HB 247

1	A bill to be entitled
2	An act relating to nursing facilities; amending s.
3	400.118, F.S.; revising the frequency of visits to nursing
4	facilities by quality-of-care monitors from the Agency for
5	Health Care Administration; amending s. 400.141, F.S.;
6	authorizing certain licensed nursing facilities to develop
7	a plan to provide certain training for nursing assistants;
8	providing for rules relating to agency approval of
9	training programs; amending s. 400.147, F.S.; redefining
10	the term "adverse incident"; deleting the requirement that
11	a nursing facility notify the agency of an adverse
12	incident; deleting notification requirements; requiring
13	that a risk manager determine if an incident was an
14	adverse incident; amending s. 400.19, F.S.; providing that
15	the most recent survey is a licensure survey under certain
16	conditions for purposes of future survey scheduling;
17	amending s. 400.195, F.S.; conforming a cross-reference;
18	amending s. 400.23, F.S.; requiring that federal posting
19	requirements for staffing standards comply with state
20	posting requirements; revising provisions relating to a
21	facility's use of licensed nurses to meet certain minimum
22	staffing requirements; providing an effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1.  Paragraph (a) of subsection (2) of section
27	400.118, Florida Statutes, is amended to read:
28	400.118  Quality assurance; early warning system;
29	monitoring; rapid response teams.--
30	(2)(a)  The agency shall establish within each district
31	office one or more quality-of-care monitors, based on the number
32	of nursing facilities in the district, to monitor all nursing
33	facilities in the district on a regular, unannounced, aperiodic
34	basis, including nights, evenings, weekends, and holidays.
35	Quality-of-care monitors shall visit each nursing facility
36	annually, shall visit each conditionally licensed nursing
37	facility at least quarterly, and shall visit other facilities as
38	directed by the agency. However, upon the request of a facility,
39	the agency shall make quarterly visits to a nursing home that is
40	not conditionally licensed. The request applies only to the
41	current licensure period and must be made again by the facility
42	at the time of license renewal in order to be continued.
43	Priority for additional monitoring visits shall be given to
44	nursing facilities that have with a history of resident care
45	deficiencies. Quality-of-care monitors shall be registered
46	nurses who are trained and experienced in nursing facility
47	regulation, standards of practice in long-term care, and
48	evaluation of patient care. Individuals in these positions may
49	shall not be deployed by the agency as a part of the district
50	survey team in the conduct of routine, scheduled surveys, but
51	shall function solely and independently as quality-of-care
52	monitors. Quality-of-care monitors shall assess the overall
53	quality of life in the nursing facility and shall assess
54	specific conditions in the facility directly related to resident
55	care, including the operations of internal quality improvement
56	and risk management programs and adverse incident reports. The
57	quality-of-care monitor shall include in an assessment visit
58	observation of the care and services rendered to residents and
59	formal and informal interviews with residents, family members,
60	facility staff, resident guests, volunteers, other regulatory
61	staff, and representatives of a long-term care ombudsman council
62	or Florida advocacy council.
63	Section 2.  Section 400.141, Florida Statutes, is amended
64	to read:
65	400.141  Administration and management of nursing home
66	facilities.--Every licensed facility shall comply with all
67	applicable standards and rules of the agency and shall:
68	(1)  Be under the administrative direction and charge of a
69	licensed administrator.
70	(2)  Appoint a medical director licensed pursuant to
71	chapter 458 or chapter 459. The agency may establish by rule
72	more specific criteria for the appointment of a medical
73	director.
74	(3)  Have available the regular, consultative, and
75	emergency services of physicians licensed by the state.
76	(4)  Provide for resident use of a community pharmacy as
77	specified in s. 400.022(1)(q). Any other law to the contrary
78	notwithstanding, a registered pharmacist licensed in Florida,
79	that is under contract with a facility licensed under this
80	chapter or chapter 429, shall repackage a nursing facility
81	resident's bulk prescription medication which has been packaged
82	by another pharmacist licensed in any state in the United States
83	into a unit dose system compatible with the system used by the
84	nursing facility, if the pharmacist is requested to offer such
85	service. In order to be eligible for the repackaging, a resident
86	or the resident's spouse must receive prescription medication
87	benefits provided through a former employer as part of his or
88	her retirement benefits, a qualified pension plan as specified
89	in s. 4972 of the Internal Revenue Code, a federal retirement
90	program as specified under 5 C.F.R. s. 831, or a long-term care
91	policy as defined in s. 627.9404(1). A pharmacist who correctly
92	repackages and relabels the medication and the nursing facility
93	which correctly administers such repackaged medication under the
94	provisions of this subsection shall not be held liable in any
95	civil or administrative action arising from the repackaging. In
96	order to be eligible for the repackaging, a nursing facility
97	resident for whom the medication is to be repackaged shall sign
98	an informed consent form provided by the facility which includes
99	an explanation of the repackaging process and which notifies the
100	resident of the immunities from liability provided herein. A
101	pharmacist who repackages and relabels prescription medications,
102	as authorized under this subsection, may charge a reasonable fee
103	for costs resulting from the implementation of this provision.
104	(5)  Provide for the access of the facility residents to
105	dental and other health-related services, recreational services,
106	rehabilitative services, and social work services appropriate to
107	their needs and conditions and not directly furnished by the
108	licensee. When a geriatric outpatient nurse clinic is conducted
109	in accordance with rules adopted by the agency, outpatients
110	attending such clinic shall not be counted as part of the
111	general resident population of the nursing home facility, nor
112	shall the nursing staff of the geriatric outpatient clinic be
113	counted as part of the nursing staff of the facility, until the
114	outpatient clinic load exceeds 15 a day.
115	(6)  Be allowed and encouraged by the agency to provide
116	other needed services under certain conditions. If the facility
117	has a standard licensure status, and has had no class I or class
118	II deficiencies during the past 2 years or has been awarded a
119	Gold Seal under the program established in s. 400.235, it may be
120	encouraged by the agency to provide services, including, but not
121	limited to, respite and adult day services, which enable
122	individuals to move in and out of the facility. A facility is
123	not subject to any additional licensure requirements for
124	providing these services. Respite care may be offered to persons
125	in need of short-term or temporary nursing home services.
126	Respite care must be provided in accordance with this part and
127	rules adopted by the agency. However, the agency shall, by rule,
128	adopt modified requirements for resident assessment, resident
129	care plans, resident contracts, physician orders, and other
130	provisions, as appropriate, for short-term or temporary nursing
131	home services. The agency shall allow for shared programming and
132	staff in a facility which meets minimum standards and offers
133	services pursuant to this subsection, but, if the facility is
134	cited for deficiencies in patient care, may require additional
135	staff and programs appropriate to the needs of service
136	recipients. A person who receives respite care may not be
137	counted as a resident of the facility for purposes of the
138	facility's licensed capacity unless that person receives 24-hour
139	respite care. A person receiving either respite care for 24
140	hours or longer or adult day services must be included when
141	calculating minimum staffing for the facility. Any costs and
142	revenues generated by a nursing home facility from
143	nonresidential programs or services shall be excluded from the
144	calculations of Medicaid per diems for nursing home
145	institutional care reimbursement.
146	(7)  If the facility has a standard license or is a Gold
147	Seal facility, exceeds the minimum required hours of licensed
148	nursing and certified nursing assistant direct care per resident
149	per day, and is part of a continuing care facility licensed
150	under chapter 651 or a retirement community that offers other
151	services pursuant to part III of this chapter or part I or part
152	III of chapter 429 on a single campus, be allowed to share
153	programming and staff. At the time of inspection and in the
154	semiannual report required pursuant to subsection (15), a
155	continuing care facility or retirement community that uses this
156	option must demonstrate through staffing records that minimum
157	staffing requirements for the facility were met. Licensed nurses
158	and certified nursing assistants who work in the nursing home
159	facility may be used to provide services elsewhere on campus if
160	the facility exceeds the minimum number of direct care hours
161	required per resident per day and the total number of residents
162	receiving direct care services from a licensed nurse or a
163	certified nursing assistant does not cause the facility to
164	violate the staffing ratios required under s. 400.23(3)(a).
165	Compliance with the minimum staffing ratios shall be based on
166	total number of residents receiving direct care services,
167	regardless of where they reside on campus. If the facility
168	receives a conditional license, it may not share staff until the
169	conditional license status ends. This subsection does not
170	restrict the agency's authority under federal or state law to
171	require additional staff if a facility is cited for deficiencies
172	in care which are caused by an insufficient number of certified
173	nursing assistants or licensed nurses. The agency may adopt
174	rules for the documentation necessary to determine compliance
175	with this provision.
176	(8)  Maintain the facility premises and equipment and
177	conduct its operations in a safe and sanitary manner.
178	(9)  If the licensee furnishes food service, provide a
179	wholesome and nourishing diet sufficient to meet generally
180	accepted standards of proper nutrition for its residents and
181	provide such therapeutic diets as may be prescribed by attending
182	physicians. In making rules to implement this subsection, the
183	agency shall be guided by standards recommended by nationally
184	recognized professional groups and associations with knowledge
185	of dietetics.
186	(10)  Keep full records of resident admissions and
187	discharges; medical and general health status, including medical
188	records, personal and social history, and identity and address
189	of next of kin or other persons who may have responsibility for
190	the affairs of the residents; and individual resident care plans
191	including, but not limited to, prescribed services, service
192	frequency and duration, and service goals. The records shall be
193	open to inspection by the agency.
194	(11)  Keep such fiscal records of its operations and
195	conditions as may be necessary to provide information pursuant
196	to this part.
197	(12)  Furnish copies of personnel records for employees
198	affiliated with such facility, to any other facility licensed by
199	this state requesting this information pursuant to this part.
200	Such information contained in the records may include, but is
201	not limited to, disciplinary matters and any reason for
202	termination. Any facility releasing such records pursuant to
203	this part shall be considered to be acting in good faith and may
204	not be held liable for information contained in such records,
205	absent a showing that the facility maliciously falsified such
206	records.
207	(13)  Publicly display a poster provided by the agency
208	containing the names, addresses, and telephone numbers for the
209	state's abuse hotline, the State Long-Term Care Ombudsman, the
210	Agency for Health Care Administration consumer hotline, the
211	Advocacy Center for Persons with Disabilities, the Florida
212	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
213	with a clear description of the assistance to be expected from
214	each.
215	(14)  Submit to the agency the information specified in s.
216	400.071(1)(b) for a management company within 30 days after the
217	effective date of the management agreement.
218	(15)  Submit semiannually to the agency, or more frequently
219	if requested by the agency, information regarding facility
220	staff-to-resident ratios, staff turnover, and staff stability,
221	including information regarding certified nursing assistants,
222	licensed nurses, the director of nursing, and the facility
223	administrator. For purposes of this reporting:
224	(a)  Staff-to-resident ratios must be reported in the
225	categories specified in s. 400.23(3)(a) and applicable rules.
226	The ratio must be reported as an average for the most recent
227	calendar quarter.
228	(b)  Staff turnover must be reported for the most recent
229	12-month period ending on the last workday of the most recent
230	calendar quarter prior to the date the information is submitted.
231	The turnover rate must be computed quarterly, with the annual
232	rate being the cumulative sum of the quarterly rates. The
233	turnover rate is the total number of terminations or separations
234	experienced during the quarter, excluding any employee
235	terminated during a probationary period of 3 months or less,
236	divided by the total number of staff employed at the end of the
237	period for which the rate is computed, and expressed as a
238	percentage.
239	(c)  The formula for determining staff stability is the
240	total number of employees that have been employed for more than
241	12 months, divided by the total number of employees employed at
242	the end of the most recent calendar quarter, and expressed as a
243	percentage.
244	(d)  A nursing facility that has failed to comply with
245	state minimum-staffing requirements for 2 consecutive days is
246	prohibited from accepting new admissions until the facility has
247	achieved the minimum-staffing requirements for a period of 6
248	consecutive days. For the purposes of this paragraph, any person
249	who was a resident of the facility and was absent from the
250	facility for the purpose of receiving medical care at a separate
251	location or was on a leave of absence is not considered a new
252	admission. Failure to impose such an admissions moratorium
253	constitutes a class II deficiency.
254	(e)  A nursing facility which does not have a conditional
255	license may be cited for failure to comply with the standards in
256	s. 400.23(3)(a)1.a. only if it has failed to meet those
257	standards on 2 consecutive days or if it has failed to meet at
258	least 97 percent of those standards on any one day.
259	(f)  A facility which has a conditional license must be in
260	compliance with the standards in s. 400.23(3)(a) at all times.
261
262	Nothing in this section shall limit the agency's ability to
263	impose a deficiency or take other actions if a facility does not
264	have enough staff to meet the residents' needs.
265	(16)  Report monthly the number of vacant beds in the
266	facility which are available for resident occupancy on the day
267	the information is reported.
268	(17)  Notify a licensed physician when a resident exhibits
269	signs of dementia or cognitive impairment or has a change of
270	condition in order to rule out the presence of an underlying
271	physiological condition that may be contributing to such
272	dementia or impairment. The notification must occur within 30
273	days after the acknowledgment of such signs by facility staff.
274	If an underlying condition is determined to exist, the facility
275	shall arrange, with the appropriate health care provider, the
276	necessary care and services to treat the condition.
277	(18)  If the facility implements a dining and hospitality
278	attendant program, ensure that the program is developed and
279	implemented under the supervision of the facility director of
280	nursing. A licensed nurse, licensed speech or occupational
281	therapist, or a registered dietitian must conduct training of
282	dining and hospitality attendants. A person employed by a
283	facility as a dining and hospitality attendant must perform
284	tasks under the direct supervision of a licensed nurse.
285	(19)  Report to the agency any filing for bankruptcy
286	protection by the facility or its parent corporation,
287	divestiture or spin-off of its assets, or corporate
288	reorganization within 30 days after the completion of such
289	activity.
290	(20)  Maintain general and professional liability insurance
291	coverage that is in force at all times. In lieu of general and
292	professional liability insurance coverage, a state-designated
293	teaching nursing home and its affiliated assisted living
294	facilities created under s. 430.80 may demonstrate proof of
295	financial responsibility as provided in s. 430.80(3)(h).
296	(21)  Maintain in the medical record for each resident a
297	daily chart of certified nursing assistant services provided to
298	the resident. The certified nursing assistant who is caring for
299	the resident must complete this record by the end of his or her
300	shift. This record must indicate assistance with activities of
301	daily living, assistance with eating, and assistance with
302	drinking, and must record each offering of nutrition and
303	hydration for those residents whose plan of care or assessment
304	indicates a risk for malnutrition or dehydration.
305	(22)  Before November 30 of each year, subject to the
306	availability of an adequate supply of the necessary vaccine,
307	provide for immunizations against influenza viruses to all its
308	consenting residents in accordance with the recommendations of
309	the United States Centers for Disease Control and Prevention,
310	subject to exemptions for medical contraindications and
311	religious or personal beliefs. Subject to these exemptions, any
312	consenting person who becomes a resident of the facility after
313	November 30 but before March 31 of the following year must be
314	immunized within 5 working days after becoming a resident.
315	Immunization shall not be provided to any resident who provides
316	documentation that he or she has been immunized as required by
317	this subsection. This subsection does not prohibit a resident
318	from receiving the immunization from his or her personal
319	physician if he or she so chooses. A resident who chooses to
320	receive the immunization from his or her personal physician
321	shall provide proof of immunization to the facility. The agency
322	may adopt and enforce any rules necessary to comply with or
323	implement this subsection.
324	(23)  Assess all residents for eligibility for pneumococcal
325	polysaccharide vaccination (PPV) and vaccinate residents when
326	indicated within 60 days after the effective date of this act in
327	accordance with the recommendations of the United States Centers
328	for Disease Control and Prevention, subject to exemptions for
329	medical contraindications and religious or personal beliefs.
330	Residents admitted after the effective date of this act shall be
331	assessed within 5 working days of admission and, when indicated,
332	vaccinated within 60 days in accordance with the recommendations
333	of the United States Centers for Disease Control and Prevention,
334	subject to exemptions for medical contraindications and
335	religious or personal beliefs. Immunization shall not be
336	provided to any resident who provides documentation that he or
337	she has been immunized as required by this subsection. This
338	subsection does not prohibit a resident from receiving the
339	immunization from his or her personal physician if he or she so
340	chooses. A resident who chooses to receive the immunization from
341	his or her personal physician shall provide proof of
342	immunization to the facility. The agency may adopt and enforce
343	any rules necessary to comply with or implement this subsection.
344	(24)  Annually encourage and promote to its employees the
345	benefits associated with immunizations against influenza viruses
346	in accordance with the recommendations of the United States
347	Centers for Disease Control and Prevention. The agency may adopt
348	and enforce any rules necessary to comply with or implement this
349	subsection.
350
351	Facilities having a standard license that have been awarded a
352	Gold Seal under the program established in s. 400.235 may
353	develop a plan to provide certified nursing assistant training
354	as prescribed by federal regulations and state rules and may
355	apply to the agency for approval of their program. The agency
356	may adopt rules relating to the approval, suspension, or
357	termination of a certified nursing assistant training program.
358	Section 3.  Subsections (5) through (15) of section
359	400.147, Florida Statutes, are amended to read:
360	400.147  Internal risk management and quality assurance
361	program.--
362	(5)  For purposes of reporting to the agency under this
363	section, the term "adverse incident" means:
364	(a)  An event over which facility personnel could exercise
365	control and which is associated in whole or in part with the
366	facility's intervention, rather than the condition for which
367	such intervention occurred, and which results in one of the
368	following:
369	1.  Death;
370	2.  Brain or spinal damage;
371	3.  Permanent disfigurement;
372	4.  Fracture or dislocation of bones or joints;
373	5.  A limitation of neurological, physical, or sensory
374	function;
375	6.  Any condition that required medical attention to which
376	the resident has not given his or her informed consent,
377	including failure to honor advanced directives; or
378	7.  Any condition that required the transfer of the
379	resident, within or outside the facility, to a unit providing a
380	more acute level of care due to the adverse incident, rather
381	than the resident's condition prior to the adverse incident;
382	(b)  Abuse, neglect, or exploitation as defined in s.
383	415.102;
384	(c)  Abuse, neglect and harm as defined in s. 39.01;
385	(d)  Resident elopement; or
386	(e)  An event that is reported to a law enforcement agency
387	for investigation.
388	(6)  The internal risk manager of each licensed facility
389	shall:
390	(a)  Investigate every allegation of sexual misconduct
391	which is made against a member of the facility's personnel who
392	has direct patient contact when the allegation is that the
393	sexual misconduct occurred at the facility or at the grounds of
394	the facility;
395	(b)  Report every allegation of sexual misconduct to the
396	administrator of the licensed facility; and
397	(c)  Notify the resident representative or guardian of the
398	victim that an allegation of sexual misconduct has been made and
399	that an investigation is being conducted.
400	(7)(a)  The facility shall initiate an investigation and
401	shall notify the agency within 1 business day after the risk
402	manager or his or her designee has received a report pursuant to
403	paragraph (1)(d). The notification must be made in writing and
404	be provided electronically, by facsimile device or overnight
405	mail delivery. The notification must include information
406	regarding the identity of the affected resident, the type of
407	adverse incident, the initiation of an investigation by the
408	facility, and whether the events causing or resulting in the
409	adverse incident represent a potential risk to any other
410	resident. The notification is confidential as provided by law
411	and is not discoverable or admissible in any civil or
412	administrative action, except in disciplinary proceedings by the
413	agency or the appropriate regulatory board. The agency may
414	investigate, as it deems appropriate, any such incident and
415	prescribe measures that must or may be taken in response to the
416	incident. The agency shall review each incident and determine
417	whether it potentially involved conduct by the health care
418	professional who is subject to disciplinary action, in which
419	case the provisions of s. 456.073 shall apply.
420	(b)(8)(a)  Each facility shall complete the investigation
421	and submit an adverse incident report to the agency for each
422	adverse incident within 15 calendar days after its occurrence.
423	If, after a complete investigation, the risk manager determines
424	that the incident was not an adverse incident as defined in
425	subsection (5), the facility shall include this information in
426	the report. The agency shall develop a form for reporting this
427	information.
428	(c)(b)  The information reported to the agency pursuant to
429	paragraph (b) (a) which relates to persons licensed under
430	chapter 458, chapter 459, chapter 461, or chapter 466 shall be
431	reviewed by the agency. The agency shall determine whether any
432	of the incidents potentially involved conduct by a health care
433	professional who is subject to disciplinary action, in which
434	case the provisions of s. 456.073 shall apply.
435	(d)(c)  The report submitted to the agency must also
436	contain the name of the risk manager of the facility.
437	(e)(d)  The adverse incident report is confidential as
438	provided by law and is not discoverable or admissible in any
439	civil or administrative action, except in disciplinary
440	proceedings by the agency or the appropriate regulatory board.
441	(8)(9)  By the 10th of each month, each facility subject to
442	this section shall report any notice received pursuant to s.
443	400.0233(2) and each initial complaint that was filed with the
444	clerk of the court and served on the facility during the
445	previous month by a resident or a resident's family member,
446	guardian, conservator, or personal legal representative. The
447	report must include the name of the resident, the resident's
448	date of birth and social security number, the Medicaid
449	identification number for Medicaid-eligible persons, the date or
450	dates of the incident leading to the claim or dates of
451	residency, if applicable, and the type of injury or violation of
452	rights alleged to have occurred. Each facility shall also submit
453	a copy of the notices received pursuant to s. 400.0233(2) and
454	complaints filed with the clerk of the court. This report is
455	confidential as provided by law and is not discoverable or
456	admissible in any civil or administrative action, except in such
457	actions brought by the agency to enforce the provisions of this
458	part.
459	(9)(10)  The agency shall review, as part of its licensure
460	inspection process, the internal risk management and quality
461	assurance program at each facility regulated by this section to
462	determine whether the program meets standards established in
463	statutory laws and rules, is being conducted in a manner
464	designed to reduce adverse incidents, and is appropriately
465	reporting incidents as required by this section.
466	(10)(11)  There is no monetary liability on the part of,
467	and a cause of action for damages may not arise against, any
468	risk manager for the implementation and oversight of the
469	internal risk management and quality assurance program in a
470	facility licensed under this part as required by this section,
471	or for any act or proceeding undertaken or performed within the
472	scope of the functions of such internal risk management and
473	quality assurance program if the risk manager acts without
474	intentional fraud.
475	(11)(12)  If the agency, through its receipt of the adverse
476	incident reports prescribed in subsection (7), or through any
477	investigation, has a reasonable belief that conduct by a staff
478	member or employee of a facility is grounds for disciplinary
479	action by the appropriate regulatory board, the agency shall
480	report this fact to the regulatory board.
481	(12)(13)  The agency may adopt rules to administer this
482	section.
483	(13)(14)  The agency shall annually submit to the
484	Legislature a report on nursing home adverse incidents. The
485	report must include the following information arranged by
486	county:
487	(a)  The total number of adverse incidents.
488	(b)  A listing, by category, of the types of adverse
489	incidents, the number of incidents occurring within each
490	category, and the type of staff involved.
491	(c)  A listing, by category, of the types of injury caused
492	and the number of injuries occurring within each category.
493	(d)  Types of liability claims filed based on an adverse
494	incident or reportable injury.
495	(e)  Disciplinary action taken against staff, categorized
496	by type of staff involved.
497	(14)(15)  Information gathered by a credentialing
498	organization under a quality assurance program is not
499	discoverable from the credentialing organization. This
500	subsection does not limit discovery of, access to, or use of
501	facility records, including those records from which the
502	credentialing organization gathered its information.
503	Section 4.  Subsection (3) of section 400.19, Florida
504	Statutes, is amended to read:
505	400.19  Right of entry and inspection.--
506	(3)  The agency shall every 15 months conduct at least one
507	unannounced inspection to determine compliance by the licensee
508	with statutes, and with rules adopted promulgated under the
509	provisions of those statutes, governing minimum standards of
510	construction, quality and adequacy of care, and rights of
511	residents. The survey shall be conducted every 6 months for the
512	next 2-year period if the facility has been cited for a class I
513	deficiency, has been cited for two or more class II deficiencies
514	arising from separate surveys or investigations within a 60-day
515	period, or has had three or more substantiated complaints within
516	a 6-month period, each resulting in at least one class I or
517	class II deficiency. In addition to any other fees or fines in
518	this part, the agency shall assess a fine for each facility that
519	is subject to the 6-month survey cycle. The fine for the 2-year
520	period shall be $6,000, one-half to be paid at the completion of
521	each survey. The agency may adjust this fine by the change in
522	the Consumer Price Index, based on the 12 months immediately
523	preceding the increase, to cover the cost of the additional
524	surveys. If such deficiencies are overturned as the result of
525	administrative action but additional surveys have already been
526	conducted pursuant to this section, the most recent survey shall
527	be considered a licensure survey for purposes of scheduling
528	future surveys. The agency shall verify through subsequent
529	inspection that any deficiency identified during inspection is
530	corrected. However, the agency may verify the correction of a
531	class III or class IV deficiency unrelated to resident rights or
532	resident care without reinspecting the facility if adequate
533	written documentation has been received from the facility, which
534	provides assurance that the deficiency has been corrected. The
535	giving or causing to be given of advance notice of such
536	unannounced inspections by an employee of the agency to any
537	unauthorized person shall constitute cause for suspension of not
538	fewer than 5 working days according to the provisions of chapter
539	110.
540	Section 5.  Paragraph (d) of subsection (1) of section
541	400.195, Florida Statutes, is amended to read:
542	400.195  Agency reporting requirements.--
543	(1)  For the period beginning June 30, 2001, and ending
544	June 30, 2005, the Agency for Health Care Administration shall
545	provide a report to the Governor, the President of the Senate,
546	and the Speaker of the House of Representatives with respect to
547	nursing homes. The first report shall be submitted no later than
548	December 30, 2002, and subsequent reports shall be submitted
549	every 6 months thereafter. The report shall identify facilities
550	based on their ownership characteristics, size, business
551	structure, for-profit or not-for-profit status, and any other
552	characteristics the agency determines useful in analyzing the
553	varied segments of the nursing home industry and shall report:
554	(d)  Information regarding deficiencies cited, including
555	information used to develop the Nursing Home Guide WATCH LIST
556	pursuant to s. 400.191, and applicable rules, a summary of data
557	generated on nursing homes by Centers for Medicare and Medicaid
558	Services Nursing Home Quality Information Project, and
559	information collected pursuant to s. 400.147(8) s. 400.147(9),
560	relating to litigation.
561	Section 6.  Paragraph (a) of subsection (3) of section
562	400.23, Florida Statutes, is amended to read:
563	400.23  Rules; evaluation and deficiencies; licensure
564	status.--
565	(3)(a)1.  The agency shall adopt rules providing minimum
566	staffing requirements for nursing homes. These requirements
567	shall include, for each nursing home facility:
568	a.  A minimum certified nursing assistant staffing of 2.6
569	hours of direct care per resident per day beginning January 1,
570	2003, and increasing to 2.7 hours of direct care per resident
571	per day beginning January 1, 2007. Beginning January 1, 2002, a
572	no facility may not shall staff below one certified nursing
573	assistant per 20 residents, and must provide a minimum licensed
574	nursing staffing of 1.0 hour of direct care per resident per day
575	but never below one licensed nurse per 40 residents.
576	b.  Beginning January 1, 2007, a minimum weekly average
577	certified nursing assistant staffing of 2.9 hours of direct care
578	per resident per day. For the purpose of this sub-subparagraph,
579	a week is defined as Sunday through Saturday.
580	2.  Nursing assistants employed under s. 400.211(2) may be
581	included in computing the staffing ratio for certified nursing
582	assistants only if their job responsibilities include only
583	nursing-assistant-related duties.
584	3.  Each nursing home must document compliance with
585	staffing standards as required under this paragraph and post
586	daily the names of staff on duty for the benefit of facility
587	residents and the public. Compliance with federal posting
588	requirements satisfies the posting requirements in this
589	subparagraph.
590	4.  The agency shall recognize the use of licensed nurses
591	for compliance with minimum staffing requirements for certified
592	nursing assistants, provided that the facility otherwise meets
593	the minimum staffing requirements for licensed nurses and that
594	the licensed nurses are performing the duties of a certified
595	nursing assistant. Unless otherwise approved by the agency,
596	Licensed nurses counted toward the minimum staffing requirements
597	for certified nursing assistants must exclusively perform the
598	duties of a certified nursing assistant for the entire shift and
599	not also be counted toward the minimum staffing requirements for
600	licensed nurses. If the agency approved a facility's request to
601	use a licensed nurse to perform both licensed nursing and
602	certified nursing assistant duties, The facility must allocate
603	the amount of staff time specifically spent on certified nursing
604	assistant duties for the purpose of documenting compliance with
605	minimum staffing requirements for certified and licensed nursing
606	staff. In no event may the hours of a licensed nurse with dual
607	job responsibilities be counted twice.
608	Section 7.  This act shall take effect July 1, 2008.

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