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;

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amending s. 400.195, F.S., relating to agency reporting

18

requirements; conforming a cross-reference; amending s.

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400.23, F.S.; providing that compliance with federal

20

posting requirements for staffing standards satisfies

21

state posting requirements; deleting provisions requiring

22

agency approval in order for a nursing home to use

23

licensed nurses to perform certain duties; providing an

24

effective date.

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26

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

27

28

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

29

400.118, Florida Statutes, is amended to read:

30

     400.118  Quality assurance; early warning system;

31

monitoring; rapid response teams.--

32

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

33

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

34

of nursing facilities in the district, to monitor all nursing

35

facilities in the district on a regular, unannounced, aperiodic

36

basis, including nights, evenings, weekends, and holidays.

37

Quality-of-care monitors shall visit each nursing facility

38

annually, shall visit each conditionally licensed nursing

39

facility at least quarterly, and shall visit other facilities as

40

directed by the agency. However, upon the request of a facility,

41

the agency shall make quarterly visits to a nursing home that is

42

not conditionally licensed. The request applies only to the

43

current licensure period and must be made again by the facility

44

at the time of license renewal in order to be continued. Priority

45

for additional monitoring visits shall be given to nursing

46

facilities that have with a history of resident care

47

deficiencies. Quality-of-care monitors shall be registered nurses

48

who are trained and experienced in nursing facility regulation,

49

standards of practice in long-term care, and evaluation of

50

patient care. Individuals in these positions may shall not be

51

deployed by the agency as a part of the district survey team in

52

the conduct of routine, scheduled surveys, but shall function

53

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

54

care monitors shall assess the overall quality of life in the

55

nursing facility and shall assess specific conditions in the

56

facility directly related to resident care, including the

57

operations of internal quality improvement and risk management

58

programs and adverse incident reports. The quality-of-care

59

monitor shall include in an assessment visit observation of the

60

care and services rendered to residents and formal and informal

61

interviews with residents, family members, facility staff,

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resident guests, volunteers, other regulatory staff, and

63

representatives of a long-term care ombudsman council or Florida

64

advocacy council.

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     Section 2.  Section 400.141, Florida Statutes, is amended to

66

read:

67

     400.141  Administration and management of nursing home

68

facilities.--Every licensed facility shall comply with all

69

applicable standards and rules of the agency and shall:

70

     (1)  Be under the administrative direction and charge of a

71

licensed administrator.

72

     (2)  Appoint a medical director licensed pursuant to chapter

73

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

74

specific criteria for the appointment of a medical director.

75

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

76

services of physicians licensed by the state.

77

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

78

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

79

notwithstanding, a registered pharmacist licensed in Florida,

80

that is under contract with a facility licensed under this

81

chapter or chapter 429, shall repackage a nursing facility

82

resident's bulk prescription medication which has been packaged

83

by another pharmacist licensed in any state in the United States

84

into a unit dose system compatible with the system used by the

85

nursing facility, if the pharmacist is requested to offer such

86

service. In order to be eligible for the repackaging, a resident

87

or the resident's spouse must receive prescription medication

88

benefits provided through a former employer as part of his or her

89

retirement benefits, a qualified pension plan as specified in s.

90

4972 of the Internal Revenue Code, a federal retirement program

91

as specified under 5 C.F.R. s. 831, or a long-term care policy as

92

defined in s. 627.9404(1). A pharmacist who correctly repackages

93

and relabels the medication and the nursing facility which

94

correctly administers such repackaged medication under the

95

provisions of this subsection shall not be held liable in any

96

civil or administrative action arising from the repackaging. In

97

order to be eligible for the repackaging, a nursing facility

98

resident for whom the medication is to be repackaged shall sign

99

an informed consent form provided by the facility which includes

100

an explanation of the repackaging process and which notifies the

101

resident of the immunities from liability provided herein. A

102

pharmacist who repackages and relabels prescription medications,

103

as authorized under this subsection, may charge a reasonable fee

104

for costs resulting from the implementation of this provision.

105

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

106

dental and other health-related services, recreational services,

107

rehabilitative services, and social work services appropriate to

108

their needs and conditions and not directly furnished by the

109

licensee.  When a geriatric outpatient nurse clinic is conducted

110

in accordance with rules adopted by the agency, outpatients

111

attending such clinic shall not be counted as part of the general

112

resident population of the nursing home facility, nor shall the

113

nursing staff of the geriatric outpatient clinic be counted as

114

part of the nursing staff of the facility, until the outpatient

115

clinic load exceeds 15 a day.

116

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

117

other needed services under certain conditions. If the facility

118

has a standard licensure status, and has had no class I or class

119

II deficiencies during the past 2 years or has been awarded a

120

Gold Seal under the program established in s. 400.235, it may be

121

encouraged by the agency to provide services, including, but not

122

limited to, respite and adult day services, which enable

123

individuals to move in and out of the facility.  A facility is

124

not subject to any additional licensure requirements for

125

providing these services. Respite care may be offered to persons

126

in need of short-term or temporary nursing home services. Respite

127

care must be provided in accordance with this part and rules

128

adopted by the agency. However, the agency shall, by rule, adopt

129

modified requirements for resident assessment, resident care

130

plans, resident contracts, physician orders, and other

131

provisions, as appropriate, for short-term or temporary nursing

132

home services.  The agency shall allow for shared programming and

133

staff in a facility which meets minimum standards and offers

134

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

135

cited for deficiencies in patient care, may require additional

136

staff and programs appropriate to the needs of service

137

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

138

as a resident of the facility for purposes of the facility's

139

licensed capacity unless that person receives 24-hour respite

140

care. A person receiving either respite care for 24 hours or

141

longer or adult day services must be included when calculating

142

minimum staffing for the facility. Any costs and revenues

143

generated by a nursing home facility from nonresidential programs

144

or services shall be excluded from the calculations of Medicaid

145

per diems for nursing home 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 under

150

chapter 651 or a retirement community that offers other services

151

pursuant to part III of this chapter or part I or part III of

152

chapter 429 on a single campus, be allowed to share programming

153

and staff. At the time of inspection and in the semiannual report

154

required pursuant to subsection (15), a continuing care facility

155

or retirement community that uses this option must demonstrate

156

through staffing records that minimum staffing requirements for

157

the facility were met. Licensed nurses and certified nursing

158

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

159

provide services elsewhere on campus if the facility exceeds the

160

minimum number of direct care hours required per resident per day

161

and the total number of residents receiving direct care services

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from a licensed nurse or a certified nursing assistant does not

163

cause the facility to violate the staffing ratios required under

164

s. 400.23(3)(a). Compliance with the minimum staffing ratios

165

shall be based on total number of residents receiving direct care

166

services, regardless of where they reside on campus. If the

167

facility receives a conditional license, it may not share staff

168

until the conditional license status ends. This subsection does

169

not restrict the agency's authority under federal or state law to

170

require additional staff if a facility is cited for deficiencies

171

in care which are caused by an insufficient number of certified

172

nursing assistants or licensed nurses. The agency may adopt rules

173

for the documentation necessary to determine compliance with this

174

provision.

175

     (8)  Maintain the facility premises and equipment and

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conduct its operations in a safe and sanitary manner.

177

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

178

wholesome and nourishing diet sufficient to meet generally

179

accepted standards of proper nutrition for its residents and

180

provide such therapeutic diets as may be prescribed by attending

181

physicians.  In making rules to implement this subsection, the

182

agency shall be guided by standards recommended by nationally

183

recognized professional groups and associations with knowledge of

184

dietetics.

185

     (10)  Keep full records of resident admissions and

186

discharges; medical and general health status, including medical

187

records, personal and social history, and identity and address of

188

next of kin or other persons who may have responsibility for the

189

affairs of the residents; and individual resident care plans

190

including, but not limited to, prescribed services, service

191

frequency and duration, and service goals.  The records shall be

192

open to inspection by the agency.

193

     (11)  Keep such fiscal records of its operations and

194

conditions as may be necessary to provide information pursuant to

195

this part.

196

     (12)  Furnish copies of personnel records for employees

197

affiliated with such facility, to any other facility licensed by

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this state requesting this information pursuant to this part.  

199

Such information contained in the records may include, but is not

200

limited to, disciplinary matters and any reason for termination.

201

Any facility releasing such records pursuant to this part shall

202

be considered to be acting in good faith and may not be held

203

liable for information contained in such records, absent a

204

showing that the facility maliciously falsified such records.

205

     (13)  Publicly display a poster provided by the agency

206

containing the names, addresses, and telephone numbers for the

207

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

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Agency for Health Care Administration consumer hotline, the

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Advocacy Center for Persons with Disabilities, the Florida

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Statewide Advocacy Council, and the Medicaid Fraud Control Unit,

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with a clear description of the assistance to be expected from

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each.

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     (14)  Submit to the agency the information specified in s.

214

400.071(1)(b) for a management company within 30 days after the

215

effective date of the management agreement.

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

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if requested by the agency, information regarding facility staff-

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to-resident ratios, staff turnover, and staff stability,

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including information regarding certified nursing assistants,

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licensed nurses, the director of nursing, and the facility

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administrator. For purposes of this reporting:

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

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

224

ratio must be reported as an average for the most recent calendar

225

quarter.

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     (b)  Staff turnover must be reported for the most recent 12-

227

month period ending on the last workday of the most recent

228

calendar quarter prior to the date the information is submitted.

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The turnover rate must be computed quarterly, with the annual

230

rate being the cumulative sum of the quarterly rates. The

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turnover rate is the total number of terminations or separations

232

experienced during the quarter, excluding any employee terminated

233

during a probationary period of 3 months or less, divided by the

234

total number of staff employed at the end of the period for which

235

the rate is computed, and expressed as a percentage.

236

     (c)  The formula for determining staff stability is the

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total number of employees that have been employed for more than

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12 months, divided by the total number of employees employed at

239

the end of the most recent calendar quarter, and expressed as a

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percentage.

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

242

minimum-staffing requirements for 2 consecutive days is

243

prohibited from accepting new admissions until the facility has

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achieved the minimum-staffing requirements for a period of 6

245

consecutive days. For the purposes of this paragraph, any person

246

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

247

facility for the purpose of receiving medical care at a separate

248

location or was on a leave of absence is not considered a new

249

admission. Failure to impose such an admissions moratorium

250

constitutes a class II deficiency.

251

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

252

license may be cited for failure to comply with the standards in

253

s. 400.23(3)(a)1.a. only if it has failed to meet those standards

254

on 2 consecutive days or if it has failed to meet at least 97

255

percent of those standards on any one day.

256

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

257

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

258

259

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

260

impose a deficiency or take other actions if a facility does not

261

have enough staff to meet the residents' needs.

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

263

facility which are available for resident occupancy on the day

264

the information is reported.

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     (17)  Notify a licensed physician when a resident exhibits

266

signs of dementia or cognitive impairment or has a change of

267

condition in order to rule out the presence of an underlying

268

physiological condition that may be contributing to such dementia

269

or impairment. The notification must occur within 30 days after

270

the acknowledgment of such signs by facility staff. If an

271

underlying condition is determined to exist, the facility shall

272

arrange, with the appropriate health care provider, the necessary

273

care and services to treat the condition.

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     (18)  If the facility implements a dining and hospitality

275

attendant program, ensure that the program is developed and

276

implemented under the supervision of the facility director of

277

nursing. A licensed nurse, licensed speech or occupational

278

therapist, or a registered dietitian must conduct training of

279

dining and hospitality attendants. A person employed by a

280

facility as a dining and hospitality attendant must perform tasks

281

under the direct supervision of a licensed nurse.

282

     (19)  Report to the agency any filing for bankruptcy

283

protection by the facility or its parent corporation, divestiture

284

or spin-off of its assets, or corporate reorganization within 30

285

days after the completion of such activity.

286

     (20)  Maintain general and professional liability insurance

287

coverage that is in force at all times. In lieu of general and

288

professional liability insurance coverage, a state-designated

289

teaching nursing home and its affiliated assisted living

290

facilities created under s. 430.80 may demonstrate proof of

291

financial responsibility as provided in s. 430.80(3)(h).

292

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

293

daily chart of certified nursing assistant services provided to

294

the resident. The certified nursing assistant who is caring for

295

the resident must complete this record by the end of his or her

296

shift. This record must indicate assistance with activities of

297

daily living, assistance with eating, and assistance with

298

drinking, and must record each offering of nutrition and

299

hydration for those residents whose plan of care or assessment

300

indicates a risk for malnutrition or dehydration.

301

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

302

availability of an adequate supply of the necessary vaccine,

303

provide for immunizations against influenza viruses to all its

304

consenting residents in accordance with the recommendations of

305

the United States Centers for Disease Control and Prevention,

306

subject to exemptions for medical contraindications and religious

307

or personal beliefs. Subject to these exemptions, any consenting

308

person who becomes a resident of the facility after November 30

309

but before March 31 of the following year must be immunized

310

within 5 working days after becoming a resident. Immunization

311

shall not be provided to any resident who provides documentation

312

that he or she has been immunized as required by this subsection.

313

This subsection does not prohibit a resident from receiving the

314

immunization from his or her personal physician if he or she so

315

chooses. A resident who chooses to receive the immunization from

316

his or her personal physician shall provide proof of immunization

317

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

318

necessary to comply with or implement this subsection.

319

     (23)  Assess all residents for eligibility for pneumococcal

320

polysaccharide vaccination (PPV) and vaccinate residents when

321

indicated within 60 days after the effective date of this act in

322

accordance with the recommendations of the United States Centers

323

for Disease Control and Prevention, subject to exemptions for

324

medical contraindications and religious or personal beliefs.

325

Residents admitted after the effective date of this act shall be

326

assessed within 5 working days of admission and, when indicated,

327

vaccinated within 60 days in accordance with the recommendations

328

of the United States Centers for Disease Control and Prevention,

329

subject to exemptions for medical contraindications and religious

330

or personal beliefs. Immunization shall not be provided to any

331

resident who provides documentation that he or she has been

332

immunized as required by this subsection. This subsection does

333

not prohibit a resident from receiving the immunization from his

334

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

335

chooses to receive the immunization from his or her personal

336

physician shall provide proof of immunization to the facility.

337

The agency may adopt and enforce any rules necessary to comply

338

with or implement this subsection.

339

     (24)  Annually encourage and promote to its employees the

340

benefits associated with immunizations against influenza viruses

341

in accordance with the recommendations of the United States

342

Centers for Disease Control and Prevention. The agency may adopt

343

and enforce any rules necessary to comply with or implement this

344

subsection.

345

346

Facilities having a standard license that have been awarded a

347

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

348

a plan to provide certified nursing assistant training as

349

prescribed by federal regulations and state rules and may apply

350

to the agency for approval of their program. The agency may adopt

351

rules relating to the approval, suspension, or termination of a

352

certified nursing assistant training program.

353

     Section 3.  Subsections (5) through (15) of section 400.147,

354

Florida Statutes, are amended to read:

355

     400.147  Internal risk management and quality assurance

356

program.--

357

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

358

section, the term "adverse incident" means:

359

     (a)  An event over which facility personnel could exercise

360

control and which is associated in whole or in part with the

361

facility's intervention, rather than the condition for which such

362

intervention occurred, and which results in one of the following:

363

     1.  Death;

364

     2.  Brain or spinal damage;

365

     3.  Permanent disfigurement;

366

     4.  Fracture or dislocation of bones or joints;

367

     5.  A limitation of neurological, physical, or sensory

368

function;

369

     6.  Any condition that required medical attention to which

370

the resident has not given his or her informed consent, including

371

failure to honor advanced directives; or

372

     7.  Any condition that required the transfer of the

373

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

374

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

375

the resident's condition prior to the adverse incident;

376

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

377

415.102;

378

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

379

     (d)  Resident elopement; or

380

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

381

for investigation.

382

     (6)  The internal risk manager of each licensed facility

383

shall:

384

     (a)  Investigate every allegation of sexual misconduct which

385

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

386

direct patient contact when the allegation is that the sexual

387

misconduct occurred at the facility or at the grounds of the

388

facility;

389

     (b)  Report every allegation of sexual misconduct to the

390

administrator of the licensed facility; and

391

     (c)  Notify the resident representative or guardian of the

392

victim that an allegation of sexual misconduct has been made and

393

that an investigation is being conducted.

394

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

395

shall notify the agency within 1 business day after the risk

396

manager or his or her designee has received a report pursuant to

397

paragraph (1)(d). The notification must be made in writing and be

398

provided electronically, by facsimile device or overnight mail

399

delivery. The notification must include information regarding the

400

identity of the affected resident, the type of adverse incident,

401

the initiation of an investigation by the facility, and whether

402

the events causing or resulting in the adverse incident represent

403

a potential risk to any other resident. The notification is

404

confidential as provided by law and is not discoverable or

405

admissible in any civil or administrative action, except in

406

disciplinary proceedings by the agency or the appropriate

407

regulatory board. The agency may investigate, as it deems

408

appropriate, any such incident and prescribe measures that must

409

or may be taken in response to the incident. The agency shall

410

review each incident and determine whether it potentially

411

involved conduct by the health care professional who is subject

412

to disciplinary action, in which case the provisions of s.

413

456.073 shall apply.

414

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

415

and submit an adverse incident report to the agency for each

416

adverse incident within 15 calendar days after its occurrence.

417

If, after a complete investigation, the risk manager determines

418

that the incident was not an adverse incident as defined in

419

subsection (5), the facility shall include this information in

420

the report. The agency shall develop a form for reporting this

421

information.

422

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

423

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

424

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

425

by the agency. The agency shall determine whether any of the

426

incidents potentially involved conduct by a health care

427

professional who is subject to disciplinary action, in which case

428

the provisions of s. 456.073 shall apply.

429

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

430

the name of the risk manager of the facility.

431

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

432

provided by law and is not discoverable or admissible in any

433

civil or administrative action, except in disciplinary

434

proceedings by the agency or the appropriate regulatory board.

435

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

436

this section shall report any notice received pursuant to s.

437

400.0233(2) and each initial complaint that was filed with the

438

clerk of the court and served on the facility during the previous

439

month by a resident or a resident's family member, guardian,

440

conservator, or personal legal representative. The report must

441

include the name of the resident, the resident's date of birth

442

and social security number, the Medicaid identification number

443

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

444

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

445

the type of injury or violation of rights alleged to have

446

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

447

received pursuant to s. 400.0233(2) and complaints filed with the

448

clerk of the court. This report is confidential as provided by

449

law and is not discoverable or admissible in any civil or

450

administrative action, except in such actions brought by the

451

agency to enforce the provisions of this part.

452

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

453

inspection process, the internal risk management and quality

454

assurance program at each facility regulated by this section to

455

determine whether the program meets standards established in

456

statutory laws and rules, is being conducted in a manner designed

457

to reduce adverse incidents, and is appropriately reporting

458

incidents as required by this section.

459

     (10)(11) There is no monetary liability on the part of, and

460

a cause of action for damages may not arise against, any risk

461

manager for the implementation and oversight of the internal risk

462

management and quality assurance program in a facility licensed

463

under this part as required by this section, or for any act or

464

proceeding undertaken or performed within the scope of the

465

functions of such internal risk management and quality assurance

466

program if the risk manager acts without intentional fraud.

467

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

468

incident reports prescribed in subsection (7), or through any

469

investigation, has a reasonable belief that conduct by a staff

470

member or employee of a facility is grounds for disciplinary

471

action by the appropriate regulatory board, the agency shall

472

report this fact to the regulatory board.

473

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

474

section.

475

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

476

Legislature a report on nursing home adverse incidents. The

477

report must include the following information arranged by county:

478

     (a)  The total number of adverse incidents.

479

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

480

incidents, the number of incidents occurring within each

481

category, and the type of staff involved.

482

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

483

and the number of injuries occurring within each category.

484

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

485

incident or reportable injury.

486

     (e)  Disciplinary action taken against staff, categorized by

487

type of staff involved.

488

     (14)(15) Information gathered by a credentialing

489

organization under a quality assurance program is not

490

discoverable from the credentialing organization. This subsection

491

does not limit discovery of, access to, or use of facility

492

records, including those records from which the credentialing

493

organization gathered its information.

494

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

495

Statutes, is amended to read:

496

     400.19  Right of entry and inspection.--

497

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

498

unannounced inspection to determine compliance by the licensee

499

with statutes, and with rules adopted promulgated under the

500

provisions of those statutes, governing minimum standards of

501

construction, quality and adequacy of care, and rights of

502

residents. The survey shall be conducted every 6 months for the

503

next 2-year period if the facility has been cited for a class I

504

deficiency, has been cited for two or more class II deficiencies

505

arising from separate surveys or investigations within a 60-day

506

period, or has had three or more substantiated complaints within

507

a 6-month period, each resulting in at least one class I or class

508

II deficiency. In addition to any other fees or fines in this

509

part, the agency shall assess a fine for each facility that is

510

subject to the 6-month survey cycle. The fine for the 2-year

511

period shall be $6,000, one-half to be paid at the completion of

512

each survey. The agency may adjust this fine by the change in the

513

Consumer Price Index, based on the 12 months immediately

514

preceding the increase, to cover the cost of the additional

515

surveys. If such deficiencies are overturned as the result of

516

administrative action but additional surveys have already been

517

conducted pursuant to this section, the most recent survey shall

518

be considered a licensure survey for purposes of scheduling

519

future surveys. The agency shall verify through subsequent

520

inspection that any deficiency identified during inspection is

521

corrected. However, the agency may verify the correction of a

522

class III or class IV deficiency unrelated to resident rights or

523

resident care without reinspecting the facility if adequate

524

written documentation has been received from the facility, which

525

provides assurance that the deficiency has been corrected. The

526

giving or causing to be given of advance notice of such

527

unannounced inspections by an employee of the agency to any

528

unauthorized person shall constitute cause for suspension of not

529

fewer than 5 working days according to the provisions of chapter

530

110.

531

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

532

400.195, Florida Statutes, is amended to read:

533

     400.195  Agency reporting requirements.--

534

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

535

30, 2005, the Agency for Health Care Administration shall provide

536

a report to the Governor, the President of the Senate, and the

537

Speaker of the House of Representatives with respect to nursing

538

homes.  The first report shall be submitted no later than

539

December 30, 2002, and subsequent reports shall be submitted

540

every 6 months thereafter.  The report shall identify facilities

541

based on their ownership characteristics, size, business

542

structure, for-profit or not-for-profit status, and any other

543

characteristics the agency determines useful in analyzing the

544

varied segments of the nursing home industry and shall report:

545

     (d)  Information regarding deficiencies cited, including

546

information used to develop the Nursing Home Guide WATCH LIST

547

pursuant to s. 400.191, and applicable rules, a summary of data

548

generated on nursing homes by Centers for Medicare and Medicaid

549

Services Nursing Home Quality Information Project, and

550

information collected pursuant to s. 400.147(8) s. 400.147(9),

551

relating to litigation.

552

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

553

400.23, Florida Statutes, is amended to read:

554

     400.23  Rules; evaluation and deficiencies; licensure

555

status.--

556

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

557

staffing requirements for nursing homes. These requirements shall

558

include, for each nursing home facility:

559

     a.  A minimum certified nursing assistant staffing of 2.6

560

hours of direct care per resident per day beginning January 1,

561

2003, and increasing to 2.7 hours of direct care per resident per

562

day beginning January 1, 2007. Beginning January 1, 2002, a no

563

facility may not shall staff below one certified nursing

564

assistant per 20 residents, and must provide a minimum licensed

565

nursing staffing of 1.0 hour of direct care per resident per day

566

but never below one licensed nurse per 40 residents.

567

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

568

certified nursing assistant staffing of 2.9 hours of direct care

569

per resident per day. For the purpose of this sub-subparagraph, a

570

week is defined as Sunday through Saturday.

571

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

572

included in computing the staffing ratio for certified nursing

573

assistants only if their job responsibilities include only

574

nursing-assistant-related duties.

575

     3.  Each nursing home must document compliance with staffing

576

standards as required under this paragraph and post daily the

577

names of staff on duty for the benefit of facility residents and

578

the public. Compliance with federal posting requirements

579

satisfies the posting requirements in this subparagraph.

580

     4.  The agency shall recognize the use of licensed nurses

581

for compliance with minimum staffing requirements for certified

582

nursing assistants, provided that the facility otherwise meets

583

the minimum staffing requirements for licensed nurses and that

584

the licensed nurses are performing the duties of a certified

585

nursing assistant. Unless otherwise approved by the agency,

586

Licensed nurses counted toward the minimum staffing requirements

587

for certified nursing assistants must exclusively perform the

588

duties of a certified nursing assistant for the entire shift and

589

not also be counted toward the minimum staffing requirements for

590

licensed nurses. If the agency approved a facility's request to

591

use a licensed nurse to perform both licensed nursing and

592

certified nursing assistant duties, The facility must allocate

593

the amount of staff time specifically spent on certified nursing

594

assistant duties for the purpose of documenting compliance with

595

minimum staffing requirements for certified and licensed nursing

596

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

597

job responsibilities be counted twice.

598

     Section 7.  This act shall take effect July 1, 2008.