 9  being operated without a license or is otherwise not in

10  compliance with rules adopted under this part, part II of

11  chapter 408, or applicable rules, the agency, notwithstanding

12  any other administrative action it takes, shall make a

13  reasonable attempt to discuss each violation and recommended

14  corrective action with the owner of the PPEC center prior to

15  written notification thereof. The agency may request that the

16  PPEC center submit a corrective action plan that which

17  demonstrates a good faith effort to remedy each violation by a

18  specific date, subject to the approval of the agency.

19         (b)  In accordance with part II of chapter 408, the

20  agency may fine a PPEC center or employee found in violation

21  of rules adopted pursuant to this part, part II of chapter

22  408, or applicable rules, in an amount not to exceed $500 for

23  each violation. Such fine may not exceed $5,000 in the

24  aggregate.

25         (c)  The failure to correct a violation by the date set

26  by the agency, or the failure to comply with an approved

27  corrective action plan, is a separate violation for each day

28  such failure continues, unless the agency approves an

29  extension to a specific date.

30         (d)  If a PPEC center desires to appeal any agency

31  action under this section and the fine is upheld, the violator

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 1  shall pay the fine, plus interest at the legal rate specified

 2  in s. 687.01, for each day beyond the date set by the agency

 3  for payment of the fine.

 4         (2)  In determining if a fine is to be imposed and in

 5  fixing the amount of any fine, the agency shall consider the

 6  following factors:

 7         (a)  The gravity of the violation, including the

 8  probability that death or serious physical or emotional harm

 9  to a child will result or has resulted, the severity of the

10  actual or potential harm, and the extent to which the

11  provisions of the applicable statutes or rules were violated.

12         (b)  Actions taken by the owner or operator to correct

13  violations.

14         (c)  Any previous violations.

15         (d)  The financial benefit to the PPEC center of

16  committing or continuing the violation.

17         (3)  Fees and fines received by the agency under this

18  part shall be deposited in the Health Care Trust Fund created

19  in s. 408.16.

20         Section 98.  Section 400.910, Florida Statutes, is

21  repealed.

22         Section 99.  Section 400.911, Florida Statutes, is

23  repealed.

24         Section 100.  Section 400.912, Florida Statutes, is

25  amended to read:

26         400.912  Closing of a PPEC center.--

27         (1)  Whenever a PPEC center voluntarily discontinues

28  operation, it shall, inform the agency in writing at least 30

29  days before the discontinuance of operation. The PPEC center

30  shall also, at such time, inform each child's legal guardian

31  of the fact and the proposed time of such discontinuance.

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 1         (2)  Immediately upon discontinuance of the operation

 2  of a PPEC center, the owner or operator shall surrender the

 3  license therefor to the agency and the license shall be

 4  canceled.

 5         Section 101.  Section 400.913, Florida Statutes, is

 6  repealed.

 7         Section 102.  Subsection (1) of section 400.914,

 8  Florida Statutes, is amended to read:

 9         400.914  Rules establishing standards.--

10         (1)  Pursuant to the intention of the Legislature to

11  provide safe and sanitary facilities and healthful programs,

12  the agency in conjunction with the Division of Children's

13  Medical Services Prevention and Intervention of the Department

14  of Health shall adopt and publish rules to implement the

15  provisions of this part and part II of chapter 408, which

16  shall include reasonable and fair standards. Any conflict

17  between these standards and those that may be set forth in

18  local, county, or city ordinances shall be resolved in favor

19  of those having statewide effect. Such standards shall relate

20  to:

21         (a)  The assurance that PPEC services are family

22  centered and provide individualized medical, developmental,

23  and family training services.

24         (b)  The maintenance of PPEC centers, not in conflict

25  with the provisions of chapter 553 and based upon the size of

26  the structure and number of children, relating to plumbing,

27  heating, lighting, ventilation, and other building conditions,

28  including adequate space, which will ensure the health,

29  safety, comfort, and protection from fire of the children

30  served.

31  

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 1         (c)  The appropriate provisions of the most recent

 2  edition of the "Life Safety Code" (NFPA-101) shall be applied.

 3         (d)  The number and qualifications of all personnel who

 4  have responsibility for the care of the children served.

 5         (e)  All sanitary conditions within the PPEC center and

 6  its surroundings, including water supply, sewage disposal,

 7  food handling, and general hygiene, and maintenance thereof,

 8  which will ensure the health and comfort of children served.

 9         (f)  Programs and basic services promoting and

10  maintaining the health and development of the children served

11  and meeting the training needs of the children's legal

12  guardians.

13         (g)  Supportive, contracted, other operational, and

14  transportation services.

15         (h)  Maintenance of appropriate medical records, data,

16  and information relative to the children and programs. Such

17  records shall be maintained in the facility for inspection by

18  the agency.

19         Section 103.  Subsection (3) of section 400.915,

20  Florida Statutes, is amended to read:

21         400.915  Construction and renovation;

22  requirements.--The requirements for the construction or

23  renovation of a PPEC center shall comply with:

24         (3)  The standards or rules adopted pursuant to this

25  part and part II of chapter 408.

26         Section 104.  Section 400.916, Florida Statutes, is

27  amended to read:

28         400.916  Prohibited acts; penalty for violation.--

29         (1)  It is unlawful for any person or public body to

30  offer or advertise to the public, in any way or by any medium,

31  basic services as defined in this part without obtaining a

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 1  valid current license.  It is unlawful for any holder of a

 2  license issued pursuant to this part to advertise or hold out

 3  to the public that it holds a license for a PPEC center other

 4  than that for which it actually holds a license.

 5         (2)  Any person who violates s. 408.812 commits the

 6  provisions of subsection (1) is guilty of a misdemeanor of the

 7  second degree, punishable as provided in s. 775.083.  Each day

 8  of continuing violation is shall be considered a separate

 9  offense.

10         Section 105.  Section 400.917, Florida Statutes, is

11  repealed.

12         Section 106.  Section 400.925, Florida Statutes, is

13  amended to read:

14         400.925  Definitions.--As used in this part, the term:

15         (1)  "Accrediting organizations" means the Joint

16  Commission on Accreditation of Healthcare Organizations or

17  other national accreditation agencies whose standards for

18  accreditation are comparable to those required by this part

19  for licensure.

20         (2)  "Affiliated person" means any person who directly

21  or indirectly manages, controls, or oversees the operation of

22  a corporation or other business entity that is a licensee,

23  regardless of whether such person is a partner, shareholder,

24  owner, officer, director, agent, or employee of the entity.

25         (2)(3)  "Agency" means the Agency for Health Care

26  Administration.

27         (4)  "Applicant" means an individual applicant in the

28  case of a sole proprietorship, or any officer, director,

29  agent, managing employee, general manager, or affiliated

30  person, or any partner or shareholder having an ownership

31  

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 1  interest equal to 5 percent or greater in the corporation,

 2  partnership, or other business entity.

 3         (3)(5)  "Consumer" or "patient" means any person who

 4  uses home medical equipment in his or her place of residence.

 5         (4)(6)  "Department" means the Department of Children

 6  and Family Services.

 7         (5)(7)  "General manager" means the individual who has

 8  the general administrative charge of the premises of a

 9  licensed home medical equipment provider.

10         (6)(8)  "Home medical equipment" includes any product

11  as defined by the Federal Drug Administration's Drugs, Devices

12  and Cosmetics Act, any products reimbursed under the Medicare

13  Part B Durable Medical Equipment benefits, or any products

14  reimbursed under the Florida Medicaid durable medical

15  equipment program. Home medical equipment includes oxygen and

16  related respiratory equipment; manual, motorized, or

17  customized wheelchairs and related seating and positioning,

18  but does not include prosthetics or orthotics or any splints,

19  braces, or aids custom fabricated by a licensed health care

20  practitioner; motorized scooters; personal transfer systems;

21  and specialty beds, for use by a person with a medical need.

22         (7)(9)  "Home medical equipment provider" means any

23  person or entity that sells or rents or offers to sell or rent

24  to or for a consumer:

25         (a)  Any home medical equipment and services; or

26         (b)  Home medical equipment that requires any home

27  medical equipment services.

28         (8)(10)  "Home medical equipment provider personnel"

29  means persons who are employed by or under contract with a

30  home medical equipment provider.

31  

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 1         (9)(11)  "Home medical equipment services" means

 2  equipment management and consumer instruction, including

 3  selection, delivery, setup, and maintenance of equipment, and

 4  other related services for the use of home medical equipment

 5  in the consumer's regular or temporary place of residence.

 6         (12)  "Licensee" means the person or entity to whom a

 7  license to operate as a home medical equipment provider is

 8  issued by the agency.

 9         (10)(13)  "Life-supporting or life-sustaining

10  equipment" means a device that is essential to, or that yields

11  information that is essential to, the restoration or

12  continuation of a bodily function important to the

13  continuation of human life. Life-supporting or life-sustaining

14  equipment includes apnea monitors, enteral feeding pumps,

15  infusion pumps, portable home dialysis equipment, and

16  ventilator equipment and supplies for all related equipment,

17  including oxygen equipment and related respiratory equipment.

18         (11)(14)  "Moratorium" means a mandated temporary

19  cessation or suspension of the sale, rental, or offering of

20  equipment after the imposition of the moratorium, in

21  accordance with part II of chapter 408. Services related to

22  equipment sold or rented prior to the moratorium must be

23  continued without interruption, unless determined deemed

24  otherwise by the agency.

25         (15)  "Person" means any individual, firm, partnership,

26  corporation, or association.

27         (12)(16)  "Premises" means those buildings and

28  equipment which are located at the address of the licensed

29  home medical equipment provider for the provision of home

30  medical equipment services, which are in such reasonable

31  

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 1  proximity as to appear to the public to be a single provider

 2  location, and which comply with zoning ordinances.

 3         (13)(17)  "Residence" means the consumer's home or

 4  place of residence, which may include nursing homes, assisted

 5  living facilities, transitional living facilities, adult

 6  family-care homes, or other congregate residential facilities.

 7         Section 107.  Subsections (3) and subsection (6) of

 8  section 400.93, Florida Statutes, are amended to read:

 9         400.93  Licensure required; exemptions; unlawful acts;

10  penalties.--

11         (3)  The requirements of part II of chapter 408 apply

12  to the provision of services that require licensure pursuant

13  to this part and part II of chapter 408 and to entities

14  licensed by or applying for such licensure from the agency

15  pursuant to this part. A license issued by the agency is

16  required in order to provide home medical equipment and

17  services in this state. A home medical equipment provider must

18  be licensed by the agency to operate in this state or to

19  provide home medical equipment and services to consumers in

20  this state. A standard license issued to a home medical

21  equipment provider, unless sooner suspended or revoked,

22  expires 2 years after its effective date.

23         (6)

24         (a)  It is unlawful for any person to offer or

25  advertise home medical equipment and services to the public

26  unless he or she has a valid license under this part or is

27  exempted from licensure under subsection (5). It is unlawful

28  for any holder of a license issued under this part to

29  advertise or indicate to the public that it holds a home

30  medical equipment provider license other than the one it has

31  been issued.

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 1         (a)(b)  A person who violates paragraph (a) is subject

 2  to an injunctive proceeding under s. 400.956. A violation of

 3  s. 408.812 paragraph (a) is a deceptive and unfair trade

 4  practice and constitutes a violation of the Florida Deceptive

 5  and Unfair Trade Practices Act.

 6         (b)(c)  A person who violates s. 408.812 paragraph (a)

 7  commits a misdemeanor of the second degree, punishable as

 8  provided in s. 775.082 or s. 775.083. A person who commits a

 9  second or subsequent violation commits a misdemeanor of the

10  first degree, punishable as provided in s. 775.082 or s.

11  775.083. Each day of continuing violation constitutes a

12  separate offense.

13         (d)  The following penalties shall be imposed for

14  operating an unlicensed home medical equipment provider:

15         1.  Any person or entity who operates an unlicensed

16  provider commits a felony of the third degree.

17         2.  For any person or entity who has received

18  government reimbursement for services provided by an

19  unlicensed provider, the agency shall make a fraud referral to

20  the appropriate government reimbursement program.

21         3.  For any licensee found to be concurrently operating

22  licensed and unlicensed provider premises, the agency may

23  impose a fine or moratorium, or revoke existing licenses of

24  any or all of the licensee's licensed provider locations until

25  such time as the unlicensed provider premises is licensed.

26         (e)  A provider found to be operating without a license

27  may apply for licensure, and must cease operations until a

28  license is awarded by the agency.

29         Section 108.  Section 400.931, Florida Statutes, is

30  amended to read:

31  

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 1         400.931  Application for license; fee; provisional

 2  license; temporary permit.--

 3         (1)  Application for an initial license or for renewal

 4  of an existing license must be made under oath to the agency

 5  on forms furnished by it and must be accompanied by the

 6  appropriate license fee as provided in subsection (12).

 7         (1)(2)  In addition to the requirements of part II of

 8  chapter 408, the applicant must file with the application

 9  satisfactory proof that the home medical equipment provider is

10  in compliance with this part and applicable rules, including:

11         (a)  A report, by category, of the equipment to be

12  provided, indicating those offered either directly by the

13  applicant or through contractual arrangements with existing

14  providers. Categories of equipment include:

15         1.  Respiratory modalities.

16         2.  Ambulation aids.

17         3.  Mobility aids.

18         4.  Sickroom setup.

19         5.  Disposables.

20         (b)  A report, by category, of the services to be

21  provided, indicating those offered either directly by the

22  applicant or through contractual arrangements with existing

23  providers. Categories of services include:

24         1.  Intake.

25         2.  Equipment selection.

26         3.  Delivery.

27         4.  Setup and installation.

28         5.  Patient training.

29         6.  Ongoing service and maintenance.

30         7.  Retrieval.

31  

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 1         (c)  A listing of those with whom the applicant

 2  contracts, both the providers the applicant uses to provide

 3  equipment or services to its consumers and the providers for

 4  whom the applicant provides services or equipment.

 5         (2)(3)  As an alternative to submitting proof of

 6  financial ability to operate as required in s. 408.810(8) The

 7  applicant for initial licensure must demonstrate financial

 8  ability to operate, the applicant may submit which may be

 9  accomplished by the submission of a $50,000 surety bond to the

10  agency.

11         (4)  An applicant for renewal who has demonstrated

12  financial inability to operate must demonstrate financial

13  ability to operate.

14         (5)  Each applicant for licensure must comply with the

15  following requirements:

16         (a)  Upon receipt of a completed, signed, and dated

17  application, the agency shall require background screening of

18  the applicant, in accordance with the level 2 standards for

19  screening set forth in chapter 435. As used in this

20  subsection, the term "applicant" means the general manager and

21  the financial officer or similarly titled individual who is

22  responsible for the financial operation of the licensed

23  facility.

24         (b)  The agency may require background screening for a

25  member of the board of directors of the licensee or an officer

26  or an individual owning 5 percent or more of the licensee if

27  the agency has probable cause to believe that such individual

28  has been convicted of an offense prohibited under the level 2

29  standards for screening set forth in chapter 435.

30         (c)  Proof of compliance with the level 2 background

31  screening requirements of chapter 435 which has been submitted

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 1  within the previous 5 years in compliance with any other

 2  health care licensure requirements of this state is acceptable

 3  in fulfillment of paragraph (a).

 4         (d)  Each applicant must submit to the agency, with its

 5  application, a description and explanation of any exclusions,

 6  permanent suspensions, or terminations of the applicant from

 7  the Medicare or Medicaid programs. Proof of compliance with

 8  disclosure of ownership and control interest requirements of

 9  the Medicaid or Medicare programs shall be accepted in lieu of

10  this submission.

11         (e)  Each applicant must submit to the agency a

12  description and explanation of any conviction of an offense

13  prohibited under the level 2 standards of chapter 435 by a

14  member of the board of directors of the applicant, its

15  officers, or any individual owning 5 percent or more of the

16  applicant. This requirement does not apply to a director of a

17  not-for-profit corporation or organization if the director

18  serves solely in a voluntary capacity for the corporation or

19  organization, does not regularly take part in the day-to-day

20  operational decisions of the corporation or organization,

21  receives no remuneration for his or her services on the

22  corporation's or organization's board of directors, and has no

23  financial interest and has no family members with a financial

24  interest in the corporation or organization, provided that the

25  director and the not-for-profit corporation or organization

26  include in the application a statement affirming that the

27  director's relationship to the corporation satisfies the

28  requirements of this provision.

29         (f)  A license may not be granted to any potential

30  licensee if any applicant, administrator, or financial officer

31  has been found guilty of, regardless of adjudication, or has

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 1  entered a plea of nolo contendere or guilty to, any offense

 2  prohibited under the level 2 standards for screening set forth

 3  in chapter 435, unless an exemption from disqualification has

 4  been granted by the agency as set forth in chapter 435.

 5         (g)  The agency may deny or revoke licensure to any

 6  potential licensee if any applicant:

 7         1.  Has falsely represented a material fact in the

 8  application required by paragraphs (d) and (e), or has omitted

 9  any material fact from the application required by paragraphs

10  (d) and (e); or

11         2.  Has had prior Medicaid or Medicare action taken

12  against the applicant as set forth in paragraph (d).

13         (h)  Upon licensure renewal, each applicant must submit

14  to the agency, under penalty of perjury, an affidavit of

15  compliance with the background screening provisions of this

16  section.

17         (3)(6)  As specified in part II of chapter 408, the

18  home medical equipment provider must also obtain and maintain

19  professional and commercial liability insurance. Proof of

20  liability insurance, as defined in s. 624.605, must be

21  submitted with the application. The agency shall set the

22  required amounts of liability insurance by rule, but the

23  required amount must not be less than $250,000 per claim. In

24  the case of contracted services, it is required that the

25  contractor have liability insurance not less than $250,000 per

26  claim.

27         (7)  A provisional license shall be issued to an

28  approved applicant for initial licensure for a period of 90

29  days, during which time a survey must be conducted

30  demonstrating substantial compliance with this section. A

31  provisional license shall also be issued pending the results

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 1  of an applicant's Federal Bureau of Investigation report of

 2  background screening confirming that all standards have been

 3  met. If substantial compliance is demonstrated, a standard

 4  license shall be issued to expire 2 years after the effective

 5  date of the provisional license.

 6         (8)  Ninety days before the expiration date, an

 7  application for license renewal must be submitted to the

 8  agency under oath on forms furnished by the agency, and a

 9  license shall be renewed if the applicant has met the

10  requirements established under this part and applicable rules.

11  The home medical equipment provider must file with the

12  application satisfactory proof that it is in compliance with

13  this part and applicable rules. The home medical equipment

14  provider must submit satisfactory proof of its financial

15  ability to comply with the requirements of this part.

16         (9)  When a change of ownership of a home medical

17  equipment provider occurs, the prospective owner must submit

18  an initial application for a license at least 15 days before

19  the effective date of the change of ownership. An application

20  for change of ownership of a license is required when

21  ownership, a majority of the ownership, or controlling

22  interest of a licensed home medical equipment provider is

23  transferred or assigned and when a licensee agrees to

24  undertake or provide services to the extent that legal

25  liability for operation of the home medical equipment provider

26  rests with the licensee. A provisional license shall be issued

27  to the new owner for a period of 90 days, during which time

28  all required documentation must be submitted and a survey must

29  be conducted demonstrating substantial compliance with this

30  section. If substantial compliance is demonstrated, a standard

31  

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 1  license shall be issued to expire 2 years after the issuance

 2  of the provisional license.

 3         (4)(10)  When a change of the general manager of a home

 4  medical equipment provider occurs, the licensee must notify

 5  the agency of the change within 45 days. thereof and must

 6  provide evidence of compliance with the background screening

 7  requirements in subsection (5); except that a general manager

 8  who has met the standards for the Department of Law

 9  Enforcement background check, but for whom background

10  screening results from the Federal Bureau of Investigation

11  have not yet been received, may be employed pending receipt of

12  the Federal Bureau of Investigation background screening

13  report. An individual may not continue to serve as general

14  manager if the Federal Bureau of Investigation background

15  screening report indicates any violation of background

16  screening standards.

17         (5)(11)  In accordance with s. 408.805, an applicant or

18  a licensee shall pay a fee for each license application

19  submitted under this part, part II of chapter 408, and

20  applicable rules. The amount of the fee shall be established

21  by rule and may not exceed $300 per biennium. All licensure

22  fees required of a home medical equipment provider are

23  nonrefundable. The agency shall set the fees in an amount that

24  is sufficient to cover its costs in carrying out its

25  responsibilities under this part. However, state, county, or

26  municipal governments applying for licenses under this part

27  are exempt from the payment of license fees. All fees

28  collected under this part must be deposited in the Health Care

29  Trust Fund for the administration of this part.

30         (6)(12)  An applicant for initial licensure, renewal,

31  or change of ownership shall also pay a license processing fee

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 1  not to exceed $300, to be paid by all applicants, and an

 2  inspection fee not to exceed $400, which shall to be paid by

 3  all applicants except those not subject to licensure

 4  inspection by the agency as described in s. 400.933(2).

 5         (13)  When a change is reported which requires issuance

 6  of a license, a fee must be assessed. The fee must be based on

 7  the actual cost of processing and issuing the license.

 8         (14)  When a duplicate license is issued, a fee must be

 9  assessed, not to exceed the actual cost of duplicating and

10  mailing.

11         (15)  When applications are mailed out upon request, a

12  fee must be assessed, not to exceed the cost of the printing,

13  preparation, and mailing.

14         (16)  The license must be displayed in a conspicuous

15  place in the administrative office of the home medical

16  equipment provider and is valid only while in the possession

17  of the person or entity to which it is issued. The license may

18  not be sold, assigned, or otherwise transferred, voluntarily

19  or involuntarily, and is valid only for the home medical

20  equipment provider and location for which originally issued.

21         (17)  A home medical equipment provider against whom a

22  proceeding for revocation or suspension, or for denial of a

23  renewal application, is pending at the time of license renewal

24  may be issued a provisional license effective until final

25  disposition by the agency of such proceedings. If judicial

26  relief is sought from the final disposition, the court that

27  has jurisdiction may issue a temporary permit for the duration

28  of the judicial proceeding.

29         Section 109.  Section 400.932, Florida Statutes, is

30  amended to read:

31  

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 1         400.932  Administrative penalties; injunctions;

 2  emergency orders; moratoriums.--

 3         (1)  The agency may deny, revoke, and or suspend a

 4  license and, or impose an administrative fine not to exceed

 5  $5,000 per violation, per day, or initiate injunctive

 6  proceedings under s. 400.956.

 7         (2)  Any of the following actions by an employee of a

 8  home medical equipment provider are or any of its employees is

 9  grounds for administrative action or penalties by the agency:

10         (a)  Violation of this part, part II of chapter 408, or

11  of applicable rules.

12         (b)  An intentional, reckless, or negligent act that

13  materially affects the health or safety of a patient.

14         (3)  The agency may deny or revoke the license of any

15  applicant that:

16         (a)  Made a false representation or omission of any

17  material fact in making the application, including the

18  submission of an application that conceals the controlling or

19  ownership interest or any officer, director, agent, managing

20  employee, affiliated person, partner, or shareholder who may

21  not be eligible to participate;

22         (a)(b)  Has been previously found by any professional

23  licensing, certifying, or standards board or agency to have

24  violated the standards or conditions relating to licensure or

25  certification or the quality of services provided.

26  "Professional licensing, certifying, or standards board or

27  agency" shall include, but is not limited to, practitioners,

28  health care facilities, programs, or services, or residential

29  care, treatment programs, or other human services; or

30         (b)(c)  Has been or is currently excluded, suspended,

31  or terminated from, or has involuntarily withdrawn from,

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 1  participation in Florida's Medicaid program or any other

 2  state's Medicaid program, or participation in the Medicare

 3  program or any other governmental or private health care or

 4  health insurance program.

 5         (4)  The agency may issue an emergency order

 6  immediately suspending or revoking a license when it

 7  determines that any condition within the responsibility of the

 8  home medical equipment provider presents a clear and present

 9  danger to public health and safety.

10         (5)  The agency may impose an immediate moratorium on

11  any licensed home medical equipment provider when the agency

12  determines that any condition within the responsibility of the

13  home medical equipment provider presents a threat to public

14  health or safety.

15         Section 110.  Section 400.933, Florida Statutes, is

16  amended to read:

17         400.933  Licensure inspections and investigations.--

18         (1)  In addition to the requirements of s. 408.811, the

19  agency shall make or cause to be made such inspections and

20  investigations as it considers necessary, including:

21         (a)  Licensure inspections.

22         (b)  Inspections directed by the federal Centers for

23  Medicare and Medicaid Services Health Care Financing

24  Administration.

25         (c)  Licensure complaint investigations, including full

26  licensure investigations with a review of all licensure

27  standards as outlined in the administrative rules. Complaints

28  received by the agency from individuals, organizations, or

29  other sources are subject to review and investigation by the

30  agency.

31  

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 1         (2)  The agency shall accept, in lieu of its own

 2  periodic inspections for licensure, submission of the

 3  following:

 4         (a)  The survey or inspection of an accrediting

 5  organization, provided the accreditation of the licensed home

 6  medical equipment provider is not provisional and provided the

 7  licensed home medical equipment provider authorizes release

 8  of, and the agency receives the report of, the accrediting

 9  organization; or

10         (b)  A copy of a valid medical oxygen retail

11  establishment permit issued by the Department of Health,

12  pursuant to chapter 499.

13         Section 111.  Section 400.935, Florida Statutes, is

14  amended to read:

15         400.935  Rules establishing minimum standards.--The

16  agency shall adopt, publish, and enforce rules to implement

17  this part and part II of chapter 408, which must provide

18  reasonable and fair minimum standards relating to:

19         (1)  The qualifications and minimum training

20  requirements of all home medical equipment provider personnel.

21         (2)  License application and renewal.

22         (3)  License and inspection fees.

23         (2)(4)  Financial ability to operate.

24         (3)(5)  The administration of the home medical

25  equipment provider.

26         (4)(6)  Procedures for maintaining patient records.

27         (5)(7)  Ensuring that the home medical equipment and

28  services provided by a home medical equipment provider are in

29  accordance with the plan of treatment established for each

30  patient, when provided as a part of a plan of treatment.

31  

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 1         (6)(8)  Contractual arrangements for the provision of

 2  home medical equipment and services by providers not employed

 3  by the home medical equipment provider providing for the

 4  consumer's needs.

 5         (7)(9)  Physical location and zoning requirements.

 6         (8)(10)  Home medical equipment requiring home medical

 7  equipment services.

 8         (9)(11)  Preparation of the comprehensive emergency

 9  management plan under s. 400.934 and the establishment of

10  minimum criteria for the plan, including the maintenance of

11  patient equipment and supply lists that can accompany patients

12  who are transported from their homes. Such rules shall be

13  formulated in consultation with the Department of Health and

14  the Department of Community Affairs.

15         Section 112.  Section 400.95, Florida Statutes, is

16  repealed.

17         Section 113.  Subsection (4) of section 400.955,

18  Florida Statutes, is amended to read:

19         400.955  Procedures for screening of home medical

20  equipment provider personnel.--

21         (4)  The general manager of each home medical equipment

22  provider must sign an affidavit annually, under penalty of

23  perjury, stating that all personnel hired on or after July 1,

24  1999, have been screened and that its remaining personnel have

25  worked for the home medical equipment provider continuously

26  since before July 1, 1999.

27         Section 114.  Section 400.956, Florida Statutes, is

28  repealed.

29         Section 115.  Section 400.962, Florida Statutes, is

30  amended to read:

31         400.962  License required; license application.--

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 1         (1)  The requirements of part II of chapter 408 apply

 2  to the provision of services that require licensure pursuant

 3  to this part and part II of chapter 408 and to entities

 4  licensed by or applying for such licensure from the Agency for

 5  Health Care Administration pursuant to this part. A license

 6  issued by the agency is required in order to operate It is

 7  unlawful to operate an intermediate care facility for the

 8  developmentally disabled in this state without a license.

 9         (2)  Separate licenses are required for facilities

10  maintained on separate premises even if operated under the

11  same management. However, a separate license is not required

12  for separate buildings on the same grounds.

13         (3)  In accordance with s. 408.805, an applicant or

14  licensee shall pay a fee for each license application

15  submitted under this part, part II of chapter 408, and

16  applicable rules. The amount of the fee shall be $234 per bed

17  unless modified by rule. The basic license fee collected shall

18  be deposited in the Health Care Trust Fund, established for

19  carrying out the purposes of this chapter.

20         (4)  The license must be conspicuously displayed inside

21  the facility.

22         (5)  A license is valid only in the hands of the

23  individual, firm, partnership, association, or corporation to

24  whom it is issued. A license is not valid for any premises

25  other than those for which it was originally issued and may

26  not be sold, assigned, or otherwise transferred, voluntarily

27  or involuntarily.

28         (6)  An application for a license shall be made to the

29  agency on forms furnished by it and must be accompanied by the

30  appropriate license fee.

31  

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 1         (7)  The application must be under oath and must

 2  contain the following:

 3         (a)  The name, address, and social security number of

 4  the applicant if an individual; if the applicant is a firm,

 5  partnership, or association, its name, address, and employer

 6  identification number (EIN), and the name and address of every

 7  member; if the applicant is a corporation, its name, address,

 8  and employer identification number (EIN), and the name and

 9  address of its director and officers and of each person having

10  at least a 5 percent interest in the corporation; and the name

11  by which the facility is to be known.

12         (b)  The name of any person whose name is required on

13  the application under paragraph (a) and who owns at least a 10

14  percent interest in any professional service, firm,

15  association, partnership, or corporation providing goods,

16  leases, or services to the facility for which the application

17  is made, and the name and address of the professional service,

18  firm, association, partnership, or corporation in which such

19  interest is held.

20         (c)  The application must indicate the location of the

21  facility for which a license is sought and an indication that

22  such location conforms to the local zoning ordinances.

23         (d)  The name of the persons under whose management or

24  supervision the facility will be operated.

25         (e)  The total number of beds.

26         (4)(8)  The applicant must demonstrate that sufficient

27  numbers of staff, qualified by training or experience, will be

28  employed to properly care for the type and number of residents

29  who will reside in the facility.

30         (9)  The applicant must submit evidence that

31  establishes the good moral character of the applicant,

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 1  manager, supervisor, and administrator. An applicant who is an

 2  individual or a member of a board of directors or officer of

 3  an applicant that is a firm, partnership, association, or

 4  corporation must not have been convicted, or found guilty,

 5  regardless of adjudication, of a crime in any jurisdiction

 6  which affects or may potentially affect residents in the

 7  facility.

 8         (10)(a)  Upon receipt of a completed, signed, and dated

 9  application, the agency shall require background screening of

10  the applicant, in accordance with the level 2 standards for

11  screening set forth in chapter 435. As used in this

12  subsection, the term "applicant" means the facility

13  administrator, or similarly titled individual who is

14  responsible for the day-to-day operation of the licensed

15  facility, and the facility financial officer, or similarly

16  titled individual who is responsible for the financial

17  operation of the licensed facility.

18         (b)  The agency may require background screening for a

19  member of the board of directors of the licensee or an officer

20  or an individual owning 5 percent or more of the licensee if

21  the agency has probable cause to believe that such individual

22  has been convicted of an offense prohibited under the level 2

23  standards for screening set forth in chapter 435.

24         (c)  Proof of compliance with the level 2 background

25  screening requirements of chapter 435 which has been submitted

26  within the previous 5 years in compliance with any other

27  licensure requirements under this chapter or chapter 429

28  satisfies the requirements of paragraph (a). Proof of

29  compliance with background screening which has been submitted

30  within the previous 5 years to fulfill the requirements of the

31  Financial Services Commission and the Office of Insurance

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 1  Regulation under chapter 651 as part of an application for a

 2  certificate of authority to operate a continuing care

 3  retirement community satisfies the requirements for the

 4  Department of Law Enforcement and Federal Bureau of

 5  Investigation background checks.

 6         (d)  A provisional license may be granted to an

 7  applicant when each individual required by this section to

 8  undergo background screening has met the standards for the

 9  Department of Law Enforcement background check, but the agency

10  has not yet received background screening results from the

11  Federal Bureau of Investigation, or a request for a

12  disqualification exemption has been submitted to the agency as

13  set forth in chapter 435, but a response has not yet been

14  issued. A license may be granted to the applicant upon the

15  agency's receipt of a report of the results of the Federal

16  Bureau of Investigation background screening for each

17  individual required by this section to undergo background

18  screening which confirms that all standards have been met, or

19  upon the granting of a disqualification exemption by the

20  agency as set forth in chapter 435. Any other person who is

21  required to undergo level 2 background screening may serve in

22  his or her capacity pending the agency's receipt of the report

23  from the Federal Bureau of Investigation; however, the person

24  may not continue to serve if the report indicates any

25  violation of background screening standards and a

26  disqualification exemption has not been granted by the agency

27  as set forth in chapter 435.

28         (e)  Each applicant must submit to the agency, with its

29  application, a description and explanation of any exclusions,

30  permanent suspensions, or terminations of the applicant from

31  the Medicare or Medicaid programs. Proof of compliance with

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 1  disclosure of ownership and control interest requirements of

 2  the Medicaid or Medicare programs shall be accepted in lieu of

 3  this submission.

 4         (f)  Each applicant must submit to the agency a

 5  description and explanation of any conviction of an offense

 6  prohibited under the level 2 standards of chapter 435 by a

 7  member of the board of directors of the applicant, its

 8  officers, or any individual owning 5 percent or more of the

 9  applicant. This requirement does not apply to a director of a

10  not-for-profit corporation or organization if the director

11  serves solely in a voluntary capacity for the corporation or

12  organization, does not regularly take part in the day-to-day

13  operational decisions of the corporation or organization,

14  receives no remuneration for his or her services on the

15  corporation's or organization's board of directors, and has no

16  financial interest and has no family members with a financial

17  interest in the corporation or organization, provided that the

18  director and the not-for-profit corporation or organization

19  include in the application a statement affirming that the

20  director's relationship to the corporation satisfies the

21  requirements of this paragraph.

22         (g)  An application for license renewal must contain

23  the information required under paragraphs (e) and (f).

24         (11)  The applicant must furnish satisfactory proof of

25  financial ability to operate and conduct the facility in

26  accordance with the requirements of this part and all rules

27  adopted under this part, and the agency shall establish

28  standards for this purpose.

29         (5)(12)  The applicant must agree to provide or arrange

30  for active treatment services by an interdisciplinary team to

31  maximize individual independence or prevent regression or loss

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 1  of functional status. Standards for active treatment shall be

 2  adopted by the Agency for Health Care Administration by rule

 3  pursuant to ss. 120.536(1) and 120.54. Active treatment

 4  services shall be provided in accordance with the individual

 5  support plan and shall be reimbursed as part of the per diem

 6  rate as paid under the Medicaid program.

 7         Section 116.  Section 400.963, Florida Statutes, is

 8  repealed.

 9         Section 117.  Section 400.965, Florida Statutes, is

10  repealed.

11         Section 118.  Section 400.967, Florida Statutes, is

12  amended to read:

13         400.967  Rules and classification of deficiencies.--

14         (1)  It is the intent of the Legislature that rules

15  adopted and enforced under this part and part II of chapter

16  408 include criteria by which a reasonable and consistent

17  quality of resident care may be ensured, the results of such

18  resident care can be demonstrated, and safe and sanitary

19  facilities can be provided.

20         (2)  Pursuant to the intention of the Legislature, the

21  agency, in consultation with the Agency for Persons with

22  Disabilities and the Department of Elderly Affairs, shall

23  adopt and enforce rules to administer this part and part II of

24  chapter 408, which shall include reasonable and fair criteria

25  governing:

26         (a)  The location and construction of the facility;

27  including fire and life safety, plumbing, heating, cooling,

28  lighting, ventilation, and other housing conditions that will

29  ensure the health, safety, and comfort of residents. The

30  agency shall establish standards for facilities and equipment

31  to increase the extent to which new facilities and a new wing

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 1  or floor added to an existing facility after July 1, 2000, are

 2  structurally capable of serving as shelters only for

 3  residents, staff, and families of residents and staff, and

 4  equipped to be self-supporting during and immediately

 5  following disasters. The Agency for Health Care Administration

 6  shall work with facilities licensed under this part and report

 7  to the Governor and the Legislature by April 1, 2000, its

 8  recommendations for cost-effective renovation standards to be

 9  applied to existing facilities. In making such rules, the

10  agency shall be guided by criteria recommended by nationally

11  recognized, reputable professional groups and associations

12  having knowledge concerning such subject matters. The agency

13  shall update or revise such criteria as the need arises. All

14  facilities must comply with those lifesafety code requirements

15  and building code standards applicable at the time of approval

16  of their construction plans. The agency may require

17  alterations to a building if it determines that an existing

18  condition constitutes a distinct hazard to life, health, or

19  safety. The agency shall adopt fair and reasonable rules

20  setting forth conditions under which existing facilities

21  undergoing additions, alterations, conversions, renovations,

22  or repairs are required to comply with the most recent updated

23  or revised standards.

24         (b)  The number and qualifications of all personnel,

25  including management, medical nursing, and other personnel,

26  having responsibility for any part of the care given to

27  residents.

28         (c)  All sanitary conditions within the facility and

29  its surroundings, including water supply, sewage disposal,

30  food handling, and general hygiene, which will ensure the

31  health and comfort of residents.

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 1         (d)  The equipment essential to the health and welfare

 2  of the residents.

 3         (e)  A uniform accounting system.

 4         (f)  The care, treatment, and maintenance of residents

 5  and measurement of the quality and adequacy thereof.

 6         (g)  The preparation and annual update of a

 7  comprehensive emergency management plan. The agency shall

 8  adopt rules establishing minimum criteria for the plan after

 9  consultation with the Department of Community Affairs. At a

10  minimum, the rules must provide for plan components that

11  address emergency evacuation transportation; adequate

12  sheltering arrangements; postdisaster activities, including

13  emergency power, food, and water; postdisaster transportation;

14  supplies; staffing; emergency equipment; individual

15  identification of residents and transfer of records; and

16  responding to family inquiries. The comprehensive emergency

17  management plan is subject to review and approval by the local

18  emergency management agency. During its review, the local

19  emergency management agency shall ensure that the following

20  agencies, at a minimum, are given the opportunity to review

21  the plan: the Department of Elderly Affairs, the Agency for

22  Persons with Disabilities, the Agency for Health Care

23  Administration, and the Department of Community Affairs. Also,

24  appropriate volunteer organizations must be given the

25  opportunity to review the plan. The local emergency management

26  agency shall complete its review within 60 days and either

27  approve the plan or advise the facility of necessary

28  revisions.

29         (h)  The posting of licenses. Each licensee shall post

30  its license in a prominent place that is in clear and

31  

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 1  unobstructed public view at or near the place where residents

 2  are being admitted to the facility.

 3         (h)(i)  The use of restraint and seclusion. Such rules

 4  must be consistent with recognized best practices; prohibit

 5  inherently dangerous restraint or seclusion procedures;

 6  establish limitations on the use and duration of restraint and

 7  seclusion; establish measures to ensure the safety of clients

 8  and staff during an incident of restraint or seclusion;

 9  establish procedures for staff to follow before, during, and

10  after incidents of restraint or seclusion, including

11  individualized plans for the use of restraints or seclusion in

12  emergency situations; establish professional qualifications of

13  and training for staff who may order or be engaged in the use

14  of restraint or seclusion; establish requirements for facility

15  data collection and reporting relating to the use of restraint

16  and seclusion; and establish procedures relating to the

17  documentation of the use of restraint or seclusion in the

18  client's facility or program record.

19         (3)  The agency shall adopt rules to provide that, when

20  the criteria established under this part and part II of

21  chapter 408 subsection (2) are not met, such deficiencies

22  shall be classified according to the nature of the deficiency.

23  The agency shall indicate the classification on the face of

24  the notice of deficiencies as follows:

25         (a)  Class I deficiencies are those which the agency

26  determines present an and imminent danger to the residents or

27  guests of the facility or a substantial probability that death

28  or serious physical harm would result therefrom. The condition

29  or practice constituting a class I violation must be abated or

30  eliminated immediately, unless a fixed period of time, as

31  determined by the agency, is required for correction.

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 1  Notwithstanding s. 400.121(2), A class I deficiency is subject

 2  to a civil penalty in an amount not less than $5,000 and not

 3  exceeding $10,000 for each deficiency. A fine may be levied

 4  notwithstanding the correction of the deficiency.

 5         (b)  Class II deficiencies are those which the agency

 6  determines have a direct or immediate relationship to the

 7  health, safety, or security of the facility residents, other

 8  than class I deficiencies. A class II deficiency is subject to

 9  a civil penalty in an amount not less than $1,000 and not

10  exceeding $5,000 for each deficiency. A citation for a class

11  II deficiency shall specify the time within which the

12  deficiency must be corrected. If a class II deficiency is

13  corrected within the time specified, no civil penalty shall be

14  imposed, unless it is a repeated offense.

15         (c)  Class III deficiencies are those which the agency

16  determines to have an indirect or potential relationship to

17  the health, safety, or security of the facility residents,

18  other than class I or class II deficiencies. A class III

19  deficiency is subject to a civil penalty of not less than $500

20  and not exceeding $1,000 for each deficiency. A citation for a

21  class III deficiency shall specify the time within which the

22  deficiency must be corrected. If a class III deficiency is

23  corrected within the time specified, no civil penalty shall be

24  imposed, unless it is a repeated offense.

25         (4)  Civil penalties paid by any licensee under

26  subsection (3) shall be deposited in the Health Care Trust

27  Fund and expended as provided in s. 400.063.

28         (4)(5)  The agency shall approve or disapprove the

29  plans and specifications within 60 days after receipt of the

30  final plans and specifications. The agency may be granted one

31  15-day extension for the review period, if the secretary of

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 1  the agency so approves. If the agency fails to act within the

 2  specified time, it is deemed to have approved the plans and

 3  specifications. When the agency disapproves plans and

 4  specifications, it must set forth in writing the reasons for

 5  disapproval. Conferences and consultations may be provided as

 6  necessary.

 7         (5)(6)  The agency may charge an initial fee of $2,000

 8  for review of plans and construction on all projects, no part

 9  of which is refundable. The agency may also collect a fee, not

10  to exceed 1 percent of the estimated construction cost or the

11  actual cost of review, whichever is less, for the portion of

12  the review which encompasses initial review through the

13  initial revised construction document review. The agency may

14  collect its actual costs on all subsequent portions of the

15  review and construction inspections. Initial fee payment must

16  accompany the initial submission of plans and specifications.

17  Any subsequent payment that is due is payable upon receipt of

18  the invoice from the agency. Notwithstanding any other

19  provision of law, all money received by the agency under this

20  section shall be deemed to be trust funds, to be held and

21  applied solely for the operations required under this section.

22         Section 119.  Section 400.968, Florida Statutes, is

23  amended to read:

24         400.968  Right of entry; protection of health, safety,

25  and welfare.--

26         (1)  In addition to the requirements of s. 408.811, any

27  designated officer or employee of the agency, or any officer

28  or employee of the state, or of the local fire marshal, may

29  enter unannounced the premises of any facility licensed under

30  this part in order to determine the state of compliance with

31  this part, part II of chapter 408, and applicable rules and

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 1  the rules or standards in force under this part. The right of

 2  entry and inspection also extends to any premises that the

 3  agency has reason to believe are being operated or maintained

 4  as a facility without a license; but such an entry or

 5  inspection may not be made without the permission of the owner

 6  or person in charge of the facility unless a warrant that

 7  authorizes the entry is first obtained from the circuit court.

 8  The warrant requirement extends only to a facility that the

 9  agency has reason to believe is being operated or maintained

10  as a facility without a license. An application for a license

11  or renewal thereof which is made under this section

12  constitutes permission for, and acquiescence in, any entry or

13  inspection of the premises for which the license is sought, in

14  order to facilitate verification of the information submitted

15  in connection with the application; to discover, investigate,

16  and determine the existence of abuse or neglect; or to elicit,

17  receive, respond to, and resolve complaints. A current valid

18  license constitutes unconditional permission for, and

19  acquiescence in, any entry or inspection of the premises by

20  authorized personnel. The agency retains the right of entry

21  and inspection of facilities that have had a license revoked

22  or suspended within the previous 24 months, to ensure that the

23  facility is not operating unlawfully. However, before the

24  facility is entered, a statement of probable cause must be

25  filed with the director of the agency, who must approve or

26  disapprove the action within 48 hours.

27         (2)  The agency may institute injunctive proceedings in

28  a court of competent jurisdiction for temporary or permanent

29  relief to:

30         (a)  Enforce this section or any minimum standard,

31  rule, or order issued pursuant thereto if the agency's effort

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 1  to correct a violation through administrative fines has failed

 2  or when the violation materially affects the health, safety,

 3  or welfare of residents; or

 4         (b)  Terminate the operation of a facility if a

 5  violation of this section or of any standard or rule adopted

 6  pursuant thereto exists which materially affects the health,

 7  safety, or welfare of residents.

 8  

 9  The Legislature recognizes that, in some instances, action is

10  necessary to protect residents of facilities from immediately

11  life-threatening situations. If it appears by competent

12  evidence or a sworn, substantiated affidavit that a temporary

13  injunction should issue, the court, pending the determination

14  on final hearing, shall enjoin operation of the facility.

15         (3)  The agency may impose an immediate moratorium on

16  admissions to a facility when the agency determines that any

17  condition in the facility presents a threat to the health,

18  safety, or welfare of the residents in the facility. If a

19  facility's license is denied, revoked, or suspended, the

20  facility may be subject to the immediate imposition of a

21  moratorium on admissions to run concurrently with licensure

22  denial, revocation, or suspension.

23         Section 120.  Subsection (1) of section 400.969,

24  Florida Statutes, is amended to read:

25         400.969  Violation of part; penalties.--

26         (1)  In addition to the requirements of part II of

27  chapter 408, and except as provided in s. 400.967(3), a

28  violation of any provision of this part, part II of chapter

29  408, or applicable rules adopted by the agency under this part

30  is punishable by payment of an administrative or civil penalty

31  not to exceed $5,000.

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 1         Section 121.  Section 400.980, Florida Statutes, is

 2  amended to read:

 3         400.980  Health care services pools.--

 4         (1)  As used in this section, the term:

 5         (a)  "Agency" means the Agency for Health Care

 6  Administration.

 7         (b)  "Health care services pool" means any person,

 8  firm, corporation, partnership, or association engaged for

 9  hire in the business of providing temporary employment in

10  health care facilities, residential facilities, and agencies

11  for licensed, certified, or trained health care personnel

12  including, without limitation, nursing assistants, nurses'

13  aides, and orderlies. However, the term does not include

14  nursing registries, a facility licensed under this chapter or

15  chapter 429, a health care services pool established within a

16  health care facility to provide services only within the

17  confines of such facility, or any individual contractor

18  directly providing temporary services to a health care

19  facility without use or benefit of a contracting agent.

20         (2)  The requirements of part II of chapter 408 apply

21  to the provision of services that require licensure or

22  registration pursuant to this part and part II of chapter 408

23  and to entities registered by or applying for such

24  registration from the agency pursuant to this part.

25  Registration or a license issued by the agency is required for

26  the operation of Each person who operates a health care

27  services pool in this state. In accordance with s. 408.805, an

28  applicant or licensee shall pay a fee for each license

29  application submitted using this part, part II of chapter 408,

30  and applicable rules. must register each separate business

31  location with the agency. The agency shall adopt rules and

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 1  provide forms required for such registration and shall impose

 2  a registration fee in an amount sufficient to cover the cost

 3  of administering this part and part II of chapter 408 section.

 4  In addition to the requirements in part II of chapter 408, the

 5  registrant must provide the agency with any change of

 6  information contained on the original registration application

 7  within 14 days prior to the change. The agency may inspect the

 8  offices of any health care services pool at any reasonable

 9  time for the purpose of determining compliance with this

10  section or the rules adopted under this section.

11         (3)  Each application for registration must include:

12         (a)  The name and address of any person who has an

13  ownership interest in the business, and, in the case of a

14  corporate owner, copies of the articles of incorporation,

15  bylaws, and names and addresses of all officers and directors

16  of the corporation.

17         (b)  Any other information required by the agency.

18         (3)(4)  Each applicant for registration must comply

19  with the following requirements:

20         (a)  Upon receipt of a completed, signed, and dated

21  application, the agency shall require background screening, in

22  accordance with the level 1 standards for screening set forth

23  in chapter 435, of every individual who will have contact with

24  patients. The agency shall require background screening of the

25  managing employee or other similarly titled individual who is

26  responsible for the operation of the entity, and of the

27  financial officer or other similarly titled individual who is

28  responsible for the financial operation of the entity,

29  including billings for services in accordance with the level 2

30  standards for background screening as set forth in chapter

31  435.

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 1         (b)  The agency may require background screening of any

 2  other individual who is affiliated with the applicant if the

 3  agency has a reasonable basis for believing that he or she has

 4  been convicted of a crime or has committed any other offense

 5  prohibited under the level 2 standards for screening set forth

 6  in chapter 435.

 7         (c)  Proof of compliance with the level 2 background

 8  screening requirements of chapter 435 which has been submitted

 9  within the previous 5 years in compliance with any other

10  health care or assisted living licensure requirements of this

11  state is acceptable in fulfillment of paragraph (a).

12         (d)  A provisional registration may be granted to an

13  applicant when each individual required by this section to

14  undergo background screening has met the standards for the

15  Department of Law Enforcement background check but the agency

16  has not yet received background screening results from the

17  Federal Bureau of Investigation. A standard registration may

18  be granted to the applicant upon the agency's receipt of a

19  report of the results of the Federal Bureau of Investigation

20  background screening for each individual required by this

21  section to undergo background screening which confirms that

22  all standards have been met, or upon the granting of a

23  disqualification exemption by the agency as set forth in

24  chapter 435. Any other person who is required to undergo level

25  2 background screening may serve in his or her capacity

26  pending the agency's receipt of the report from the Federal

27  Bureau of Investigation. However, the person may not continue

28  to serve if the report indicates any violation of background

29  screening standards and if a disqualification exemption has

30  not been requested of and granted by the agency as set forth

31  in chapter 435.

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 1         (e)  Each applicant must submit to the agency, with its

 2  application, a description and explanation of any exclusions,

 3  permanent suspensions, or terminations of the applicant from

 4  the Medicare or Medicaid programs. Proof of compliance with

 5  the requirements for disclosure of ownership and controlling

 6  interests under the Medicaid or Medicare programs may be

 7  accepted in lieu of this submission.

 8         (f)  Each applicant must submit to the agency a

 9  description and explanation of any conviction of an offense

10  prohibited under the level 2 standards of chapter 435 which

11  was committed by a member of the board of directors of the

12  applicant, its officers, or any individual owning 5 percent or

13  more of the applicant. This requirement does not apply to a

14  director of a not-for-profit corporation or organization who

15  serves solely in a voluntary capacity for the corporation or

16  organization, does not regularly take part in the day-to-day

17  operational decisions of the corporation or organization,

18  receives no remuneration for his or her services on the

19  corporation's or organization's board of directors, and has no

20  financial interest and no family members having a financial

21  interest in the corporation or organization, if the director

22  and the not-for-profit corporation or organization include in

23  the application a statement affirming that the director's

24  relationship to the corporation satisfies the requirements of

25  this paragraph.

26         (g)  A registration may not be granted to an applicant

27  if the applicant or managing employee has been found guilty

28  of, regardless of adjudication, or has entered a plea of nolo

29  contendere or guilty to, any offense prohibited under the

30  level 2 standards for screening set forth in chapter 435,

31  

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 1  unless an exemption from disqualification has been granted by

 2  the agency as set forth in chapter 435.

 3         (h)  Failure to provide all required documentation

 4  within 30 days after a written request from the agency will

 5  result in denial of the application for registration.

 6         (i)  The agency must take final action on an

 7  application for registration within 60 days after receipt of

 8  all required documentation.

 9         (j)  The agency may deny, revoke, or suspend the

10  registration of any applicant or registrant who:

11         1.  Has falsely represented a material fact in the

12  application required by paragraph (e) or paragraph (f), or has

13  omitted any material fact from the application required by

14  paragraph (e) or paragraph (f); or

15         2.  Has had prior action taken against the applicant

16  under the Medicaid or Medicare program as set forth in

17  paragraph (e).

18         3.  Fails to comply with this section or applicable

19  rules.

20         4.  Commits an intentional, reckless, or negligent act

21  that materially affects the health or safety of a person

22  receiving services.

23         (5)  It is a misdemeanor of the first degree,

24  punishable under s. 775.082 or s. 775.083, for any person

25  willfully, knowingly, or intentionally to:

26         (a)  Fail, by false statement, misrepresentation,

27  impersonation, or other fraudulent means, to disclose in any

28  application for voluntary or paid employment a material fact

29  used in making a determination as to an applicant's

30  qualifications to be a contractor under this section;

31  

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 1         (b)  Operate or attempt to operate an entity registered

 2  under this part with persons who do not meet the minimum

 3  standards of chapter 435 as contained in this section; or

 4         (c)  Use information from the criminal records obtained

 5  under this section for any purpose other than screening an

 6  applicant for temporary employment as specified in this

 7  section, or release such information to any other person for

 8  any purpose other than screening for employment under this

 9  section.

10         (6)  It is a felony of the third degree, punishable

11  under s. 775.082, s. 775.083, or s. 775.084, for any person

12  willfully, knowingly, or intentionally to use information from

13  the juvenile records of a person obtained under this section

14  for any purpose other than screening for employment under this

15  section.

16         (7)  It is unlawful for a person to offer or advertise

17  services, as defined by rule, to the public without obtaining

18  a certificate of registration from the Agency for Health Care

19  Administration. It is unlawful for any holder of a certificate

20  of registration to advertise or hold out to the public that he

21  or she holds a certificate of registration for other than that

22  for which he or she actually holds a certificate of

23  registration. Any person who violates this subsection is

24  subject to injunctive proceedings under s. 400.515.

25         (8)  Each registration shall be for a period of 2

26  years. The application for renewal must be received by the

27  agency at least 30 days before the expiration date of the

28  registration. An application for a new registration is

29  required within 30 days prior to the sale of a controlling

30  interest in a health care services pool.

31  

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 1         (4)(9)  A health care services pool may not require an

 2  employee to recruit new employees from persons employed at a

 3  health care facility to which the health care services pool

 4  employee is assigned. Nor shall a health care facility to

 5  which employees of a health care services pool are assigned

 6  recruit new employees from the health care services pool.

 7         (5)(10)  A health care services pool shall document

 8  that each temporary employee provided to a health care

 9  facility has met the licensing, certification, training, or

10  continuing education requirements, as established by the

11  appropriate regulatory agency, for the position in which he or

12  she will be working.

13         (6)(11)  When referring persons for temporary

14  employment in health care facilities, a health care services

15  pool shall comply with all pertinent state and federal laws,

16  rules, and regulations relating to health, background

17  screening, and other qualifications required of persons

18  working in a facility of that type.

19         (7)(12)(a)  As a condition of registration and prior to

20  the issuance or renewal of a certificate of registration, a

21  health care services pool applicant must prove financial

22  responsibility to pay claims, and costs ancillary thereto,

23  arising out of the rendering of services or failure to render

24  services by the pool or by its employees in the course of

25  their employment with the pool. The agency shall promulgate

26  rules establishing minimum financial responsibility coverage

27  amounts which shall be adequate to pay potential claims and

28  costs ancillary thereto.

29         (b)  Each health care services pool shall give written

30  notification to the agency within 20 days after any change in

31  the method of assuring financial responsibility or upon

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 1  cancellation or nonrenewal of professional liability

 2  insurance. Unless the pool demonstrates that it is otherwise

 3  in compliance with the requirements of this subsection

 4  section, the agency shall suspend the registration of the pool

 5  pursuant to s. 408.814 ss. 120.569 and 120.57. Any suspension

 6  under this section shall remain in effect until the pool

 7  demonstrates compliance with the requirements of this

 8  subsection section.

 9         (c)  Proof of financial responsibility must be

10  demonstrated to the satisfaction of the agency, through one of

11  the following methods:

12         1.  Establishing and maintaining an escrow account

13  consisting of cash or assets eligible for deposit in

14  accordance with s. 625.52;

15         2.  Obtaining and maintaining an unexpired irrevocable

16  letter of credit established pursuant to chapter 675. Such

17  letters of credit shall be nontransferable and nonassignable

18  and shall be issued by any bank or savings association

19  organized and existing under the laws of this state or any

20  bank or savings association organized under the laws of the

21  United States that has its principal place of business in this

22  state or has a branch office which is authorized under the

23  laws of this state or of the United States to receive deposits

24  in this state; or

25         3.  Obtaining and maintaining professional liability

26  coverage from one of the following:

27         a.  An authorized insurer as defined under s. 624.09;

28         b.  An eligible surplus lines insurer as defined under

29  s. 626.918(2);

30         c.  A risk retention group or purchasing group as

31  defined under s. 627.942; or

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 1         d.  A plan of self-insurance as provided in s. 627.357.

 2         (d)  If financial responsibility requirements are met

 3  by maintaining an escrow account or letter of credit, as

 4  provided in this subsection section, upon the entry of an

 5  adverse final judgment arising from a medical malpractice

 6  arbitration award from a claim of medical malpractice either

 7  in contract or tort, or from noncompliance with the terms of a

 8  settlement agreement arising from a claim of medical

 9  malpractice either in contract or tort, the financial

10  institution holding the escrow account or the letter of credit

11  shall pay directly to the claimant the entire amount of the

12  judgment together with all accrued interest or the amount

13  maintained in the escrow account or letter of credit as

14  required by this subsection section, whichever is less, within

15  60 days after the date such judgment became final and subject

16  to execution, unless otherwise mutually agreed to in writing

17  by the parties. If timely payment is not made, the agency

18  shall suspend the registration of the pool pursuant to

19  procedures set forth by the agency through rule. Nothing in

20  this paragraph shall abrogate a judgment debtor's obligation

21  to satisfy the entire amount of any judgment.

22         (e)  Each health care services pool carrying

23  claims-made coverage must demonstrate proof of extended

24  reporting coverage through either tail or nose coverage, in

25  the event the policy is canceled, replaced, or not renewed.

26  Such extended coverage shall provide coverage for incidents

27  that occurred during the claims-made policy period but were

28  reported after the policy period.

29         (f)  The financial responsibility requirements of this

30  subsection section shall apply to claims for incidents that

31  

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 1  occur on or after January 1, 1991, or the initial date of

 2  registration in this state, whichever is later.

 3         (g)  Meeting the financial responsibility requirements

 4  of this subsection section must be established at the time of

 5  issuance or renewal of a certificate of registration.

 6         (8)(13)  In addition to the requirements of part II of

 7  chapter 408, the agency shall adopt rules to implement this

 8  part section, including rules providing for the establishment

 9  of:

10         (a)  Minimum standards for the operation and

11  administration of health care personnel pools, including

12  procedures for recordkeeping and personnel.

13         (b)  Fines for the violation of this part, part II of

14  chapter 408, or applicable rules section in an amount not to

15  exceed $2,500 and suspension or revocation of registration.

16         (c)  Disciplinary sanctions for failure to comply with

17  this section or the rules adopted under this section.

18         Section 122.  Section 400.991, Florida Statutes, is

19  amended to read:

20         400.991  License requirements; background screenings;

21  prohibitions.--

22         (1)(a)  The requirements of part II of chapter 408

23  apply to the provision of services that require licensure

24  pursuant to this part and part II of chapter 408 and to

25  entities licensed by or applying for such licensure from the

26  agency pursuant to this part. A license issued by the agency

27  is required in order to operate a clinic in this state. Each

28  clinic, as defined in s. 400.9905, must be licensed and shall

29  at all times maintain a valid license with the agency. Each

30  clinic location shall be licensed separately regardless of

31  

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 1  whether the clinic is operated under the same business name or

 2  management as another clinic.

 3         (b)  Each mobile clinic must obtain a separate health

 4  care clinic license and must provide to the agency, at least

 5  quarterly, its projected street location to enable the agency

 6  to locate and inspect such clinic. A portable equipment

 7  provider must obtain a health care clinic license for a single

 8  administrative office and is not required to submit quarterly

 9  projected street locations.

10         (2)  The initial clinic license application shall be

11  filed with the agency by all clinics, as defined in s.

12  400.9905, on or before July 1, 2004. A clinic license must be

13  renewed biennially.

14         (3)  Applicants that submit an application on or before

15  July 1, 2004, which meets all requirements for initial

16  licensure as specified in this section shall receive a

17  temporary license until the completion of an initial

18  inspection verifying that the applicant meets all requirements

19  in rules authorized in s. 400.9925. However, a clinic engaged

20  in magnetic resonance imaging services may not receive a

21  temporary license unless it presents evidence satisfactory to

22  the agency that such clinic is making a good faith effort and

23  substantial progress in seeking accreditation required under

24  s. 400.9935.

25         (4)  Application for an initial clinic license or for

26  renewal of an existing license shall be notarized on forms

27  furnished by the agency and must be accompanied by the

28  appropriate license fee as provided in s. 400.9925. The agency

29  shall take final action on an initial license application

30  within 60 days after receipt of all required documentation.

31  

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 1         (3)(5)  The application shall contain information that

 2  includes, but need not be limited to, information pertaining

 3  to the name, residence and business address, phone number,

 4  social security number, and license number of the medical or

 5  clinic director, of the licensed medical providers employed or

 6  under contract with the clinic, and of each person who,

 7  directly or indirectly, owns or controls 5 percent or more of

 8  an interest in the clinic, or general partners in limited

 9  liability partnerships.

10         (4)(6)  In addition to the requirements of part II of

11  chapter 408, the applicant must file with the application

12  satisfactory proof that the clinic is in compliance with this

13  part and applicable rules, including:

14         (a)  A listing of services to be provided either

15  directly by the applicant or through contractual arrangements

16  with existing providers;

17         (b)  The number and discipline of each professional

18  staff member to be employed; and

19         (c)  Proof of financial ability to operate as required

20  under s. 408.810(8). An applicant must demonstrate financial

21  ability to operate a clinic by submitting a balance sheet and

22  an income and expense statement for the first year of

23  operation which provide evidence of the applicant's having

24  sufficient assets, credit, and projected revenues to cover

25  liabilities and expenses. The applicant shall have

26  demonstrated financial ability to operate if the applicant's

27  assets, credit, and projected revenues meet or exceed

28  projected liabilities and expenses. All documents required

29  under this subsection must be prepared in accordance with

30  generally accepted accounting principles, may be in a

31  compilation form, and the financial statement must be signed

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 1  by a certified public accountant. As an alternative to

 2  submitting proof of financial ability to operate as required

 3  under s. 408.810(8) a balance sheet and an income and expense

 4  statement for the first year of operation, the applicant may

 5  file a surety bond of at least $500,000 which guarantees that

 6  the clinic will act in full conformity with all legal

 7  requirements for operating a clinic, payable to the agency.

 8  The agency may adopt rules to specify related requirements for

 9  such surety bond.

10         (5)(7)  Each applicant for licensure shall comply with

11  the following requirements:

12         (a)  As used in this subsection, the term "applicant"

13  means individuals owning or controlling, directly or

14  indirectly, 5 percent or more of an interest in a clinic; the

15  medical or clinic director, or a similarly titled person who

16  is responsible for the day-to-day operation of the licensed

17  clinic; the financial officer or similarly titled individual

18  who is responsible for the financial operation of the clinic;

19  and licensed health care practitioners at the clinic.

20         (b)  Upon receipt of a completed, signed, and dated

21  application, the agency shall require background screening of

22  the applicant, in accordance with the level 2 standards for

23  screening set forth in chapter 435. Proof of compliance with

24  the level 2 background screening requirements of chapter 435

25  which has been submitted within the previous 5 years in

26  compliance with any other health care licensure requirements

27  of this state is acceptable in fulfillment of this paragraph.

28  Applicants who own less than 10 percent of a health care

29  clinic are not required to submit fingerprints under this

30  section.

31  

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 1         (c)  Each applicant must submit to the agency, with the

 2  application, a description and explanation of any exclusions,

 3  permanent suspensions, or terminations of an applicant from

 4  the Medicare or Medicaid programs. Proof of compliance with

 5  the requirements for disclosure of ownership and control

 6  interest under the Medicaid or Medicare programs may be

 7  accepted in lieu of this submission. The description and

 8  explanation may indicate whether such exclusions, suspensions,

 9  or terminations were voluntary or not voluntary on the part of

10  the applicant.

11         (d)  A license may not be granted to a clinic if the

12  applicant has been found guilty of, regardless of

13  adjudication, or has entered a plea of nolo contendere or

14  guilty to, any offense prohibited under the level 2 standards

15  for screening set forth in chapter 435, or a violation of

16  insurance fraud under s. 817.234, within the past 5 years. If

17  the applicant has been convicted of an offense prohibited

18  under the level 2 standards or insurance fraud in any

19  jurisdiction, the applicant must show that his or her civil

20  rights have been restored prior to submitting an application.

21         (e)  The agency may deny or revoke licensure if the

22  applicant has falsely represented any material fact or omitted

23  any material fact from the application required by this part.

24         (8)  Requested information omitted from an application

25  for licensure, license renewal, or transfer of ownership must

26  be filed with the agency within 21 days after receipt of the

27  agency's request for omitted information, or the application

28  shall be deemed incomplete and shall be withdrawn from further

29  consideration.

30  

31  

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 1         (9)  The failure to file a timely renewal application

 2  shall result in a late fee charged to the facility in an

 3  amount equal to 50 percent of the current license fee.

 4         Section 123.  Section 400.9915, Florida Statutes, is

 5  amended to read:

 6         400.9915  Clinic inspections; Emergency suspension;

 7  costs.--

 8         (1)  Any authorized officer or employee of the agency

 9  shall make inspections of the clinic as part of the initial

10  license application or renewal application. The application

11  for a clinic license issued under this part or for a renewal

12  license constitutes permission for an appropriate agency

13  inspection to verify the information submitted on or in

14  connection with the application or renewal.

15         (2)  An authorized officer or employee of the agency

16  may make unannounced inspections of clinics licensed pursuant

17  to this part as are necessary to determine that the clinic is

18  in compliance with this part and with applicable rules. A

19  licensed clinic shall allow full and complete access to the

20  premises and to billing records or information to any

21  representative of the agency who makes an inspection to

22  determine compliance with this part and with applicable rules.

23         (1)(3)  Failure by a clinic licensed under this part to

24  allow full and complete access to the premises and to billing

25  records or information to any representative of the agency who

26  makes a request to inspect the clinic to determine compliance

27  with this part or failure by a clinic to employ a qualified

28  medical director or clinic director constitutes a ground for

29  emergency suspension of the license by the agency pursuant to

30  s. 408.814 s. 120.60(6).

31  

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 1         (2)(4)  In addition to any administrative fines imposed

 2  pursuant to this part or part II of chapter 408, the agency

 3  may assess a fee equal to the cost of conducting a complaint

 4  investigation.

 5         Section 124.  Section 400.992, Florida Statutes, is

 6  repealed.

 7         Section 125.  Section 400.9925, Florida Statutes, is

 8  amended to read:

 9         400.9925  Rulemaking authority; license fees.--

10         (1)  The agency shall adopt rules necessary to

11  administer the clinic administration, regulation, and

12  licensure program, including rules pursuant to this part and

13  part II of chapter 408, establishing the specific licensure

14  requirements, procedures, forms, and fees. It shall adopt

15  rules establishing a procedure for the biennial renewal of

16  licenses. The agency may issue initial licenses for less than

17  the full 2-year period by charging a prorated licensure fee

18  and specifying a different renewal date than would otherwise

19  be required for biennial licensure. The rules shall specify

20  the expiration dates of licenses, the process of tracking

21  compliance with financial responsibility requirements, and any

22  other conditions of renewal required by law or rule.

23         (2)  The agency shall adopt rules specifying

24  limitations on the number of licensed clinics and licensees

25  for which a medical director or a clinic director may assume

26  responsibility for purposes of this part. In determining the

27  quality of supervision a medical director or a clinic director

28  can provide, the agency shall consider the number of clinic

29  employees, the clinic location, and the health care services

30  provided by the clinic.

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 1         (3)  In accordance with s. 408.805, an applicant or a

 2  licensee shall pay a fee for each license application

 3  submitted under this part, part II of chapter 408, and

 4  applicable rules. The amount of the fee shall be established

 5  by rule and may not exceed $2,000. License application and

 6  renewal fees must be reasonably calculated by the agency to

 7  cover its costs in carrying out its responsibilities under

 8  this part, including the cost of licensure, inspection, and

 9  regulation of clinics, and must be of such amount that the

10  total fees collected do not exceed the cost of administering

11  and enforcing compliance with this part. Clinic licensure fees

12  are nonrefundable and may not exceed $2,000. The agency shall

13  adjust the license fee annually by not more than the change in

14  the Consumer Price Index based on the 12 months immediately

15  preceding the increase. All fees collected under this part

16  must be deposited in the Health Care Trust Fund for the

17  administration of this part.

18         Section 126.  Section 400.993, Florida Statutes, is

19  amended to read:

20         400.993  Unlicensed clinics; reporting penalties;

21  fines; verification of licensure status.--

22         (1)  It is unlawful to own, operate, or maintain a

23  clinic without obtaining a license under this part.

24         (1)(2)  Any person who violates s. 408.812 regarding

25  unlicensed activity owns, operates, or maintains an unlicensed

26  clinic commits a felony of the third degree, punishable as

27  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

28  continued operation is a separate offense.

29         (2)(3)  Any person found guilty of violating s. 408.812

30  subsection (2) a second or subsequent time commits a felony of

31  the second degree, punishable as provided under s. 775.082, s.

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 1  775.083, or s. 775.084. Each day of continued operation is a

 2  separate offense.

 3         (4)  Any person who owns, operates, or maintains an

 4  unlicensed clinic due to a change in this part or a

 5  modification in agency rules within 6 months after the

 6  effective date of such change or modification and who, within

 7  10 working days after receiving notification from the agency,

 8  fails to cease operation or apply for a license under this

 9  part commits a felony of the third degree, punishable as

10  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

11  continued operation is a separate offense.

12         (5)  Any clinic that fails to cease operation after

13  agency notification may be fined for each day of noncompliance

14  pursuant to this part.

15         (6)  When a person has an interest in more than one

16  clinic, and fails to obtain a license for any one of these

17  clinics, the agency may revoke the license, impose a

18  moratorium, or impose a fine pursuant to this part on any or

19  all of the licensed clinics until such time as the unlicensed

20  clinic is licensed or ceases operation.

21         (7)  Any person aware of the operation of an unlicensed

22  clinic must report that facility to the agency.

23         (3)(8)  In addition to the requirements of part II of

24  chapter 408, any health care provider who is aware of the

25  operation of an unlicensed clinic shall report that facility

26  to the agency. Failure to report a clinic that the provider

27  knows or has reasonable cause to suspect is unlicensed shall

28  be reported to the provider's licensing board.

29         (9)  The agency may not issue a license to a clinic

30  that has any unpaid fines assessed under this part.

31  

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 1         Section 127.  Section 400.9935, Florida Statutes, is

 2  amended to read:

 3         400.9935  Clinic responsibilities.--

 4         (1)  Each clinic shall appoint a medical director or

 5  clinic director who shall agree in writing to accept legal

 6  responsibility for the following activities on behalf of the

 7  clinic. The medical director or the clinic director shall:

 8         (a)  Have signs identifying the medical director or

 9  clinic director posted in a conspicuous location within the

10  clinic readily visible to all patients.

11         (b)  Ensure that all practitioners providing health

12  care services or supplies to patients maintain a current

13  active and unencumbered Florida license.

14         (c)  Review any patient referral contracts or

15  agreements executed by the clinic.

16         (d)  Ensure that all health care practitioners at the

17  clinic have active appropriate certification or licensure for

18  the level of care being provided.

19         (e)  Serve as the clinic records owner as defined in s.

20  456.057.

21         (f)  Ensure compliance with the recordkeeping, office

22  surgery, and adverse incident reporting requirements of

23  chapter 456, the respective practice acts, and rules adopted

24  under this part and part II of chapter 408.

25         (g)  Conduct systematic reviews of clinic billings to

26  ensure that the billings are not fraudulent or unlawful. Upon

27  discovery of an unlawful charge, the medical director or

28  clinic director shall take immediate corrective action. If the

29  clinic performs only the technical component of magnetic

30  resonance imaging, static radiographs, computed tomography, or

31  positron emission tomography, and provides the professional

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 1  interpretation of such services, in a fixed facility that is

 2  accredited by the Joint Commission on Accreditation of

 3  Healthcare Organizations or the Accreditation Association for

 4  Ambulatory Health Care, and the American College of Radiology;

 5  and if, in the preceding quarter, the percentage of scans

 6  performed by that clinic which was billed to all personal

 7  injury protection insurance carriers was less than 15 percent,

 8  the chief financial officer of the clinic may, in a written

 9  acknowledgment provided to the agency, assume the

10  responsibility for the conduct of the systematic reviews of

11  clinic billings to ensure that the billings are not fraudulent

12  or unlawful.

13         (h)  Not refer a patient to the clinic if the clinic

14  performs magnetic resonance imaging, static radiographs,

15  computed tomography, or positron emission tomography. The term

16  "refer a patient" means the referral of one or more patients

17  of the medical or clinical director or a member of the medical

18  or clinical director's group practice to the clinic for

19  magnetic resonance imaging, static radiographs, computed

20  tomography, or positron emission tomography. A medical

21  director who is found to violate this paragraph commits a

22  felony of the third degree, punishable as provided in s.

23  775.082, s. 775.083, or s. 775.084.

24         (2)  Any business that becomes a clinic after

25  commencing operations must, within 5 days after becoming a

26  clinic, file a license application under this part and shall

27  be subject to all provisions of this part applicable to a

28  clinic.

29         (2)(3)  Any contract to serve as a medical director or

30  a clinic director entered into or renewed by a physician or a

31  licensed health care practitioner in violation of this part is

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 1  void as contrary to public policy. This subsection shall apply

 2  to contracts entered into or renewed on or after March 1,

 3  2004.

 4         (3)(4)  All charges or reimbursement claims made by or

 5  on behalf of a clinic that is required to be licensed under

 6  this part, but that is not so licensed, or that is otherwise

 7  operating in violation of this part, are unlawful charges, and

 8  therefore are noncompensable and unenforceable.

 9         (4)(5)  In addition to the requirements of s. 408.812,

10  any person establishing, operating, or managing an unlicensed

11  clinic otherwise required to be licensed under this part or

12  part II of chapter 408, or any person who knowingly files a

13  false or misleading license application or license renewal

14  application, or false or misleading information related to

15  such application or department rule, commits a felony of the

16  third degree, punishable as provided in s. 775.082, s.

17  775.083, or s. 775.084.

18         (5)(6)  Any licensed health care provider who violates

19  this part is subject to discipline in accordance with this

20  chapter and his or her respective practice act.

21         (7)  The agency may fine, or suspend or revoke the

22  license of, any clinic licensed under this part for operating

23  in violation of the requirements of this part or the rules

24  adopted by the agency.

25         (8)  The agency shall investigate allegations of

26  noncompliance with this part and the rules adopted under this

27  part.

28         (6)(9)  Any person or entity providing health care

29  services which is not a clinic, as defined under s. 400.9905,

30  may voluntarily apply for a certificate of exemption from

31  licensure under its exempt status with the agency on a form

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 1  that sets forth its name or names and addresses, a statement

 2  of the reasons why it cannot be defined as a clinic, and other

 3  information deemed necessary by the agency. An exemption is

 4  not transferable. The agency may charge an applicant for a

 5  certificate of exemption in an amount equal to $100 or the

 6  actual cost of processing the certificate, whichever is less.

 7         (10)  The clinic shall display its license in a

 8  conspicuous location within the clinic readily visible to all

 9  patients.

10         (7)(11)(a)  Each clinic engaged in magnetic resonance

11  imaging services must be accredited by the Joint Commission on

12  Accreditation of Healthcare Organizations, the American

13  College of Radiology, or the Accreditation Association for

14  Ambulatory Health Care, within 1 year after licensure.

15  However, a clinic may request a single, 6-month extension if

16  it provides evidence to the agency establishing that, for good

17  cause shown, such clinic can not be accredited within 1 year

18  after licensure, and that such accreditation will be completed

19  within the 6-month extension. After obtaining accreditation as

20  required by this subsection, each such clinic must maintain

21  accreditation as a condition of renewal of its license.

22         (b)  The agency may deny the application or revoke the

23  license of any entity formed for the purpose of avoiding

24  compliance with the accreditation provisions of this

25  subsection and whose principals were previously principals of

26  an entity that was unable to meet the accreditation

27  requirements within the specified timeframes. The agency may

28  adopt rules as to the accreditation of magnetic resonance

29  imaging clinics.

30         (8)(12)  The agency shall give full faith and credit

31  pertaining to any past variance and waiver granted to a

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 1  magnetic resonance imaging clinic from rule 64-2002, Florida

 2  Administrative Code, by the Department of Health, until

 3  September 2004. After that date, such clinic must request a

 4  variance and waiver from the agency under s. 120.542.

 5         (9)(13)  In addition to the requirements of part II of

 6  chapter 408, the clinic shall display a sign in a conspicuous

 7  location within the clinic readily visible to all patients

 8  indicating that, pursuant to s. 626.9892, the Department of

 9  Financial Services may pay rewards of up to $25,000 to persons

10  providing information leading to the arrest and conviction of

11  persons committing crimes investigated by the Division of

12  Insurance Fraud arising from violations of s. 440.105, s.

13  624.15, s. 626.9541, s. 626.989, or s. 817.234. An authorized

14  employee of the Division of Insurance Fraud may make

15  unannounced inspections of a clinic licensed under this part

16  as necessary to determine whether the clinic is in compliance

17  with this subsection. A licensed clinic shall allow full and

18  complete access to the premises to such authorized employee of

19  the division who makes an inspection to determine compliance

20  with this subsection.

21         Section 128.  Section 400.994, Florida Statutes, is

22  repealed.

23         Section 129.  Section 400.9945, Florida Statutes, is

24  repealed.

25         Section 130.  Section 400.995, Florida Statutes, is

26  amended to read:

27         400.995  Agency administrative penalties.--

28         (1)  In addition to the requirements of part II of

29  chapter 408, the agency may deny the application for a license

30  renewal, revoke and or suspend the license, and impose

31  administrative fines of up to $5,000 per violation for

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 1  violations of the requirements of this part or rules of the

 2  agency. In determining if a penalty is to be imposed and in

 3  fixing the amount of the fine, the agency shall consider the

 4  following factors:

 5         (a)  The gravity of the violation, including the

 6  probability that death or serious physical or emotional harm

 7  to a patient will result or has resulted, the severity of the

 8  action or potential harm, and the extent to which the

 9  provisions of the applicable laws or rules were violated.

10         (b)  Actions taken by the owner, medical director, or

11  clinic director to correct violations.

12         (c)  Any previous violations.

13         (d)  The financial benefit to the clinic of committing

14  or continuing the violation.

15         (2)  Each day of continuing violation after the date

16  fixed for termination of the violation, as ordered by the

17  agency, constitutes an additional, separate, and distinct

18  violation.

19         (3)  Any action taken to correct a violation shall be

20  documented in writing by the owner, medical director, or

21  clinic director of the clinic and verified through followup

22  visits by agency personnel. The agency may impose a fine and,

23  in the case of an owner-operated clinic, revoke or deny a

24  clinic's license when a clinic medical director or clinic

25  director knowingly misrepresents actions taken to correct a

26  violation.

27         (4)  For fines that are upheld following administrative

28  or judicial review, the violator shall pay the fine, plus

29  interest at the rate as specified in s. 55.03, for each day

30  beyond the date set by the agency for payment of the fine.

31  

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 1         (5)  Any unlicensed clinic that continues to operate

 2  after agency notification is subject to a $1,000 fine per day.

 3         (4)(6)  Any licensed clinic whose owner, medical

 4  director, or clinic director concurrently operates an

 5  unlicensed clinic shall be subject to an administrative fine

 6  of $5,000 per day.

 7         (5)(7)  Any clinic whose owner fails to apply for a

 8  change-of-ownership license in accordance with s. 400.992 and

 9  operates the clinic under the new ownership is subject to a

10  fine of $5,000.

11         (6)(8)  The agency, as an alternative to or in

12  conjunction with an administrative action against a clinic for

13  violations of this part and adopted rules, shall make a

14  reasonable attempt to discuss each violation and recommended

15  corrective action with the owner, medical director, or clinic

16  director of the clinic, prior to written notification. The

17  agency, instead of fixing a period within which the clinic

18  shall enter into compliance with standards, may request a plan

19  of corrective action from the clinic which demonstrates a good

20  faith effort to remedy each violation by a specific date,

21  subject to the approval of the agency.

22         (9)  Administrative fines paid by any clinic under this

23  section shall be deposited into the Health Care Trust Fund.

24         (10)  If the agency issues a notice of intent to deny a

25  license application after a temporary license has been issued

26  pursuant to s. 400.991(3), the temporary license shall expire

27  on the date of the notice and may not be extended during any

28  proceeding for administrative or judicial review pursuant to

29  chapter 120.

30         Section 131.  Section 408.802, Florida Statutes, is

31  amended to read:

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 1         408.802  Applicability.--The provisions of this part

 2  apply to the provision of services that require licensure as

 3  defined in this part and to the following entities licensed,

 4  registered, or certified by the agency, as described in

 5  chapters 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:

 6         (1)  Laboratories authorized to perform testing under

 7  the Drug-Free Workplace Act, as provided under ss. 112.0455

 8  and 440.102.

 9         (2)  Birth centers, as provided under chapter 383.

10         (3)  Abortion clinics, as provided under chapter 390.

11         (4)  Crisis stabilization units, as provided under

12  parts I and IV of chapter 394.

13         (5)  Short-term residential treatment facilities, as

14  provided under parts I and IV of chapter 394.

15         (6)  Residential treatment facilities, as provided

16  under part IV of chapter 394.

17         (7)  Residential treatment centers for children and

18  adolescents, as provided under part IV of chapter 394.

19         (8)  Hospitals, as provided under part I of chapter

20  395.

21         (9)  Ambulatory surgical centers, as provided under

22  part I of chapter 395.

23         (10)  Mobile surgical facilities, as provided under

24  part I of chapter 395.

25         (11)  Private review agents, as provided under part I

26  of chapter 395.

27         (12)  Health care risk managers, as provided under part

28  I of chapter 395.

29         (13)  Nursing homes, as provided under part II of

30  chapter 400.

31  

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 1         (14)  Assisted living facilities, as provided under

 2  part I III of chapter 429 400.

 3         (15)  Home health agencies, as provided under part III

 4  IV of chapter 400.

 5         (16)  Nurse registries, as provided under part III IV

 6  of chapter 400.

 7         (17)  Companion services or homemaker services

 8  providers, as provided under part III IV of chapter 400.

 9         (18)  Adult day care centers, as provided under part

10  III V of chapter 429 400.

11         (19)  Hospices, as provided under part IV VI of chapter

12  400.

13         (20)  Adult family-care homes, as provided under part

14  II VII of chapter 429 400.

15         (21)  Homes for special services, as provided under

16  part V VIII of chapter 400.

17         (22)  Transitional living facilities, as provided under

18  part V VIII of chapter 400.

19         (23)  Prescribed pediatric extended care centers, as

20  provided under part VI IX of chapter 400.

21         (24)  Home medical equipment providers, as provided

22  under part VII X of chapter 400.

23         (25)  Intermediate care facilities for persons with

24  developmental disabilities, as provided under part VIII XI of

25  chapter 400.

26         (26)  Health care services pools, as provided under

27  part IX XII of chapter 400.

28         (27)  Health care clinics, as provided under part X

29  XIII of chapter 400.

30         (28)  Clinical laboratories, as provided under part I

31  of chapter 483.

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 1         (29)  Multiphasic health testing centers, as provided

 2  under part II of chapter 483.

 3         (30)  Organ and tissue procurement agencies, as

 4  provided under chapter 765.

 5         Section 132.  Section 408.832, Florida Statutes, is

 6  amended to read:

 7         408.832  Conflicts.--In case of conflict between the

 8  provisions of part II of chapter 408 and the authorizing

 9  statutes governing the licensure of health care providers by

10  the Agency for Health Care Administration found in s. 112.0455

11  and chapters 383, 390, 394, 395, 400, 429, 440, 483, and 765,

12  the provisions of part II of chapter 408 shall prevail.

13         Section 133.  Paragraph (e) of subsection (4) of

14  section 409.221, Florida Statutes, is amended to read:

15         409.221  Consumer-directed care program.--

16         (4)  CONSUMER-DIRECTED CARE.--

17         (e)  Services.--Consumers shall use the budget

18  allowance only to pay for home and community-based services

19  that meet the consumer's long-term care needs and are a

20  cost-efficient use of funds. Such services may include, but

21  are not limited to, the following:

22         1.  Personal care.

23         2.  Homemaking and chores, including housework, meals,

24  shopping, and transportation.

25         3.  Home modifications and assistive devices which may

26  increase the consumer's independence or make it possible to

27  avoid institutional placement.

28         4.  Assistance in taking self-administered medication.

29         5.  Day care and respite care services, including those

30  provided by nursing home facilities pursuant to s. 400.141(6)

31  

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 1  or by adult day care facilities licensed pursuant to s.

 2  429.907 400.554.

 3         6.  Personal care and support services provided in an

 4  assisted living facility.

 5         Section 134.  Paragraph (g) of subsection (2) of

 6  section 409.815, Florida Statutes, is amended to read:

 7         409.815  Health benefits coverage; limitations.--

 8         (2)  BENCHMARK BENEFITS.--In order for health benefits

 9  coverage to qualify for premium assistance payments for an

10  eligible child under ss. 409.810-409.820, the health benefits

11  coverage, except for coverage under Medicaid and Medikids,

12  must include the following minimum benefits, as medically

13  necessary.

14         (g)  Behavioral health services.--

15         1.  Mental health benefits include:

16         a.  Inpatient services, limited to not more than 30

17  inpatient days per contract year for psychiatric admissions,

18  or residential services in facilities licensed under s.

19  394.875(6)(8) or s. 395.003 in lieu of inpatient psychiatric

20  admissions; however, a minimum of 10 of the 30 days shall be

21  available only for inpatient psychiatric services when

22  authorized by a physician; and

23         b.  Outpatient services, including outpatient visits

24  for psychological or psychiatric evaluation, diagnosis, and

25  treatment by a licensed mental health professional, limited to

26  a maximum of 40 outpatient visits each contract year.

27         2.  Substance abuse services include:

28         a.  Inpatient services, limited to not more than 7

29  inpatient days per contract year for medical detoxification

30  only and 30 days of residential services; and

31  

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 1         b.  Outpatient services, including evaluation,

 2  diagnosis, and treatment by a licensed practitioner, limited

 3  to a maximum of 40 outpatient visits per contract year.

 4         Section 135.  Subsection (8) of section 409.905,

 5  Florida Statutes, is amended to read:

 6         409.905  Mandatory Medicaid services.--The agency may

 7  make payments for the following services, which are required

 8  of the state by Title XIX of the Social Security Act,

 9  furnished by Medicaid providers to recipients who are

10  determined to be eligible on the dates on which the services

11  were provided. Any service under this section shall be

12  provided only when medically necessary and in accordance with

13  state and federal law. Mandatory services rendered by

14  providers in mobile units to Medicaid recipients may be

15  restricted by the agency. Nothing in this section shall be

16  construed to prevent or limit the agency from adjusting fees,

17  reimbursement rates, lengths of stay, number of visits, number

18  of services, or any other adjustments necessary to comply with

19  the availability of moneys and any limitations or directions

20  provided for in the General Appropriations Act or chapter 216.

21         (8)  NURSING FACILITY SERVICES.--The agency shall pay

22  for 24-hour-a-day nursing and rehabilitative services for a

23  recipient in a nursing facility licensed under part II of

24  chapter 400 or in a rural hospital, as defined in s. 395.602,

25  or in a Medicare certified skilled nursing facility operated

26  by a hospital, as defined by s. 395.002(10)(11), that is

27  licensed under part I of chapter 395, and in accordance with

28  provisions set forth in s. 409.908(2)(a), which services are

29  ordered by and provided under the direction of a licensed

30  physician. However, if a nursing facility has been destroyed

31  or otherwise made uninhabitable by natural disaster or other

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 1  emergency and another nursing facility is not available, the

 2  agency must pay for similar services temporarily in a hospital

 3  licensed under part I of chapter 395 provided federal funding

 4  is approved and available. The agency shall pay only for

 5  bed-hold days if the facility has an occupancy rate of 95

 6  percent or greater. The agency is authorized to seek any

 7  federal waivers to implement this policy.

 8         Section 136.  Subsection (7) of section 409.907,

 9  Florida Statutes, is amended to read:

10         409.907  Medicaid provider agreements.--The agency may

11  make payments for medical assistance and related services

12  rendered to Medicaid recipients only to an individual or

13  entity who has a provider agreement in effect with the agency,

14  who is performing services or supplying goods in accordance

15  with federal, state, and local law, and who agrees that no

16  person shall, on the grounds of handicap, race, color, or

17  national origin, or for any other reason, be subjected to

18  discrimination under any program or activity for which the

19  provider receives payment from the agency.

20         (7)  The agency may require, as a condition of

21  participating in the Medicaid program and before entering into

22  the provider agreement, that the provider submit information,

23  in an initial and any required renewal applications,

24  concerning the professional, business, and personal background

25  of the provider and permit an onsite inspection of the

26  provider's service location by agency staff or other personnel

27  designated by the agency to perform this function. The agency

28  shall perform a random onsite inspection, within 60 days after

29  receipt of a fully complete new provider's application, of the

30  provider's service location prior to making its first payment

31  to the provider for Medicaid services to determine the

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 1  applicant's ability to provide the services that the applicant

 2  is proposing to provide for Medicaid reimbursement. The agency

 3  is not required to perform an onsite inspection of a provider

 4  or program that is licensed by the agency, that provides

 5  services under waiver programs for home and community-based

 6  services, or that is licensed as a medical foster home by the

 7  Department of Children and Family Services. As a continuing

 8  condition of participation in the Medicaid program, a provider

 9  shall immediately notify the agency of any current or pending

10  bankruptcy filing. Before entering into the provider

11  agreement, or as a condition of continuing participation in

12  the Medicaid program, the agency may also require that

13  Medicaid providers reimbursed on a fee-for-services basis or

14  fee schedule basis which is not cost-based, post a surety bond

15  not to exceed $50,000 or the total amount billed by the

16  provider to the program during the current or most recent

17  calendar year, whichever is greater. For new providers, the

18  amount of the surety bond shall be determined by the agency

19  based on the provider's estimate of its first year's billing.

20  If the provider's billing during the first year exceeds the

21  bond amount, the agency may require the provider to acquire an

22  additional bond equal to the actual billing level of the

23  provider. A provider's bond shall not exceed $50,000 if a

24  physician or group of physicians licensed under chapter 458,

25  chapter 459, or chapter 460 has a 50 percent or greater

26  ownership interest in the provider or if the provider is an

27  assisted living facility licensed under chapter 429. The bonds

28  permitted by this section are in addition to the bonds

29  referenced in s. 400.179(2)(5)(d). If the provider is a

30  corporation, partnership, association, or other entity, the

31  agency may require the provider to submit information

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 1  concerning the background of that entity and of any principal

 2  of the entity, including any partner or shareholder having an

 3  ownership interest in the entity equal to 5 percent or

 4  greater, and any treating provider who participates in or

 5  intends to participate in Medicaid through the entity. The

 6  information must include:

 7         (a)  Proof of holding a valid license or operating

 8  certificate, as applicable, if required by the state or local

 9  jurisdiction in which the provider is located or if required

10  by the Federal Government.

11         (b)  Information concerning any prior violation, fine,

12  suspension, termination, or other administrative action taken

13  under the Medicaid laws, rules, or regulations of this state

14  or of any other state or the Federal Government; any prior

15  violation of the laws, rules, or regulations relating to the

16  Medicare program; any prior violation of the rules or

17  regulations of any other public or private insurer; and any

18  prior violation of the laws, rules, or regulations of any

19  regulatory body of this or any other state.

20         (c)  Full and accurate disclosure of any financial or

21  ownership interest that the provider, or any principal,

22  partner, or major shareholder thereof, may hold in any other

23  Medicaid provider or health care related entity or any other

24  entity that is licensed by the state to provide health or

25  residential care and treatment to persons.

26         (d)  If a group provider, identification of all members

27  of the group and attestation that all members of the group are

28  enrolled in or have applied to enroll in the Medicaid program.

29         Section 137.  Subsections (6) through (27) of section

30  429.02, Florida Statutes, are renumbered as subsections (5)

31  

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 1  through (26), respectively, and present subsections (5) and

 2  (12) of that section are amended to read:

 3         429.02  Definitions.--When used in this part, the term:

 4         (5)  "Applicant" means an individual owner,

 5  corporation, partnership, firm, association, or governmental

 6  entity that applies for a license.

 7         (11)(12)  "Extended congregate care" means acts beyond

 8  those authorized in subsection (16) (17) that may be performed

 9  pursuant to part I of chapter 464 by persons licensed

10  thereunder while carrying out their professional duties, and

11  other supportive services which may be specified by rule. The

12  purpose of such services is to enable residents to age in

13  place in a residential environment despite mental or physical

14  limitations that might otherwise disqualify them from

15  residency in a facility licensed under this part.

16         Section 138.  Section 429.07, Florida Statutes, is

17  amended to read:

18         429.07  License required; fee, display.--

19         (1)  The requirements of part II of chapter 408 apply

20  to the provision of services that require licensure pursuant

21  to this part and part II of chapter 408 and to entities

22  licensed by or applying for such licensure from the agency

23  pursuant to this part. A license issued by the agency is

24  required in order to operate for an assisted living facility

25  operating in this state.

26         (2)  Separate licenses shall be required for facilities

27  maintained in separate premises, even though operated under

28  the same management. A separate license shall not be required

29  for separate buildings on the same grounds.

30         (3)  In addition to the requirements of s. 408.806,

31  each Any license granted by the agency must state the maximum

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 1  resident capacity of the facility, the type of care for which

 2  the license is granted, the date the license is issued, the

 3  expiration date of the license, and any other information

 4  deemed necessary by the agency. Licenses shall be issued for

 5  one or more of the following categories of care: standard,

 6  extended congregate care, limited nursing services, or limited

 7  mental health.

 8         (a)  A standard license shall be issued to facilities

 9  providing one or more of the personal services identified in

10  s. 429.02. Such facilities may also employ or contract with a

11  person licensed under part I of chapter 464 to administer

12  medications and perform other tasks as specified in s.

13  429.255.

14         (b)  An extended congregate care license shall be

15  issued to facilities providing, directly or through contract,

16  services beyond those authorized in paragraph (a), including

17  acts performed pursuant to part I of chapter 464 by persons

18  licensed thereunder, and supportive services defined by rule

19  to persons who otherwise would be disqualified from continued

20  residence in a facility licensed under this part.

21         1.  In order for extended congregate care services to

22  be provided in a facility licensed under this part, the agency

23  must first determine that all requirements established in law

24  and rule are met and must specifically designate, on the

25  facility's license, that such services may be provided and

26  whether the designation applies to all or part of a facility.

27  Such designation may be made at the time of initial licensure

28  or relicensure, or upon request in writing by a licensee under

29  this part and part II of chapter 408. Notification of approval

30  or denial of such request shall be made in accordance with

31  part II of chapter 408 within 90 days after receipt of such

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 1  request and all necessary documentation. Existing facilities

 2  qualifying to provide extended congregate care services must

 3  have maintained a standard license and may not have been

 4  subject to administrative sanctions during the previous 2

 5  years, or since initial licensure if the facility has been

 6  licensed for less than 2 years, for any of the following

 7  reasons:

 8         a.  A class I or class II violation;

 9         b.  Three or more repeat or recurring class III

10  violations of identical or similar resident care standards as

11  specified in rule from which a pattern of noncompliance is

12  found by the agency;

13         c.  Three or more class III violations that were not

14  corrected in accordance with the corrective action plan

15  approved by the agency;

16         d.  Violation of resident care standards resulting in a

17  requirement to employ the services of a consultant pharmacist

18  or consultant dietitian;

19         e.  Denial, suspension, or revocation of a license for

20  another facility under this part in which the applicant for an

21  extended congregate care license has at least 25 percent

22  ownership interest; or

23         f.  Imposition of a moratorium pursuant to this part or

24  part II of chapter 408 on admissions or initiation of

25  injunctive proceedings.

26         2.  Facilities that are licensed to provide extended

27  congregate care services shall maintain a written progress

28  report on each person who receives such services, which report

29  describes the type, amount, duration, scope, and outcome of

30  services that are rendered and the general status of the

31  resident's health. A registered nurse, or appropriate

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 1  designee, representing the agency shall visit such facilities

 2  at least quarterly to monitor residents who are receiving

 3  extended congregate care services and to determine if the

 4  facility is in compliance with this part, part II of chapter

 5  408, and with rules that relate to extended congregate care.

 6  One of these visits may be in conjunction with the regular

 7  survey. The monitoring visits may be provided through

 8  contractual arrangements with appropriate community agencies.

 9  A registered nurse shall serve as part of the team that

10  inspects such facility. The agency may waive one of the

11  required yearly monitoring visits for a facility that has been

12  licensed for at least 24 months to provide extended congregate

13  care services, if, during the inspection, the registered nurse

14  determines that extended congregate care services are being

15  provided appropriately, and if the facility has no class I or

16  class II violations and no uncorrected class III violations.

17  Before such decision is made, the agency shall consult with

18  the long-term care ombudsman council for the area in which the

19  facility is located to determine if any complaints have been

20  made and substantiated about the quality of services or care.

21  The agency may not waive one of the required yearly monitoring

22  visits if complaints have been made and substantiated.

23         3.  Facilities that are licensed to provide extended

24  congregate care services shall:

25         a.  Demonstrate the capability to meet unanticipated

26  resident service needs.

27         b.  Offer a physical environment that promotes a

28  homelike setting, provides for resident privacy, promotes

29  resident independence, and allows sufficient congregate space

30  as defined by rule.

31  

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 1         c.  Have sufficient staff available, taking into

 2  account the physical plant and firesafety features of the

 3  building, to assist with the evacuation of residents in an

 4  emergency, as necessary.

 5         d.  Adopt and follow policies and procedures that

 6  maximize resident independence, dignity, choice, and

 7  decisionmaking to permit residents to age in place to the

 8  extent possible, so that moves due to changes in functional

 9  status are minimized or avoided.

10         e.  Allow residents or, if applicable, a resident's

11  representative, designee, surrogate, guardian, or attorney in

12  fact to make a variety of personal choices, participate in

13  developing service plans, and share responsibility in

14  decisionmaking.

15         f.  Implement the concept of managed risk.

16         g.  Provide, either directly or through contract, the

17  services of a person licensed pursuant to part I of chapter

18  464.

19         h.  In addition to the training mandated in s. 429.52,

20  provide specialized training as defined by rule for facility

21  staff.

22         4.  Facilities licensed to provide extended congregate

23  care services are exempt from the criteria for continued

24  residency as set forth in rules adopted under s. 429.41.

25  Facilities so licensed shall adopt their own requirements

26  within guidelines for continued residency set forth by the

27  department in rule. However, such facilities may not serve

28  residents who require 24-hour nursing supervision. Facilities

29  licensed to provide extended congregate care services shall

30  provide each resident with a written copy of facility policies

31  governing admission and retention.

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 1         5.  The primary purpose of extended congregate care

 2  services is to allow residents, as they become more impaired,

 3  the option of remaining in a familiar setting from which they

 4  would otherwise be disqualified for continued residency. A

 5  facility licensed to provide extended congregate care services

 6  may also admit an individual who exceeds the admission

 7  criteria for a facility with a standard license, if the

 8  individual is determined appropriate for admission to the

 9  extended congregate care facility.

10         6.  Before admission of an individual to a facility

11  licensed to provide extended congregate care services, the

12  individual must undergo a medical examination as provided in

13  s. 429.26(4) and the facility must develop a preliminary

14  service plan for the individual.

15         7.  When a facility can no longer provide or arrange

16  for services in accordance with the resident's service plan

17  and needs and the facility's policy, the facility shall make

18  arrangements for relocating the person in accordance with s.

19  429.28(1)(k).

20         8.  Failure to provide extended congregate care

21  services may result in denial of extended congregate care

22  license renewal.

23         9.  No later than January 1 of each year, the

24  department, in consultation with the agency, shall prepare and

25  submit to the Governor, the President of the Senate, the

26  Speaker of the House of Representatives, and the chairs of

27  appropriate legislative committees, a report on the status of,

28  and recommendations related to, extended congregate care

29  services. The status report must include, but need not be

30  limited to, the following information:

31  

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 1         a.  A description of the facilities licensed to provide

 2  such services, including total number of beds licensed under

 3  this part.

 4         b.  The number and characteristics of residents

 5  receiving such services.

 6         c.  The types of services rendered that could not be

 7  provided through a standard license.

 8         d.  An analysis of deficiencies cited during licensure

 9  inspections.

10         e.  The number of residents who required extended

11  congregate care services at admission and the source of

12  admission.

13         f.  Recommendations for statutory or regulatory

14  changes.

15         g.  The availability of extended congregate care to

16  state clients residing in facilities licensed under this part

17  and in need of additional services, and recommendations for

18  appropriations to subsidize extended congregate care services

19  for such persons.

20         h.  Such other information as the department considers

21  appropriate.

22         (c)  A limited nursing services license shall be issued

23  to a facility that provides services beyond those authorized

24  in paragraph (a) and as specified in this paragraph.

25         1.  In order for limited nursing services to be

26  provided in a facility licensed under this part, the agency

27  must first determine that all requirements established in law

28  and rule are met and must specifically designate, on the

29  facility's license, that such services may be provided. Such

30  designation may be made at the time of initial licensure or

31  relicensure, or upon request in writing by a licensee under

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 1  this part and part II of chapter 408. Notification of approval

 2  or denial of such request shall be made in accordance with

 3  part II of chapter 408 within 90 days after receipt of such

 4  request and all necessary documentation. Existing facilities

 5  qualifying to provide limited nursing services shall have

 6  maintained a standard license and may not have been subject to

 7  administrative sanctions that affect the health, safety, and

 8  welfare of residents for the previous 2 years or since initial

 9  licensure if the facility has been licensed for less than 2

10  years.

11         2.  Facilities that are licensed to provide limited

12  nursing services shall maintain a written progress report on

13  each person who receives such nursing services, which report

14  describes the type, amount, duration, scope, and outcome of

15  services that are rendered and the general status of the

16  resident's health. A registered nurse representing the agency

17  shall visit such facilities at least twice a year to monitor

18  residents who are receiving limited nursing services and to

19  determine if the facility is in compliance with applicable

20  provisions of this part, part II of chapter 408, and with

21  related rules. The monitoring visits may be provided through

22  contractual arrangements with appropriate community agencies.

23  A registered nurse shall also serve as part of the team that

24  inspects such facility.

25         3.  A person who receives limited nursing services

26  under this part must meet the admission criteria established

27  by the agency for assisted living facilities. When a resident

28  no longer meets the admission criteria for a facility licensed

29  under this part, arrangements for relocating the person shall

30  be made in accordance with s. 429.28(1)(k), unless the

31  

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 1  facility is licensed to provide extended congregate care

 2  services.

 3         (4)  In accordance with s. 408.805, an applicant or

 4  licensee shall pay a fee for each license application

 5  submitted under this part, part II of chapter 408, and

 6  applicable rules. The amount of the fee shall be established

 7  by rule.

 8         (a)  The biennial license fee required of a facility is

 9  $300 per license, with an additional fee of $50 per resident

10  based on the total licensed resident capacity of the facility,

11  except that no additional fee will be assessed for beds

12  designated for recipients of optional state supplementation

13  payments provided for in s. 409.212. The total fee may not

14  exceed $10,000, no part of which shall be returned to the

15  facility. The agency shall adjust the per bed license fee and

16  the total licensure fee annually by not more than the change

17  in the consumer price index based on the 12 months immediately

18  preceding the increase.

19         (b)  In addition to the total fee assessed under

20  paragraph (a), the agency shall require facilities that are

21  licensed to provide extended congregate care services under

22  this part to pay an additional fee per licensed facility. The

23  amount of the biennial fee shall be $400 per license, with an

24  additional fee of $10 per resident based on the total licensed

25  resident capacity of the facility. No part of this fee shall

26  be returned to the facility. The agency may adjust the per bed

27  license fee and the annual license fee once each year by not

28  more than the average rate of inflation for the 12 months

29  immediately preceding the increase.

30         (c)  In addition to the total fee assessed under

31  paragraph (a), the agency shall require facilities that are

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 1  licensed to provide limited nursing services under this part

 2  to pay an additional fee per licensed facility. The amount of

 3  the biennial fee shall be $250 per license, with an additional

 4  fee of $10 per resident based on the total licensed resident

 5  capacity of the facility. No part of this fee shall be

 6  returned to the facility. The agency may adjust the per bed

 7  license fee and the biennial license fee once each year by not

 8  more than the average rate of inflation for the 12 months

 9  immediately preceding the increase.

10         (5)  Counties or municipalities applying for licenses

11  under this part are exempt from the payment of license fees.

12         (6)  The license shall be displayed in a conspicuous

13  place inside the facility.

14         (7)  A license shall be valid only in the possession of

15  the individual, firm, partnership, association, or corporation

16  to which it is issued and shall not be subject to sale,

17  assignment, or other transfer, voluntary or involuntary; nor

18  shall a license be valid for any premises other than that for

19  which originally issued.

20         (8)  A fee may be charged to a facility requesting a

21  duplicate license. The fee shall not exceed the actual cost of

22  duplication and postage.

23         Section 139.  Subsection (1) of section 429.075,

24  Florida Statutes, is amended to read:

25         429.075  Limited mental health license.--An assisted

26  living facility that serves three or more mental health

27  residents must obtain a limited mental health license.

28         (1)  To obtain a limited mental health license, a

29  facility must hold a standard license as an assisted living

30  facility, must not have any current uncorrected deficiencies

31  or violations, and must ensure that, within 6 months after

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 1  receiving a limited mental health license, the facility

 2  administrator and the staff of the facility who are in direct

 3  contact with mental health residents must complete training of

 4  no less than 6 hours related to their duties. Such designation

 5  may be made at the time of initial licensure or relicensure or

 6  upon request in writing by a licensee under this part and part

 7  II of chapter 408. Notification of approval or denial of such

 8  request shall be made in accordance with this part, part II of

 9  chapter 408, and applicable rules. This training will be

10  provided by or approved by the Department of Children and

11  Family Services.

12         Section 140.  Section 429.08, Florida Statutes, is

13  amended to read:

14         429.08  Unlicensed facilities; referral of person for

15  residency to unlicensed facility; penalties; verification of

16  licensure status.--

17         (1)(a)  This section applies to the unlicensed

18  operation of an assisted living facility in addition to the

19  requirements of part II of chapter 408. It is unlawful to own,

20  operate, or maintain an assisted living facility without

21  obtaining a license under this part.

22         (b)  Except as provided under paragraph (d), any person

23  who owns, operates, or maintains an unlicensed assisted living

24  facility commits a felony of the third degree, punishable as

25  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

26  continued operation is a separate offense.

27         (c)  Any person found guilty of violating paragraph (a)

28  a second or subsequent time commits a felony of the second

29  degree, punishable as provided under s. 775.082, s. 775.083,

30  or s. 775.084. Each day of continued operation is a separate

31  offense.

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 1         (d)  Any person who owns, operates, or maintains an

 2  unlicensed assisted living facility due to a change in this

 3  part or a modification in department rule within 6 months

 4  after the effective date of such change and who, within 10

 5  working days after receiving notification from the agency,

 6  fails to cease operation or apply for a license under this

 7  part commits a felony of the third degree, punishable as

 8  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

 9  continued operation is a separate offense.

10         (e)  Any facility that fails to cease operation after

11  agency notification may be fined for each day of noncompliance

12  pursuant to s. 429.19.

13         (f)  When a licensee has an interest in more than one

14  assisted living facility, and fails to license any one of

15  these facilities, the agency may revoke the license, impose a

16  moratorium, or impose a fine pursuant to s. 429.19, on any or

17  all of the licensed facilities until such time as the

18  unlicensed facility is licensed or ceases operation.

19         (g)  If the agency determines that an owner is

20  operating or maintaining an assisted living facility without

21  obtaining a license and determines that a condition exists in

22  the facility that poses a threat to the health, safety, or

23  welfare of a resident of the facility, the owner is subject to

24  the same actions and fines imposed against a licensed facility

25  as specified in ss. 429.14 and 429.19.

26         (e)(h)  Any person aware of the operation of an

27  unlicensed assisted living facility must report that facility

28  to the agency. The agency shall provide to the department's

29  elder information and referral providers a list, by county, of

30  licensed assisted living facilities, to assist persons who are

31  

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 1  considering an assisted living facility placement in locating

 2  a licensed facility.

 3         (2)(i)  Each field office of the Agency for Health Care

 4  Administration shall establish a local coordinating workgroup

 5  which includes representatives of local law enforcement

 6  agencies, state attorneys, the Medicaid Fraud Control Unit of

 7  the Department of Legal Affairs, local fire authorities, the

 8  Department of Children and Family Services, the district

 9  long-term care ombudsman council, and the district human

10  rights advocacy committee to assist in identifying the

11  operation of unlicensed facilities and to develop and

12  implement a plan to ensure effective enforcement of state laws

13  relating to such facilities. The workgroup shall report its

14  findings, actions, and recommendations semiannually to the

15  Director of Health Quality Assurance Facility Regulation of

16  the agency.

17         (3)(2)  It is unlawful to knowingly refer a person for

18  residency to an unlicensed assisted living facility; to an

19  assisted living facility the license of which is under denial

20  or has been suspended or revoked; or to an assisted living

21  facility that has a moratorium pursuant to part II of chapter

22  408 on admissions. Any person who violates this subsection

23  commits a noncriminal violation, punishable by a fine not

24  exceeding $500 as provided in s. 775.083.

25         (a)  Any health care practitioner, as defined in s.

26  456.001, who is aware of the operation of an unlicensed

27  facility shall report that facility to the agency. Failure to

28  report a facility that the practitioner knows or has

29  reasonable cause to suspect is unlicensed shall be reported to

30  the practitioner's licensing board.

31  

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 1         (b)  Any hospital or community mental health center

 2  licensed under chapter 395 or chapter 394 which knowingly

 3  discharges a patient or client to an unlicensed facility is

 4  subject to sanction by the agency.

 5         (c)  Any employee of the agency or department, or the

 6  Department of Children and Family Services, who knowingly

 7  refers a person for residency to an unlicensed facility; to a

 8  facility the license of which is under denial or has been

 9  suspended or revoked; or to a facility that has a moratorium

10  pursuant to part II of chapter 408 on admissions is subject to

11  disciplinary action by the agency or department, or the

12  Department of Children and Family Services.

13         (d)  The employer of any person who is under contract

14  with the agency or department, or the Department of Children

15  and Family Services, and who knowingly refers a person for

16  residency to an unlicensed facility; to a facility the license

17  of which is under denial or has been suspended or revoked; or

18  to a facility that has a moratorium pursuant to part II of

19  chapter 408 on admissions shall be fined and required to

20  prepare a corrective action plan designed to prevent such

21  referrals.

22         (e)  The agency shall provide the department and the

23  Department of Children and Family Services with a list of

24  licensed facilities within each county and shall update the

25  list at least quarterly.

26         (f)  At least annually, the agency shall notify, in

27  appropriate trade publications, physicians licensed under

28  chapter 458 or chapter 459, hospitals licensed under chapter

29  395, nursing home facilities licensed under part II of chapter

30  400, and employees of the agency or the department, or the

31  Department of Children and Family Services, who are

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 1  responsible for referring persons for residency, that it is

 2  unlawful to knowingly refer a person for residency to an

 3  unlicensed assisted living facility and shall notify them of

 4  the penalty for violating such prohibition. The department and

 5  the Department of Children and Family Services shall, in turn,

 6  notify service providers under contract to the respective

 7  departments who have responsibility for resident referrals to

 8  facilities. Further, the notice must direct each noticed

 9  facility and individual to contact the appropriate agency

10  office in order to verify the licensure status of any facility

11  prior to referring any person for residency. Each notice must

12  include the name, telephone number, and mailing address of the

13  appropriate office to contact.

14         Section 141.  Section 429.11, Florida Statutes, is

15  amended to read:

16         429.11  Initial application for license; provisional

17  license.--

18         (1)  Each applicant for licensure must comply with all

19  provisions of part II of chapter 408 and must: Application for

20  a license shall be made to the agency on forms furnished by it

21  and shall be accompanied by the appropriate license fee.

22         (2)  The applicant may be an individual owner, a

23  corporation, a partnership, a firm, an association, or a

24  governmental entity.

25         (3)  The application must be signed by the applicant

26  under oath and must contain the following:

27         (a)  The name, address, date of birth, and social

28  security number of the applicant and the name by which the

29  facility is to be known. If the applicant is a firm,

30  partnership, or association, the application shall contain the

31  name, address, date of birth, and social security number of

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 1  every member thereof. If the applicant is a corporation, the

 2  application shall contain the corporation's name and address;

 3  the name, address, date of birth, and social security number

 4  of each of its directors and officers; and the name and

 5  address of each person having at least a 5-percent ownership

 6  interest in the corporation.

 7         (b)  The name and address of any professional service,

 8  firm, association, partnership, or corporation that is to

 9  provide goods, leases, or services to the facility if a

10  5-percent or greater ownership interest in the service, firm,

11  association, partnership, or corporation is owned by a person

12  whose name must be listed on the application under paragraph

13  (a).

14         (c)  The name and address of any long-term care

15  facility with which the applicant, administrator, or financial

16  officer has been affiliated through ownership or employment

17  within 5 years of the date of this license application; and a

18  signed affidavit disclosing any financial or ownership

19  interest that the applicant, or any person listed in paragraph

20  (a), holds or has held within the last 5 years in any facility

21  licensed under this part, or in any other entity licensed by

22  this state or another state to provide health or residential

23  care, which facility or entity closed or ceased to operate as

24  a result of financial problems, or has had a receiver

25  appointed or a license denied, suspended or revoked, or was

26  subject to a moratorium on admissions, or has had an

27  injunctive proceeding initiated against it.

28         (d)  A description and explanation of any exclusions,

29  permanent suspensions, or terminations of the applicant from

30  the Medicare or Medicaid programs. Proof of compliance with

31  disclosure of ownership and control interest requirements of

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 1  the Medicaid or Medicare programs shall be accepted in lieu of

 2  this submission.

 3         (e)  The names and addresses of persons of whom the

 4  agency may inquire as to the character, reputation, and

 5  financial responsibility of the owner and, if different from

 6  the applicant, the administrator and financial officer.

 7         (a)(f)  Identify Identification of all other homes or

 8  facilities, including the addresses and the license or

 9  licenses under which they operate, if applicable, which are

10  currently operated by the applicant or administrator and which

11  provide housing, meals, and personal services to residents.

12         (b)(g)  Provide the location of the facility for which

13  a license is sought and documentation, signed by the

14  appropriate local government official, which states that the

15  applicant has met local zoning requirements.

16         (c)(h)  Provide the name, address, date of birth,

17  social security number, education, and experience of the

18  administrator, if different from the applicant.

19         (4)  The applicant shall furnish satisfactory proof of

20  financial ability to operate and conduct the facility in

21  accordance with the requirements of this part. A certificate

22  of authority, pursuant to chapter 651, may be provided as

23  proof of financial ability.

24         (5)  If the applicant is a continuing care facility

25  certified under chapter 651, a copy of the facility's

26  certificate of authority must be provided.

27         (2)(6)  The applicant shall provide proof of liability

28  insurance as defined in s. 624.605.

29         (3)(7)  If the applicant is a community residential

30  home, the applicant must provide proof that it has met the

31  requirements specified in chapter 419.

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 1         (8)  The applicant must provide the agency with proof

 2  of legal right to occupy the property.

 3         (4)(9)  The applicant must furnish proof that the

 4  facility has received a satisfactory firesafety inspection.

 5  The local authority having jurisdiction or the State Fire

 6  Marshal must conduct the inspection within 30 days after

 7  written request by the applicant.

 8         (5)(10)  The applicant must furnish documentation of a

 9  satisfactory sanitation inspection of the facility by the

10  county health department.

11         (11)  The applicant must furnish proof of compliance

12  with level 2 background screening as required under s.

13  429.174.

14         (6)(12)  In addition to the license categories

15  available in s. 408.808, a provisional license may be issued

16  to an applicant making initial application for licensure or

17  making application for a change of ownership. A provisional

18  license shall be limited in duration to a specific period of

19  time not to exceed 6 months, as determined by the agency.

20         (7)(13)  A county or municipality may not issue an

21  occupational license that is being obtained for the purpose of

22  operating a facility regulated under this part without first

23  ascertaining that the applicant has been licensed to operate

24  such facility at the specified location or locations by the

25  agency. The agency shall furnish to local agencies responsible

26  for issuing occupational licenses sufficient instruction for

27  making such determinations.

28         Section 142.  Section 429.12, Florida Statutes, is

29  amended to read:

30         429.12  Sale or transfer of ownership of a

31  facility.--It is the intent of the Legislature to protect the

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 1  rights of the residents of an assisted living facility when

 2  the facility is sold or the ownership thereof is transferred.

 3  Therefore, in addition to the requirements of part II of

 4  chapter 408, whenever a facility is sold or the ownership

 5  thereof is transferred, including leasing:

 6         (1)  The transferee shall make application to the

 7  agency for a new license at least 60 days before the date of

 8  transfer of ownership. The application must comply with the

 9  provisions of s. 429.11.

10         (2)(a)  The transferor shall notify the agency in

11  writing at least 60 days before the date of transfer of

12  ownership.

13         (1)(b)  The transferee new owner shall notify the

14  residents, in writing, of the change transfer of ownership

15  within 7 days after of his or her receipt of the new license.

16         (3)  The transferor shall be responsible and liable

17  for:

18         (a)  The lawful operation of the facility and the

19  welfare of the residents domiciled in the facility until the

20  date the transferee is licensed by the agency.

21         (b)  Any and all penalties imposed against the facility

22  for violations occurring before the date of transfer of

23  ownership unless the penalty imposed is a moratorium on

24  admissions or denial of licensure. The moratorium on

25  admissions or denial of licensure remains in effect after the

26  transfer of ownership, unless the agency has approved the

27  transferee's corrective action plan or the conditions which

28  created the moratorium or denial have been corrected, and may

29  be grounds for denial of license to the transferee in

30  accordance with chapter 120.

31  

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 1         (c)  Any outstanding liability to the state, unless the

 2  transferee has agreed, as a condition of sale or transfer, to

 3  accept the outstanding liabilities and to guarantee payment

 4  therefor; except that, if the transferee fails to meet these

 5  obligations, the transferor shall remain liable for the

 6  outstanding liability.

 7         (2)(4)  The transferor of a facility the license of

 8  which is denied pending an administrative hearing shall, as a

 9  part of the written change-of-ownership transfer-of-ownership

10  contract, advise the transferee that a plan of correction must

11  be submitted by the transferee and approved by the agency at

12  least 7 days before the change transfer of ownership and that

13  failure to correct the condition which resulted in the

14  moratorium pursuant to part II of chapter 408 on admissions or

15  denial of licensure is grounds for denial of the transferee's

16  license.

17         (5)  The transferee must provide the agency with proof

18  of legal right to occupy the property before a license may be

19  issued. Proof may include, but is not limited to, copies of

20  warranty deeds, or copies of lease or rental agreements,

21  contracts for deeds, quitclaim deeds, or other such

22  documentation.

23         Section 143.  Section 429.14, Florida Statutes, is

24  amended to read:

25         429.14  Denial, revocation, or suspension of license;

26  imposition of Administrative penalties fine; grounds.--

27         (1)  In addition to the requirements of part II of

28  chapter 408, the agency may deny, revoke, and or suspend any

29  license issued under this part and, or impose an

30  administrative fine in the manner provided in chapter 120

31  against a licensee of an assisted living facility for a

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 1  violation of any provision of this part, part II of chapter

 2  408, or applicable rules, or for any of the following actions

 3  by a licensee of an assisted living facility, for the actions

 4  of any person subject to level 2 background screening under s.

 5  408.809 s. 429.174, or for the actions of any facility

 6  employee:

 7         (a)  An intentional or negligent act seriously

 8  affecting the health, safety, or welfare of a resident of the

 9  facility.

10         (b)  The determination by the agency that the owner

11  lacks the financial ability to provide continuing adequate

12  care to residents.

13         (c)  Misappropriation or conversion of the property of

14  a resident of the facility.

15         (d)  Failure to follow the criteria and procedures

16  provided under part I of chapter 394 relating to the

17  transportation, voluntary admission, and involuntary

18  examination of a facility resident.

19         (e)  A citation of any of the following deficiencies as

20  defined in s. 429.19:

21         1.  One or more cited class I deficiencies.

22         2.  Three or more cited class II deficiencies.

23         3.  Five or more cited class III deficiencies that have

24  been cited on a single survey and have not been corrected

25  within the times specified.

26         (f)  A determination that a person subject to level 2

27  background screening under s. 408.809 s. 429.174(1) does not

28  meet the screening standards of s. 435.04 or that the facility

29  is retaining an employee subject to level 1 background

30  screening standards under s. 429.174(2) who does not meet the

31  

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 1  screening standards of s. 435.03 and for whom exemptions from

 2  disqualification have not been provided by the agency.

 3         (g)  A determination that an employee, volunteer,

 4  administrator, or owner, or person who otherwise has access to

 5  the residents of a facility does not meet the criteria

 6  specified in s. 435.03(2), and the owner or administrator has

 7  not taken action to remove the person. Exemptions from

 8  disqualification may be granted as set forth in s. 435.07. No

 9  administrative action may be taken against the facility if the

10  person is granted an exemption.

11         (h)  Violation of a moratorium.

12         (i)  Failure of the license applicant, the licensee

13  during relicensure, or a licensee that holds a provisional

14  license to meet the minimum license requirements of this part,

15  or related rules, at the time of license application or

16  renewal.

17         (j)  A fraudulent statement or omission of any material

18  fact on an application for a license or any other document

19  required by the agency, including the submission of a license

20  application that conceals the fact that any board member,

21  officer, or person owning 5 percent or more of the facility

22  may not meet the background screening requirements of s.

23  429.174, or that the applicant has been excluded, permanently

24  suspended, or terminated from the Medicaid or Medicare

25  programs.

26         (j)(k)  An intentional or negligent life-threatening

27  act in violation of the uniform firesafety standards for

28  assisted living facilities or other firesafety standards that

29  threatens the health, safety, or welfare of a resident of a

30  facility, as communicated to the agency by the local authority

31  having jurisdiction or the State Fire Marshal.

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 1         (l)  Exclusion, permanent suspension, or termination

 2  from the Medicare or Medicaid programs.

 3         (k)(m)  Knowingly operating any unlicensed facility or

 4  providing without a license any service that must be licensed

 5  under this chapter or chapter 400.

 6         (l)(n)  Any act constituting a ground upon which

 7  application for a license may be denied.

 8  

 9  Administrative proceedings challenging agency action under

10  this subsection shall be reviewed on the basis of the facts

11  and conditions that resulted in the agency action.

12         (2)  Upon notification by the local authority having

13  jurisdiction or by the State Fire Marshal, the agency may deny

14  or revoke the license of an assisted living facility that

15  fails to correct cited fire code violations that affect or

16  threaten the health, safety, or welfare of a resident of a

17  facility.

18         (3)  The agency may deny a license to any applicant or

19  controlling interest as defined in part II of chapter 408

20  which to any officer or board member of an applicant who is a

21  firm, corporation, partnership, or association or who owns 5

22  percent or more of the facility, if the applicant, officer, or

23  board member has or had a 25-percent or greater financial or

24  ownership interest in any other facility licensed under this

25  part, or in any entity licensed by this state or another state

26  to provide health or residential care, which facility or

27  entity during the 5 years prior to the application for a

28  license closed due to financial inability to operate; had a

29  receiver appointed or a license denied, suspended, or revoked;

30  was subject to a moratorium on admissions; or had an

31  

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 1  injunctive proceeding initiated against it; or has an

 2  outstanding fine assessed under this chapter or chapter 400.

 3         (4)  The agency shall deny or revoke the license of an

 4  assisted living facility that has two or more class I

 5  violations that are similar or identical to violations

 6  identified by the agency during a survey, inspection,

 7  monitoring visit, or complaint investigation occurring within

 8  the previous 2 years.

 9         (5)  An action taken by the agency to suspend, deny, or

10  revoke a facility's license under this part or part II of

11  chapter 408, in which the agency claims that the facility

12  owner or an employee of the facility has threatened the

13  health, safety, or welfare of a resident of the facility be

14  heard by the Division of Administrative Hearings of the

15  Department of Management Services within 120 days after

16  receipt of the facility's request for a hearing, unless that

17  time limitation is waived by both parties. The administrative

18  law judge must render a decision within 30 days after receipt

19  of a proposed recommended order.

20         (6)  The agency shall provide to the Division of Hotels

21  and Restaurants of the Department of Business and Professional

22  Regulation, on a monthly basis, a list of those assisted

23  living facilities that have had their licenses denied,

24  suspended, or revoked or that are involved in an appellate

25  proceeding pursuant to s. 120.60 related to the denial,

26  suspension, or revocation of a license.

27         (7)  Agency notification of a license suspension or

28  revocation, or denial of a license renewal, shall be posted

29  and visible to the public at the facility.

30  

31  

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 1         (8)  The agency may issue a temporary license pending

 2  final disposition of a proceeding involving the suspension or

 3  revocation of an assisted living facility license.

 4         Section 144.  Section 429.15, Florida Statutes, is

 5  repealed.

 6         Section 145.  Section 429.17, Florida Statutes, is

 7  amended to read:

 8         429.17  Expiration of license; renewal; conditional

 9  license.--

10         (1)  Biennial licenses, unless sooner suspended or

11  revoked, shall expire 2 years from the date of issuance.

12  Limited nursing, extended congregate care, and limited mental

13  health licenses shall expire at the same time as the

14  facility's standard license, regardless of when issued. The

15  agency shall notify the facility at least 120 days prior to

16  expiration that a renewal license is necessary to continue

17  operation. The notification must be provided electronically or

18  by mail delivery. Ninety days prior to the expiration date, an

19  application for renewal shall be submitted to the agency. Fees

20  must be prorated. The failure to file a timely renewal

21  application shall result in a late fee charged to the facility

22  in an amount equal to 50 percent of the current fee.

23         (2)  A license shall be renewed in accordance with part

24  II of chapter 408 within 90 days upon the timely filing of an

25  application on forms furnished by the agency and the provision

26  of satisfactory proof of ability to operate and conduct the

27  facility in accordance with the requirements of this part and

28  adopted rules, including proof that the facility has received

29  a satisfactory firesafety inspection, conducted by the local

30  authority having jurisdiction or the State Fire Marshal,

31  

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 1  within the preceding 12 months and an affidavit of compliance

 2  with the background screening requirements of s. 429.174.

 3         (3)  In addition to the requirements of part II of

 4  chapter 408, An applicant for renewal of a license who has

 5  complied with the provisions of s. 429.11 with respect to

 6  proof of financial ability to operate shall not be required to

 7  provide further proof unless the facility or any other

 8  facility owned or operated in whole or in part by the same

 9  person has demonstrated financial instability as provided

10  under s. 429.47(2) or unless the agency suspects that the

11  facility is not financially stable as a result of the annual

12  survey or complaints from the public or a report from the

13  State Long-Term Care Ombudsman Council. each facility must

14  report to the agency any adverse court action concerning the

15  facility's financial viability, within 7 days after its

16  occurrence. The agency shall have access to books, records,

17  and any other financial documents maintained by the facility

18  to the extent necessary to determine the facility's financial

19  stability. A license for the operation of a facility shall not

20  be renewed if the licensee has any outstanding fines assessed

21  pursuant to this part which are in final order status.

22         (4)  A licensee against whom a revocation or suspension

23  proceeding is pending at the time of license renewal may be

24  issued a conditional license effective until final disposition

25  by the agency. If judicial relief is sought from the final

26  disposition, the court having jurisdiction may issue a

27  conditional license for the duration of the judicial

28  proceeding.

29         (4)(5)  In addition to the license categories available

30  in s. 408.808, a conditional license may be issued to an

31  applicant for license renewal if the applicant fails to meet

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 1  all standards and requirements for licensure. A conditional

 2  license issued under this subsection shall be limited in

 3  duration to a specific period of time not to exceed 6 months,

 4  as determined by the agency, and shall be accompanied by an

 5  agency-approved plan of correction.

 6         (5)(6)  When an extended care or limited nursing

 7  license is requested during a facility's biennial license

 8  period, the fee shall be prorated in order to permit the

 9  additional license to expire at the end of the biennial

10  license period. The fee shall be calculated as of the date the

11  additional license application is received by the agency.

12         (6)(7)  The department may by rule establish renewal

13  procedures, identify forms, and specify documentation

14  necessary to administer this section. The agency, in

15  consultation with the department, may adopt rules to

16  administer the requirements of part II of chapter 408.

17         Section 146.  Section 429.174, Florida Statutes, is

18  amended to read:

19         429.174  Background screening; exemptions.--

20         (1)(a)  Level 2 background screening must be conducted

21  on each of the following persons, who shall be considered

22  employees for the purposes of conducting screening under

23  chapter 435:

24         1.  The facility owner if an individual, the

25  administrator, and the financial officer.

26         2.  An officer or board member if the facility owner is

27  a firm, corporation, partnership, or association, or any

28  person owning 5 percent or more of the facility if the agency

29  has probable cause to believe that such person has been

30  convicted of any offense prohibited by s. 435.04. For each

31  officer, board member, or person owning 5 percent or more who

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 1  has been convicted of any such offense, the facility shall

 2  submit to the agency a description and explanation of the

 3  conviction at the time of license application. This

 4  subparagraph does not apply to a board member of a

 5  not-for-profit corporation or organization if the board member

 6  serves solely in a voluntary capacity, does not regularly take

 7  part in the day-to-day operational decisions of the

 8  corporation or organization, receives no remuneration for his

 9  or her services, and has no financial interest and has no

10  family members with a financial interest in the corporation or

11  organization, provided that the board member and facility

12  submit a statement affirming that the board member's

13  relationship to the facility satisfies the requirements of

14  this subparagraph.

15         (b)  Proof of compliance with level 2 screening

16  standards which has been submitted within the previous 5 years

17  to meet any facility or professional licensure requirements of

18  the agency or the Department of Health satisfies the

19  requirements of this subsection, provided that such proof is

20  accompanied, under penalty of perjury, by an affidavit of

21  compliance with the provisions of chapter 435. Proof of

22  compliance with the background screening requirements of the

23  Financial Services Commission and the Office of Insurance

24  Regulation for applicants for a certificate of authority to

25  operate a continuing care retirement community under chapter

26  651, submitted within the last 5 years, satisfies the

27  Department of Law Enforcement and Federal Bureau of

28  Investigation portions of a level 2 background check.

29         (c)  The agency may grant a provisional license to a

30  facility applying for an initial license when each individual

31  required by this subsection to undergo screening has completed

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 1  the Department of Law Enforcement background checks, but has

 2  not yet received results from the Federal Bureau of

 3  Investigation, or when a request for an exemption from

 4  disqualification has been submitted to the agency pursuant to

 5  s. 435.07, but a response has not been issued.

 6         (2)  The owner or administrator of an assisted living

 7  facility must conduct level 1 background screening, as set

 8  forth in chapter 435, on all employees hired on or after

 9  October 1, 1998, who perform personal services as defined in

10  s. 429.02(16)(17). The agency may exempt an individual from

11  employment disqualification as set forth in chapter 435. Such

12  persons shall be considered as having met this requirement if:

13         (1)(a)  Proof of compliance with level 1 screening

14  requirements obtained to meet any professional license

15  requirements in this state is provided and accompanied, under

16  penalty of perjury, by a copy of the person's current

17  professional license and an affidavit of current compliance

18  with the background screening requirements.

19         (2)(b)  The person required to be screened has been

20  continuously employed in the same type of occupation for which

21  the person is seeking employment without a breach in service

22  which exceeds 180 days, and proof of compliance with the level

23  1 screening requirement which is no more than 2 years old is

24  provided. Proof of compliance shall be provided directly from

25  one employer or contractor to another, and not from the person

26  screened. Upon request, a copy of screening results shall be

27  provided by the employer retaining documentation of the

28  screening to the person screened.

29         (3)(c)  The person required to be screened is employed

30  by a corporation or business entity or related corporation or

31  business entity that owns, operates, or manages more than one

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 1  facility or agency licensed under this chapter, and for whom a

 2  level 1 screening was conducted by the corporation or business

 3  entity as a condition of initial or continued employment.

 4         Section 147.  Section 429.176, Florida Statutes, is

 5  amended to read:

 6         429.176  Notice of change of administrator.--If, during

 7  the period for which a license is issued, the owner changes

 8  administrators, the owner must notify the agency of the change

 9  within 10 days and provide documentation within 90 days that

10  the new administrator has completed the applicable core

11  educational requirements under s. 429.52. Background screening

12  shall be completed on any new administrator as specified in s.

13  429.174.

14         Section 148.  Section 429.18, Florida Statutes, is

15  amended to read:

16         429.18  Disposition of fees and administrative fines.--

17         (1)  Income from license fees, inspection fees, late

18  fees, and administrative fines collected under this part

19  generated pursuant to ss. 429.07, 429.08, 429.17, 429.19, and

20  429.31 shall be deposited in the Health Care Trust Fund

21  administered by the agency. Such funds shall be directed to

22  and used by the agency for the following purposes:

23         (1)(a)  Up to 50 percent of the trust funds accrued

24  each fiscal year under this part may be used to offset the

25  expenses of receivership, pursuant to s. 429.22, if the court

26  determines that the income and assets of the facility are

27  insufficient to provide for adequate management and operation.

28         (2)(b)  An amount of $5,000 of the trust funds accrued

29  each year under this part shall be allocated to pay for

30  inspection-related physical and mental health examinations

31  requested by the agency pursuant to s. 429.26 for residents

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 1  who are either recipients of supplemental security income or

 2  have monthly incomes not in excess of the maximum combined

 3  federal and state cash subsidies available to supplemental

 4  security income recipients, as provided for in s. 409.212.

 5  Such funds shall only be used where the resident is ineligible

 6  for Medicaid.

 7         (3)(c)  Any trust funds accrued each year under this

 8  part and not used for the purposes specified in subsections

 9  (1) and (2) paragraphs (a) and (b) shall be used to offset the

10  costs of the licensure program, including the costs of

11  conducting background investigations, verifying information

12  submitted, defraying the costs of processing the names of

13  applicants, and conducting inspections and monitoring visits

14  pursuant to this part and part II of chapter 408.

15         (2)  Income from fees generated pursuant to s.

16  429.41(5) shall be deposited in the Health Care Trust Fund and

17  used to offset the costs of printing and postage.

18         Section 149.  Section 429.19, Florida Statutes, is

19  amended to read:

20         429.19  Violations; imposition of administrative fines;

21  grounds.--

22         (1)  In addition to the requirements of part II of

23  chapter 408, the agency shall impose an administrative fine in

24  the manner provided in chapter 120 for the violation of any

25  provision of this part, part II of chapter 408, and applicable

26  rules any of the actions or violations as set forth within

27  this section by an assisted living facility, for the actions

28  of any person subject to level 2 background screening under s.

29  408.809 s. 429.174, for the actions of any facility employee,

30  or for an intentional or negligent act seriously affecting the

31  health, safety, or welfare of a resident of the facility.

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 1         (2)  Each violation of this part and adopted rules

 2  shall be classified according to the nature of the violation

 3  and the gravity of its probable effect on facility residents.

 4  The agency shall indicate the classification on the written

 5  notice of the violation as follows:

 6         (a)  Class "I" violations are those conditions or

 7  occurrences related to the operation and maintenance of a

 8  facility or to the personal care of residents which the agency

 9  determines present an imminent danger to the residents or

10  guests of the facility or a substantial probability that death

11  or serious physical or emotional harm would result therefrom.

12  The condition or practice constituting a class I violation

13  shall be abated or eliminated within 24 hours, unless a fixed

14  period, as determined by the agency, is required for

15  correction. The agency shall impose an administrative fine for

16  a cited class I violation in an amount not less than $5,000

17  and not exceeding $10,000 for each violation. A fine may be

18  levied notwithstanding the correction of the violation.

19         (b)  Class "II" violations are those conditions or

20  occurrences related to the operation and maintenance of a

21  facility or to the personal care of residents which the agency

22  determines directly threaten the physical or emotional health,

23  safety, or security of the facility residents, other than

24  class I violations. The agency shall impose an administrative

25  fine for a cited class II violation in an amount not less than

26  $1,000 and not exceeding $5,000 for each violation. A fine

27  shall be levied notwithstanding the correction of the

28  violation.

29         (c)  Class "III" violations are those conditions or

30  occurrences related to the operation and maintenance of a

31  facility or to the personal care of residents which the agency

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 1  determines indirectly or potentially threaten the physical or

 2  emotional health, safety, or security of facility residents,

 3  other than class I or class II violations. The agency shall

 4  impose an administrative fine for a cited class III violation

 5  in an amount not less than $500 and not exceeding $1,000 for

 6  each violation. A citation for a class III violation must

 7  specify the time within which the violation is required to be

 8  corrected. If a class III violation is corrected within the

 9  time specified, no fine may be imposed, unless it is a

10  repeated offense.

11         (d)  Class "IV" violations are those conditions or

12  occurrences related to the operation and maintenance of a

13  building or to required reports, forms, or documents that do

14  not have the potential of negatively affecting residents.

15  These violations are of a type that the agency determines do

16  not threaten the health, safety, or security of residents of

17  the facility. The agency shall impose an administrative fine

18  for a cited class IV violation in an amount not less than $100

19  and not exceeding $200 for each violation. A citation for a

20  class IV violation must specify the time within which the

21  violation is required to be corrected. If a class IV violation

22  is corrected within the time specified, no fine shall be

23  imposed. Any class IV violation that is corrected during the

24  time an agency survey is being conducted will be identified as

25  an agency finding and not as a violation.

26         (3)  For purposes of this section, in determining if a

27  penalty is to be imposed and in fixing the amount of the fine,

28  the agency shall consider the following factors:

29         (a)  The gravity of the violation, including the

30  probability that death or serious physical or emotional harm

31  to a resident will result or has resulted, the severity of the

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 1  action or potential harm, and the extent to which the

 2  provisions of the applicable laws or rules were violated.

 3         (b)  Actions taken by the owner or administrator to

 4  correct violations.

 5         (c)  Any previous violations.

 6         (d)  The financial benefit to the facility of

 7  committing or continuing the violation.

 8         (e)  The licensed capacity of the facility.

 9         (4)  Each day of continuing violation after the date

10  fixed for termination of the violation, as ordered by the

11  agency, constitutes an additional, separate, and distinct

12  violation.

13         (5)  Any action taken to correct a violation shall be

14  documented in writing by the owner or administrator of the

15  facility and verified through followup visits by agency

16  personnel. The agency may impose a fine and, in the case of an

17  owner-operated facility, revoke or deny a facility's license

18  when a facility administrator fraudulently misrepresents

19  action taken to correct a violation.

20         (6)  For fines that are upheld following administrative

21  or judicial review, the violator shall pay the fine, plus

22  interest at the rate as specified in s. 55.03, for each day

23  beyond the date set by the agency for payment of the fine.

24         (7)  Any unlicensed facility that continues to operate

25  after agency notification is subject to a $1,000 fine per day.

26         (8)  Any licensed facility whose owner or administrator

27  concurrently operates an unlicensed facility shall be subject

28  to an administrative fine of $5,000 per day.

29         (6)(9)  Any facility whose owner fails to apply for a

30  change-of-ownership license in accordance with part II of

31  

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 1  chapter 408 s. 429.12 and operates the facility under the new

 2  ownership is subject to a fine of $5,000.

 3         (7)(10)  In addition to any administrative fines

 4  imposed, the agency may assess a survey fee, equal to the

 5  lesser of one half of the facility's biennial license and bed

 6  fee or $500, to cover the cost of conducting initial complaint

 7  investigations that result in the finding of a violation that

 8  was the subject of the complaint or monitoring visits

 9  conducted under s. 429.28(3)(c) to verify the correction of

10  the violations.

11         (8)(11)  The agency, as an alternative to or in

12  conjunction with an administrative action against a facility

13  for violations of this part and adopted rules, shall make a

14  reasonable attempt to discuss each violation and recommended

15  corrective action with the owner or administrator of the

16  facility, prior to written notification. The agency, instead

17  of fixing a period within which the facility shall enter into

18  compliance with standards, may request a plan of corrective

19  action from the facility which demonstrates a good faith

20  effort to remedy each violation by a specific date, subject to

21  the approval of the agency.

22         (12)  Administrative fines paid by any facility under

23  this section shall be deposited into the Health Care Trust

24  Fund and expended as provided in s. 429.18.

25         (9)(13)  The agency shall develop and disseminate an

26  annual list of all facilities sanctioned or fined $5,000 or

27  more for violations of state standards, the number and class

28  of violations involved, the penalties imposed, and the current

29  status of cases. The list shall be disseminated, at no charge,

30  to the Department of Elderly Affairs, the Department of

31  Health, the Department of Children and Family Services, the

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 1  Agency for Persons with Disabilities, the area agencies on

 2  aging, the Florida Statewide Advocacy Council, and the state

 3  and local ombudsman councils. The Department of Children and

 4  Family Services shall disseminate the list to service

 5  providers under contract to the department who are responsible

 6  for referring persons to a facility for residency. The agency

 7  may charge a fee commensurate with the cost of printing and

 8  postage to other interested parties requesting a copy of this

 9  list.

10         Section 150.  Section 429.21, Florida Statutes, is

11  repealed.

12         Section 151.  Subsection (9) of section 429.22, Florida

13  Statutes, is amended to read:

14         429.22  Receivership proceedings.--

15         (9)  The court may direct the agency to allocate funds

16  from the Health Care Trust Fund to the receiver, subject to

17  the provisions of s. 429.18(1).

18         Section 152.  Subsection (9) of section 429.26, Florida

19  Statutes, is amended to read:

20         429.26  Appropriateness of placements; examinations of

21  residents.--

22         (9)  If, at any time after admission to a facility, a

23  resident appears to need care beyond that which the facility

24  is licensed to provide, the agency shall require the resident

25  to be physically examined by a licensed physician, physician

26  assistant, or licensed nurse practitioner. This examination

27  shall, to the extent possible, be performed by the resident's

28  preferred physician or nurse practitioner and shall be paid

29  for by the resident with personal funds, except as provided in

30  s. 429.18(2)(1)(b). Following this examination, the examining

31  physician, physician assistant, or licensed nurse practitioner

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 1  shall complete and sign a medical form provided by the agency.

 2  The completed medical form shall be submitted to the agency

 3  within 30 days after the date the facility owner or

 4  administrator is notified by the agency that the physical

 5  examination is required. After consultation with the

 6  physician, physician assistant, or licensed nurse practitioner

 7  who performed the examination, a medical review team

 8  designated by the agency shall then determine whether the

 9  resident is appropriately residing in the facility. The

10  medical review team shall base its decision on a comprehensive

11  review of the resident's physical and functional status,

12  including the resident's preferences, and not on an isolated

13  health-related problem. In the case of a mental health

14  resident, if the resident appears to have needs in addition to

15  those identified in the community living support plan, the

16  agency may require an evaluation by a mental health

17  professional, as determined by the Department of Children and

18  Family Services. A facility may not be required to retain a

19  resident who requires more services or care than the facility

20  is able to provide in accordance with its policies and

21  criteria for admission and continued residency. Members of the

22  medical review team making the final determination may not

23  include the agency personnel who initially questioned the

24  appropriateness of a resident's placement. Such determination

25  is final and binding upon the facility and the resident. Any

26  resident who is determined by the medical review team to be

27  inappropriately residing in a facility shall be given 30 days'

28  written notice to relocate by the owner or administrator,

29  unless the resident's continued residence in the facility

30  presents an imminent danger to the health, safety, or welfare

31  of the resident or a substantial probability exists that death

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 1  or serious physical harm would result to the resident if

 2  allowed to remain in the facility.

 3         Section 153.  Subsections (1), (4), and (5) of section

 4  429.31, Florida Statutes, are amended to read:

 5         429.31  Closing of facility; notice; penalty.--

 6         (1)  In addition to the requirements of part II of

 7  chapter 408, Whenever a facility voluntarily discontinues

 8  operation, it shall inform the agency in writing at least 90

 9  days prior to the discontinuance of operation. the facility

10  shall also inform each resident or the next of kin, legal

11  representative, or agency acting on each resident's behalf, of

12  the fact and the proposed time of such discontinuance of

13  operation, following the notification requirements provided in

14  s. 429.28(1)(k). In the event a resident has no person to

15  represent him or her, the facility shall be responsible for

16  referral to an appropriate social service agency for

17  placement.

18         (4)  Immediately upon discontinuance of the operation

19  of a facility, the owner shall surrender the license therefor

20  to the agency, and the license shall be canceled.

21         (4)(5)  The agency may levy a fine in an amount no

22  greater than $5,000 upon each person or business entity that

23  owns any interest in a facility that terminates operation

24  without providing notice to the agency and the residents of

25  the facility at least 30 days before operation ceases. This

26  fine shall not be levied against any facility involuntarily

27  closed at the initiation of the agency. The agency shall use

28  the proceeds of the fines to operate the facility until all

29  residents of the facility are relocated and shall deposit any

30  balance of the proceeds into the Health Care Trust Fund

31  established pursuant to s. 429.18.

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 1         Section 154.  Section 429.34, Florida Statutes, is

 2  amended to read:

 3         429.34  Right of entry and inspection.--In addition to

 4  the requirements of s. 408.811, any duly designated officer or

 5  employee of the department, the Department of Children and

 6  Family Services, the agency, the Medicaid Fraud Control Unit

 7  of the Office of the Attorney General Department of Legal

 8  Affairs, the state or local fire marshal, or a member of the

 9  state or local long-term care ombudsman council shall have the

10  right to enter unannounced upon and into the premises of any

11  facility licensed pursuant to this part in order to determine

12  the state of compliance with the provisions of this part, part

13  II of chapter 408, and applicable of rules or standards in

14  force pursuant thereto. The right of entry and inspection

15  shall also extend to any premises which the agency has reason

16  to believe is being operated or maintained as a facility

17  without a license; but no such entry or inspection of any

18  premises may be made without the permission of the owner or

19  person in charge thereof, unless a warrant is first obtained

20  from the circuit court authorizing such entry. The warrant

21  requirement shall extend only to a facility which the agency

22  has reason to believe is being operated or maintained as a

23  facility without a license. Any application for a license or

24  renewal thereof made pursuant to this part shall constitute

25  permission for, and complete acquiescence in, any entry or

26  inspection of the premises for which the license is sought, in

27  order to facilitate verification of the information submitted

28  on or in connection with the application; to discover,

29  investigate, and determine the existence of abuse or neglect;

30  or to elicit, receive, respond to, and resolve complaints. Any

31  current valid license shall constitute unconditional

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 1  permission for, and complete acquiescence in, any entry or

 2  inspection of the premises by authorized personnel. The agency

 3  shall retain the right of entry and inspection of facilities

 4  that have had a license revoked or suspended within the

 5  previous 24 months, to ensure that the facility is not

 6  operating unlawfully. However, before entering the facility, a

 7  statement of probable cause must be filed with the director of

 8  the agency, who must approve or disapprove the action within

 9  48 hours. Probable cause shall include, but is not limited to,

10  evidence that the facility holds itself out to the public as a

11  provider of personal care services or the receipt of a

12  complaint by the long-term care ombudsman council about the

13  facility. Data collected by the state or local long-term care

14  ombudsman councils or the state or local advocacy councils may

15  be used by the agency in investigations involving violations

16  of regulatory standards.

17         Section 155.  Section 429.35, Florida Statutes, is

18  amended to read:

19         429.35  Maintenance of records; reports.--

20         (1)  Every facility shall maintain, as public

21  information available for public inspection under such

22  conditions as the agency shall prescribe, records containing

23  copies of all inspection reports pertaining to the facility

24  that have been issued by the agency to the facility. Copies of

25  inspection reports shall be retained in the records for 5

26  years from the date the reports are filed or issued.

27         (2)  Within 60 days after the date of the biennial

28  inspection visit required under s. 408.811 or within 30 days

29  after the date of any interim visit, the agency shall forward

30  the results of the inspection to the local ombudsman council

31  in whose planning and service area, as defined in part I II of

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 1  chapter 400, the facility is located; to at least one public

 2  library or, in the absence of a public library, the county

 3  seat in the county in which the inspected assisted living

 4  facility is located; and, when appropriate, to the district

 5  Adult Services and Mental Health Program Offices.

 6         (3)  Every facility shall post a copy of the last

 7  inspection report of the agency for that facility in a

 8  prominent location within the facility so as to be accessible

 9  to all residents and to the public.  Upon request, the

10  facility shall also provide a copy of the report to any

11  resident of the facility or to an applicant for admission to

12  the facility.

13         Section 156.  Section 429.41, Florida Statutes, is

14  amended to read:

15         429.41  Rules establishing standards.--

16         (1)  It is the intent of the Legislature that rules

17  published and enforced pursuant to this section shall include

18  criteria by which a reasonable and consistent quality of

19  resident care and quality of life may be ensured and the

20  results of such resident care may be demonstrated. Such rules

21  shall also ensure a safe and sanitary environment that is

22  residential and noninstitutional in design or nature. It is

23  further intended that reasonable efforts be made to

24  accommodate the needs and preferences of residents to enhance

25  the quality of life in a facility. The agency, in consultation

26  with the department, may adopt rules to administer the

27  requirements of part II of chapter 408. In order to provide

28  safe and sanitary facilities and the highest quality of

29  resident care accommodating the needs and preferences of

30  residents, the department, in consultation with the agency,

31  the Department of Children and Family Services, and the

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 1  Department of Health, shall adopt rules, policies, and

 2  procedures to administer this part, which must include

 3  reasonable and fair minimum standards in relation to:

 4         (a)  The requirements for and maintenance of

 5  facilities, not in conflict with the provisions of chapter

 6  553, relating to plumbing, heating, cooling, lighting,

 7  ventilation, living space, and other housing conditions, which

 8  will ensure the health, safety, and comfort of residents and

 9  protection from fire hazard, including adequate provisions for

10  fire alarm and other fire protection suitable to the size of

11  the structure. Uniform firesafety standards shall be

12  established and enforced by the State Fire Marshal in

13  cooperation with the agency, the department, and the

14  Department of Health.

15         1.  Evacuation capability determination.--

16         a.  The provisions of the National Fire Protection

17  Association, NFPA 101A, Chapter 5, 1995 edition, shall be used

18  for determining the ability of the residents, with or without

19  staff assistance, to relocate from or within a licensed

20  facility to a point of safety as provided in the fire codes

21  adopted herein. An evacuation capability evaluation for

22  initial licensure shall be conducted within 6 months after the

23  date of licensure. For existing licensed facilities that are

24  not equipped with an automatic fire sprinkler system, the

25  administrator shall evaluate the evacuation capability of

26  residents at least annually. The evacuation capability

27  evaluation for each facility not equipped with an automatic

28  fire sprinkler system shall be validated, without liability,

29  by the State Fire Marshal, by the local fire marshal, or by

30  the local authority having jurisdiction over firesafety,

31  before the license renewal date. If the State Fire Marshal,

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 1  local fire marshal, or local authority having jurisdiction

 2  over firesafety has reason to believe that the evacuation

 3  capability of a facility as reported by the administrator may

 4  have changed, it may, with assistance from the facility

 5  administrator, reevaluate the evacuation capability through

 6  timed exiting drills. Translation of timed fire exiting drills

 7  to evacuation capability may be determined:

 8         (I)  Three minutes or less: prompt.

 9         (II)  More than 3 minutes, but not more than 13

10  minutes: slow.

11         (III)  More than 13 minutes: impractical.

12         b.  The Office of the State Fire Marshal shall provide

13  or cause the provision of training and education on the proper

14  application of Chapter 5, NFPA 101A, 1995 edition, to its

15  employees, to staff of the Agency for Health Care

16  Administration who are responsible for regulating facilities

17  under this part, and to local governmental inspectors. The

18  Office of the State Fire Marshal shall provide or cause the

19  provision of this training within its existing budget, but may

20  charge a fee for this training to offset its costs. The

21  initial training must be delivered within 6 months after July

22  1, 1995, and as needed thereafter.

23         c.  The Office of the State Fire Marshal, in

24  cooperation with provider associations, shall provide or cause

25  the provision of a training program designed to inform

26  facility operators on how to properly review bid documents

27  relating to the installation of automatic fire sprinklers. The

28  Office of the State Fire Marshal shall provide or cause the

29  provision of this training within its existing budget, but may

30  charge a fee for this training to offset its costs. The

31  

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 1  initial training must be delivered within 6 months after July

 2  1, 1995, and as needed thereafter.

 3         d.  The administrator of a licensed facility shall sign

 4  an affidavit verifying the number of residents occupying the

 5  facility at the time of the evacuation capability evaluation.

 6         2.  Firesafety requirements.--

 7         a.  Except for the special applications provided

 8  herein, effective January 1, 1996, the provisions of the

 9  National Fire Protection Association, Life Safety Code, NFPA

10  101, 1994 edition, Chapter 22 for new facilities and Chapter

11  23 for existing facilities shall be the uniform fire code

12  applied by the State Fire Marshal for assisted living

13  facilities, pursuant to s. 633.022.

14         b.  Any new facility, regardless of size, that applies

15  for a license on or after January 1, 1996, must be equipped

16  with an automatic fire sprinkler system. The exceptions as

17  provided in s. 22-2.3.5.1, NFPA 101, 1994 edition, as adopted

18  herein, apply to any new facility housing eight or fewer

19  residents. On July 1, 1995, local governmental entities

20  responsible for the issuance of permits for construction shall

21  inform, without liability, any facility whose permit for

22  construction is obtained prior to January 1, 1996, of this

23  automatic fire sprinkler requirement. As used in this part,

24  the term "a new facility" does not mean an existing facility

25  that has undergone change of ownership.

26         c.  Notwithstanding any provision of s. 633.022 or of

27  the National Fire Protection Association, NFPA 101A, Chapter

28  5, 1995 edition, to the contrary, any existing facility

29  housing eight or fewer residents is not required to install an

30  automatic fire sprinkler system, nor to comply with any other

31  requirement in Chapter 23, NFPA 101, 1994 edition, that

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 1  exceeds the firesafety requirements of NFPA 101, 1988 edition,

 2  that applies to this size facility, unless the facility has

 3  been classified as impractical to evacuate. Any existing

 4  facility housing eight or fewer residents that is classified

 5  as impractical to evacuate must install an automatic fire

 6  sprinkler system within the timeframes granted in this

 7  section.

 8         d.  Any existing facility that is required to install

 9  an automatic fire sprinkler system under this paragraph need

10  not meet other firesafety requirements of Chapter 23, NFPA

11  101, 1994 edition, which exceed the provisions of NFPA 101,

12  1988 edition. The mandate contained in this paragraph which

13  requires certain facilities to install an automatic fire

14  sprinkler system supersedes any other requirement.

15         e.  This paragraph does not supersede the exceptions

16  granted in NFPA 101, 1988 edition or 1994 edition.

17         f.  This paragraph does not exempt facilities from

18  other firesafety provisions adopted under s. 633.022 and local

19  building code requirements in effect before July 1, 1995.

20         g.  A local government may charge fees only in an

21  amount not to exceed the actual expenses incurred by local

22  government relating to the installation and maintenance of an

23  automatic fire sprinkler system in an existing and properly

24  licensed assisted living facility structure as of January 1,

25  1996.

26         h.  If a licensed facility undergoes major

27  reconstruction or addition to an existing building on or after

28  January 1, 1996, the entire building must be equipped with an

29  automatic fire sprinkler system. Major reconstruction of a

30  building means repair or restoration that costs in excess of

31  50 percent of the value of the building as reported on the tax

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 1  rolls, excluding land, before reconstruction. Multiple

 2  reconstruction projects within a 5-year period the total costs

 3  of which exceed 50 percent of the initial value of the

 4  building at the time the first reconstruction project was

 5  permitted are to be considered as major reconstruction.

 6  Application for a permit for an automatic fire sprinkler

 7  system is required upon application for a permit for a

 8  reconstruction project that creates costs that go over the

 9  50-percent threshold.

10         i.  Any facility licensed before January 1, 1996, that

11  is required to install an automatic fire sprinkler system

12  shall ensure that the installation is completed within the

13  following timeframes based upon evacuation capability of the

14  facility as determined under subparagraph 1.:

15         (I)  Impractical evacuation capability, 24 months.

16         (II)  Slow evacuation capability, 48 months.

17         (III)  Prompt evacuation capability, 60 months.

18  

19  The beginning date from which the deadline for the automatic

20  fire sprinkler installation requirement must be calculated is

21  upon receipt of written notice from the local fire official

22  that an automatic fire sprinkler system must be installed. The

23  local fire official shall send a copy of the document

24  indicating the requirement of a fire sprinkler system to the

25  Agency for Health Care Administration.

26         j.  It is recognized that the installation of an

27  automatic fire sprinkler system may create financial hardship

28  for some facilities. The appropriate local fire official

29  shall, without liability, grant two 1-year extensions to the

30  timeframes for installation established herein, if an

31  automatic fire sprinkler installation cost estimate and proof

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 1  of denial from two financial institutions for a construction

 2  loan to install the automatic fire sprinkler system are

 3  submitted. However, for any facility with a class I or class

 4  II, or a history of uncorrected class III, firesafety

 5  deficiencies, an extension must not be granted. The local fire

 6  official shall send a copy of the document granting the time

 7  extension to the Agency for Health Care Administration.

 8         k.  A facility owner whose facility is required to be

 9  equipped with an automatic fire sprinkler system under Chapter

10  23, NFPA 101, 1994 edition, as adopted herein, must disclose

11  to any potential buyer of the facility that an installation of

12  an automatic fire sprinkler requirement exists. The sale of

13  the facility does not alter the timeframe for the installation

14  of the automatic fire sprinkler system.

15         l.  Existing facilities required to install an

16  automatic fire sprinkler system as a result of

17  construction-type restrictions in Chapter 23, NFPA 101, 1994

18  edition, as adopted herein, or evacuation capability

19  requirements shall be notified by the local fire official in

20  writing of the automatic fire sprinkler requirement, as well

21  as the appropriate date for final compliance as provided in

22  this subparagraph. The local fire official shall send a copy

23  of the document to the Agency for Health Care Administration.

24         m.  Except in cases of life-threatening fire hazards,

25  if an existing facility experiences a change in the evacuation

26  capability, or if the local authority having jurisdiction

27  identifies a construction-type restriction, such that an

28  automatic fire sprinkler system is required, it shall be

29  afforded time for installation as provided in this

30  subparagraph.

31  

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 1  Facilities that are fully sprinkled and in compliance with

 2  other firesafety standards are not required to conduct more

 3  than one of the required fire drills between the hours of 11

 4  p.m. and 7 a.m., per year. In lieu of the remaining drills,

 5  staff responsible for residents during such hours may be

 6  required to participate in a mock drill that includes a review

 7  of evacuation procedures. Such standards must be included or

 8  referenced in the rules adopted by the State Fire Marshal.

 9  Pursuant to s. 633.022(1)(b), the State Fire Marshal is the

10  final administrative authority for firesafety standards

11  established and enforced pursuant to this section. All

12  licensed facilities must have an annual fire inspection

13  conducted by the local fire marshal or authority having

14  jurisdiction.

15         3.  Resident elopement requirements.--Facilities are

16  required to conduct a minimum of two resident elopement

17  prevention and response drills per year. All administrators

18  and direct care staff must participate in the drills which

19  shall include a review of procedures to address resident

20  elopement. Facilities must document the implementation of the

21  drills and ensure that the drills are conducted in a manner

22  consistent with the facility's resident elopement policies and

23  procedures.

24         (b)  The preparation and annual update of a

25  comprehensive emergency management plan. Such standards must

26  be included in the rules adopted by the department after

27  consultation with the Department of Community Affairs. At a

28  minimum, the rules must provide for plan components that

29  address emergency evacuation transportation; adequate

30  sheltering arrangements; postdisaster activities, including

31  provision of emergency power, food, and water; postdisaster

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 1  transportation; supplies; staffing; emergency equipment;

 2  individual identification of residents and transfer of

 3  records; communication with families; and responses to family

 4  inquiries. The comprehensive emergency management plan is

 5  subject to review and approval by the local emergency

 6  management agency. During its review, the local emergency

 7  management agency shall ensure that the following agencies, at

 8  a minimum, are given the opportunity to review the plan: the

 9  Department of Elderly Affairs, the Department of Health, the

10  Agency for Health Care Administration, and the Department of

11  Community Affairs. Also, appropriate volunteer organizations

12  must be given the opportunity to review the plan. The local

13  emergency management agency shall complete its review within

14  60 days and either approve the plan or advise the facility of

15  necessary revisions.

16         (c)  The number, training, and qualifications of all

17  personnel having responsibility for the care of residents. The

18  rules must require adequate staff to provide for the safety of

19  all residents. Facilities licensed for 17 or more residents

20  are required to maintain an alert staff for 24 hours per day.

21         (d)  All sanitary conditions within the facility and

22  its surroundings which will ensure the health and comfort of

23  residents. The rules must clearly delineate the

24  responsibilities of the agency's licensure and survey staff,

25  the county health departments, and the local authority having

26  jurisdiction over firesafety and ensure that inspections are

27  not duplicative. The agency may collect fees for food service

28  inspections conducted by the county health departments and

29  transfer such fees to the Department of Health.

30         (e)  License application and license renewal, transfer

31  of ownership, proper management of resident funds and personal

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 1  property, surety bonds, resident contracts, refund policies,

 2  financial ability to operate, and facility and staff records.

 3         (f)  Inspections, complaint investigations,

 4  moratoriums, classification of deficiencies, levying and

 5  enforcement of penalties, and use of income from fees and

 6  fines.

 7         (g)  The enforcement of the resident bill of rights

 8  specified in s. 429.28.

 9         (h)  The care and maintenance of residents, which must

10  include, but is not limited to:

11         1.  The supervision of residents;

12         2.  The provision of personal services;

13         3.  The provision of, or arrangement for, social and

14  leisure activities;

15         4.  The arrangement for appointments and transportation

16  to appropriate medical, dental, nursing, or mental health

17  services, as needed by residents;

18         5.  The management of medication;

19         6.  The nutritional needs of residents;

20         7.  Resident records; and

21         8.  Internal risk management and quality assurance.

22         (i)  Facilities holding a limited nursing, extended

23  congregate care, or limited mental health license.

24         (j)  The establishment of specific criteria to define

25  appropriateness of resident admission and continued residency

26  in a facility holding a standard, limited nursing, extended

27  congregate care, and limited mental health license.

28         (k)  The use of physical or chemical restraints. The

29  use of physical restraints is limited to half-bed rails as

30  prescribed and documented by the resident's physician with the

31  consent of the resident or, if applicable, the resident's

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 1  representative or designee or the resident's surrogate,

 2  guardian, or attorney in fact. The use of chemical restraints

 3  is limited to prescribed dosages of medications authorized by

 4  the resident's physician and must be consistent with the

 5  resident's diagnosis. Residents who are receiving medications

 6  that can serve as chemical restraints must be evaluated by

 7  their physician at least annually to assess:

 8         1.  The continued need for the medication.

 9         2.  The level of the medication in the resident's

10  blood.

11         3.  The need for adjustments in the prescription.

12         (l)  The establishment of specific policies and

13  procedures on resident elopement. Facilities shall conduct a

14  minimum of two resident elopement drills each year. All

15  administrators and direct care staff shall participate in the

16  drills. Facilities shall document the drills.

17         (2)  In adopting any rules pursuant to this part, the

18  department, in conjunction with the agency, shall make

19  distinct standards for facilities based upon facility size;

20  the types of care provided; the physical and mental

21  capabilities and needs of residents; the type, frequency, and

22  amount of services and care offered; and the staffing

23  characteristics of the facility. Rules developed pursuant to

24  this section shall not restrict the use of shared staffing and

25  shared programming in facilities that are part of retirement

26  communities that provide multiple levels of care and otherwise

27  meet the requirements of law and rule. Except for uniform

28  firesafety standards, the department shall adopt by rule

29  separate and distinct standards for facilities with 16 or

30  fewer beds and for facilities with 17 or more beds. The

31  standards for facilities with 16 or fewer beds shall be

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 1  appropriate for a noninstitutional residential environment,

 2  provided that the structure is no more than two stories in

 3  height and all persons who cannot exit the facility unassisted

 4  in an emergency reside on the first floor. The department, in

 5  conjunction with the agency, may make other distinctions among

 6  types of facilities as necessary to enforce the provisions of

 7  this part. Where appropriate, the agency shall offer alternate

 8  solutions for complying with established standards, based on

 9  distinctions made by the department and the agency relative to

10  the physical characteristics of facilities and the types of

11  care offered therein.

12         (3)  The department shall submit a copy of proposed

13  rules to the Speaker of the House of Representatives, the

14  President of the Senate, and appropriate committees of

15  substance for review and comment prior to the promulgation

16  thereof.

17         (a)  Rules promulgated by the department shall

18  encourage the development of homelike facilities which promote

19  the dignity, individuality, personal strengths, and

20  decisionmaking ability of residents.

21         (4)(b)  The agency, in consultation with the

22  department, may waive rules promulgated pursuant to this part

23  in order to demonstrate and evaluate innovative or

24  cost-effective congregate care alternatives which enable

25  individuals to age in place. Such waivers may be granted only

26  in instances where there is reasonable assurance that the

27  health, safety, or welfare of residents will not be

28  endangered. To apply for a waiver, the licensee shall submit

29  to the agency a written description of the concept to be

30  demonstrated, including goals, objectives, and anticipated

31  benefits; the number and types of residents who will be

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 1  affected, if applicable; a brief description of how the

 2  demonstration will be evaluated; and any other information

 3  deemed appropriate by the agency. Any facility granted a

 4  waiver shall submit a report of findings to the agency and the

 5  department within 12 months. At such time, the agency may

 6  renew or revoke the waiver or pursue any regulatory or

 7  statutory changes necessary to allow other facilities to adopt

 8  the same practices. The department may by rule clarify terms

 9  and establish waiver application procedures, criteria for

10  reviewing waiver proposals, and procedures for reporting

11  findings, as necessary to implement this subsection.

12         (5)(4)  The agency may use an abbreviated biennial

13  standard licensure inspection that consists of a review of key

14  quality-of-care standards in lieu of a full inspection in

15  facilities which have a good record of past performance.

16  However, a full inspection shall be conducted in facilities

17  which have had a history of class I or class II violations,

18  uncorrected class III violations, confirmed ombudsman council

19  complaints, or confirmed licensure complaints, within the

20  previous licensure period immediately preceding the inspection

21  or when a potentially serious problem is identified during the

22  abbreviated inspection. The agency, in consultation with the

23  department, shall develop the key quality-of-care standards

24  with input from the State Long-Term Care Ombudsman Council and

25  representatives of provider groups for incorporation into its

26  rules. The department, in consultation with the agency, shall

27  report annually to the Legislature concerning its

28  implementation of this subsection. The report shall include,

29  at a minimum, the key quality-of-care standards which have

30  been developed; the number of facilities identified as being

31  eligible for the abbreviated inspection; the number of

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 1  facilities which have received the abbreviated inspection and,

 2  of those, the number that were converted to full inspection;

 3  the number and type of subsequent complaints received by the

 4  agency or department on facilities which have had abbreviated

 5  inspections; any recommendations for modification to this

 6  subsection; any plans by the agency to modify its

 7  implementation of this subsection; and any other information

 8  which the department believes should be reported.

 9         (5)  A fee shall be charged by the department to any

10  person requesting a copy of this part or rules promulgated

11  under this part. Such fees shall not exceed the actual cost of

12  duplication and postage.

13         Section 157.  Subsections (4) through (7) of section

14  429.47, Florida Statutes, are renumbered as subsections (1)

15  through (4), respectively, and present subsections (1), (2),

16  and (3) of that section are amended to read:

17         429.47  Prohibited acts; penalties for violation.--

18         (1)  It is unlawful for any person or public body to

19  offer or advertise to the public, in any way by any medium

20  whatever, personal services as defined in this act, without

21  obtaining a valid current license. It is unlawful for any

22  holder of a license issued pursuant to the provisions of this

23  act to advertise or hold out to the public that it holds a

24  license for a facility other than that for which it actually

25  holds a license.

26         (2)  It is unlawful for any holder of a license issued

27  pursuant to the provisions of this act to withhold from the

28  agency any evidence of financial instability, including, but

29  not limited to, bad checks, delinquent accounts, nonpayment of

30  withholding taxes, unpaid utility expenses, nonpayment for

31  essential services, or adverse court action concerning the

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 1  financial viability of the facility or any other facility

 2  licensed under part II of chapter 400 or under this part which

 3  is owned by the licensee.

 4         (3)  Any person found guilty of violating subsection

 5  (1) or subsection (2) commits a misdemeanor of the second

 6  degree, punishable as provided in s. 775.083. Each day of

 7  continuing violation shall be considered a separate offense.

 8         Section 158.  Section 429.51, Florida Statutes, is

 9  repealed.

10         Section 159.  Section 429.67, Florida Statutes, is

11  amended to read:

12         429.67  Licensure application and renewal.--

13         (1)  The requirements of part II of chapter 408 apply

14  to the provision of services that require licensure pursuant

15  to this part and part II of chapter 408 and to entities

16  licensed by or applying for such licensure from the Agency for

17  Health Care Administration pursuant to this part. A license

18  issued by the agency is required in order to operate an adult

19  family-care home in this state. Each person who intends to be

20  an adult family-care home provider must apply for a license

21  from the agency at least 90 days before the applicant intends

22  to operate the adult family-care home.

23         (2)  A person who intends to be an adult family-care

24  home provider must own or rent the adult family-care home that

25  is to be licensed and reside therein.

26         (3)  In accordance with s. 408.805, an applicant or

27  licensee shall pay a fee for each license application

28  submitted under this part, part II of chapter 408, and

29  applicable rules. The amount of the fee shall be $200 per

30  biennium. The agency shall notify a licensee at least 120 days

31  before the expiration date that license renewal is required to

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 1  continue operation. The notification must be provided

 2  electronically or by mail delivery. Application for a license

 3  or annual license renewal must be made on a form provided by

 4  the agency, signed under oath, and must be accompanied by a

 5  licensing fee of $100 per year.

 6         (4)  Upon receipt of a completed license application or

 7  license renewal, and the fee, the agency shall initiate a

 8  level 1 background screening as provided under chapter 435 on

 9  the adult family-care home provider, the designated relief

10  person, all adult household members, and all staff members.

11  The agency shall conduct an onsite visit to the home that is

12  to be licensed.

13         (a)  Proof of compliance with level 1 screening

14  standards which has been submitted within the previous 5 years

15  to meet any facility or professional licensure requirements of

16  the agency or the Department of Health satisfies the

17  requirements of this subsection. Such proof must be

18  accompanied, under penalty of perjury, by a copy of the

19  person's current professional license and an affidavit of

20  current compliance with the background screening requirements.

21         (b)  The person required to be screened must have been

22  continuously employed in the same type of occupation for which

23  the person is seeking employment without a breach in service

24  that exceeds 180 days, and proof of compliance with the level

25  1 screening requirement which is no more than 2 years old must

26  be provided. Proof of compliance shall be provided directly

27  from one employer or contractor to another, and not from the

28  person screened. Upon request, a copy of screening results

29  shall be provided to the person screened by the employer

30  retaining documentation of the screening.

31  

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 1         (5)  The application must be accompanied by a

 2  description and explanation of any exclusions, permanent

 3  suspensions, or terminations of the applicant from

 4  participation in the Medicaid or Medicare programs or any

 5  other governmental health care or health insurance program.

 6         (5)(6)  Unless the adult family-care home is a

 7  community residential home subject to chapter 419, the

 8  applicant must provide documentation, signed by the

 9  appropriate governmental official, that the home has met local

10  zoning requirements for the location for which the license is

11  sought.

12         (6)(7)  In addition to the requirements of s. 408.811,

13  access to a licensed adult family-care home must be provided

14  at reasonable times for the appropriate officials of the

15  department, the Department of Health, the Department of

16  Children and Family Services, the agency, and the State Fire

17  Marshal, who are responsible for the development and

18  maintenance of fire, health, sanitary, and safety standards,

19  to inspect the facility to assure compliance with these

20  standards. In addition, access to a licensed adult family-care

21  home must be provided at reasonable times for the local

22  long-term care ombudsman council.

23         (8)  A license is effective for 1 year after the date

24  of issuance unless revoked sooner. Each license must state the

25  name of the provider, the address of the home to which the

26  license applies, and the maximum number of residents of the

27  home. Failure to timely file a license renewal application

28  shall result in a late fee equal to 50 percent of the license

29  fee.

30  

31  

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 1         (9)  A license is not transferable or applicable to any

 2  location or person other than the location and person

 3  indicated on the license.

 4         (7)(10)  The licensed maximum capacity of each adult

 5  family-care home is based on the service needs of the

 6  residents and the capability of the provider to meet the needs

 7  of the residents. Any relative who lives in the adult

 8  family-care home and who is a disabled adult or frail elder

 9  must be included in that limitation.

10         (8)(11)  Each adult family-care home must designate at

11  least one licensed space for a resident receiving optional

12  state supplementation. The Department of Children and Family

13  Services shall specify by rule the procedures to be followed

14  for referring residents who receive optional state

15  supplementation to adult family-care homes. Those homes

16  licensed as adult foster homes or assisted living facilities

17  prior to January 1, 1994, that convert to adult family-care

18  homes, are exempt from this requirement.

19         (9)(12)  In addition to the license categories

20  available in s. 408.808, the agency may issue a conditional

21  license to a provider for the purpose of bringing the adult

22  family-care home into compliance with licensure requirements.

23  A conditional license must be limited to a specific period,

24  not exceeding 6 months. The department shall, by rule,

25  establish criteria for issuing conditional licenses.

26         (13)  All moneys collected under this section must be

27  deposited into the Department of Elderly Affairs

28  Administrative Trust Fund.

29         (10)(14)  The department may adopt rules to establish

30  procedures, identify forms, specify documentation, and clarify

31  terms, as necessary, to administer this section.

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 1         (11)  The agency may adopt rules to administer the

 2  requirements of part II of chapter 408.

 3         Section 160.  Section 429.69, Florida Statutes, is

 4  amended to read:

 5         429.69  Denial, revocation, and or suspension of a

 6  license.--In addition to the requirements of part II of

 7  chapter 408, the agency may deny, suspend, and or revoke a

 8  license for any of the following reasons:

 9         (1)  Failure of any of the persons required to undergo

10  background screening under s. 429.67 to meet the level 1

11  screening standards of s. 435.03, unless an exemption from

12  disqualification has been provided by the agency.

13         (2)  An intentional or negligent act materially

14  affecting the health, safety, or welfare of the adult

15  family-care home residents.

16         (3)  Submission of fraudulent information or omission

17  of any material fact on a license application or any other

18  document required by the agency.

19         (4)  Failure to pay an administrative fine assessed

20  under this part.

21         (5)  A violation of this part or adopted rules which

22  results in conditions or practices that directly threaten the

23  physical or emotional health, safety, or welfare of residents.

24         (2)(6)  Failure to correct cited fire code violations

25  that threaten the health, safety, or welfare of residents.

26         (7)  Failure to submit a completed initial license

27  application or to complete an application for license renewal

28  within the specified timeframes.

29         (8)  Exclusion, permanent suspension, or termination of

30  the provider from the Medicare or Medicaid program.

31  

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 1         Section 161.  Section 429.71, Florida Statutes, is

 2  amended to read:

 3         429.71  Classification of deficiencies; administrative

 4  fines Violations; penalties.--

 5         (1)  In addition to the requirements of part II of

 6  chapter 408 and in addition to any other liability or penalty

 7  provided by law, the agency may impose an administrative fine

 8  a civil penalty on a provider according to the following

 9  classification:

10         (a)  Class I violations are those conditions or

11  practices related to the operation and maintenance of an adult

12  family-care home or to the care of residents which the agency

13  determines present an imminent danger to the residents or

14  guests of the facility or a substantial probability that death

15  or serious physical or emotional harm would result therefrom.

16  The condition or practice that constitutes a class I violation

17  must be abated or eliminated within 24 hours, unless a fixed

18  period, as determined by the agency, is required for

19  correction. A class I deficiency is subject to an

20  administrative fine in an amount not less than $500 and not

21  exceeding $1,000 for each violation. A fine may be levied

22  notwithstanding the correction of the deficiency.

23         (b)  Class II violations are those conditions or

24  practices related to the operation and maintenance of an adult

25  family-care home or to the care of residents which the agency

26  determines directly threaten the physical or emotional health,

27  safety, or security of the residents, other than class I

28  violations. A class II violation is subject to an

29  administrative fine in an amount not less than $250 and not

30  exceeding $500 for each violation. A citation for a class II

31  violation must specify the time within which the violation is

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 1  required to be corrected. If a class II violation is corrected

 2  within the time specified, no civil penalty shall be imposed,

 3  unless it is a repeated offense.

 4         (c)  Class III violations are those conditions or

 5  practices related to the operation and maintenance of an adult

 6  family-care home or to the care of residents which the agency

 7  determines indirectly or potentially threaten the physical or

 8  emotional health, safety, or security of residents, other than

 9  class I or class II violations. A class III violation is

10  subject to an administrative fine in an amount not less than

11  $100 and not exceeding $250 for each violation. A citation for

12  a class III violation shall specify the time within which the

13  violation is required to be corrected. If a class III

14  violation is corrected within the time specified, no civil

15  penalty shall be imposed, unless it is a repeated offense.

16         (d)  Class IV violations are those conditions or

17  occurrences related to the operation and maintenance of an

18  adult family-care home, or related to the required reports,

19  forms, or documents, which do not have the potential of

20  negatively affecting the residents. A provider that does not

21  correct a class IV violation within the time limit specified

22  by the agency is subject to an administrative fine in an

23  amount not less than $50 and not exceeding $100 for each

24  violation. Any class IV violation that is corrected during the

25  time the agency survey is conducted will be identified as an

26  agency finding and not as a violation.

27         (2)  The agency may impose an administrative fine for

28  violations which do not qualify as class I, class II, class

29  III, or class IV violations. The amount of the fine shall not

30  exceed $250 for each violation or $2,000 in the aggregate.

31  Unclassified violations may include:

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 1         (a)  Violating any term or condition of a license.

 2         (b)  Violating any provision of rule adopted under this

 3  part, part II of chapter 408, or applicable rules.

 4         (c)  Failure to follow the criteria and procedures

 5  provided under part I of chapter 394 relating to the

 6  transportation, voluntary admission, and involuntary

 7  examination of adult family-care home residents.

 8         (d)  Exceeding licensed capacity.

 9         (e)  Providing services beyond the scope of the

10  license.

11         (f)  Violating a moratorium.

12         (3)  Each day during which a violation occurs

13  constitutes a separate offense.

14         (4)  In determining whether a penalty is to be imposed,

15  and in fixing the amount of any penalty to be imposed, the

16  agency must consider:

17         (a)  The gravity of the violation.

18         (b)  Actions taken by the provider to correct a

19  violation.

20         (c)  Any previous violation by the provider.

21         (d)  The financial benefit to the provider of

22  committing or continuing the violation.

23         (5)  As an alternative to or in conjunction with an

24  administrative action against a provider, the agency may

25  request a plan of corrective action that demonstrates a good

26  faith effort to remedy each violation by a specific date,

27  subject to the approval of the agency.

28         (6)  The department shall set forth, by rule, notice

29  requirements and procedures for correction of deficiencies.

30         (7)  Civil penalties paid by a provider must be

31  deposited into the Department of Elderly Affairs

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 1  Administrative Trust Fund and used to offset the expenses of

 2  departmental training and education for adult family-care home

 3  providers.

 4         (8)  The agency may impose an immediate moratorium on

 5  admissions to any adult family-care home if the agency finds

 6  that a condition in the home presents a threat to the health,

 7  safety, or welfare of its residents. The department may by

 8  rule establish facility conditions that constitute grounds for

 9  imposing a moratorium and establish procedures for imposing

10  and lifting a moratorium.

11         Section 162.  Section 429.73, Florida Statutes, is

12  amended to read:

13         429.73  Rules and standards relating to adult

14  family-care homes.--

15         (1)  The agency, in consultation with the department,

16  may adopt rules to administer the requirements of part II of

17  chapter 408. The department, in consultation with the

18  Department of Health, the Department of Children and Family

19  Services, and the agency shall, by rule, establish minimum

20  standards to ensure the health, safety, and well-being of each

21  resident in the adult family-care home pursuant to this part.

22  The rules must address:

23         (a)  Requirements for the physical site of the facility

24  and facility maintenance.

25         (b)  Services that must be provided to all residents of

26  an adult family-care home and standards for such services,

27  which must include, but need not be limited to:

28         1.  Room and board.

29         2.  Assistance necessary to perform the activities of

30  daily living.

31         3.  Assistance necessary to administer medication.

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 1         4.  Supervision of residents.

 2         5.  Health monitoring.

 3         6.  Social and leisure activities.

 4         (c)  Standards and procedures for license application

 5  and annual license renewal, advertising, proper management of

 6  each resident's funds and personal property and personal

 7  affairs, financial ability to operate, medication management,

 8  inspections, complaint investigations, and facility, staff,

 9  and resident records.

10         (d)  Qualifications, training, standards, and

11  responsibilities for providers and staff.

12         (e)  Compliance with chapter 419, relating to community

13  residential homes.

14         (f)  Criteria and procedures for determining the

15  appropriateness of a resident's placement and continued

16  residency in an adult family-care home. A resident who

17  requires 24-hour nursing supervision may not be retained in an

18  adult family-care home unless such resident is an enrolled

19  hospice patient and the resident's continued residency is

20  mutually agreeable to the resident and the provider.

21         (g)  Procedures for providing notice and assuring the

22  least possible disruption of residents' lives when residents

23  are relocated, an adult family-care home is closed, or the

24  ownership of an adult family-care home is transferred.

25         (h)  Procedures to protect the residents' rights as

26  provided in s. 429.85.

27         (i)  Procedures to promote the growth of adult

28  family-care homes as a component of a long-term care system.

29         (j)  Procedures to promote the goal of aging in place

30  for residents of adult family-care homes.

31  

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 1         (2)  The department shall by rule provide minimum

 2  standards and procedures for emergencies. Pursuant to s.

 3  633.022, the State Fire Marshal, in consultation with the

 4  department and the agency, shall adopt uniform firesafety

 5  standards for adult family-care homes.

 6         (3)  The department shall adopt rules providing for the

 7  implementation of orders not to resuscitate. The provider may

 8  withhold or withdraw cardiopulmonary resuscitation if

 9  presented with an order not to resuscitate executed pursuant

10  to s. 401.45. The provider shall not be subject to criminal

11  prosecution or civil liability, nor be considered to have

12  engaged in negligent or unprofessional conduct, for

13  withholding or withdrawing cardiopulmonary resuscitation

14  pursuant to such an order and applicable rules adopted by the

15  department.

16         (4)  The provider of any adult family-care home that is

17  in operation at the time any rules are adopted or amended

18  under this part may be given a reasonable time, not exceeding

19  6 months, within which to comply with the new or revised rules

20  and standards.

21         Section 163.  Section 429.77, Florida Statutes, is

22  repealed.

23         Section 164.  Subsections (6) and (7) of section

24  429.901, Florida Statutes, are amended to read:

25         429.901  Definitions.--As used in this part, the term:

26         (6)  "Operator" means the licensee or person having

27  general administrative charge of an adult day care center.

28         (7)  "Owner" means the licensee owner of an adult day

29  care center.

30         Section 165.  Section 429.907, Florida Statutes, is

31  amended to read:

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 1         429.907  License requirement; fee; exemption;

 2  display.--

 3         (1)  The requirements of part II of chapter 408 apply

 4  to the provision of services that require licensure pursuant

 5  to this part and part II of chapter 408 and to entities

 6  licensed by or applying for such licensure from the Agency for

 7  Health Care Administration pursuant to this part. A license

 8  issued by the agency is required in order to operate an adult

 9  day care in this state. It is unlawful to operate an adult day

10  care center without first obtaining from the agency a license

11  authorizing such operation. The agency is responsible for

12  licensing adult day care centers in accordance with this part.

13         (2)  Separate licenses are required for centers

14  operated on separate premises, even though operated under the

15  same management. Separate licenses are not required for

16  separate buildings on the same premises.

17         (3)  In accordance with s. 408.805, an applicant or

18  licensee shall pay a fee for each license application

19  submitted under this part and part II of chapter 408. The

20  amount of the fee shall be established by rule and The

21  biennial license fee required of a center shall be determined

22  by the department, but may not exceed $150.

23         (4)  County-operated or municipally operated centers

24  applying for licensure under this part are exempt from the

25  payment of license fees.

26         (5)  The license for a center shall be displayed in a

27  conspicuous place inside the center.

28         (6)  A license is valid only in the possession of the

29  individual, firm, partnership, association, or corporation to

30  which it is issued and is not subject to sale, assignment, or

31  other transfer, voluntary or involuntary; nor is a license

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 1  valid for any premises other than the premises for which

 2  originally issued.

 3         Section 166.  Section 429.909, Florida Statutes, is

 4  amended to read:

 5         429.909  Application for license.--

 6         (1)  An application for a license to operate an adult

 7  day care center must be made to the agency on forms furnished

 8  by the agency and must be accompanied by the appropriate

 9  license fee unless the applicant is exempt from payment of the

10  fee as provided in s. 429.907(4).

11         (2)  In addition to all provisions of part II of

12  chapter 408, the applicant for licensure must furnish:

13         (a)  a description of the physical and mental

14  capabilities and needs of the participants to be served and

15  the availability, frequency, and intensity of basic services

16  and of supportive and optional services to be provided and;

17         (b)  Satisfactory proof of financial ability to operate

18  and conduct the center in accordance with the requirements of

19  this part, which must include, in the case of an initial

20  application, a 1-year operating plan and proof of a 3-month

21  operating reserve fund; and

22         (c)  proof of adequate liability insurance coverage.

23         (d)  Proof of compliance with level 2 background

24  screening as required under s. 429.919.

25         (e)  A description and explanation of any exclusions,

26  permanent suspensions, or terminations of the application from

27  the Medicare or Medicaid programs. Proof of compliance with

28  disclosure of ownership and control interest requirements of

29  the Medicare or Medicaid programs shall be accepted in lieu of

30  this submission.

31  

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 1         Section 167.  Section 429.911, Florida Statutes, is

 2  amended to read:

 3         429.911  Denial, suspension, revocation of license;

 4  emergency action; administrative fines; investigations and

 5  inspections.--

 6         (1)  The agency may deny, revoke, and or suspend a

 7  license under this part, impose an action under s. 408.814,

 8  and or may impose an administrative fine against the owner of

 9  an adult day care center or its operator or employee in the

10  manner provided in chapter 120 for the violation of any

11  provision of this part, part II of chapter 408, or applicable

12  rules.

13         (2)  Each of the following actions by the owner of an

14  adult day care center or by its operator or employee is a

15  ground for action by the agency against the owner of the

16  center or its operator or employee:

17         (a)  An intentional or negligent act materially

18  affecting the health or safety of center participants.

19         (b)  A violation of this part or of any standard or

20  rule under this part or part II of chapter 408.

21         (c)  A failure of persons subject to level 2 background

22  screening under s. 408.809 429.174(1) to meet the screening

23  standards of s. 435.04, or the retention by the center of an

24  employee subject to level 1 background screening standards

25  under s. 429.174(2) who does not meet the screening standards

26  of s. 435.03 and for whom exemptions from disqualification

27  have not been provided by the agency.

28         (d)  Failure to follow the criteria and procedures

29  provided under part I of chapter 394 relating to the

30  transportation, voluntary admission, and involuntary

31  examination of center participants.

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 1         (e)  Multiple or repeated violations of this part or of

 2  any standard or rule adopted under this part or part II of

 3  chapter 408.

 4         (f)  Exclusion, permanent suspension, or termination of

 5  the owner, if an individual, officer, or board member of the

 6  adult day care center, if the owner is a firm, corporation,

 7  partnership, or association, or any person owning 5 percent or

 8  more of the center, from the Medicare or Medicaid program.

 9         (3)  The agency is responsible for all investigations

10  and inspections conducted pursuant to this part and s.

11  408.811.

12         Section 168.  Section 429.913, Florida Statutes, is

13  amended to read:

14         429.913  Administrative fines; interest.--

15         (1)(a)  In addition to the requirements of part II of

16  chapter 408, if the agency determines that an adult day care

17  center is not operated in compliance with this part or with

18  rules adopted under this part, the agency, notwithstanding any

19  other administrative action it takes, shall make a reasonable

20  attempt to discuss with the owner each violation and

21  recommended corrective action prior to providing the owner

22  with written notification. The agency may request the

23  submission of a corrective action plan for the center which

24  demonstrates a good faith effort to remedy each violation by a

25  specific date, subject to the approval of the agency.

26         (b)  The owner of a center or its operator or employee

27  found in violation of this part, part II of chapter 408, or

28  applicable rules or of rules adopted under this part may be

29  fined by the agency. A fine may not exceed $500 for each

30  violation. In no event, however, may such fines in the

31  aggregate exceed $5,000.

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 1         (c)  The failure to correct a violation by the date set

 2  by the agency, or the failure to comply with an approved

 3  corrective action plan, is a separate violation for each day

 4  such failure continues, unless the agency approves an

 5  extension to a specific date.

 6         (d)  If the owner of a center or its operator or

 7  employee appeals an agency action under this section and the

 8  fine is upheld, the violator shall pay the fine, plus interest

 9  at the legal rate specified in s. 687.01 for each day that the

10  fine remains unpaid after the date set by the agency for

11  payment of the fine.

12         (2)  In determining whether to impose a fine and in

13  fixing the amount of any fine, the agency shall consider the

14  following factors:

15         (a)  The gravity of the violation, including the

16  probability that death or serious physical or emotional harm

17  to a participant will result or has resulted, the severity of

18  the actual or potential harm, and the extent to which the

19  provisions of the applicable statutes or rules were violated.

20         (b)  Actions taken by the owner or operator to correct

21  violations.

22         (c)  Any previous violations.

23         (d)  The financial benefit to the center of committing

24  or continuing the violation.

25         Section 169.  Section 429.915, Florida Statutes, is

26  amended to read:

27         429.915  Expiration of license; renewal; Conditional

28  license or permit.--

29         (1)  A license issued for the operation of an adult day

30  care center, unless sooner suspended or revoked, expires 2

31  years after the date of issuance. The agency shall notify a

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 1  licensee at least 120 days before the expiration date that

 2  license renewal is required to continue operation. The

 3  notification must be provided electronically or by mail

 4  delivery. At least 90 days prior to the expiration date, an

 5  application for renewal must be submitted to the agency. A

 6  license shall be renewed, upon the filing of an application on

 7  forms furnished by the agency, if the applicant has first met

 8  the requirements of this part and of the rules adopted under

 9  this part. The applicant must file with the application

10  satisfactory proof of financial ability to operate the center

11  in accordance with the requirements of this part and in

12  accordance with the needs of the participants to be served and

13  an affidavit of compliance with the background screening

14  requirements of s. 429.919.

15         (2)  A licensee against whom a revocation or suspension

16  proceeding is pending at the time for license renewal may be

17  issued a conditional license effective until final disposition

18  by the agency of the proceeding. If judicial relief is sought

19  from the final disposition, the court having jurisdiction may

20  issue a conditional permit effective for the duration of the

21  judicial proceeding.

22         (3)  In addition to the license categories available in

23  part II of chapter 408, the agency may issue a conditional

24  license to an applicant for license renewal or change of

25  ownership if the applicant fails to meet all standards and

26  requirements for licensure. A conditional license issued under

27  this subsection must be limited to a specific period not

28  exceeding 6 months, as determined by the agency, and must be

29  accompanied by an approved plan of correction.

30         Section 170.  Section 429.919, Florida Statutes, is

31  amended to read:

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 1         429.919  Background screening.--

 2         (1)(a)  Level 2 background screening must be conducted

 3  on each of the following persons, who shall be considered

 4  employees for the purposes of conducting screening under

 5  chapter 435:

 6         1.  The adult day care center owner if an individual,

 7  the operator, and the financial officer.

 8         2.  An officer or board member if the owner of the

 9  adult day care center is a firm, corporation, partnership, or

10  association, or any person owning 5 percent or more of the

11  facility, if the agency has probable cause to believe that

12  such person has been convicted of any offense prohibited by s.

13  435.04. For each officer, board member, or person owning 5

14  percent or more who has been convicted of any such offense,

15  the facility shall submit to the agency a description and

16  explanation of the conviction at the time of license

17  application. This subparagraph does not apply to a board

18  member of a not-for-profit corporation or organization if the

19  board member serves solely in a voluntary capacity, does not

20  regularly take part in the day-to-day operational decisions of

21  the corporation or organization, receives no remuneration for

22  his or her services, and has no financial interest and has no

23  family members with a financial interest in the corporation or

24  organization, provided that the board member and facility

25  submit a statement affirming that the board member's

26  relationship to the facility satisfies the requirements of

27  this subparagraph.

28         (b)  Proof of compliance with level 2 screening

29  standards which has been submitted within the previous 5 years

30  to meet any facility or professional licensure requirements of

31  

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 1  the agency or the Department of Health satisfies the

 2  requirements of this subsection.

 3         (c)  The agency may grant a provisional license to an

 4  adult day care center applying for an initial license when

 5  each individual required by this subsection to undergo

 6  screening has completed the Department of Law Enforcement

 7  background check, but has not yet received results from the

 8  Federal Bureau of Investigation, or when a request for an

 9  exemption from disqualification has been submitted to the

10  agency pursuant to s. 435.07, but a response has not been

11  issued.

12         (2)  The owner or administrator of an adult day care

13  center must conduct level 1 background screening as set forth

14  in chapter 435 on all employees hired on or after October 1,

15  1998, who provide basic services or supportive and optional

16  services to the participants. Such persons satisfy this

17  requirement if:

18         (1)(a)  Proof of compliance with level 1 screening

19  requirements obtained to meet any professional license

20  requirements in this state is provided and accompanied, under

21  penalty of perjury, by a copy of the person's current

22  professional license and an affidavit of current compliance

23  with the background screening requirements.

24         (2)(b)  The person required to be screened has been

25  continuously employed, without a breach in service that

26  exceeds 180 days, in the same type of occupation for which the

27  person is seeking employment and provides proof of compliance

28  with the level 1 screening requirement which is no more than 2

29  years old. Proof of compliance must be provided directly from

30  one employer or contractor to another, and not from the person

31  screened. Upon request, a copy of screening results shall be

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 1  provided to the person screened by the employer retaining

 2  documentation of the screening.

 3         (3)(c)  The person required to be screened is employed

 4  by a corporation or business entity or related corporation or

 5  business entity that owns, operates, or manages more than one

 6  facility or agency licensed under chapter 400 or this chapter,

 7  and for whom a level 1 screening was conducted by the

 8  corporation or business entity as a condition of initial or

 9  continued employment.

10         Section 171.  Section 429.921, Florida Statutes, is

11  repealed.

12         Section 172.  Section 429.923, Florida Statutes, is

13  repealed.

14         Section 173.  Section 429.925, Florida Statutes, is

15  amended to read:

16         429.925  Discontinuance of operation of adult day care

17  centers Closing or change of owner or operator of center.--

18         (1)  In addition to the requirements of part II of

19  chapter 408, before operation of an adult day care center may

20  be voluntarily discontinued, the operator must, inform the

21  agency in writing at least 60 days before prior to the

22  discontinuance of operation. The operator must also, at such

23  time, inform each participant of the fact and the proposed

24  date of such discontinuance of operation.

25         (2)  Immediately upon discontinuance of the operation

26  of a center, the owner or operator shall surrender the license

27  for the center to the agency, and the license shall be

28  canceled by the agency.

29         (3)  If a center has a change of ownership, the new

30  owner shall apply to the agency for a new license at least 60

31  days before the date of the change of ownership.

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 1         (4)  If a center has a change of operator, the new

 2  operator shall notify the agency in writing within 30 days

 3  after the change of operator.

 4         Section 174.  Section 429.927, Florida Statutes, is

 5  amended to read:

 6         429.927  Right of entry and inspection.--In accordance

 7  with s. 408.811, any duly designated officer or employee of

 8  the agency or department has the right to enter the premises

 9  of any adult day care center licensed pursuant to this part,

10  at any reasonable time, in order to determine the state of

11  compliance with this part, part II of chapter 408, and

12  applicable the rules or standards in force pursuant to this

13  part. The right of entry and inspection also extends to any

14  premises that the agency has reason to believe are being

15  operated as a center without a license, but no entry or

16  inspection of any unlicensed premises may be made without the

17  permission of the owner or operator unless a warrant is first

18  obtained from the circuit court authorizing entry or

19  inspection.  Any application for a center license or license

20  renewal made pursuant to this part constitutes permission for,

21  and complete acquiescence in, any entry or inspection of the

22  premises for which the license is sought in order to

23  facilitate verification of the information submitted on or in

24  connection with the application.

25         Section 175.  Section 429.929, Florida Statutes, is

26  amended to read:

27         429.929  Rules establishing standards.--

28         (1)  The agency, in consultation with the department,

29  may adopt rules to administer the requirements of part II of

30  chapter 408. The Department of Elderly Affairs, in conjunction

31  with the agency, shall adopt rules to implement the provisions

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 1  of this part. The rules must include reasonable and fair

 2  standards. Any conflict between these standards and those that

 3  may be set forth in local, county, or municipal ordinances

 4  shall be resolved in favor of those having statewide effect.

 5  Such standards must relate to:

 6         (a)  The maintenance of adult day care centers with

 7  respect to plumbing, heating, lighting, ventilation, and other

 8  building conditions, including adequate meeting space, to

 9  ensure the health, safety, and comfort of participants and

10  protection from fire hazard. Such standards may not conflict

11  with chapter 553 and must be based upon the size of the

12  structure and the number of participants.

13         (b)  The number and qualifications of all personnel

14  employed by adult day care centers who have responsibilities

15  for the care of participants.

16         (c)  All sanitary conditions within adult day care

17  centers and their surroundings, including water supply, sewage

18  disposal, food handling, and general hygiene, and maintenance

19  of sanitary conditions, to ensure the health and comfort of

20  participants.

21         (d)  Basic services provided by adult day care centers.

22         (e)  Supportive and optional services provided by adult

23  day care centers.

24         (f)  Data and information relative to participants and

25  programs of adult day care centers, including, but not limited

26  to, the physical and mental capabilities and needs of the

27  participants, the availability, frequency, and intensity of

28  basic services and of supportive and optional services

29  provided, the frequency of participation, the distances

30  traveled by participants, the hours of operation, the number

31  

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 1  of referrals to other centers or elsewhere, and the incidence

 2  of illness.

 3         (g)  Components of a comprehensive emergency management

 4  plan, developed in consultation with the Department of Health,

 5  the Agency for Health Care Administration, and the Department

 6  of Community Affairs.

 7         (2)  Pursuant to s. 119.07, the agency may charge a fee

 8  for furnishing a copy of this part, or of the rules adopted

 9  under this part, to any person upon request for the copy.

10         (2)(3)  Pursuant to this part, s. 408.811, and

11  applicable rules adopted by the department, the agency may

12  conduct an abbreviated biennial inspection of key

13  quality-of-care standards, in lieu of a full inspection, of a

14  center that has a record of good performance. However, the

15  agency must conduct a full inspection of a center that has had

16  one or more confirmed complaints within the licensure period

17  immediately preceding the inspection or which has a serious

18  problem identified during the abbreviated inspection. The

19  agency shall develop the key quality-of-care standards, taking

20  into consideration the comments and recommendations of the

21  Department of Elderly Affairs and of provider groups. These

22  standards shall be included in rules adopted by the Department

23  of Elderly Affairs.

24         Section 176.  Section 429.933, Florida Statutes, is

25  repealed.

26         Section 177.  Subsections (9) and (10) of section

27  440.102, Florida Statutes, are amended to read:

28         440.102  Drug-free workplace program requirements.--The

29  following provisions apply to a drug-free workplace program

30  implemented pursuant to law or to rules adopted by the Agency

31  for Health Care Administration:

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 1         (9)  DRUG-TESTING STANDARDS FOR LABORATORIES.--

 2         (a)  The requirements of part II of chapter 408 apply

 3  to the provision of services that require licensure pursuant

 4  to this section and part II of chapter 408 and to entities

 5  licensed by or applying for such licensure from the agency

 6  pursuant to this section. A license issued by the agency is

 7  required in order to operate a drug-free workplace laboratory.

 8         (b)(a)  A laboratory may analyze initial or

 9  confirmation test specimens only if:

10         1.  The laboratory obtains a license under part II of

11  chapter 408 and s. 112.0455(17). Each applicant for licensure

12  and each licensee must comply with all requirements of this

13  section, part II of chapter 408, and applicable rules. is

14  licensed and approved by the Agency for Health Care

15  Administration using criteria established by the United States

16  Department of Health and Human Services as general guidelines

17  for modeling the state drug-testing program pursuant to this

18  section or the laboratory is certified by the United States

19  Department of Health and Human Services.

20         2.  The laboratory has written procedures to ensure the

21  chain of custody.

22         3.  The laboratory follows proper quality control

23  procedures, including, but not limited to:

24         a.  The use of internal quality controls, including the

25  use of samples of known concentrations which are used to check

26  the performance and calibration of testing equipment, and

27  periodic use of blind samples for overall accuracy.

28         b.  An internal review and certification process for

29  drug test results, conducted by a person qualified to perform

30  that function in the testing laboratory.

31  

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 1         c.  Security measures implemented by the testing

 2  laboratory to preclude adulteration of specimens and drug test

 3  results.

 4         d.  Other necessary and proper actions taken to ensure

 5  reliable and accurate drug test results.

 6         (c)(b)  A laboratory shall disclose to the medical

 7  review officer a written positive confirmed test result report

 8  within 7 working days after receipt of the sample. All

 9  laboratory reports of a drug test result must, at a minimum,

10  state:

11         1.  The name and address of the laboratory that

12  performed the test and the positive identification of the

13  person tested.

14         2.  Positive results on confirmation tests only, or

15  negative results, as applicable.

16         3.  A list of the drugs for which the drug analyses

17  were conducted.

18         4.  The type of tests conducted for both initial tests

19  and confirmation tests and the minimum cutoff levels of the

20  tests.

21         5.  Any correlation between medication reported by the

22  employee or job applicant pursuant to subparagraph (5)(b)2.

23  and a positive confirmed drug test result.

24  

25  A report must not disclose the presence or absence of any drug

26  other than a specific drug and its metabolites listed pursuant

27  to this section.

28         (d)(c)  The laboratory shall submit to the Agency for

29  Health Care Administration a monthly report with statistical

30  information regarding the testing of employees and job

31  applicants. The report must include information on the methods

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 1  of analysis conducted, the drugs tested for, the number of

 2  positive and negative results for both initial tests and

 3  confirmation tests, and any other information deemed

 4  appropriate by the Agency for Health Care Administration. A

 5  monthly report must not identify specific employees or job

 6  applicants.

 7         (10)  RULES.--The Agency for Health Care Administration

 8  shall adopt rules pursuant to s. 112.0455, part II of chapter

 9  408, and criteria established by the United States Department

10  of Health and Human Services as general guidelines for

11  modeling drug-free workplace laboratories the state

12  drug-testing program, concerning, but not limited to:

13         (a)  Standards for licensing drug-testing laboratories

14  and suspension and revocation of such licenses.

15         (b)  Urine, hair, blood, and other body specimens and

16  minimum specimen amounts that are appropriate for drug

17  testing.

18         (c)  Methods of analysis and procedures to ensure

19  reliable drug-testing results, including standards for initial

20  tests and confirmation tests.

21         (d)  Minimum cutoff detection levels for each drug or

22  metabolites of such drug for the purposes of determining a

23  positive test result.

24         (e)  Chain-of-custody procedures to ensure proper

25  identification, labeling, and handling of specimens tested.

26         (f)  Retention, storage, and transportation procedures

27  to ensure reliable results on confirmation tests and retests.

28         Section 178.  Paragraph (l) of subsection (1) of

29  section 468.505, Florida Statutes, is amended to read:

30         468.505  Exemptions; exceptions.--

31  

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 1         (1)  Nothing in this part may be construed as

 2  prohibiting or restricting the practice, services, or

 3  activities of:

 4         (l)  A person employed by a nursing facility exempt

 5  from licensing under s. 395.002(12)(13), or a person exempt

 6  from licensing under s. 464.022.

 7         Section 179.  Subsection (3) is added to section

 8  483.035, Florida Statutes, to read:

 9         483.035  Clinical laboratories operated by

10  practitioners for exclusive use; licensure and regulation.--

11         (3)  The requirements of part II of chapter 408 apply

12  to the provision of services that require licensure pursuant

13  to this part and part II of chapter 408 and to entities

14  licensed by or applying for such licensure from the agency

15  pursuant to this part. A license issued by the agency is

16  required in order to operate a clinical laboratory.

17         Section 180.  Subsection (1) of section 483.051,

18  Florida Statutes, is amended to read:

19         483.051  Powers and duties of the agency.--The agency

20  shall adopt rules to implement this part, which rules must

21  include, but are not limited to, the following:

22         (1)  LICENSING; QUALIFICATIONS.--The agency shall

23  provide for biennial licensure of all clinical laboratories

24  meeting the requirements of this part and shall prescribe the

25  qualifications necessary for such licensure. A license issued

26  for operating a clinical laboratory, unless sooner suspended

27  or revoked, expires on the date set forth by the agency on the

28  face of the license.

29         Section 181.  Section 483.061, Florida Statutes, is

30  amended to read:

31         483.061  Inspection of clinical laboratories.--

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 1         (1)  In addition to the requirements of s. 408.811, the

 2  agency shall ensure that each clinical laboratory subject to

 3  this part is inspected either onsite or offsite when deemed

 4  necessary by the agency, but at least every 2 years, for the

 5  purpose of evaluating the operation, supervision, and

 6  procedures of the facility to ensure compliance with this

 7  part. Collection stations and branch offices may be inspected

 8  either onsite or offsite, when deemed necessary by the agency.

 9  The agency may conduct or cause to be conducted the following

10  announced or unannounced inspections at any reasonable time:

11         (a)  An inspection conducted at the direction of the

12  federal Centers for Medicare and Medicaid Services Health Care

13  Financing Administration.

14         (b)  A licensure inspection.

15         (b)(c)  A validation inspection.

16         (c)(d)  A complaint investigation, including a full

17  licensure investigation with a review of all licensure

18  standards as outlined in rule. Complaints received by the

19  agency from individuals, organizations, or other sources are

20  subject to review and investigation by the agency. If a

21  complaint has been filed against a laboratory or if a

22  laboratory has a substantial licensure deficiency, the agency

23  may inspect the laboratory annually or as the agency considers

24  necessary.

25         (2)  However, For laboratories operated under s.

26  483.035, biennial licensure inspections shall be scheduled so

27  as to cause the least disruption to the practitioner's

28  scheduled patients.

29         (2)  The right of entry and inspection is extended to

30  any premises that is maintained as a laboratory without a

31  license, but such entry or inspection may not be made without

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 1  the permission of the owner or person in charge of the

 2  laboratory, unless an inspection warrant as defined in s.

 3  933.20 is first obtained.

 4         (3)  The agency may shall inspect an out-of-state

 5  clinical laboratory under this section at the expense of the

 6  out-of-state clinical laboratory to determine whether the

 7  laboratory meets the requirements of this part and part II of

 8  chapter 408.

 9         (4)  The agency shall accept, in lieu of its own

10  periodic inspections for licensure, the survey of or

11  inspection by private accrediting organizations that perform

12  inspections of clinical laboratories accredited by such

13  organizations, including postinspection activities required by

14  the agency.

15         (a)  The agency shall accept inspections performed by

16  such organizations if the accreditation is not provisional, if

17  such organizations perform postinspection activities required

18  by the agency and provide the agency with all necessary

19  inspection and postinspection reports and information

20  necessary for enforcement, if such organizations apply

21  standards equal to or exceeding standards established and

22  approved by the agency, and if such accrediting organizations

23  are approved by the federal Health Care Financing

24  Administration to perform such inspections.

25         (b)  The agency may conduct complaint investigations

26  made against laboratories inspected by accrediting

27  organizations.

28         (c)  The agency may conduct sample validation

29  inspections of laboratories inspected by accrediting

30  organizations to evaluate the accreditation process used by an

31  accrediting organization.

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 1         (d)  The agency may conduct a full inspection if an

 2  accrediting survey has not been conducted within the previous

 3  24 months, and the laboratory must pay the appropriate license

 4  inspection fee under s. 483.172(2) s. 483.172.

 5         (e)  The agency shall develop, and adopt, by rule,

 6  criteria for accepting inspection and postinspection reports

 7  of accrediting organizations in lieu of conducting a state

 8  licensure inspection.

 9         Section 182.  Section 483.091, Florida Statutes, is

10  amended to read:

11         483.091  Clinical laboratory license.--A person may not

12  conduct, maintain, or operate a clinical laboratory in this

13  state, except a laboratory that is exempt under s. 483.031,

14  unless the clinical laboratory has obtained a license from the

15  agency. A clinical laboratory may not send a specimen drawn

16  within this state to any clinical laboratory outside the state

17  for examination unless the out-of-state laboratory has

18  obtained a license from the agency. A license is valid only

19  for the person or persons to whom it is issued and may not be

20  sold, assigned, or transferred, voluntarily or involuntarily,

21  and is not valid for any premises other than those for which

22  the license is issued. However, A new license may be secured

23  for the new location before the actual change, if the

24  contemplated change complies with this part, part II of

25  chapter 408, and the applicable rules adopted under this part.

26  Application for a new clinical laboratory license must be made

27  60 days before a change in the ownership of the clinical

28  laboratory.

29         Section 183.  Section 483.101, Florida Statutes, is

30  amended to read:

31         483.101  Application for Clinical laboratory license.--

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 1         (1)  An application for a clinical laboratory license

 2  must be made under oath by the owner or director of the

 3  clinical laboratory or by the public official responsible for

 4  operating a state, municipal, or county clinical laboratory or

 5  institution that contains a clinical laboratory, upon forms

 6  provided by the agency.

 7         (2)  Each applicant for licensure must comply with the

 8  following requirements:

 9         (a)  Upon receipt of a completed, signed, and dated

10  application, the agency shall require background screening, in

11  accordance with the level 2 standards for screening set forth

12  in chapter 435, of the managing director or other similarly

13  titled individual who is responsible for the daily operation

14  of the laboratory and of the financial officer, or other

15  similarly titled individual who is responsible for the

16  financial operation of the laboratory, including billings for

17  patient services. The applicant must comply with the

18  procedures for level 2 background screening as set forth in

19  chapter 435, as well as the requirements of s. 435.03(3).

20         (b)  The agency may require background screening of any

21  other individual who is an applicant if the agency has

22  probable cause to believe that he or she has been convicted of

23  a crime or has committed any other offense prohibited under

24  the level 2 standards for screening set forth in chapter 435.

25         (c)  Proof of compliance with the level 2 background

26  screening requirements of chapter 435 which has been submitted

27  within the previous 5 years in compliance with any other

28  health care licensure requirements of this state is acceptable

29  in fulfillment of the requirements of paragraph (a).

30         (d)  A provisional license may be granted to an

31  applicant when each individual required by this section to

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 1  undergo background screening has met the standards for the

 2  Department of Law Enforcement background check but the agency

 3  has not yet received background screening results from the

 4  Federal Bureau of Investigation, or a request for a

 5  disqualification exemption has been submitted to the agency as

 6  set forth in chapter 435 but a response has not yet been

 7  issued. A license may be granted to the applicant upon the

 8  agency's receipt of a report of the results of the Federal

 9  Bureau of Investigation background screening for each

10  individual required by this section to undergo background

11  screening which confirms that all standards have been met, or

12  upon the granting of a disqualification exemption by the

13  agency as set forth in chapter 435. Any other person who is

14  required to undergo level 2 background screening may serve in

15  his or her capacity pending the agency's receipt of the report

16  from the Federal Bureau of Investigation. However, the person

17  may not continue to serve if the report indicates any

18  violation of background screening standards and a

19  disqualification exemption has not been requested of and

20  granted by the agency as set forth in chapter 435.

21         (e)  Each applicant must submit to the agency, with its

22  application, a description and explanation of any exclusions,

23  permanent suspensions, or terminations of the applicant from

24  the Medicare or Medicaid programs. Proof of compliance with

25  the requirements for disclosure of ownership and control

26  interests under the Medicaid or Medicare programs may be

27  accepted in lieu of this submission.

28         (f)  Each applicant must submit to the agency a

29  description and explanation of any conviction of an offense

30  prohibited under the level 2 standards of chapter 435 by a

31  member of the board of directors of the applicant, its

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 1  officers, or any individual owning 5 percent or more of the

 2  applicant. This requirement does not apply to a director of a

 3  not-for-profit corporation or organization if the director

 4  serves solely in a voluntary capacity for the corporation or

 5  organization, does not regularly take part in the day-to-day

 6  operational decisions of the corporation or organization,

 7  receives no remuneration for his or her services on the

 8  corporation or organization's board of directors, and has no

 9  financial interest and has no family members with a financial

10  interest in the corporation or organization, provided that the

11  director and the not-for-profit corporation or organization

12  include in the application a statement affirming that the

13  director's relationship to the corporation satisfies the

14  requirements of this paragraph.

15         (g)  A license may not be granted to an applicant if

16  the applicant or managing employee has been found guilty of,

17  regardless of adjudication, or has entered a plea of nolo

18  contendere or guilty to, any offense prohibited under the

19  level 2 standards for screening set forth in chapter 435,

20  unless an exemption from disqualification has been granted by

21  the agency as set forth in chapter 435.

22         (h)  The agency may deny or revoke licensure if the

23  applicant:

24         1.  Has falsely represented a material fact in the

25  application required by paragraph (e) or paragraph (f), or has

26  omitted any material fact from the application required by

27  paragraph (e) or paragraph (f); or

28         2.  Has had prior action taken against the applicant

29  under the Medicaid or Medicare program as set forth in

30  paragraph (e).

31  

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 1         (i)  An application for license renewal must contain

 2  the information required under paragraphs (e) and (f).

 3         (3)  A license must be issued authorizing the

 4  performance of one or more clinical laboratory procedures or

 5  one or more tests on each specialty or subspecialty. A

 6  separate license is required of all laboratories maintained on

 7  separate premises even if the laboratories are operated under

 8  the same management. Upon receipt of a request for an

 9  application for a clinical laboratory license, the agency

10  shall provide to the applicant a copy of the rules relating to

11  licensure and operations applicable to the laboratory for

12  which licensure is sought.

13         Section 184.  Section 483.106, Florida Statutes, is

14  amended to read:

15         483.106  Application for a certificate of

16  exemption.--An application for a certificate of exemption must

17  be made under oath by the owner or director of a clinical

18  laboratory that performs only waived tests as defined in s.

19  483.041. A certificate of exemption authorizes a clinical

20  laboratory to perform waived tests. Laboratories maintained on

21  separate premises and operated under the same management may

22  apply for a single certificate of exemption or multiple

23  certificates of exemption. The agency shall, by rule, specify

24  the process for biennially issuing certificates of exemption.

25  Sections 483.011, 483.021, 483.031, 483.041, 483.172, and

26  483.23, and 483.25 apply to a clinical laboratory that obtains

27  a certificate of exemption under this section.

28         Section 185.  Section 483.111, Florida Statutes, is

29  amended to read:

30         483.111  Limitations on licensure.--A license may be

31  issued to a clinical laboratory to perform only those clinical

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 1  laboratory procedures and tests that are within the

 2  specialties or subspecialties in which the clinical laboratory

 3  personnel are qualified. A license may not be issued unless

 4  the agency determines that the clinical laboratory is

 5  adequately staffed and equipped to operate in conformity with

 6  the requirements of this part, part II of chapter 408, and

 7  applicable the rules adopted under this part.

 8         Section 186.  Section 483.131, Florida Statutes, is

 9  repealed.

10         Section 187.  Subsections (1) and (2) of section

11  483.172, Florida Statutes, are amended to read:

12         483.172  License fees.--

13         (1)  In accordance with s. 408.805, an applicant or a

14  licensee shall pay a fee for each license application

15  submitted under this part, part II of chapter 408, and

16  applicable rules. The agency shall collect fees for all

17  licenses issued under this part. Each fee is due at the time

18  of application and must be payable to the agency to be

19  deposited in the Health Care Trust Fund administered by the

20  agency.

21         (2)  The biennial license fee schedule is as follows:

22         (a)  If a laboratory performs not more than 2,000 tests

23  annually, the fee is $400.

24         (b)  If a laboratory performs not more than 3

25  categories of procedures with a total annual volume of more

26  than 2,000 but no more than 10,000 tests, the license fee is

27  $965.

28         (c)  If a laboratory performs at least 4 categories of

29  procedures with a total annual volume of not more than 10,000

30  tests, the license fee is $1,294.

31  

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 1         (d)  If a laboratory performs not more than 3

 2  categories of procedures with a total annual volume of more

 3  than 10,000 but not more than 25,000 tests, the license fee is

 4  $1,592.

 5         (e)  If a laboratory performs at least 4 categories of

 6  procedures with a total annual volume of more than 10,000 but

 7  not more than 25,000 tests, the license fee is $2,103.

 8         (f)  If a laboratory performs a total of more than

 9  25,000 but not more than 50,000 tests annually, the license

10  fee is $2,364.

11         (g)  If a laboratory performs a total of more than

12  50,000 but not more than 75,000 tests annually, the license

13  fee is $2,625.

14         (h)  If a laboratory performs a total of more than

15  75,000 but not more than 100,000 tests annually, the license

16  fee is $2,886.

17         (i)  If a laboratory performs a total of more than

18  100,000 but not more than 500,000 tests annually, the license

19  fee is $3,397.

20         (j)  If a laboratory performs a total of more than

21  500,000 but not more than 1 million tests annually, the

22  license fee is $3,658.

23         (k)  If a laboratory performs a total of more than 1

24  million tests annually, the license fee is $3,919.

25         Section 188.  Section 483.201, Florida Statutes, is

26  amended to read:

27         483.201  Grounds for disciplinary action against

28  clinical laboratories.--In addition to the requirements of

29  part II of chapter 408, the following acts constitute grounds

30  for which a disciplinary action specified in s. 483.221 may be

31  taken against a clinical laboratory:

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 1         (1)  Making a fraudulent statement on an application

 2  for a clinical laboratory license or any other document

 3  required by the agency.

 4         (1)(2)  Permitting unauthorized persons to perform

 5  technical procedures or to issue reports.

 6         (2)(3)  Demonstrating incompetence or making consistent

 7  errors in the performance of clinical laboratory examinations

 8  and procedures or erroneous reporting.

 9         (3)(4)  Performing a test and rendering a report

10  thereon to a person not authorized by law to receive such

11  services.

12         (4)(5)  Knowingly having professional connection with

13  or knowingly lending the use of the name of the licensed

14  clinical laboratory or its director to an unlicensed clinical

15  laboratory.

16         (5)(6)  Violating or aiding and abetting in the

17  violation of any provision of this part or the rules adopted

18  under this part.

19         (6)(7)  Failing to file any report required by the

20  provisions of this part or the rules adopted under this part.

21         (7)(8)  Reporting a test result for a clinical specimen

22  if the test was not performed on the clinical specimen.

23         (8)(9)  Performing and reporting tests in a specialty

24  or subspecialty in which the laboratory is not licensed.

25         (9)(10)  Knowingly advertising false services or

26  credentials.

27         (10)(11)  Failing to correct deficiencies within the

28  time required by the agency.

29         Section 189.  Section 483.221, Florida Statutes, is

30  amended to read:

31         483.221  Administrative fines penalties.--

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 1         (1)(a)  In accordance with part II of chapter 408, the

 2  agency may deny, suspend, revoke, annul, limit, or deny

 3  renewal of a license or impose an administrative fine, not to

 4  exceed $1,000 per violation, for the violation of any

 5  provision of this part or rules adopted under this part. Each

 6  day of violation constitutes a separate violation and is

 7  subject to a separate fine.

 8         (2)(b)  In determining the penalty to be imposed for a

 9  violation, as provided in subsection (1) paragraph (a), the

10  following factors must be considered:

11         (a)1.  The severity of the violation, including the

12  probability that death or serious harm to the health or safety

13  of any person will result or has resulted; the severity of the

14  actual or potential harm; and the extent to which the

15  provisions of this part were violated.

16         (b)2.  Actions taken by the licensee to correct the

17  violation or to remedy complaints.

18         (c)3.  Any previous violation by the licensee.

19         (d)4.  The financial benefit to the licensee of

20  committing or continuing the violation.

21         (c)  All amounts collected under this section must be

22  deposited into the Health Care Trust Fund administered by the

23  agency.

24         (2)  The agency may issue an emergency order

25  immediately suspending, revoking, annulling, or limiting a

26  license if it determines that any condition in the licensed

27  facility presents a clear and present danger to public health

28  or safety.

29         Section 190.  Section 483.25, Florida Statutes, is

30  repealed.

31  

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 1         Section 191.  Section 483.291, Florida Statutes, is

 2  amended to read:

 3         483.291  Powers and duties of the agency; rules.--The

 4  agency shall adopt rules to implement this part and part II of

 5  chapter 408, which rules must include the following:

 6         (1)  LICENSING STANDARDS.--The agency shall license all

 7  multiphasic health testing centers meeting the requirements of

 8  this part and shall prescribe standards necessary for

 9  licensure.

10         (2)  FEES.--In accordance with s. 408.805, an applicant

11  or a licensee shall pay a fee for each license application

12  submitted under this part, part II of chapter 408, and

13  applicable rules. The agency shall establish annual fees,

14  which shall be reasonable in amount, for licensing of centers.

15  The fees must be sufficient in amount to cover the cost of

16  licensing and inspecting centers.

17         (a)  The annual licensure fee is due at the time of

18  application and is payable to the agency to be deposited in

19  the Health Care Trust Fund administered by the agency. The

20  license fee must be not less than $600 $300 or more than

21  $2,000 $1,000.

22         (b)  The fee for late filing of an application for

23  license renewal is $200 and is in addition to the licensure

24  fee due for renewing the license.

25         (3)  ANNUAL LICENSING.--The agency shall provide for

26  annual licensing of centers. Any center that fails to pay the

27  proper fee or otherwise fails to qualify by the date of

28  expiration of its license is delinquent, and its license is

29  automatically canceled without notice or further proceeding.

30  Upon cancellation of its license under this subsection, a

31  center may have its license reinstated only upon application

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 1  and qualification as provided for initial applicants and upon

 2  payment of all delinquent fees.

 3         (3)(4)  STANDARDS OF PERFORMANCE.--The agency shall

 4  prescribe standards for the performance of health testing

 5  procedures.

 6         (4)(5)  CONSTRUCTION OF CENTERS.--The agency may adopt

 7  rules to ensure that centers comply with all local, county,

 8  state, and federal standards for the construction, renovation,

 9  maintenance, or repair of centers, which standards must ensure

10  the conduct and operation of the centers in a manner that will

11  protect the public health.

12         (5)(6)  SAFETY AND SANITARY CONDITIONS WITHIN THE

13  CENTER AND ITS SURROUNDINGS.--The agency shall establish

14  standards relating to safety and sanitary conditions within

15  the center and its surroundings, including water supply;

16  sewage; the handling of specimens; identification,

17  segregation, and separation of biohazardous waste as required

18  by s. 381.0098; storage of chemicals; workspace; firesafety;

19  and general measures, which standards must ensure the

20  protection of the public health. The agency shall determine

21  compliance by a multiphasic health testing center with the

22  requirements of s. 381.0098 by verifying that the center has

23  obtained all required permits.

24         (6)(7)  EQUIPMENT.--The agency shall establish minimum

25  standards for center equipment essential to the proper conduct

26  and operation of the center.

27         (7)(8)  PERSONNEL.--The agency shall prescribe minimum

28  qualifications for center personnel. A center may employ as a

29  medical assistant a person who has at least one of the

30  following qualifications:

31  

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 1         (a)  Prior experience of not less than 6 months as a

 2  medical assistant in the office of a licensed medical doctor

 3  or osteopathic physician or in a hospital, an ambulatory

 4  surgical center, a home health agency, or a health maintenance

 5  organization.

 6         (b)  Certification and registration by the American

 7  Medical Technologists Association or other similar

 8  professional association approved by the agency.

 9         (c)  Prior employment as a medical assistant in a

10  licensed center for at least 6 consecutive months at some time

11  during the preceding 2 years.

12         Section 192.  Section 483.294, Florida Statutes, is

13  amended to read:

14         483.294  Inspection of centers.--In accordance with s.

15  408.811, the agency shall, at least once annually, inspect the

16  premises and operations of all centers subject to licensure

17  under this part, without prior notice to the centers, for the

18  purpose of studying and evaluating the operation, supervision,

19  and procedures of such facilities, to determine their

20  compliance with agency standards and to determine their effect

21  upon the health and safety of the people of this state.

22         Section 193.  Section 483.30, Florida Statutes, is

23  amended to read:

24         483.30  Licensing of centers.--The requirements of part

25  II of chapter 408 apply to the provision of services that

26  require licensure pursuant to this part and part II of chapter

27  408 and to entities licensed by or applying for such licensure

28  from the agency pursuant to this part. A license issued by the

29  agency is required in order to operate a center.

30         (1)  A person may not conduct, maintain, or operate a

31  multiphasic health testing center in this state without

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 1  obtaining a multiphasic health testing center license from the

 2  agency. The license is valid only for the person or persons to

 3  whom it is issued and may not be sold, assigned, or

 4  transferred, voluntarily or involuntarily. A license is not

 5  valid for any premises other than the center for which it is

 6  issued. However, a new license may be secured for the new

 7  location for a fixed center before the actual change, if the

 8  contemplated change is in compliance with this part and the

 9  rules adopted under this part. A center must be relicensed if

10  a change of ownership occurs. Application for relicensure must

11  be made 60 days before the change of ownership.

12         (2)  Each applicant for licensure must comply with the

13  following requirements:

14         (a)  Upon receipt of a completed, signed, and dated

15  application, the agency shall require background screening, in

16  accordance with the level 2 standards for screening set forth

17  in chapter 435, of the managing employee, or other similarly

18  titled individual who is responsible for the daily operation

19  of the center, and of the financial officer, or other

20  similarly titled individual who is responsible for the

21  financial operation of the center, including billings for

22  patient services. The applicant must comply with the

23  procedures for level 2 background screening as set forth in

24  chapter 435, as well as the requirements of s. 435.03(3).

25         (b)  The agency may require background screening of any

26  other individual who is an applicant if the agency has

27  probable cause to believe that he or she has been convicted of

28  a crime or has committed any other offense prohibited under

29  the level 2 standards for screening set forth in chapter 435.

30         (c)  Proof of compliance with the level 2 background

31  screening requirements of chapter 435 which has been submitted

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 1  within the previous 5 years in compliance with any other

 2  health care licensure requirements of this state is acceptable

 3  in fulfillment of the requirements of paragraph (a).

 4         (d)  A provisional license may be granted to an

 5  applicant when each individual required by this section to

 6  undergo background screening has met the standards for the

 7  Department of Law Enforcement background check, but the agency

 8  has not yet received background screening results from the

 9  Federal Bureau of Investigation, or a request for a

10  disqualification exemption has been submitted to the agency as

11  set forth in chapter 435 but a response has not yet been

12  issued. A license may be granted to the applicant upon the

13  agency's receipt of a report of the results of the Federal

14  Bureau of Investigation background screening for each

15  individual required by this section to undergo background

16  screening which confirms that all standards have been met, or

17  upon the granting of a disqualification exemption by the

18  agency as set forth in chapter 435. Any other person who is

19  required to undergo level 2 background screening may serve in

20  his or her capacity pending the agency's receipt of the report

21  from the Federal Bureau of Investigation. However, the person

22  may not continue to serve if the report indicates any

23  violation of background screening standards and a

24  disqualification exemption has not been requested of and

25  granted by the agency as set forth in chapter 435.

26         (e)  Each applicant must submit to the agency, with its

27  application, a description and explanation of any exclusions,

28  permanent suspensions, or terminations of the applicant from

29  the Medicare or Medicaid programs. Proof of compliance with

30  the requirements for disclosure of ownership and control

31  

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 1  interests under the Medicaid or Medicare programs may be

 2  accepted in lieu of this submission.

 3         (f)  Each applicant must submit to the agency a

 4  description and explanation of any conviction of an offense

 5  prohibited under the level 2 standards of chapter 435 by a

 6  member of the board of directors of the applicant, its

 7  officers, or any individual owning 5 percent or more of the

 8  applicant. This requirement does not apply to a director of a

 9  not-for-profit corporation or organization if the director

10  serves solely in a voluntary capacity for the corporation or

11  organization, does not regularly take part in the day-to-day

12  operational decisions of the corporation or organization,

13  receives no remuneration for his or her services on the

14  corporation or organization's board of directors, and has no

15  financial interest and has no family members with a financial

16  interest in the corporation or organization, provided that the

17  director and the not-for-profit corporation or organization

18  include in the application a statement affirming that the

19  director's relationship to the corporation satisfies the

20  requirements of this paragraph.

21         (g)  A license may not be granted to an applicant if

22  the applicant or managing employee has been found guilty of,

23  regardless of adjudication, or has entered a plea of nolo

24  contendere or guilty to, any offense prohibited under the

25  level 2 standards for screening set forth in chapter 435,

26  unless an exemption from disqualification has been granted by

27  the agency as set forth in chapter 435.

28         (h)  The agency may deny or revoke licensure if the

29  applicant:

30         1.  Has falsely represented a material fact in the

31  application required by paragraph (e) or paragraph (f), or has

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 1  omitted any material fact from the application required by

 2  paragraph (e) or paragraph (f); or

 3         2.  Has had prior action taken against the applicant

 4  under the Medicaid or Medicare program as set forth in

 5  paragraph (e).

 6         (i)  An application for license renewal must contain

 7  the information required under paragraphs (e) and (f).

 8         Section 194.  Section 483.302, Florida Statutes, is

 9  amended to read:

10         483.302  Application for license.--

11         (1)  Application for a license as required by s. 483.30

12  must be made to the agency on forms furnished by it and must

13  be accompanied by the appropriate license fee.

14         (2)  The application for a license must shall contain:

15         (1)(a)  A determination as to whether the facility will

16  be fixed or mobile and the location for a fixed facility.

17         (b)  The name and address of the owner if an

18  individual; if the owner is a firm, partnership, or

19  association, the name and address of every member thereof; if

20  the owner is a corporation, its name and address and the name

21  and address of its medical director and officers and of each

22  person having at least a 10 percent interest in the

23  corporation.

24         (2)(c)  The name of any person whose name is required

25  on the application under the provisions of paragraph (b) and

26  who owns at least a 10 percent interest in any professional

27  service, firm, association, partnership, or corporation

28  providing goods, leases, or services to the center for which

29  the application is made, and the name and address of the

30  professional service, firm, association, partnership, or

31  corporation in which such interest is held.

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 1         (d)  The name by which the facility is to be known.

 2         (3)(e)  The name, address, and Florida physician's

 3  license number of the medical director.

 4         Section 195.  Section 483.311, Florida Statutes, is

 5  repealed.

 6         Section 196.  Subsections (2) through (8) of section

 7  483.317, Florida Statutes, are renumbered as subsections (1)

 8  through (7), respectively, and present subsection (1) of that

 9  section is amended to read:

10         483.317  Grounds for disciplinary action against

11  centers.--The following acts constitute grounds for which a

12  disciplinary action specified in s. 483.32 may be taken

13  against a center:

14         (1)  Making a fraudulent statement on an application

15  for a license or on any other document required by the agency

16  pursuant to this part.

17         Section 197.  Section 483.32, Florida Statutes, is

18  amended to read:

19         483.32  Administrative fines penalties.--

20         (1)(a)  The agency may deny, suspend, revoke, annul,

21  limit, or deny renewal of a license or impose an

22  administrative fine, not to exceed $500 per violation, for the

23  violation of any provision of this part, part II of chapter

24  408, or applicable rules adopted under this part. Each day of

25  violation constitutes a separate violation and is subject to a

26  separate fine.

27         (2)(b)  In determining the amount of the fine to be

28  levied for a violation, as provided in subsection (1)

29  paragraph (a), the following factors shall be considered:

30         (a)1.  The severity of the violation, including the

31  probability that death or serious harm to the health or safety

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 1  of any person will result or has resulted; the severity of the

 2  actual or potential harm; and the extent to which the

 3  provisions of this part were violated.

 4         (b)2.  Actions taken by the licensee to correct the

 5  violation or to remedy complaints.

 6         (c)3.  Any previous violation by the licensee.

 7         (d)4.  The financial benefit to the licensee of

 8  committing or continuing the violation.

 9         (c)  All amounts collected under this section must be

10  deposited into the Health Care Trust Fund administered by the

11  agency.

12         (2)  The agency may issue an emergency order

13  immediately suspending, revoking, annulling, or limiting a

14  license when it determines that any condition in the licensed

15  facility presents a clear and present danger to public health

16  and safety.

17         Section 198.  Subsections (2) and (3) of section

18  483.322, Florida Statutes, are renumbered as subsections (1)

19  and (2), respectively, and present subsection (1) of that

20  section is amended to read:

21         483.322  Offenses.--It is unlawful for any person to:

22         (1)  Operate, maintain, direct, or engage in the

23  business of operating a multiphasic health testing center

24  unless the person has obtained a license for the center.

25         Section 199.  Section 483.328, Florida Statutes, is

26  repealed.

27         Section 200.  Subsection (2) of section 765.541,

28  Florida Statutes, is amended to read:

29         765.541  Certification of organizations engaged in the

30  practice of cadaveric organ and tissue procurement.--The

31  Agency for Health Care Administration shall:

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 1         (2)  Adopt rules that set forth appropriate standards

 2  and guidelines for the program in accordance with ss.

 3  765.541-765.546 and part II of chapter 408. These standards

 4  and guidelines must be substantially based on the existing

 5  laws of the Federal Government and this state and the existing

 6  standards and guidelines of the United Network for Organ

 7  Sharing (UNOS), the American Association of Tissue Banks

 8  (AATB), the South-Eastern Organ Procurement Foundation

 9  (SEOPF), the North American Transplant Coordinators

10  Organization (NATCO), and the Eye Bank Association of America

11  (EBAA). In addition, the Agency for Health Care Administration

12  shall, before adopting these standards and guidelines, seek

13  input from all organ procurement organizations, tissue banks,

14  and eye banks based in this state;

15         Section 201.  Subsection (1) of section 765.542,

16  Florida Statutes, is amended to read:

17         765.542  Certification of organ procurement

18  organizations, tissue banks, and eye banks.--

19         (1)  The requirements of part II of chapter 408 apply

20  to the provision of services that require licensure pursuant

21  to ss. 765.541-765.546 and part II of chapter 408 and to

22  entities licensed or certified by or applying for such

23  licensure or certification from the Agency for Health Care

24  Administration pursuant to ss. 765.541-765.546. An

25  organization, agency, or other entity may not engage in the

26  practice of organ procurement in this state without being

27  designated as an organ procurement organization by the

28  secretary of the United States Department of Health and Human

29  Services and being appropriately certified by the Agency for

30  Health Care Administration. As used in this subsection, the

31  term "procurement" includes the retrieval, processing, or

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 1  distribution of human organs. A physician or organ procurement

 2  organization based outside this state is exempt from these

 3  certification requirements if:

 4         (a)  The organs are procured for an out-of-state

 5  patient who is listed on, or referred through, the United

 6  Network for Organ Sharing System; and

 7         (b)  The organs are procured through an agreement of an

 8  organ procurement organization certified by the state.

 9         Section 202.  Section 765.544, Florida Statutes, is

10  amended to read:

11         765.544  Fees; Florida Organ and Tissue Donor Education

12  and Procurement Trust Fund.--

13         (1)  In accordance with s. 408.805, an applicant or a

14  certificateholder shall pay a fee for each application

15  submitted under this part, part II of chapter 408, and

16  applicable rules. The amount of the fee shall be as follows:

17  The Agency for Health Care Administration shall collect

18         (a)  An initial application fee of $1,000 from organ

19  procurement organizations and tissue banks and $500 from eye

20  banks. The fee must be submitted with each application for

21  initial certification and is nonrefundable.

22         (b)(2)  The Agency for Health Care Administration shall

23  assess Annual fees to be used, in the following order of

24  priority, for the certification program, the advisory board,

25  maintenance of the organ and tissue donor registry, and the

26  organ and tissue donor education program in the following

27  amounts, which may not exceed $35,000 per organization:

28         1.(a)  Each general organ procurement organization

29  shall pay the greater of $1,000 or 0.25 percent of its total

30  revenues produced from procurement activity in this state by

31  

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 1  the certificateholder during its most recently completed

 2  fiscal year or operational year.

 3         2.(b)  Each bone and tissue procurement agency or bone

 4  and tissue bank shall pay the greater of $1,000 or 0.25

 5  percent of its total revenues from procurement and processing

 6  activity in this state by the certificateholder during its

 7  most recently completed fiscal year or operational year.

 8         3.(c)  Each eye bank shall pay the greater of $500 or

 9  0.25 percent of its total revenues produced from procurement

10  activity in this state by the certificateholder during its

11  most recently completed fiscal year or operational year.

12         (2)(3)  The Agency for Health Care Administration shall

13  specify provide by rule the for administrative penalties for

14  the purpose of ensuring adherence to the standards of quality

15  and practice required by this chapter, part II of chapter 408,

16  and applicable rules of the agency for continued

17  certification.

18         (3)(4)(a)  Proceeds from fees, administrative

19  penalties, and surcharges collected pursuant to this section

20  subsections (2) and (3) must be deposited into the Florida

21  Organ and Tissue Donor Education and Procurement Trust Fund

22  created by s. 765.52155.

23         (b)  Moneys deposited in the trust fund pursuant to

24  this section must be used exclusively for the implementation,

25  administration, and operation of the certification program and

26  the advisory board, for maintaining the organ and tissue donor

27  registry, and for organ and tissue donor education.

28         (4)(5)  As used in this section, the term "procurement

29  activity in this state" includes the bringing into this state

30  for processing, storage, distribution, or transplantation of

31  

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 1  organs or tissues that are initially procured in another state

 2  or country.

 3         Section 203.  Subsection (4) of section 766.118,

 4  Florida Statutes, is amended to read:

 5         766.118  Determination of noneconomic damages.--

 6         (4)  LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE

 7  OF PRACTITIONERS PROVIDING EMERGENCY SERVICES AND

 8  CARE.--Notwithstanding subsections (2) and (3), with respect

 9  to a cause of action for personal injury or wrongful death

10  arising from medical negligence of practitioners providing

11  emergency services and care, as defined in s. 395.002(9)(10),

12  or providing services as provided in s. 401.265, or providing

13  services pursuant to obligations imposed by 42 U.S.C. s.

14  1395dd to persons with whom the practitioner does not have a

15  then-existing health care patient-practitioner relationship

16  for that medical condition:

17         (a)  Regardless of the number of such practitioner

18  defendants, noneconomic damages shall not exceed $150,000 per

19  claimant.

20         (b)  Notwithstanding paragraph (a), the total

21  noneconomic damages recoverable by all claimants from all such

22  practitioners shall not exceed $300,000.

23  

24  The limitation provided by this subsection applies only to

25  noneconomic damages awarded as a result of any act or omission

26  of providing medical care or treatment, including diagnosis

27  that occurs prior to the time the patient is stabilized and is

28  capable of receiving medical treatment as a nonemergency

29  patient, unless surgery is required as a result of the

30  emergency within a reasonable time after the patient is

31  stabilized, in which case the limitation provided by this

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 1  subsection applies to any act or omission of providing medical

 2  care or treatment which occurs prior to the stabilization of

 3  the patient following the surgery.

 4         Section 204.  Section 766.316, Florida Statutes, is

 5  amended to read:

 6         766.316  Notice to obstetrical patients of

 7  participation in the plan.--Each hospital with a participating

 8  physician on its staff and each participating physician, other

 9  than residents, assistant residents, and interns deemed to be

10  participating physicians under s. 766.314(4)(c), under the

11  Florida Birth-Related Neurological Injury Compensation Plan

12  shall provide notice to the obstetrical patients as to the

13  limited no-fault alternative for birth-related neurological

14  injuries. Such notice shall be provided on forms furnished by

15  the association and shall include a clear and concise

16  explanation of a patient's rights and limitations under the

17  plan. The hospital or the participating physician may elect to

18  have the patient sign a form acknowledging receipt of the

19  notice form. Signature of the patient acknowledging receipt of

20  the notice form raises a rebuttable presumption that the

21  notice requirements of this section have been met. Notice need

22  not be given to a patient when the patient has an emergency

23  medical condition as defined in s. 395.002(8)(9)(b) or when

24  notice is not practicable.

25         Section 205.  Paragraph (b) of subsection (2) of

26  section 812.014, Florida Statutes, is amended to read:

27         812.014  Theft.--

28         (2)

29         (b)1.  If the property stolen is valued at $20,000 or

30  more, but less than $100,000;

31  

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 1         2.  The property stolen is cargo valued at less than

 2  $50,000 that has entered the stream of interstate or

 3  intrastate commerce from the shipper's loading platform to the

 4  consignee's receiving dock; or

 5         3.  The property stolen is emergency medical equipment,

 6  valued at $300 or more, that is taken from a facility licensed

 7  under chapter 395 or from an aircraft or vehicle permitted

 8  under chapter 401,

 9  

10  the offender commits grand theft in the second degree,

11  punishable as a felony of the second degree, as provided in s.

12  775.082, s. 775.083, or s. 775.084. Emergency medical

13  equipment means mechanical or electronic apparatus used to

14  provide emergency services and care as defined in s.

15  395.002(9)(10) or to treat medical emergencies.

16         Section 206.  This act shall take effect July 1, 2007.

17  

18            *****************************************

19                          SENATE SUMMARY

20    Provides applicability of licensure requirements of
      health care providers under part II of chapter 408,
21    Florida Statutes.

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

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