CS for CS for CS for SB 1986 First Engrossed
20091986e1
1 A bill to be entitled
2 An act relating to health care; providing legislative
3 findings; designating Miami-Dade County as a health
4 care fraud area of concern; amending s. 68.085, F.S.;
5 allocating certain funds recovered under the Florida
6 False Claims Act to fund rewards for persons who
7 report and provide information relating to Medicaid
8 fraud; amending s. 68.086, F.S.; providing that a
9 defendant who prevails in an action under the Florida
10 False Claims Act may be awarded attorney’s fees and
11 costs against the person bringing the action under
12 certain circumstances; amending s. 400.471, F.S.;
13 prohibiting the Agency for Health Care Administration
14 from renewing a license of a home health agency in
15 certain counties if the agency has been sanctioned for
16 certain misconduct; providing limitations on licensing
17 of home health agencies in certain counties; amending
18 s. 400.474, F.S.; authorizing the Agency for Health
19 Care Administration to deny, revoke, or suspend the
20 license of or fine a home health agency that provides
21 remuneration to certain facilities or bills the
22 Medicaid program for medically unnecessary services;
23 providing that certain discounts, compensations,
24 waivers of payments, or payment practices; exempting
25 nurse registries that meet certain conditions from a
26 prohibition; creating s. 408.8065, F.S.; providing
27 additional licensure requirements for home health
28 agencies, home medical equipment providers, and health
29 care clinics; requiring the posting of a surety bond
30 in a specified minimum amount under certain
31 circumstances; amending s. 400.506, F.S.; exempting
32 certain items from a prohibition against providing
33 remuneration to certain persons by a nurse registry;
34 imposing criminal penalties against a person who
35 knowingly submits misleading information to the Agency
36 for Health Care Administration in connection with
37 applications for certain licenses; amending ss.
38 395.602 and 408.07, F.S.; revising the definition of
39 the term “rural hospital” relating to hospital
40 licensing and regulation and health care
41 administration; amending s. 408.040, F.S.; providing
42 an exception to the termination of certain
43 certificates of need; creating s. 408.8065, F.S.;
44 amending s. 408.810, F.S.; revising provisions
45 relating to information required for licensure;
46 requiring certain licensees to provide clients with a
47 description of Medicaid fraud and the statewide toll
48 free telephone number for the central Medicaid fraud
49 hotline; amending s. 408.815, F.S.; providing
50 additional grounds to deny an application for a
51 license; amending s. 409.905, F.S.; authorizing the
52 Agency for Health Care Administration to require prior
53 authorization of care based on utilization rates;
54 requiring a home health agency to submit a plan of
55 care and documentation of a recipient’s medical
56 condition to the Agency for Health Care Administration
57 when requesting prior authorization; prohibiting the
58 Agency for Health Care Administration from paying for
59 home health services unless specified requirements are
60 satisfied; amending s. 409.907, F.S.; providing for
61 certain out-of-state providers to enroll as Medicaid
62 providers; amending s. 409.912, F.S.; requiring that
63 certain entities that provide comprehensive behavioral
64 health care services to certain Medicaid recipients be
65 licensed or authorized; requiring the Agency for
66 Health Care Administration to establish norms for the
67 utilization of Medicaid services; requiring the agency
68 to submit a report relating to the overutilization of
69 Medicaid services; revising the requirement for an
70 entity that contracts on a prepaid or fixed-sum basis
71 to meet certain surplus requirements; deleting the
72 requirement that an entity maintain certain
73 investments and restricted funds or deposits; revising
74 the circumstances in which the agency must prohibit
75 the entity from engaging in certain activities, cease
76 to process new enrollments, and not renew the entity’s
77 contract; amending s. 409.913, F.S.; requiring that
78 the annual report submitted by the Agency for Health
79 Care Administration and the Medicaid Fraud Control
80 Unit of the Department of Legal Affairs recommend
81 changes necessary to prevent and detect Medicaid
82 fraud; requiring the Agency for Health Care
83 Administration to monitor patterns of overutilization
84 of Medicaid services; requiring the agency to deny
85 payment or require repayment for Medicaid services
86 under certain circumstances; requiring the Agency for
87 Health Care Administration to immediately terminate a
88 Medicaid provider’s participation in the Medicaid
89 program as a result of certain adjudications against
90 the provider or certain affiliated persons; requiring
91 the Agency for Health Care Administration to suspend
92 or terminate a Medicaid provider’s participation in
93 the Medicaid program if the provider or certain
94 affiliated persons participating in the Medicaid
95 program have been suspended or terminated by the
96 Federal Government or another state; providing that a
97 provider is subject to sanctions for violations of law
98 as the result of actions or inactions of the provider
99 or certain affiliated persons; requiring that the
100 agency provide notice of certain administrative
101 sanctions to other regulatory agencies within a
102 specified period; requiring the Agency for Health Care
103 Administration to withhold or deny Medicaid payments
104 under certain circumstances; requiring the agency to
105 terminate a provider’s participation in the Medicaid
106 program if the provider fails to repay certain
107 overpayments from the Medicaid program; requiring the
108 agency to provide at least annually information on
109 Medicaid fraud in an explanation of benefits letter;
110 requiring the Agency for Health Care Administration to
111 post a list on its website of Medicaid providers and
112 affiliated persons of providers who have been
113 terminated or sanctioned; requiring the agency to take
114 certain actions to improve the prevention and
115 detection of health care fraud through the use of
116 technology; amending s. 409.920, F.S.; defining the
117 term “managed care organization”; providing criminal
118 penalties and fines for Medicaid fraud; granting civil
119 immunity to certain persons who report suspected
120 Medicaid fraud; creating s. 409.9203, F.S.;
121 authorizing the payment of rewards to persons who
122 report and provide information relating to Medicaid
123 fraud; amending s. 456.004, F.S.; amending s. 456.053,
124 F.S.; excluding referrals to a sleep care provider for
125 sleep related testing to the definition of a referral;
126 requiring the Department of Health to work
127 cooperatively with the Agency for Health Care
128 Administration and the judicial system to recover
129 overpayments by the Medicaid program; amending s.
130 456.041, F.S.; requiring the Department of Health to
131 include a statement in the practitioner profile if a
132 practitioner has been terminated from participating in
133 the Medicaid program; creating s. 456.0635, F.S.;
134 prohibiting Medicaid fraud in the practice of health
135 care professions; requiring the Department of Health
136 or boards within the department to refuse to admit to
137 exams and to deny licenses, permits, or certificates
138 to certain persons who have engaged in certain acts;
139 requiring health care practitioners to report
140 allegations of Medicaid fraud; specifying that
141 acceptance of the relinquishment of a license in
142 anticipation of charges relating to Medicaid fraud
143 constitutes permanent revocation of a license;
144 amending s. 456.072, F.S.; creating additional grounds
145 for the Department of Health to take disciplinary
146 action against certain applicants or licensees for
147 misconduct relating to a Medicaid program or to health
148 care fraud; amending s. 456.074, F.S.; requiring the
149 Department of Health to issue an emergency order
150 suspending the license of a person who engages in
151 certain criminal conduct relating to the Medicaid
152 program; amending s. 465.022, F.S.; authorizing
153 partnerships and corporations to obtain pharmacy
154 permits; requiring applicants or certain persons
155 affiliated with an applicant for a pharmacy permit to
156 submit a set of fingerprints for a criminal history
157 records check and pay the costs of the criminal
158 history records check; requiring the Department of
159 Health or Board of Pharmacy to deny an application for
160 a pharmacy permit for certain misconduct by the
161 applicant; or persons affiliated with the applicant;
162 amending s. 465.023, F.S.; authorizing the Department
163 of Health or the Board of Pharmacy to take
164 disciplinary action against a permitee for certain
165 misconduct by the permitee, or persons affiliated with
166 the permitee; amending s. 825.103, F.S.; redefining
167 the term “exploitation of an elderly person or
168 disabled adult”; amending s. 921.0022, F.S.; revising
169 the severity level ranking of Medicaid fraud under the
170 Criminal Punishment Code; creating a pilot project to
171 monitor and verify the delivery of home health
172 services and provide for electronic claims for home
173 health services; requiring the Agency for Health Care
174 Administration to issue a report evaluating the pilot
175 project; creating a pilot project for home health care
176 management in Miami-Dade County; amending ss. 400.0077
177 and 430.608, F.S.; conforming cross-references to
178 changes made by the act; repealing s. 395.0199, F.S.,
179 relating to private utilization review of health care
180 services; amending ss. 395.405 and 400.0712, F.S.;
181 conforming cross-references; repealing s. 400.118(2),
182 F.S.; removing provisions requiring quality-of-care
183 monitors for nursing facilities in agency district
184 offices; amending s. 400.141, F.S.; deleting a
185 requirement that licensed nursing home facilities
186 provide the agency with a monthly report on the number
187 of vacant beds in the facility; amending s. 400.147,
188 F.S.; revising the definition of the term “adverse
189 incident” for reporting purposes; requiring abuse,
190 neglect, and exploitation to be reported to the agency
191 and the Department of Children and Family Services;
192 deleting a requirement that the agency submit an
193 annual report on nursing home adverse incidents to the
194 Legislature; amending s. 400.162, F.S.; revising
195 requirements for policies and procedures regarding the
196 safekeeping of a resident’s personal effects and
197 property; amending s. 400.191; F.S.; revising the
198 information on the agency’s Internet site regarding
199 nursing homes; deleting the provision that requires
200 the agency to provide information about nursing homes
201 in printed form; amending s. 400.195, F.S.; conforming
202 a cross-reference; amending s. 400.23, F.S.; deleting
203 the requirement of the agency to adopt rules regarding
204 the eating assistance provided to residents; amending
205 s. 400.9935, F.S.; revising accreditation requirements
206 for clinics providing magnetic resonance imaging
207 services; amending s. 400.995, F.S.; revising agency
208 responsibilities with respect to agency administrative
209 penalties; amending s. 408.803, F.S.; revising
210 definitions applicable to part II of ch. 408, F.S.,
211 the “Health Care Licensing Procedures Act”; amending
212 s. 408.806, F.S.; revising contents of and procedures
213 relating to health care provider applications for
214 licensure; providing an exception from certain
215 licensure inspections for adult family-care homes;
216 authorizing the agency to provide electronic access to
217 certain information and documents; amending s.
218 408.808, F.S.; providing for a provisional license to
219 be issued to applicants applying for a change of
220 ownership; providing a time limit on provisional
221 licenses; amending s. 408.809, F.S.; revising
222 provisions relating to background screening of
223 specified employees; requiring health care providers
224 to submit to the agency an affidavit of compliance
225 with background screening requirements at the time of
226 license renewal; deleting a provision to conform to
227 changes made by the act; amending s. 408.811, F.S.;
228 providing for certain inspections to be accepted in
229 lieu of complete licensure inspections; granting
230 agency access to records requested during an offsite
231 review; providing timeframes for correction of certain
232 deficiencies and submission of plans to correct the
233 deficiencies; amending s. 408.813, F.S.; providing
234 classifications of violations of part II of ch. 408,
235 F.S.; providing for fines; amending s. 408.820, F.S.;
236 revising applicability of certain exemptions from
237 specified requirements of part II of ch. 408, F.S.;
238 creating s. 408.821, F.S.; requiring entities
239 regulated or licensed by the agency to designate a
240 liaison officer for emergency operations; authorizing
241 entities regulated or licensed by the agency to
242 temporarily exceed their licensed capacity to act as
243 receiving providers under specified circumstances;
244 providing requirements that apply while such entities
245 are in an overcapacity status; providing for issuance
246 of an inactive license to such licensees under
247 specified conditions; providing requirements and
248 procedures with respect to the issuance and
249 reactivation of an inactive license; authorizing the
250 agency to adopt rules; amending s. 408.831, F.S.;
251 deleting provisions relating to the authorization for
252 entities regulated or licensed by the agency to exceed
253 their licensed capacity to act as receiving facilities
254 and issuance and reactivation of inactive licenses;
255 amending s. 408.918, F.S.; revising the requirements
256 of a provider to participate in the Florida 211
257 network; requiring the Public Service Commission to
258 request the Federal Communications Commission to
259 direct the revocation of a 211 number under certain
260 circumstances; deleting the requirement for the Agency
261 for Health Care Administration to seek assistance in
262 resolving jurisdictional disputes related to 211
263 numbers; providing that the Florida Alliance of
264 Information and Referral Services is the collaborative
265 organization for the state; amending s. 409.221, F.S.;
266 conforming a cross-reference; amending s. 409.901,
267 F.S.; redefining the term “change of ownership” as it
268 relates to Medicaid providers; repealing s. 429.071,
269 F.S., relating to the intergenerational respite care
270 assisted living facility pilot program; amending s.
271 429.08, F.S.; authorizing the agency to provide
272 information regarding licensed assisted living
273 facilities on its Internet website; abolishing local
274 coordinating workgroups established by agency field
275 offices; amending s. 429.14, F.S.; conforming a
276 reference; amending s. 429.19, F.S.; revising agency
277 procedures for imposition of fines for violations of
278 part I of ch. 429, F.S., the “Assisted Living
279 Facilities Act”; amending s. 429.23, F.S.; redefining
280 the term “adverse incident” for reporting purposes;
281 requiring abuse, neglect, and exploitation to be
282 reported to the agency and the Department of Children
283 and Family Services; deleting a requirement that the
284 agency submit an annual report on assisted living
285 facility adverse incidents to the Legislature;
286 repealing s. 429.26(9), F.S., relating to the removal
287 of the requirement for a resident of an assisted
288 living facility to undergo examinations and
289 evaluations under certain circumstances; amending s.
290 430.80, F.S.; conforming a cross-reference; amending
291 ss. 435.04 and 435.05, F.S.; requiring employers of
292 certain employees to submit an affidavit of compliance
293 with level 2 screening requirements at the time of
294 license renewal; amending s. 483.031, F.S.; revising a
295 provision relating to the exemption of certain
296 clinical laboratories, to conform to changes made by
297 the act; amending s. 483.041, F.S.; redefining the
298 term “waived test” as it is used in part I of ch. 483,
299 F.S., the “Florida Clinical Laboratory Law”; repealing
300 s. 483.106, F.S., relating to applications for
301 certificates of exemption by clinical laboratories
302 that perform certain tests; amending ss. 483.172,
303 F.S.; conforming provisions; amending s. 627.4239,
304 F.S.; revising the term “standard reference
305 compendium” for purposes of regulating the insurance
306 coverage of drugs used in the treatment of cancer;
307 requiring a carrier to submit an annual report
308 regarding the coverage of routine patient care costs
309 to the Office of Insurance Regulation under certain
310 circumstances; requiring the Office of Insurance
311 Regulation to provide the annual report to the
312 Governor, Legislature, and the Secretary of Health
313 Care Administration; providing a definition; amending
314 s. 651.118, F.S.; conforming a cross-reference;
315 creating s. 409.91207; requiring the agency to develop
316 a plan to create a medical home pilot project;
317 providing waiver authority for the agency; providing
318 an exception; requiring each medical home network to
319 provide specified services; providing responsibilities
320 of the agency; requiring the Secretary of the agency
321 to appoint a task force; requiring the agency to
322 submit a medical home implementation plan; specifying
323 that implementation of the medical home pilot project
324 is contingent upon legislative approval; authorizing
325 the agency to develop rules; providing an effective
326 date.
327
328 Be It Enacted by the Legislature of the State of Florida:
329
330 Section 1. The Legislature finds that:
331 (1) Immediate and proactive measures are necessary to
332 prevent, reduce, and mitigate health care fraud, waste, and
333 abuse and are essential to maintaining the integrity and
334 financial viability of health care delivery systems, including
335 those funded in whole or in part by the Medicare and Medicaid
336 trust funds. Without these measures, health care delivery
337 systems in this state will be depleted of necessary funds to
338 deliver patient care, and taxpayers’ dollars will be devalued
339 and not used for their intended purposes.
340 (2) Sufficient justification exists for increased oversight
341 of health care clinics, home health agencies, providers of home
342 medical equipment, and other health care providers throughout
343 the state, and in particular, in Miami-Dade County.
344 (3) The state’s best interest is served by deterring health
345 care fraud, abuse, and waste and identifying patterns of
346 fraudulent or abusive Medicare and Medicaid activity early,
347 especially in high-risk localities, such as Miami-Dade County,
348 in order to prevent inappropriate expenditures of public funds
349 and harm to the state’s residents.
350 (4) The Legislature designates Miami-Dade County as a
351 health care fraud crisis area for purposes of implementing
352 increased scrutiny of home health agencies, home medical
353 equipment providers, health care clinics, and other health care
354 providers in Miami-Dade County in order to assist the state’s
355 efforts to prevent Medicaid fraud, waste, and abuse in the
356 county and throughout the state.
357 Section 2. Section 68.085, Florida Statutes, is amended to
358 read:
359 68.085 Awards to plaintiffs bringing action.—
360 (1) If the department proceeds with and prevails in an
361 action brought by a person under this act, except as provided in
362 subsection (2), the court shall order the distribution to the
363 person of at least 15 percent but not more than 25 percent of
364 the proceeds recovered under any judgment obtained by the
365 department in an action under s. 68.082 or of the proceeds of
366 any settlement of the claim, depending upon the extent to which
367 the person substantially contributed to the prosecution of the
368 action.
369 (2) If the department proceeds with an action which the
370 court finds to be based primarily on disclosures of specific
371 information, other than that provided by the person bringing the
372 action, relating to allegations or transactions in a criminal,
373 civil, or administrative hearing; a legislative, administrative,
374 inspector general, or auditor general report, hearing, audit, or
375 investigation; or from the news media, the court may award such
376 sums as it considers appropriate, but in no case more than 10
377 percent of the proceeds recovered under a judgment or received
378 in settlement of a claim under this act, taking into account the
379 significance of the information and the role of the person
380 bringing the action in advancing the case to litigation.
381 (3) If the department does not proceed with an action under
382 this section, the person bringing the action or settling the
383 claim shall receive an amount which the court decides is
384 reasonable for collecting the civil penalty and damages. The
385 amount shall be not less than 25 percent and not more than 30
386 percent of the proceeds recovered under a judgment rendered in
387 an action under this act or in settlement of a claim under this
388 act.
389 (4) Following any distributions under subsection (1),
390 subsection (2), or subsection (3), the agency injured by the
391 submission of a false or fraudulent claim shall be awarded an
392 amount not to exceed its compensatory damages. If the action was
393 based on a claim of funds from the state Medicaid program, 10
394 percent of any remaining proceeds shall be deposited into the
395 Legal Affairs Revolving Trust Fund to fund rewards for persons
396 who report and provide information relating to Medicaid fraud
397 pursuant to s. 409.9203. Any remaining proceeds, including civil
398 penalties awarded under s. 68.082, shall be deposited in the
399 General Revenue Fund.
400 (5) Any payment under this section to the person bringing
401 the action shall be paid only out of the proceeds recovered from
402 the defendant.
403 (6) Whether or not the department proceeds with the action,
404 if the court finds that the action was brought by a person who
405 planned and initiated the violation of s. 68.082 upon which the
406 action was brought, the court may, to the extent the court
407 considers appropriate, reduce the share of the proceeds of the
408 action which the person would otherwise receive under this
409 section, taking into account the role of the person in advancing
410 the case to litigation and any relevant circumstances pertaining
411 to the violation. If the person bringing the action is convicted
412 of criminal conduct arising from his or her role in the
413 violation of s. 68.082, the person shall be dismissed from the
414 civil action and shall not receive any share of the proceeds of
415 the action. Such dismissal shall not prejudice the right of the
416 department to continue the action.
417 Section 3. Section 68.086, Florida Statutes, is amended to
418 read:
419 68.086 Expenses; attorney’s fees and costs.—
420 (1) If the department initiates an action under this act or
421 assumes control of an action brought by a person under this act,
422 the department shall be awarded its reasonable attorney’s fees,
423 expenses, and costs.
424 (2) If the court awards the person bringing the action
425 proceeds under this act, the person shall also be awarded an
426 amount for reasonable attorney’s fees and costs. Payment for
427 reasonable attorney’s fees and costs shall be made from the
428 recovered proceeds before the distribution of any award.
429 (3) If the department does not proceed with an action under
430 this act and the person bringing the action conducts the action
431 defendant is the prevailing party, the court may shall award to
432 the defendant its reasonable attorney’s fees and costs if the
433 defendant prevails in the action and the court finds that the
434 claim of against the person bringing the action was clearly
435 frivolous, clearly vexatious, or brought primarily for purposes
436 of harassment.
437 (4) No liability shall be incurred by the state government,
438 the affected agency, or the department for any expenses,
439 attorney’s fees, or other costs incurred by any person in
440 bringing or defending an action under this act.
441 Section 4. Subsections (10) and (11) are added to section
442 400.471, Florida Statutes, to read:
443 400.471 Application for license; fee.—
444 (10) The agency may not issue a renewal license for a home
445 health agency in any county having at least one licensed home
446 health agency and that has more than one home health agency per
447 5,000 persons, as indicated by the most recent population
448 estimates published by the Legislature’s Office of Economic and
449 Demographic Research, if the applicant or any controlling
450 interest has been administratively sanctioned by the agency
451 during the two years prior to the submission of the licensure
452 renewal application for one or more of the following acts:
453 (a) An intentional or negligent act that materially affects
454 the health or safety of a client of the provider;
455 (b) Knowingly providing home health services in an
456 unlicensed assisted living facility or unlicensed adult family
457 care home, unless the home health agency or employee reports the
458 unlicensed facility or home to the agency within 72 hours after
459 providing the services;
460 (c) Preparing or maintaining fraudulent patient records,
461 such as, but not limited to, charting ahead, recording vital
462 signs or symptoms which were not personally obtained or observed
463 by the home health agency’s staff at the time indicated,
464 borrowing patients or patient records from other home
465 healthagencies to pass a survey or inspection, or falsifying
466 signatures;
467 (d) Failing to provide at least one service directly to a
468 patient for a period of 60 days;
469 (e) Demonstrating a pattern of falsifying documents
470 relating to the training of home health aides or certified
471 nursing assistants or demonstrating a pattern of falsifying
472 health statements for staff who provide direct care to patients.
473 A pattern may be demonstrated by a showing of at least three
474 fraudulent entries or documents;
475 (f) Demonstrating a pattern of billing any payor for
476 services not provided. A pattern may be demonstrated by a
477 showing of at least three billings for services not provided
478 within a 12-month period;
479 (g) Demonstrating a pattern of failing to provide a service
480 specified in the home health agency’s written agreement with a
481 patient or the patient’s legal representative, or the plan of
482 care for that patient, unless a reduction in service is mandated
483 by Medicare, Medicaid, or a state program or as provided in s.
484 400.492(3). A pattern may be demonstrated by a showing of at
485 least three incidents, regardless of the patient or service, in
486 which the home health agency did not provide a service specified
487 in a written agreement or plan of care during a 3-month period;
488 (h) Giving remuneration to a case manager, discharge
489 planner, facility-based staff member, or third-party vendor who
490 is involved in the discharge planning process of a facility
491 licensed under chapter 395, chapter 429, or this chapter from
492 whom the home health agency receives referrals or gives
493 remuneration as prohibited in s. 400.474(6)(a);
494 (i) Giving cash, or its equivalent, to a Medicare or
495 Medicaid beneficiary;
496 (j) Demonstrating a pattern of billing the Medicaid program
497 for services to Medicaid recipients which are medically
498 unnecessary as determined by a final order. A pattern may be
499 demonstrated by a showing of at least two such medically
500 unnecessary services within one Medicaid program integrity audit
501 period;
502 (k) Providing services to residents in an assisted living
503 facility for which the home health agency does not receive fair
504 market value remuneration; or
505 (l) Providing staffing to an assisted living facility for
506 which the home health agency does not receive fair market value
507 remuneration.
508 (11) The agency may not issue an initial or change of
509 ownership license to a home health agency under part III of
510 chapter 400 or this part for the purpose of opening a new home
511 health agency until July 1, 2010, in any county that has at
512 least one actively licensed home health agency and a population
513 of persons 65 years of age or older, as indicated in the most
514 recent population estimates published by the Executive Office of
515 the Governor, of fewer than 1,200 per home health agency. In
516 such counties, for any application received by the agency prior
517 to July 1, 2009, which has been deemed by the agency to be
518 complete except for proof of accreditation, the agency may issue
519 an initial or a change of ownership license only if the
520 applicant has applied for accreditation before May 1, 2009, from
521 an accrediting organization that is recognized by the agency.
522 Section 5. Subsection (6) of section 400.474, Florida
523 Statutes, is amended to read:
524 400.474 Administrative penalties.—
525 (6) The agency may deny, revoke, or suspend the license of
526 a home health agency and shall impose a fine of $5,000 against a
527 home health agency that:
528 (a) Gives remuneration for staffing services to:
529 1. Another home health agency with which it has formal or
530 informal patient-referral transactions or arrangements; or
531 2. A health services pool with which it has formal or
532 informal patient-referral transactions or arrangements,
533
534 unless the home health agency has activated its comprehensive
535 emergency management plan in accordance with s. 400.492. This
536 paragraph does not apply to a Medicare-certified home health
537 agency that provides fair market value remuneration for staffing
538 services to a non-Medicare-certified home health agency that is
539 part of a continuing care facility licensed under chapter 651
540 for providing services to its own residents if each resident
541 receiving home health services pursuant to this arrangement
542 attests in writing that he or she made a decision without
543 influence from staff of the facility to select, from a list of
544 Medicare-certified home health agencies provided by the
545 facility, that Medicare-certified home health agency to provide
546 the services.
547 (b) Provides services to residents in an assisted living
548 facility for which the home health agency does not receive fair
549 market value remuneration.
550 (c) Provides staffing to an assisted living facility for
551 which the home health agency does not receive fair market value
552 remuneration.
553 (d) Fails to provide the agency, upon request, with copies
554 of all contracts with assisted living facilities which were
555 executed within 5 years before the request.
556 (e) Gives remuneration to a case manager, discharge
557 planner, facility-based staff member, or third-party vendor who
558 is involved in the discharge planning process of a facility
559 licensed under chapter 395, chapter 429, or this chapter from
560 whom the home health agency receives referrals.
561 (f) Fails to submit to the agency, within 15 days after the
562 end of each calendar quarter, a written report that includes the
563 following data based on data as it existed on the last day of
564 the quarter:
565 1. The number of insulin-dependent diabetic patients
566 receiving insulin-injection services from the home health
567 agency;
568 2. The number of patients receiving both home health
569 services from the home health agency and hospice services;
570 3. The number of patients receiving home health services
571 from that home health agency; and
572 4. The names and license numbers of nurses whose primary
573 job responsibility is to provide home health services to
574 patients and who received remuneration from the home health
575 agency in excess of $25,000 during the calendar quarter.
576 (g) Gives cash, or its equivalent, to a Medicare or
577 Medicaid beneficiary.
578 (h) Has more than one medical director contract in effect
579 at one time or more than one medical director contract and one
580 contract with a physician-specialist whose services are mandated
581 for the home health agency in order to qualify to participate in
582 a federal or state health care program at one time.
583 (i) Gives remuneration to a physician without a medical
584 director contract being in effect. The contract must:
585 1. Be in writing and signed by both parties;
586 2. Provide for remuneration that is at fair market value
587 for an hourly rate, which must be supported by invoices
588 submitted by the medical director describing the work performed,
589 the dates on which that work was performed, and the duration of
590 that work; and
591 3. Be for a term of at least 1 year.
592
593 The hourly rate specified in the contract may not be increased
594 during the term of the contract. The home health agency may not
595 execute a subsequent contract with that physician which has an
596 increased hourly rate and covers any portion of the term that
597 was in the original contract.
598 (j) Gives remuneration to:
599 1. A physician, and the home health agency is in violation
600 of paragraph (h) or paragraph (i);
601 2. A member of the physician’s office staff; or
602 3. An immediate family member of the physician,
603
604 if the home health agency has received a patient referral in the
605 preceding 12 months from that physician or physician’s office
606 staff.
607 (k) Fails to provide to the agency, upon request, copies of
608 all contracts with a medical director which were executed within
609 5 years before the request.
610 (l) Demonstrates a pattern of billing the Medicaid program
611 for services to Medicaid recipients which are medically
612 unnecessary as determined by a final order. A pattern may be
613 demonstrated by a showing of at least two such medically
614 unnecessary services within one Medicaid program integrity audit
615 period.
616
617 Nothing in paragraph (e) or paragraph (j) shall be interpreted
618 as applying to or precluding any discount, compensation, waiver
619 of payment, or payment practice permitted by 52 U.S.C. s. 1320a
620 7(b) or regulations adopted thereunder, including 42 C.F.R. s.
621 1001.952, or 42 U.S.C. s. 1395nn or regulations adopted
622 thereunder.
623 Section 6. Paragraph (a) of subsection (15) of section
624 400.506, Florida Statutes, is amended to read:
625 400.506 Licensure of nurse registries; requirements;
626 penalties.—
627 (15)(a) The agency may deny, suspend, or revoke the license
628 of a nurse registry and shall impose a fine of $5,000 against a
629 nurse registry that:
630 1. Provides services to residents in an assisted living
631 facility for which the nurse registry does not receive fair
632 market value remuneration.
633 2. Provides staffing to an assisted living facility for
634 which the nurse registry does not receive fair market value
635 remuneration.
636 3. Fails to provide the agency, upon request, with copies
637 of all contracts with assisted living facilities which were
638 executed within the last 5 years.
639 4. Gives remuneration to a case manager, discharge planner,
640 facility-based staff member, or third-party vendor who is
641 involved in the discharge planning process of a facility
642 licensed under chapter 395 or this chapter and from whom the
643 nurse registry receives referrals. A nurse registry is exempt
644 from this subparagraph if it does not bill the Florida Medicaid
645 program or the Medicare program or share a controlling interest
646 with any entity licensed, registered, or certified under part II
647 of chapter 408 that bills the Florida Medicaid program or the
648 Medicare program.
649 5. Gives remuneration to a physician, a member of the
650 physician’s office staff, or an immediate family member of the
651 physician, and the nurse registry received a patient referral in
652 the last 12 months from that physician or the physician’s office
653 staff. A nurse registry is exempt from this subparagraph if it
654 does not bill the Florida Medicaid program or the Medicare
655 program or share a controlling interest with any entity
656 licensed, registered, or certified under part II of chapter 408
657 that bills the Florida Medicaid program or the Medicare program.
658 Section 7. Section 408.8065, Florida Statutes, is created
659 to read:
660 408.8065 Additional licensure requirements for home health
661 agencies, home medical equipment providers, and health care
662 clinics.—
663 (1) An applicant for initial licensure, or initial
664 licensure due to a change of ownership, as a home health agency,
665 home medical equipment provider, or health care clinic shall:
666 (a) Demonstrate financial ability to operate, as required
667 under s. 408.810(8) and this section. If the applicant’s assets,
668 credit, and projected revenues meet or exceed projected
669 liabilities and expenses, and the applicant provides independent
670 evidence that the funds necessary for startup costs, working
671 capital, and contingency financing exist and will be available
672 as needed, the applicant has demonstrated the financial ability
673 to operate.
674 (b) Submit pro forma financial statements, including a
675 balance sheet, income and expense statement, and a statement of
676 cash flows for the first 2 years of operation which provide
677 evidence that the applicant has sufficient assets, credit, and
678 projected revenues to cover liabilities and expenses.
679 (c) Submit a statement of the applicant’s estimated startup
680 costs and sources of funds through the break-even point in
681 operations demonstrating that the applicant has the ability to
682 fund all startup costs, working capital, and contingency
683 financing. The statement must show that the applicant has at a
684 minimum 3 months of average projected expenses to cover startup
685 costs, working capital, and contingency financing. The minimum
686 amount for contingency funding may not be less than 1 month of
687 average projected expenses.
688
689 All documents required under this subsection must be prepared in
690 accordance with generally accepted accounting principles and may
691 be in a compilation form. The financial statements must be
692 signed by a certified public accountant.
693 (2) For initial, renewal, or change of ownership licenses
694 for a home health agency, a home medical equipment provider, or
695 a health care clinic, applicants and controlling interests who
696 are nonimmigrant aliens, as described in 8 U.S.C. s. 1101, must
697 file a surety bond of at least $500,000, payable to the agency,
698 which guarantees that the home health agency, home medical
699 equipment provider, or health care clinic will act in full
700 conformity with all legal requirements for operation.
701 (3) In addition to the requirements of s. 408.812, any
702 person who offers services that require licensure under part VII
703 or part X of chapter 400, or who offers skilled services that
704 require licensure under part III of chapter 400, without
705 obtaining a valid license; any person who knowingly files a
706 false or or misleading license or license renewal application or
707 who submits false or misleading information related to such
708 application, and any person who violates or conspires to violate
709 this section, commits a felony of the third degree, punishable
710 as provided in s. 775.082, s. 775.083, or s. 775.084.
711 Section 8. Subsection (3) and paragraph (a) of subsection
712 (5) of section 408.810, Florida Statutes, are amended to read:
713 408.810 Minimum licensure requirements.—In addition to the
714 licensure requirements specified in this part, authorizing
715 statutes, and applicable rules, each applicant and licensee must
716 comply with the requirements of this section in order to obtain
717 and maintain a license.
718 (3) Unless otherwise specified in this part, authorizing
719 statutes, or applicable rules, any information required to be
720 reported to the agency must be submitted within 21 calendar days
721 after the report period or effective date of the information,
722 whichever is earlier, including, but not limited to, any change
723 of:
724 (a) Information contained in the most recent application
725 for licensure.
726 (b) Required insurance or bonds.
727 (5)(a) On or before the first day services are provided to
728 a client, a licensee must inform the client and his or her
729 immediate family or representative, if appropriate, of the right
730 to report:
731 1. Complaints. The statewide toll-free telephone number for
732 reporting complaints to the agency must be provided to clients
733 in a manner that is clearly legible and must include the words:
734 “To report a complaint regarding the services you receive,
735 please call toll-free (phone number).”
736 2. Abusive, neglectful, or exploitative practices. The
737 statewide toll-free telephone number for the central abuse
738 hotline must be provided to clients in a manner that is clearly
739 legible and must include the words: “To report abuse, neglect,
740 or exploitation, please call toll-free (phone number).”
741 3. Medicaid fraud. An agency-written description of
742 Medicaid fraud and the statewide toll-free telephone number for
743 the central Medicaid fraud hotline must be provided to clients
744 in a manner that is clearly legible and must include the words:
745 “To report suspected Medicaid fraud, please call toll-free
746 (phone number).”
747
748 The agency shall publish a minimum of a 90-day advance notice of
749 a change in the toll-free telephone numbers.
750 Section 9. Subsection (4) is added to section 408.815,
751 Florida Statutes, to read:
752 408.815 License or application denial; revocation.—
753 (4) In addition to the grounds provided in authorizing
754 statutes, the agency shall deny an application for a license or
755 license renewal if the applicant or a person having a
756 controlling interest in an applicant has been:
757 (a) Convicted of, or enters a plea of guilty or nolo
758 contendere to, regardless of adjudication, a felony under
759 chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
760 42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent
761 period of probation for such convictions or plea ended more than
762 fifteen years prior to the date of the application;
763 (b) Terminated for cause from the Florida Medicaid program
764 pursuant to s. 409.913, unless the applicant has been in good
765 standing with the Florida Medicaid program for the most recent
766 five years; or
767 (c) Terminated for cause, pursuant to the appeals
768 procedures established by the state or Federal Government, from
769 the federal Medicare program or from any other state Medicaid
770 program, unless the applicant has been in good standing with a
771 state Medicaid program or the federal Medicare program for the
772 most recent five years and the termination occurred at least 20
773 years prior to the date of the application.
774 Section 10. Subsection (4) of section 409.905, Florida
775 Statutes, is amended to read:
776 409.905 Mandatory Medicaid services.—The agency may make
777 payments for the following services, which are required of the
778 state by Title XIX of the Social Security Act, furnished by
779 Medicaid providers to recipients who are determined to be
780 eligible on the dates on which the services were provided. Any
781 service under this section shall be provided only when medically
782 necessary and in accordance with state and federal law.
783 Mandatory services rendered by providers in mobile units to
784 Medicaid recipients may be restricted by the agency. Nothing in
785 this section shall be construed to prevent or limit the agency
786 from adjusting fees, reimbursement rates, lengths of stay,
787 number of visits, number of services, or any other adjustments
788 necessary to comply with the availability of moneys and any
789 limitations or directions provided for in the General
790 Appropriations Act or chapter 216.
791 (4) HOME HEALTH CARE SERVICES.—The agency shall pay for
792 nursing and home health aide services, supplies, appliances, and
793 durable medical equipment, necessary to assist a recipient
794 living at home. An entity that provides services pursuant to
795 this subsection shall be licensed under part III of chapter 400.
796 These services, equipment, and supplies, or reimbursement
797 therefor, may be limited as provided in the General
798 Appropriations Act and do not include services, equipment, or
799 supplies provided to a person residing in a hospital or nursing
800 facility.
801 (a) In providing home health care services, the agency may
802 require prior authorization of care based on diagnosis,
803 utilization rates, or billing rates. The agency shall require
804 prior authorization for visits for home health services that are
805 not associated with a skilled nursing visit when the home health
806 agency billing rates exceed the state average by 50 percent or
807 more. The home health agency must submit the recipient’s plan of
808 care and documentation that supports the recipient’s diagnosis
809 to the agency when requesting prior authorization.
810 (b) The agency shall implement a comprehensive utilization
811 management program that requires prior authorization of all
812 private duty nursing services, an individualized treatment plan
813 that includes information about medication and treatment orders,
814 treatment goals, methods of care to be used, and plans for care
815 coordination by nurses and other health professionals. The
816 utilization management program shall also include a process for
817 periodically reviewing the ongoing use of private duty nursing
818 services. The assessment of need shall be based on a child’s
819 condition, family support and care supplements, a family’s
820 ability to provide care, and a family’s and child’s schedule
821 regarding work, school, sleep, and care for other family
822 dependents. When implemented, the private duty nursing
823 utilization management program shall replace the current
824 authorization program used by the Agency for Health Care
825 Administration and the Children’s Medical Services program of
826 the Department of Health. The agency may competitively bid on a
827 contract to select a qualified organization to provide
828 utilization management of private duty nursing services. The
829 agency is authorized to seek federal waivers to implement this
830 initiative.
831 (c) The agency may not pay for home health services, unless
832 the services are medically necessary, and:
833 1. The services are ordered by a physician.
834 2. The written prescription for the services is signed and
835 dated by the recipient’s physician before the development of a
836 plan of care and before any request requiring prior
837 authorization.
838 3. The physician ordering the services is not employed,
839 under contract with, or otherwise affiliated with the home
840 health agency rendering the services. However, this subparagraph
841 does not apply to a home health agency affiliated with a
842 retirement community, of which the parent corporation or a
843 related legal entity owns a rural health clinic certified under
844 42 C.F.R. part 491, subpart A, ss. 1-11, a nursing home licensed
845 under part II of chapter 400, or an apartment or single-family
846 home for independent living. For purposes of this subparagraph,
847 the agency may, on a case-by-case basis, provide an exception
848 for medically fragile children who are younger than 21 years of
849 age.
850 4. The physician ordering the services has examined the
851 recipient within the 30 days preceding the initial request for
852 the services and biannually thereafter.
853 5. The written prescription for the services includes the
854 recipient’s acute or chronic medical condition or diagnosis, the
855 home health service required, and, for skilled nursing services,
856 the frequency and duration of the services.
857 6. The national provider identifier, Medicaid
858 identification number, or medical practitioner license number of
859 the physician ordering the services is listed on the written
860 prescription for the services, the claim for home health
861 reimbursement, and the prior authorization request.
862 Section 11. Paragraph (a) of subsection (9) of section
863 409.907, Florida Statutes, is amended to read:
864 409.907 Medicaid provider agreements.—The agency may make
865 payments for medical assistance and related services rendered to
866 Medicaid recipients only to an individual or entity who has a
867 provider agreement in effect with the agency, who is performing
868 services or supplying goods in accordance with federal, state,
869 and local law, and who agrees that no person shall, on the
870 grounds of handicap, race, color, or national origin, or for any
871 other reason, be subjected to discrimination under any program
872 or activity for which the provider receives payment from the
873 agency.
874 (9) Upon receipt of a completed, signed, and dated
875 application, and completion of any necessary background
876 investigation and criminal history record check, the agency must
877 either:
878 (a) Enroll the applicant as a Medicaid provider upon
879 approval of the provider application. The enrollment effective
880 date shall be the date the agency receives the provider
881 application. With respect to a provider that requires a Medicare
882 certification survey, the enrollment effective date is the date
883 the certification is awarded. With respect to a provider that
884 completes a change of ownership, the effective date is the date
885 the agency received the application, the date the change of
886 ownership was complete, or the date the applicant became
887 eligible to provide services under Medicaid, whichever date is
888 later. With respect to a provider of emergency medical services
889 transportation or emergency services and care, the effective
890 date is the date the services were rendered. Payment for any
891 claims for services provided to Medicaid recipients between the
892 date of receipt of the application and the date of approval is
893 contingent on applying any and all applicable audits and edits
894 contained in the agency’s claims adjudication and payment
895 processing systems. The agency may enroll a provider located
896 outside the State of Florida if the provider’s location is no
897 more than 50 miles from the Florida state line, or the agency
898 determines a need for that provider type to ensure adequate
899 access to care; or
900 Section 12. Paragraph (e) of subsection (2) of section
901 395.602, Florida Statutes, is amended to read:
902 395.602 Rural hospitals.—
903 (2) DEFINITIONS.—As used in this part:
904 (e) “Rural hospital” means an acute care hospital licensed
905 under this chapter, having 100 or fewer licensed beds and an
906 emergency room, which is:
907 1. The sole provider within a county with a population
908 density of no greater than 100 persons per square mile;
909 2. An acute care hospital, in a county with a population
910 density of no greater than 100 persons per square mile, which is
911 at least 30 minutes of travel time, on normally traveled roads
912 under normal traffic conditions, from any other acute care
913 hospital within the same county;
914 3. A hospital supported by a tax district or subdistrict
915 whose boundaries encompass a population of 100 persons or fewer
916 per square mile;
917 4. A hospital in a constitutional charter county with a
918 population of over 1 million persons that has imposed a local
919 option health service tax pursuant to law and in an area that
920 was directly impacted by a catastrophic event on August 24,
921 1992, for which the Governor of Florida declared a state of
922 emergency pursuant to chapter 125, and has 120 beds or less that
923 serves an agricultural community with an emergency room
924 utilization of no less than 20,000 visits and a Medicaid
925 inpatient utilization rate greater than 15 percent;
926 5. A hospital with a service area that has a population of
927 100 persons or fewer per square mile. As used in this
928 subparagraph, the term “service area” means the fewest number of
929 zip codes that account for 75 percent of the hospital’s
930 discharges for the most recent 5-year period, based on
931 information available from the hospital inpatient discharge
932 database in the Florida Center for Health Information and Policy
933 Analysis at the Agency for Health Care Administration; or
934 6. A hospital designated as a critical access hospital, as
935 defined in s. 408.07(15).
936
937 Population densities used in this paragraph must be based upon
938 the most recently completed United States census. A hospital
939 that received funds under s. 409.9116 for a quarter beginning no
940 later than July 1, 2002, is deemed to have been and shall
941 continue to be a rural hospital from that date through June 30,
942 2015 2012, if the hospital continues to have 100 or fewer
943 licensed beds and an emergency room, or meets the criteria of
944 subparagraph 4. An acute care hospital that has not previously
945 been designated as a rural hospital and that meets the criteria
946 of this paragraph shall be granted such designation upon
947 application, including supporting documentation to the Agency
948 for Health Care Administration.
949 Section 13. Paragraph (a) of subsection (2) of section
950 408.040, Florida Statutes, is amended to read:
951 408.040 Conditions and monitoring.—
952 (2)(a) Unless the applicant has commenced construction, if
953 the project provides for construction, unless the applicant has
954 incurred an enforceable capital expenditure commitment for a
955 project, if the project does not provide for construction, or
956 unless subject to paragraph (b), a certificate of need shall
957 terminate 18 months after the date of issuance, except a
958 certificate of need of an entity which was issued on or before
959 April 1, 2009, shall terminate 36 months after the date of
960 issuance. The agency shall monitor the progress of the holder of
961 the certificate of need in meeting the timetable for project
962 development specified in the application, and may revoke the
963 certificate of need, if the holder of the certificate is not
964 meeting such timetable and is not making a good-faith effort, as
965 defined by rule, to meet it.
966 Section 14. Subsection (43) of section 408.07, Florida
967 Statutes, is amended to read:
968 408.07 Definitions.—As used in this chapter, with the
969 exception of ss. 408.031-408.045, the term:
970 (43) “Rural hospital” means an acute care hospital licensed
971 under chapter 395, having 100 or fewer licensed beds and an
972 emergency room, and which is:
973 (a) The sole provider within a county with a population
974 density of no greater than 100 persons per square mile;
975 (b) An acute care hospital, in a county with a population
976 density of no greater than 100 persons per square mile, which is
977 at least 30 minutes of travel time, on normally traveled roads
978 under normal traffic conditions, from another acute care
979 hospital within the same county;
980 (c) A hospital supported by a tax district or subdistrict
981 whose boundaries encompass a population of 100 persons or fewer
982 per square mile;
983 (d) A hospital with a service area that has a population of
984 100 persons or fewer per square mile. As used in this paragraph,
985 the term “service area” means the fewest number of zip codes
986 that account for 75 percent of the hospital’s discharges for the
987 most recent 5-year period, based on information available from
988 the hospital inpatient discharge database in the Florida Center
989 for Health Information and Policy Analysis at the Agency for
990 Health Care Administration; or
991 (e) A critical access hospital.
992
993 Population densities used in this subsection must be based upon
994 the most recently completed United States census. A hospital
995 that received funds under s. 409.9116 for a quarter beginning no
996 later than July 1, 2002, is deemed to have been and shall
997 continue to be a rural hospital from that date through June 30,
998 2015 2012, if the hospital continues to have 100 or fewer
999 licensed beds and an emergency room, or meets the criteria of s.
1000 395.602(2)(e)4. An acute care hospital that has not previously
1001 been designated as a rural hospital and that meets the criteria
1002 of this subsection shall be granted such designation upon
1003 application, including supporting documentation, to the Agency
1004 for Health Care Administration.
1005 Section 15. Paragraph (b) of subsection (4), subsection
1006 (14), and subsection (17) of section 409.912, Florida Statutes,
1007 are amended to read:
1008 409.912 Cost-effective purchasing of health care.—The
1009 agency shall purchase goods and services for Medicaid recipients
1010 in the most cost-effective manner consistent with the delivery
1011 of quality medical care. To ensure that medical services are
1012 effectively utilized, the agency may, in any case, require a
1013 confirmation or second physician’s opinion of the correct
1014 diagnosis for purposes of authorizing future services under the
1015 Medicaid program. This section does not restrict access to
1016 emergency services or poststabilization care services as defined
1017 in 42 C.F.R. part 438.114. Such confirmation or second opinion
1018 shall be rendered in a manner approved by the agency. The agency
1019 shall maximize the use of prepaid per capita and prepaid
1020 aggregate fixed-sum basis services when appropriate and other
1021 alternative service delivery and reimbursement methodologies,
1022 including competitive bidding pursuant to s. 287.057, designed
1023 to facilitate the cost-effective purchase of a case-managed
1024 continuum of care. The agency shall also require providers to
1025 minimize the exposure of recipients to the need for acute
1026 inpatient, custodial, and other institutional care and the
1027 inappropriate or unnecessary use of high-cost services. The
1028 agency shall contract with a vendor to monitor and evaluate the
1029 clinical practice patterns of providers in order to identify
1030 trends that are outside the normal practice patterns of a
1031 provider’s professional peers or the national guidelines of a
1032 provider’s professional association. The vendor must be able to
1033 provide information and counseling to a provider whose practice
1034 patterns are outside the norms, in consultation with the agency,
1035 to improve patient care and reduce inappropriate utilization.
1036 The agency may mandate prior authorization, drug therapy
1037 management, or disease management participation for certain
1038 populations of Medicaid beneficiaries, certain drug classes, or
1039 particular drugs to prevent fraud, abuse, overuse, and possible
1040 dangerous drug interactions. The Pharmaceutical and Therapeutics
1041 Committee shall make recommendations to the agency on drugs for
1042 which prior authorization is required. The agency shall inform
1043 the Pharmaceutical and Therapeutics Committee of its decisions
1044 regarding drugs subject to prior authorization. The agency is
1045 authorized to limit the entities it contracts with or enrolls as
1046 Medicaid providers by developing a provider network through
1047 provider credentialing. The agency may competitively bid single
1048 source-provider contracts if procurement of goods or services
1049 results in demonstrated cost savings to the state without
1050 limiting access to care. The agency may limit its network based
1051 on the assessment of beneficiary access to care, provider
1052 availability, provider quality standards, time and distance
1053 standards for access to care, the cultural competence of the
1054 provider network, demographic characteristics of Medicaid
1055 beneficiaries, practice and provider-to-beneficiary standards,
1056 appointment wait times, beneficiary use of services, provider
1057 turnover, provider profiling, provider licensure history,
1058 previous program integrity investigations and findings, peer
1059 review, provider Medicaid policy and billing compliance records,
1060 clinical and medical record audits, and other factors. Providers
1061 shall not be entitled to enrollment in the Medicaid provider
1062 network. The agency shall determine instances in which allowing
1063 Medicaid beneficiaries to purchase durable medical equipment and
1064 other goods is less expensive to the Medicaid program than long
1065 term rental of the equipment or goods. The agency may establish
1066 rules to facilitate purchases in lieu of long-term rentals in
1067 order to protect against fraud and abuse in the Medicaid program
1068 as defined in s. 409.913. The agency may seek federal waivers
1069 necessary to administer these policies.
1070 (4) The agency may contract with:
1071 (b) An entity that is providing comprehensive behavioral
1072 health care services to certain Medicaid recipients through a
1073 capitated, prepaid arrangement pursuant to the federal waiver
1074 provided for by s. 409.905(5). Such an entity must be licensed
1075 under chapter 624, chapter 636, or chapter 641, or authorized
1076 under paragraph (c), and must possess the clinical systems and
1077 operational competence to manage risk and provide comprehensive
1078 behavioral health care to Medicaid recipients. As used in this
1079 paragraph, the term “comprehensive behavioral health care
1080 services” means covered mental health and substance abuse
1081 treatment services that are available to Medicaid recipients.
1082 The secretary of the Department of Children and Family Services
1083 shall approve provisions of procurements related to children in
1084 the department’s care or custody before prior to enrolling such
1085 children in a prepaid behavioral health plan. Any contract
1086 awarded under this paragraph must be competitively procured. In
1087 developing the behavioral health care prepaid plan procurement
1088 document, the agency shall ensure that the procurement document
1089 requires the contractor to develop and implement a plan to
1090 ensure compliance with s. 394.4574 related to services provided
1091 to residents of licensed assisted living facilities that hold a
1092 limited mental health license. Except as provided in
1093 subparagraph 8., and except in counties where the Medicaid
1094 managed care pilot program is authorized pursuant to s.
1095 409.91211, the agency shall seek federal approval to contract
1096 with a single entity meeting these requirements to provide
1097 comprehensive behavioral health care services to all Medicaid
1098 recipients not enrolled in a Medicaid managed care plan
1099 authorized under s. 409.91211 or a Medicaid health maintenance
1100 organization in an AHCA area. In an AHCA area where the Medicaid
1101 managed care pilot program is authorized pursuant to s.
1102 409.91211 in one or more counties, the agency may procure a
1103 contract with a single entity to serve the remaining counties as
1104 an AHCA area or the remaining counties may be included with an
1105 adjacent AHCA area and are shall be subject to this paragraph.
1106 Each entity must offer a sufficient choice of providers in its
1107 network to ensure recipient access to care and the opportunity
1108 to select a provider with whom they are satisfied. The network
1109 shall include all public mental health hospitals. To ensure
1110 unimpaired access to behavioral health care services by Medicaid
1111 recipients, all contracts issued pursuant to this paragraph must
1112 shall require 80 percent of the capitation paid to the managed
1113 care plan, including health maintenance organizations, to be
1114 expended for the provision of behavioral health care services.
1115 If In the event the managed care plan expends less than 80
1116 percent of the capitation paid pursuant to this paragraph for
1117 the provision of behavioral health care services, the difference
1118 shall be returned to the agency. The agency shall provide the
1119 managed care plan with a certification letter indicating the
1120 amount of capitation paid during each calendar year for the
1121 provision of behavioral health care services pursuant to this
1122 section. The agency may reimburse for substance abuse treatment
1123 services on a fee-for-service basis until the agency finds that
1124 adequate funds are available for capitated, prepaid
1125 arrangements.
1126 1. By January 1, 2001, the agency shall modify the
1127 contracts with the entities providing comprehensive inpatient
1128 and outpatient mental health care services to Medicaid
1129 recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
1130 Counties, to include substance abuse treatment services.
1131 2. By July 1, 2003, the agency and the Department of
1132 Children and Family Services shall execute a written agreement
1133 that requires collaboration and joint development of all policy,
1134 budgets, procurement documents, contracts, and monitoring plans
1135 that have an impact on the state and Medicaid community mental
1136 health and targeted case management programs.
1137 3. Except as provided in subparagraph 8., by July 1, 2006,
1138 the agency and the Department of Children and Family Services
1139 shall contract with managed care entities in each AHCA area
1140 except area 6 or arrange to provide comprehensive inpatient and
1141 outpatient mental health and substance abuse services through
1142 capitated prepaid arrangements to all Medicaid recipients who
1143 are eligible to participate in such plans under federal law and
1144 regulation. In AHCA areas where eligible individuals number less
1145 than 150,000, the agency shall contract with a single managed
1146 care plan to provide comprehensive behavioral health services to
1147 all recipients who are not enrolled in a Medicaid health
1148 maintenance organization or a Medicaid capitated managed care
1149 plan authorized under s. 409.91211. The agency may contract with
1150 more than one comprehensive behavioral health provider to
1151 provide care to recipients who are not enrolled in a Medicaid
1152 capitated managed care plan authorized under s. 409.91211 or a
1153 Medicaid health maintenance organization in AHCA areas where the
1154 eligible population exceeds 150,000. In an AHCA area where the
1155 Medicaid managed care pilot program is authorized pursuant to s.
1156 409.91211 in one or more counties, the agency may procure a
1157 contract with a single entity to serve the remaining counties as
1158 an AHCA area or the remaining counties may be included with an
1159 adjacent AHCA area and shall be subject to this paragraph.
1160 Contracts for comprehensive behavioral health providers awarded
1161 pursuant to this section shall be competitively procured. Both
1162 for-profit and not-for-profit corporations are shall be eligible
1163 to compete. Managed care plans contracting with the agency under
1164 subsection (3) shall provide and receive payment for the same
1165 comprehensive behavioral health benefits as provided in AHCA
1166 rules, including handbooks incorporated by reference. In AHCA
1167 area 11, the agency shall contract with at least two
1168 comprehensive behavioral health care providers to provide
1169 behavioral health care to recipients in that area who are
1170 enrolled in, or assigned to, the MediPass program. One of the
1171 behavioral health care contracts must shall be with the existing
1172 provider service network pilot project, as described in
1173 paragraph (d), for the purpose of demonstrating the cost
1174 effectiveness of the provision of quality mental health services
1175 through a public hospital-operated managed care model. Payment
1176 shall be at an agreed-upon capitated rate to ensure cost
1177 savings. Of the recipients in area 11 who are assigned to
1178 MediPass under the provisions of s. 409.9122(2)(k), a minimum of
1179 50,000 of those MediPass-enrolled recipients shall be assigned
1180 to the existing provider service network in area 11 for their
1181 behavioral care.
1182 4. By October 1, 2003, the agency and the department shall
1183 submit a plan to the Governor, the President of the Senate, and
1184 the Speaker of the House of Representatives which provides for
1185 the full implementation of capitated prepaid behavioral health
1186 care in all areas of the state.
1187 a. Implementation shall begin in 2003 in those AHCA areas
1188 of the state where the agency is able to establish sufficient
1189 capitation rates.
1190 b. If the agency determines that the proposed capitation
1191 rate in any area is insufficient to provide appropriate
1192 services, the agency may adjust the capitation rate to ensure
1193 that care will be available. The agency and the department may
1194 use existing general revenue to address any additional required
1195 match but may not over-obligate existing funds on an annualized
1196 basis.
1197 c. Subject to any limitations provided for in the General
1198 Appropriations Act, the agency, in compliance with appropriate
1199 federal authorization, shall develop policies and procedures
1200 that allow for certification of local and state funds.
1201 5. Children residing in a statewide inpatient psychiatric
1202 program, or in a Department of Juvenile Justice or a Department
1203 of Children and Family Services residential program approved as
1204 a Medicaid behavioral health overlay services provider may shall
1205 not be included in a behavioral health care prepaid health plan
1206 or any other Medicaid managed care plan pursuant to this
1207 paragraph.
1208 6. In converting to a prepaid system of delivery, the
1209 agency shall in its procurement document require an entity
1210 providing only comprehensive behavioral health care services to
1211 prevent the displacement of indigent care patients by enrollees
1212 in the Medicaid prepaid health plan providing behavioral health
1213 care services from facilities receiving state funding to provide
1214 indigent behavioral health care, to facilities licensed under
1215 chapter 395 which do not receive state funding for indigent
1216 behavioral health care, or reimburse the unsubsidized facility
1217 for the cost of behavioral health care provided to the displaced
1218 indigent care patient.
1219 7. Traditional community mental health providers under
1220 contract with the Department of Children and Family Services
1221 pursuant to part IV of chapter 394, child welfare providers
1222 under contract with the Department of Children and Family
1223 Services in areas 1 and 6, and inpatient mental health providers
1224 licensed pursuant to chapter 395 must be offered an opportunity
1225 to accept or decline a contract to participate in any provider
1226 network for prepaid behavioral health services.
1227 8. All Medicaid-eligible children, except children in area
1228 1 and children in Highlands County, Hardee County, Polk County,
1229 or Manatee County of area 6, that who are open for child welfare
1230 services in the HomeSafeNet system, shall receive their
1231 behavioral health care services through a specialty prepaid plan
1232 operated by community-based lead agencies either through a
1233 single agency or formal agreements among several agencies. The
1234 specialty prepaid plan must result in savings to the state
1235 comparable to savings achieved in other Medicaid managed care
1236 and prepaid programs. Such plan must provide mechanisms to
1237 maximize state and local revenues. The specialty prepaid plan
1238 shall be developed by the agency and the Department of Children
1239 and Family Services. The agency may is authorized to seek any
1240 federal waivers to implement this initiative. Medicaid-eligible
1241 children whose cases are open for child welfare services in the
1242 HomeSafeNet system and who reside in AHCA area 10 are exempt
1243 from the specialty prepaid plan upon the development of a
1244 service delivery mechanism for children who reside in area 10 as
1245 specified in s. 409.91211(3)(dd).
1246 (14)(a) The agency shall operate or contract for the
1247 operation of utilization management and incentive systems
1248 designed to encourage cost-effective use of services and to
1249 eliminate services that are medically unnecessary. The agency
1250 shall track Medicaid provider prescription and billing patterns
1251 and evaluate them against Medicaid medical necessity criteria
1252 and coverage and limitation guidelines adopted by rule. Medical
1253 necessity determination requires that service be consistent with
1254 symptoms or confirmed diagnosis of illness or injury under
1255 treatment and not in excess of the patient’s needs. The agency
1256 shall conduct reviews of provider exceptions to peer group norms
1257 and shall, using statistical methodologies, provider profiling,
1258 and analysis of billing patterns, detect and investigate
1259 abnormal or unusual increases in billing or payment of claims
1260 for Medicaid services and medically unnecessary provision of
1261 services. Providers that demonstrate a pattern of submitting
1262 claims for medically unnecessary services shall be referred to
1263 the Medicaid program integrity unit for investigation. In its
1264 annual report, required in s. 409.913, the agency shall report
1265 on its efforts to control overutilization as described in this
1266 paragraph.
1267 (b) The agency shall develop a procedure for determining
1268 whether health care providers and service vendors can provide
1269 the Medicaid program using a business case that demonstrates
1270 whether a particular good or service can offset the cost of
1271 providing the good or service in an alternative setting or
1272 through other means and therefore should receive a higher
1273 reimbursement. The business case must include, but need not be
1274 limited to:
1275 1. A detailed description of the good or service to be
1276 provided, a description and analysis of the agency’s current
1277 performance of the service, and a rationale documenting how
1278 providing the service in an alternative setting would be in the
1279 best interest of the state, the agency, and its clients.
1280 2. A cost-benefit analysis documenting the estimated
1281 specific direct and indirect costs, savings, performance
1282 improvements, risks, and qualitative and quantitative benefits
1283 involved in or resulting from providing the service. The cost
1284 benefit analysis must include a detailed plan and timeline
1285 identifying all actions that must be implemented to realize
1286 expected benefits. The Secretary of Health Care Administration
1287 shall verify that all costs, savings, and benefits are valid and
1288 achievable.
1289 (c) If the agency determines that the increased
1290 reimbursement is cost-effective, the agency shall recommend a
1291 change in the reimbursement schedule for that particular good or
1292 service. If, within 12 months after implementing any rate change
1293 under this procedure, the agency determines that costs were not
1294 offset by the increased reimbursement schedule, the agency may
1295 revert to the former reimbursement schedule for the particular
1296 good or service.
1297 (17) An entity contracting on a prepaid or fixed-sum basis
1298 shall meet the, in addition to meeting any applicable statutory
1299 surplus requirements of s. 641.225, also maintain at all times
1300 in the form of cash, investments that mature in less than 180
1301 days allowable as admitted assets by the Office of Insurance
1302 Regulation, and restricted funds or deposits controlled by the
1303 agency or the Office of Insurance Regulation, a surplus amount
1304 equal to one-and-one-half times the entity’s monthly Medicaid
1305 prepaid revenues. As used in this subsection, the term “surplus”
1306 means the entity’s total assets minus total liabilities. If an
1307 entity’s surplus falls below an amount equal to the surplus
1308 requirements of s. 641.225 one-and-one-half times the entity’s
1309 monthly Medicaid prepaid revenues, the agency shall prohibit the
1310 entity from engaging in marketing and preenrollment activities,
1311 shall cease to process new enrollments, and may shall not renew
1312 the entity’s contract until the required balance is achieved.
1313 The requirements of this subsection do not apply:
1314 (a) Where a public entity agrees to fund any deficit
1315 incurred by the contracting entity; or
1316 (b) Where the entity’s performance and obligations are
1317 guaranteed in writing by a guaranteeing organization which:
1318 1. Has been in operation for at least 5 years and has
1319 assets in excess of $50 million; or
1320 2. Submits a written guarantee acceptable to the agency
1321 which is irrevocable during the term of the contracting entity’s
1322 contract with the agency and, upon termination of the contract,
1323 until the agency receives proof of satisfaction of all
1324 outstanding obligations incurred under the contract.
1325 Section 16. Section 409.91207, Florida Statutes, is created
1326 to read:
1327 409.91207 Medical Home Pilot Project.—
1328 (1) The agency shall develop a plan to implement a medical
1329 home pilot project that utilizes primary care case management
1330 enhanced by medical home networks to provide coordinated and
1331 cost-effective care that is reimbursed on a fee-for-service
1332 basis and to compare the performance of the medical home
1333 networks with other existing Medicaid managed care models. The
1334 agency is authorized to seek a federal Medicaid waiver or an
1335 amendment to any existing Medicaid waiver, except for the
1336 current 1115 Medicaid waiver authorized in s. 409.91211, as
1337 needed, to develop the pilot project created in this section but
1338 must obtain approval of the Legislature prior to implementing
1339 the pilot project.
1340 (2) Each medical home network shall:
1341 (a) Provide Medicaid recipients primary care, coordinated
1342 services to control chronic illness, pharmacy services,
1343 specialty physician services, and hospital outpatient and
1344 inpatient services.
1345 (b) Coordinate with other health care providers, as
1346 necessary, to ensure that Medicaid recipients receive efficient
1347 and effective access to other needed medical services,
1348 consistent with the scope of services provided to Medipass
1349 recipients.
1350 (c) Consist of primary care physicians, federally qualified
1351 health centers, clinics affiliated with Florida medical schools
1352 or teaching hospitals, programs serving children with special
1353 health care needs, medical school faculty, statutory teaching
1354 hospitals, and other hospitals that agree to participate in the
1355 network. A managed care organization is eligible to be
1356 designated as a medical home network if it documents policies
1357 and procedures consistent with subsection (3).
1358 (3) The medical home pilot project developed by the agency
1359 must be designed to modify the processes and patterns of health
1360 care service delivery in the Medicaid program by requiring a
1361 medical home network to:
1362 (a) Assign a personal medical provider to lead an
1363 interdisciplinary team of professionals who share the
1364 responsibility for ongoing care to a specific panel of patients.
1365 (b) Require the personal medical provider to identify the
1366 patient’s health care needs and respond to those needs either
1367 directly or through arrangements with other qualified providers.
1368 (c) Coordinate or integrate care across all parts of the
1369 health care delivery system.
1370 (d) Integrate information technology into the health care
1371 delivery system to enhance clinical performance and monitor
1372 patient outcomes.
1373 (4) The agency shall have the following duties, and
1374 responsibilities with respect to the development of the medical
1375 home pilot project:
1376 (a) To develop and recommend a medical home pilot project
1377 in at least two geographic regions in the state that will
1378 facilitate access to specialty services in the state’s medical
1379 schools and teaching hospitals.
1380 (b) To develop and recommend funding strategies that
1381 maximize available state and federal funds, including:
1382 1. Enhanced primary care case management fees to
1383 participating federally qualified health centers and primary
1384 care clinics owned or operated by a medical school or teaching
1385 hospital.
1386 2. Enhanced payments to participating medical schools
1387 through the supplemental physician payment program using
1388 certified funds.
1389 3. Reimbursement for facility costs, in addition to medical
1390 services, for participating outpatient primary or specialty
1391 clinics.
1392 4. Supplemental Medicaid payments through the low-income
1393 pool and exempt fee-for-service rates for participating
1394 hospitals.
1395 5. Enhanced capitation rates for managed care organizations
1396 designated as medical home networks to reflect enhanced fee-for
1397 service payments to medical home network providers.
1398 (c) To develop and recommend criteria to designate medical
1399 home networks as eligible to participate in the pilot program
1400 and recommend incentives for medical home networks to
1401 participate in the medical home pilot project, including bonus
1402 payments and shared saving arrangements.
1403 (d) To develop a comprehensive fiscal estimate of the
1404 medical home pilot project that includes, but is not limited to,
1405 anticipated savings to the Medicaid program and any anticipated
1406 administrative costs.
1407 (e) To develop and recommend which medical services the
1408 medical home network would be responsible for providing to
1409 enrolled Medicaid recipients.
1410 (f) To develop and recommend methodologies to measure the
1411 performance of the medical home pilot project including patient
1412 outcomes, cost-effectiveness, provider participation, recipient
1413 satisfaction, and accountability to ensure the quality of the
1414 medical care provided to Medicaid recipients enrolled in the
1415 pilot.
1416 (g) To recommend policies and procedures for the medical
1417 home pilot project administration including, but not limited to:
1418 an implementation timeline, the Medicaid recipient enrollment
1419 process, recruitment and enrollment of Medicaid providers, and
1420 the reimbursement methodologies for participating Medicaid
1421 providers.
1422 (h) To determine and recommend methods to evaluate the
1423 medical home pilot project including but not limited to the
1424 comparison of the Medicaid fee-for service system, Medipass
1425 system, and other Medicaid managed care programs.
1426 (i) To develop and recommend standards and designation
1427 requirements for a medical home network that include, but are
1428 not limited to: medical care provided by the network, referral
1429 arrangements, medical record requirements, health information
1430 technology standards, follow-up care processes, and data
1431 collection requirements.
1432 (5) The Secretary of Health Care Administration shall
1433 appoint a task force by August 1, 2009, to assist the agency in
1434 the development and implementation of the medical home pilot
1435 project. The task force must include, but is not limited to,
1436 representatives of providers who could potentially participate
1437 in a medical home network, Medicaid recipients, and existing
1438 Medipass and managed care providers. Members of the task force
1439 shall serve without compensation but are entitled to
1440 reimbursement for per diem and travel expenses as provided in s.
1441 112.061.
1442 (6) The agency shall submit an implementation plan for the
1443 medical home pilot project authorized in this section to the
1444 Speaker of the House of Representatives, the President of the
1445 Senate, and the Governor by February 1, 2010. The implementation
1446 plan must include any approved waivers, waiver applications, or
1447 state plan amendments necessary to implement the medical home
1448 pilot project.
1449 (a) The agency shall post any waiver applications, or
1450 waiver amendments, authorized under this section on its Internet
1451 website 15 days before submitting the applications to the United
1452 States Centers for Medicare and Medicaid Services.
1453 (b) The implementation of the medical home pilot project,
1454 including any Medicaid waivers authorized in this section, is
1455 contingent upon review and approval by the Legislature.
1456 (c) Upon legislative approval to implement the medical home
1457 pilot project, the agency may initiate the adoption of
1458 administrative rules to implement and administer the medical
1459 home pilot project created in this section.
1460 Section 17. Subsections (2), (7), (11), (13), (14), (15),
1461 (24), (25), (27), (30), (31), and (36) of section 409.913,
1462 Florida Statutes, are amended, and subsections (37) and (38) are
1463 added to that section, to read:
1464 409.913 Oversight of the integrity of the Medicaid
1465 program.—The agency shall operate a program to oversee the
1466 activities of Florida Medicaid recipients, and providers and
1467 their representatives, to ensure that fraudulent and abusive
1468 behavior and neglect of recipients occur to the minimum extent
1469 possible, and to recover overpayments and impose sanctions as
1470 appropriate. Beginning January 1, 2003, and each year
1471 thereafter, the agency and the Medicaid Fraud Control Unit of
1472 the Department of Legal Affairs shall submit a joint report to
1473 the Legislature documenting the effectiveness of the state’s
1474 efforts to control Medicaid fraud and abuse and to recover
1475 Medicaid overpayments during the previous fiscal year. The
1476 report must describe the number of cases opened and investigated
1477 each year; the sources of the cases opened; the disposition of
1478 the cases closed each year; the amount of overpayments alleged
1479 in preliminary and final audit letters; the number and amount of
1480 fines or penalties imposed; any reductions in overpayment
1481 amounts negotiated in settlement agreements or by other means;
1482 the amount of final agency determinations of overpayments; the
1483 amount deducted from federal claiming as a result of
1484 overpayments; the amount of overpayments recovered each year;
1485 the amount of cost of investigation recovered each year; the
1486 average length of time to collect from the time the case was
1487 opened until the overpayment is paid in full; the amount
1488 determined as uncollectible and the portion of the uncollectible
1489 amount subsequently reclaimed from the Federal Government; the
1490 number of providers, by type, that are terminated from
1491 participation in the Medicaid program as a result of fraud and
1492 abuse; and all costs associated with discovering and prosecuting
1493 cases of Medicaid overpayments and making recoveries in such
1494 cases. The report must also document actions taken to prevent
1495 overpayments and the number of providers prevented from
1496 enrolling in or reenrolling in the Medicaid program as a result
1497 of documented Medicaid fraud and abuse and must include policy
1498 recommendations recommend changes necessary to prevent or
1499 recover overpayments and changes necessary to prevent and detect
1500 Medicaid fraud. All policy recommendations in the report must
1501 include a detailed fiscal analysis, including, but not limited
1502 to, implementation costs, estimated savings to the Medicaid
1503 program, and the return on investment. The agency must submit
1504 the policy recommendations and fiscal analyses in the report to
1505 the appropriate estimating conference, pursuant to s. 216.137,
1506 by February 15 of each year. The agency and the Medicaid Fraud
1507 Control Unit of the Department of Legal Affairs each must
1508 include detailed unit-specific performance standards,
1509 benchmarks, and metrics in the report, including projected cost
1510 savings to the state Medicaid program during the following
1511 fiscal year.
1512 (2) The agency shall conduct, or cause to be conducted by
1513 contract or otherwise, reviews, investigations, analyses,
1514 audits, or any combination thereof, to determine possible fraud,
1515 abuse, overpayment, or recipient neglect in the Medicaid program
1516 and shall report the findings of any overpayments in audit
1517 reports as appropriate. At least 5 percent of all audits shall
1518 be conducted on a random basis. As part of its ongoing fraud
1519 detection activities, the agency shall identify and monitor, by
1520 contract or otherwise, patterns of overutilization of Medicaid
1521 services based on state averages. The agency shall track
1522 Medicaid provider prescription and billing patterns and evaluate
1523 them against Medicaid medical necessity criteria and coverage
1524 and limitation guidelines adopted by rule. Medical necessity
1525 determination requires that service be consistent with symptoms
1526 or confirmed diagnosis of illness or injury under treatment and
1527 not in excess of the patient’s needs. The agency shall conduct
1528 reviews of provider exceptions to peer group norms and shall,
1529 using statistical methodologies, provider profiling, and
1530 analysis of billing patterns, detect and investigate abnormal or
1531 unusual increases in billing or payment of claims for Medicaid
1532 services and medically unnecessary provision of services.
1533 (7) When presenting a claim for payment under the Medicaid
1534 program, a provider has an affirmative duty to supervise the
1535 provision of, and be responsible for, goods and services claimed
1536 to have been provided, to supervise and be responsible for
1537 preparation and submission of the claim, and to present a claim
1538 that is true and accurate and that is for goods and services
1539 that:
1540 (a) Have actually been furnished to the recipient by the
1541 provider prior to submitting the claim.
1542 (b) Are Medicaid-covered goods or services that are
1543 medically necessary.
1544 (c) Are of a quality comparable to those furnished to the
1545 general public by the provider’s peers.
1546 (d) Have not been billed in whole or in part to a recipient
1547 or a recipient’s responsible party, except for such copayments,
1548 coinsurance, or deductibles as are authorized by the agency.
1549 (e) Are provided in accord with applicable provisions of
1550 all Medicaid rules, regulations, handbooks, and policies and in
1551 accordance with federal, state, and local law.
1552 (f) Are documented by records made at the time the goods or
1553 services were provided, demonstrating the medical necessity for
1554 the goods or services rendered. Medicaid goods or services are
1555 excessive or not medically necessary unless both the medical
1556 basis and the specific need for them are fully and properly
1557 documented in the recipient’s medical record.
1558
1559 The agency shall may deny payment or require repayment for goods
1560 or services that are not presented as required in this
1561 subsection.
1562 (11) The agency shall may deny payment or require repayment
1563 for inappropriate, medically unnecessary, or excessive goods or
1564 services from the person furnishing them, the person under whose
1565 supervision they were furnished, or the person causing them to
1566 be furnished.
1567 (13) The agency shall immediately may terminate
1568 participation of a Medicaid provider in the Medicaid program and
1569 may seek civil remedies or impose other administrative sanctions
1570 against a Medicaid provider, if the provider or any principal,
1571 officer, director, agent, managing employee, or affiliated
1572 person of the provider, or any partner or shareholder having an
1573 ownership interest in the provider equal to 5 percent or
1574 greater, has been:
1575 (a) Convicted of a criminal offense related to the delivery
1576 of any health care goods or services, including the performance
1577 of management or administrative functions relating to the
1578 delivery of health care goods or services;
1579 (b) Convicted of a criminal offense under federal law or
1580 the law of any state relating to the practice of the provider’s
1581 profession; or
1582 (c) Found by a court of competent jurisdiction to have
1583 neglected or physically abused a patient in connection with the
1584 delivery of health care goods or services.
1585
1586 If the agency determines a provider did not participate or
1587 acquiesce in an offense specified in paragraph (a), paragraph
1588 (b), or paragraph (c), termination will not be imposed. If the
1589 agency effects a termination under this subsection, the agency
1590 shall issue an immediate final order pursuant to s.
1591 120.569(2)(n).
1592 (14) If the provider has been suspended or terminated from
1593 participation in the Medicaid program or the Medicare program by
1594 the Federal Government or any state, the agency must immediately
1595 suspend or terminate, as appropriate, the provider’s
1596 participation in this state’s the Florida Medicaid program for a
1597 period no less than that imposed by the Federal Government or
1598 any other state, and may not enroll such provider in this
1599 state’s the Florida Medicaid program while such foreign
1600 suspension or termination remains in effect. The agency shall
1601 also immediately suspend or terminate, as appropriate, a
1602 provider’s participation in this state’s Medicaid program if the
1603 provider participated or acquiesced in any action for which any
1604 principal, officer, director, agent, managing employee, or
1605 affiliated person of the provider, or any partner or shareholder
1606 having an ownership interest in the provider equal to 5 percent
1607 or greater, was suspended or terminated from participating in
1608 the Medicaid program or the Medicare program by the Federal
1609 Government or any state. This sanction is in addition to all
1610 other remedies provided by law.
1611 (15) The agency shall may seek a any remedy provided by
1612 law, including, but not limited to, any remedy the remedies
1613 provided in subsections (13) and (16) and s. 812.035, if:
1614 (a) The provider’s license has not been renewed, or has
1615 been revoked, suspended, or terminated, for cause, by the
1616 licensing agency of any state;
1617 (b) The provider has failed to make available or has
1618 refused access to Medicaid-related records to an auditor,
1619 investigator, or other authorized employee or agent of the
1620 agency, the Attorney General, a state attorney, or the Federal
1621 Government;
1622 (c) The provider has not furnished or has failed to make
1623 available such Medicaid-related records as the agency has found
1624 necessary to determine whether Medicaid payments are or were due
1625 and the amounts thereof;
1626 (d) The provider has failed to maintain medical records
1627 made at the time of service, or prior to service if prior
1628 authorization is required, demonstrating the necessity and
1629 appropriateness of the goods or services rendered;
1630 (e) The provider is not in compliance with provisions of
1631 Medicaid provider publications that have been adopted by
1632 reference as rules in the Florida Administrative Code; with
1633 provisions of state or federal laws, rules, or regulations; with
1634 provisions of the provider agreement between the agency and the
1635 provider; or with certifications found on claim forms or on
1636 transmittal forms for electronically submitted claims that are
1637 submitted by the provider or authorized representative, as such
1638 provisions apply to the Medicaid program;
1639 (f) The provider or person who ordered or prescribed the
1640 care, services, or supplies has furnished, or ordered the
1641 furnishing of, goods or services to a recipient which are
1642 inappropriate, unnecessary, excessive, or harmful to the
1643 recipient or are of inferior quality;
1644 (g) The provider has demonstrated a pattern of failure to
1645 provide goods or services that are medically necessary;
1646 (h) The provider or an authorized representative of the
1647 provider, or a person who ordered or prescribed the goods or
1648 services, has submitted or caused to be submitted false or a
1649 pattern of erroneous Medicaid claims;
1650 (i) The provider or an authorized representative of the
1651 provider, or a person who has ordered or prescribed the goods or
1652 services, has submitted or caused to be submitted a Medicaid
1653 provider enrollment application, a request for prior
1654 authorization for Medicaid services, a drug exception request,
1655 or a Medicaid cost report that contains materially false or
1656 incorrect information;
1657 (j) The provider or an authorized representative of the
1658 provider has collected from or billed a recipient or a
1659 recipient’s responsible party improperly for amounts that should
1660 not have been so collected or billed by reason of the provider’s
1661 billing the Medicaid program for the same service;
1662 (k) The provider or an authorized representative of the
1663 provider has included in a cost report costs that are not
1664 allowable under a Florida Title XIX reimbursement plan, after
1665 the provider or authorized representative had been advised in an
1666 audit exit conference or audit report that the costs were not
1667 allowable;
1668 (l) The provider is charged by information or indictment
1669 with fraudulent billing practices. The sanction applied for this
1670 reason is limited to suspension of the provider’s participation
1671 in the Medicaid program for the duration of the indictment
1672 unless the provider is found guilty pursuant to the information
1673 or indictment;
1674 (m) The provider or a person who has ordered, or prescribed
1675 the goods or services is found liable for negligent practice
1676 resulting in death or injury to the provider’s patient;
1677 (n) The provider fails to demonstrate that it had available
1678 during a specific audit or review period sufficient quantities
1679 of goods, or sufficient time in the case of services, to support
1680 the provider’s billings to the Medicaid program;
1681 (o) The provider has failed to comply with the notice and
1682 reporting requirements of s. 409.907;
1683 (p) The agency has received reliable information of patient
1684 abuse or neglect or of any act prohibited by s. 409.920; or
1685 (q) The provider has failed to comply with an agreed-upon
1686 repayment schedule.
1687
1688 A provider is subject to sanctions for violations of this
1689 subsection as the result of actions or inactions of the
1690 provider, or actions or inactions of any principal, officer,
1691 director, agent, managing employee, or affiliated person of the
1692 provider, or any partner or shareholder having an ownership
1693 interest in the provider equal to 5 percent or greater, in which
1694 the provider participated or acquiesced.
1695 (24) If the agency imposes an administrative sanction
1696 pursuant to subsection (13), subsection (14), or subsection
1697 (15), except paragraphs (15)(e) and (o), upon any provider or
1698 any principal, officer, director, agent, managing employee, or
1699 affiliated person of the provider other person who is regulated
1700 by another state entity, the agency shall notify that other
1701 entity of the imposition of the sanction within 5 business days.
1702 Such notification must include the provider’s or person’s name
1703 and license number and the specific reasons for sanction.
1704 (25)(a) The agency shall may withhold Medicaid payments, in
1705 whole or in part, to a provider upon receipt of reliable
1706 evidence that the circumstances giving rise to the need for a
1707 withholding of payments involve fraud, willful
1708 misrepresentation, or abuse under the Medicaid program, or a
1709 crime committed while rendering goods or services to Medicaid
1710 recipients. If it is determined that fraud, willful
1711 misrepresentation, abuse, or a crime did not occur, the payments
1712 withheld must be paid to the provider within 14 days after such
1713 determination with interest at the rate of 10 percent a year.
1714 Any money withheld in accordance with this paragraph shall be
1715 placed in a suspended account, readily accessible to the agency,
1716 so that any payment ultimately due the provider shall be made
1717 within 14 days.
1718 (b) The agency shall may deny payment, or require
1719 repayment, if the goods or services were furnished, supervised,
1720 or caused to be furnished by a person who has been suspended or
1721 terminated from the Medicaid program or Medicare program by the
1722 Federal Government or any state.
1723 (c) Overpayments owed to the agency bear interest at the
1724 rate of 10 percent per year from the date of determination of
1725 the overpayment by the agency, and payment arrangements must be
1726 made at the conclusion of legal proceedings. A provider who does
1727 not enter into or adhere to an agreed-upon repayment schedule
1728 may be terminated by the agency for nonpayment or partial
1729 payment.
1730 (d) The agency, upon entry of a final agency order, a
1731 judgment or order of a court of competent jurisdiction, or a
1732 stipulation or settlement, may collect the moneys owed by all
1733 means allowable by law, including, but not limited to, notifying
1734 any fiscal intermediary of Medicare benefits that the state has
1735 a superior right of payment. Upon receipt of such written
1736 notification, the Medicare fiscal intermediary shall remit to
1737 the state the sum claimed.
1738 (e) The agency may institute amnesty programs to allow
1739 Medicaid providers the opportunity to voluntarily repay
1740 overpayments. The agency may adopt rules to administer such
1741 programs.
1742 (27) When the Agency for Health Care Administration has
1743 made a probable cause determination and alleged that an
1744 overpayment to a Medicaid provider has occurred, the agency,
1745 after notice to the provider, shall may:
1746 (a) Withhold, and continue to withhold during the pendency
1747 of an administrative hearing pursuant to chapter 120, any
1748 medical assistance reimbursement payments until such time as the
1749 overpayment is recovered, unless within 30 days after receiving
1750 notice thereof the provider:
1751 1. Makes repayment in full; or
1752 2. Establishes a repayment plan that is satisfactory to the
1753 Agency for Health Care Administration.
1754 (b) Withhold, and continue to withhold during the pendency
1755 of an administrative hearing pursuant to chapter 120, medical
1756 assistance reimbursement payments if the terms of a repayment
1757 plan are not adhered to by the provider.
1758 (30) The agency shall may terminate a provider’s
1759 participation in the Medicaid program if the provider fails to
1760 reimburse an overpayment that has been determined by final
1761 order, not subject to further appeal, within 35 days after the
1762 date of the final order, unless the provider and the agency have
1763 entered into a repayment agreement.
1764 (31) If a provider requests an administrative hearing
1765 pursuant to chapter 120, such hearing must be conducted within
1766 90 days following assignment of an administrative law judge,
1767 absent exceptionally good cause shown as determined by the
1768 administrative law judge or hearing officer. Upon issuance of a
1769 final order, the outstanding balance of the amount determined to
1770 constitute the overpayment shall become due. If a provider fails
1771 to make payments in full, fails to enter into a satisfactory
1772 repayment plan, or fails to comply with the terms of a repayment
1773 plan or settlement agreement, the agency shall may withhold
1774 medical assistance reimbursement payments until the amount due
1775 is paid in full.
1776 (36) At least three times a year, the agency shall provide
1777 to each Medicaid recipient or his or her representative an
1778 explanation of benefits in the form of a letter that is mailed
1779 to the most recent address of the recipient on the record with
1780 the Department of Children and Family Services. The explanation
1781 of benefits must include the patient’s name, the name of the
1782 health care provider and the address of the location where the
1783 service was provided, a description of all services billed to
1784 Medicaid in terminology that should be understood by a
1785 reasonable person, and information on how to report
1786 inappropriate or incorrect billing to the agency or other law
1787 enforcement entities for review or investigation. At least once
1788 a year, the letter also must include information on how to
1789 report criminal Medicaid fraud, the Medicaid Fraud Control
1790 Unit’s toll-free hotline number, and information about the
1791 rewards available under s. 409.9203. The explanation of benefits
1792 may not be mailed for Medicaid independent laboratory services
1793 as described in s. 409.905(7) or for Medicaid certified match
1794 services as described in ss. 409.9071 and 1011.70.
1795 (37) The agency shall post on its website a current list of
1796 each Medicaid provider, including any principal, officer,
1797 director, agent, managing employee, or affiliated person of the
1798 provider, or any partner or shareholder having an ownership
1799 interest in the provider equal to 5 percent or greater, who has
1800 been terminated for cause from the Medicaid program or
1801 sanctioned under this section. The list must be searchable by a
1802 variety of search parameters and provide for the creation of
1803 formatted lists that may be printed or imported into other
1804 applications, including spreadsheets. The agency shall update
1805 the list at least monthly.
1806 (38) In order to improve the detection of health care
1807 fraud, use technology to prevent and detect fraud, and maximize
1808 the electronic exchange of health care fraud information, the
1809 agency shall:
1810 (a) Compile, maintain, and publish on its website a
1811 detailed list of all state and federal databases that contain
1812 health care fraud information and update the list at least
1813 biannually;
1814 (b) Develop a strategic plan to connect all databases that
1815 contain health care fraud information to facilitate the
1816 electronic exchange of health information between the agency,
1817 the Department of Health, the Department of Law Enforcement, and
1818 the Attorney General’s Office. The plan must include recommended
1819 standard data formats, fraud-identification strategies, and
1820 specifications for the technical interface between state and
1821 federal health care fraud databases;
1822 (c) Monitor innovations in health information technology,
1823 specifically as it pertains to Medicaid fraud prevention and
1824 detection; and
1825 (d) Periodically publish policy briefs that highlight
1826 available new technology to prevent or detect health care fraud
1827 and projects implemented by other states, the private sector, or
1828 the Federal Government which use technology to prevent or detect
1829 health care fraud.
1830 Section 18. Subsections (1) and (2) of section 409.920,
1831 Florida Statutes, are amended, present subsections (8) and (9)
1832 of that section are renumbered as subsections (9) and (10),
1833 respectively, and a new subsection (8) is added to that section,
1834 to read:
1835 409.920 Medicaid provider fraud.—
1836 (1) For the purposes of this section, the term:
1837 (a) “Agency” means the Agency for Health Care
1838 Administration.
1839 (b) “Fiscal agent” means any individual, firm, corporation,
1840 partnership, organization, or other legal entity that has
1841 contracted with the agency to receive, process, and adjudicate
1842 claims under the Medicaid program.
1843 (c) “Item or service” includes:
1844 1. Any particular item, device, medical supply, or service
1845 claimed to have been provided to a recipient and listed in an
1846 itemized claim for payment; or
1847 2. In the case of a claim based on costs, any entry in the
1848 cost report, books of account, or other documents supporting
1849 such claim.
1850 (d) “Knowingly” means that the act was done voluntarily and
1851 intentionally and not because of mistake or accident. As used in
1852 this section, the term “knowingly” also includes the word
1853 “willfully” or “willful” which, as used in this section, means
1854 that an act was committed voluntarily and purposely, with the
1855 specific intent to do something that the law forbids, and that
1856 the act was committed with bad purpose, either to disobey or
1857 disregard the law.
1858 (e) “Managed care plans” means a health insurer authorized
1859 under chapter 624, an exclusive provider organization authorized
1860 under chapter 627, a health maintenance organization authorized
1861 under chapter 641, the Children’s Medical Services Network
1862 authorized under chapter 391, a prepaid health plan authorized
1863 under chapter 409, a provider service network authorized under
1864 chapter 409, a minority physician network authorized under
1865 chapter 409, and an emergency department diversion program
1866 authorized under chapter 409 or the General Appropriations Act,
1867 providing health care services pursuant to a contract with the
1868 Medicaid program.
1869 (2)(a) A person may not It is unlawful to:
1870 1.(a) Knowingly make, cause to be made, or aid and abet in
1871 the making of any false statement or false representation of a
1872 material fact, by commission or omission, in any claim submitted
1873 to the agency or its fiscal agent or a managed care plan for
1874 payment.
1875 2.(b) Knowingly make, cause to be made, or aid and abet in
1876 the making of a claim for items or services that are not
1877 authorized to be reimbursed by the Medicaid program.
1878 3.(c) Knowingly charge, solicit, accept, or receive
1879 anything of value, other than an authorized copayment from a
1880 Medicaid recipient, from any source in addition to the amount
1881 legally payable for an item or service provided to a Medicaid
1882 recipient under the Medicaid program or knowingly fail to credit
1883 the agency or its fiscal agent for any payment received from a
1884 third-party source.
1885 4.(d) Knowingly make or in any way cause to be made any
1886 false statement or false representation of a material fact, by
1887 commission or omission, in any document containing items of
1888 income and expense that is or may be used by the agency to
1889 determine a general or specific rate of payment for an item or
1890 service provided by a provider.
1891 5.(e) Knowingly solicit, offer, pay, or receive any
1892 remuneration, including any kickback, bribe, or rebate, directly
1893 or indirectly, overtly or covertly, in cash or in kind, in
1894 return for referring an individual to a person for the
1895 furnishing or arranging for the furnishing of any item or
1896 service for which payment may be made, in whole or in part,
1897 under the Medicaid program, or in return for obtaining,
1898 purchasing, leasing, ordering, or arranging for or recommending,
1899 obtaining, purchasing, leasing, or ordering any goods, facility,
1900 item, or service, for which payment may be made, in whole or in
1901 part, under the Medicaid program.
1902 6.(f) Knowingly submit false or misleading information or
1903 statements to the Medicaid program for the purpose of being
1904 accepted as a Medicaid provider.
1905 7.(g) Knowingly use or endeavor to use a Medicaid
1906 provider’s identification number or a Medicaid recipient’s
1907 identification number to make, cause to be made, or aid and abet
1908 in the making of a claim for items or services that are not
1909 authorized to be reimbursed by the Medicaid program.
1910 (b)1. A person who violates this subsection and receives or
1911 endeavors to receive anything of value of:
1912 a. Ten thousand dollars or less commits a felony of the
1913 third degree, punishable as provided in s. 775.082, s. 775.083,
1914 or s. 775.084.
1915 b. More than $10,000, but less than $50,000, commits a
1916 felony of the second degree, punishable as provided in s.
1917 775.082, s. 775.083, or s. 775.084.
1918 c. Fifty thousand dollars or more commits a felony of the
1919 first degree, punishable as provided in s. 775.082, s. 775.083,
1920 or s. 775.084.
1921 2. The value of separate funds, goods, or services that a
1922 person received or attempted to receive pursuant to a scheme or
1923 course of conduct may be aggregated in determining the degree of
1924 the offense.
1925 3. In addition to the sentence authorized by law, a person
1926 who is convicted of a violation of this subsection shall pay a
1927 fine in an amount equal to five times the pecuniary gain
1928 unlawfully received or the loss incurred by the Medicaid program
1929 or managed care organization, whichever is greater.
1930 (8) A person who provides the state, any state agency, any
1931 of the state’s political subdivisions, or any agency of the
1932 state’s political subdivisions with information about fraud or
1933 suspected fraud by a Medicaid provider, including a managed care
1934 organization, is immune from civil liability for providing the
1935 information unless the person acted with knowledge that the
1936 information was false or with reckless disregard for the truth
1937 or falsity of the information.
1938 Section 19. Section 409.9203, Florida Statutes, is created
1939 to read:
1940 409.9203 Rewards for reporting Medicaid fraud.—
1941 (1) The Department of Law Enforcement or director of the
1942 Medicaid Fraud Control Unit shall, subject to availability of
1943 funds, pay a reward to a person who furnishes original
1944 information relating to and reports a violation of the state’s
1945 Medicaid fraud laws, unless the person declines the reward, if
1946 the information and report:
1947 (a) Is made to the Office of the Attorney General, the
1948 Agency for Health Care Administration, the Department of Health,
1949 or the Department of Law Enforcement;
1950 (b) Relates to criminal fraud upon Medicaid funds or a
1951 criminal violation of Medicaid laws by another person; and
1952 (c) Leads to a recovery of a fine, penalty, or forfeiture
1953 of property.
1954 (2) The reward may not exceed the lesser of 25 percent of
1955 the amount recovered or $500,000 in a single case.
1956 (3) The reward shall be paid from the Legal Affairs
1957 Revolving Trust Fund from moneys collected pursuant to s.
1958 68.085.
1959 (4) A person who receives a reward pursuant to this section
1960 is not eligible to receive any funds pursuant to the Florida
1961 False Claims Act for Medicaid fraud for which a reward is
1962 received pursuant to this section.
1963 Section 20. Subsection (11) is added to section 456.004,
1964 Florida Statutes, to read:
1965 456.004 Department; powers and duties.—The department, for
1966 the professions under its jurisdiction, shall:
1967 (11) Work cooperatively with the Agency for Health Care
1968 Administration and the judicial system to recover Medicaid
1969 overpayments by the Medicaid program. The department shall
1970 investigate and prosecute health care practitioners who have not
1971 remitted amounts owed to the state for an overpayment from the
1972 Medicaid program pursuant to a final order, judgment, or
1973 stipulation or settlement.
1974 Section 21. Present subsections (6) through (10) of section
1975 456.041, Florida Statutes, are renumbered as subsections (7)
1976 through (11), respectively, and a new subsection (6) is added to
1977 that section, to read:
1978 456.041 Practitioner profile; creation.—
1979 (6) The Department of Health shall provide in each
1980 practitioner profile for every physician or advanced registered
1981 nurse practitioner terminated for cause from participating in
1982 the Medicaid program, pursuant to s. 409.913, or sanctioned by
1983 the Medicaid program a statement that the practitioner has been
1984 terminated from participating in the Florida Medicaid program or
1985 sanctioned by the Medicaid program.
1986 Section 22. Paragraph (o) of subsection (3) of section
1987 456.053, Florida Statutes, is amended to read:
1988 456.053 Financial arrangements between referring health
1989 care providers and providers of health care services.—
1990 (3) DEFINITIONS.—For the purpose of this section, the word,
1991 phrase, or term:
1992 (o) “Referral” means any referral of a patient by a health
1993 care provider for health care services, including, without
1994 limitation:
1995 1. The forwarding of a patient by a health care provider to
1996 another health care provider or to an entity which provides or
1997 supplies designated health services or any other health care
1998 item or service; or
1999 2. The request or establishment of a plan of care by a
2000 health care provider, which includes the provision of designated
2001 health services or other health care item or service.
2002 3. The following orders, recommendations, or plans of care
2003 shall not constitute a referral by a health care provider:
2004 a. By a radiologist for diagnostic-imaging services.
2005 b. By a physician specializing in the provision of
2006 radiation therapy services for such services.
2007 c. By a medical oncologist for drugs and solutions to be
2008 prepared and administered intravenously to such oncologist’s
2009 patient, as well as for the supplies and equipment used in
2010 connection therewith to treat such patient for cancer and the
2011 complications thereof.
2012 d. By a cardiologist for cardiac catheterization services.
2013 e. By a pathologist for diagnostic clinical laboratory
2014 tests and pathological examination services, if furnished by or
2015 under the supervision of such pathologist pursuant to a
2016 consultation requested by another physician.
2017 f. By a health care provider who is the sole provider or
2018 member of a group practice for designated health services or
2019 other health care items or services that are prescribed or
2020 provided solely for such referring health care provider’s or
2021 group practice’s own patients, and that are provided or
2022 performed by or under the direct supervision of such referring
2023 health care provider or group practice; provided, however, that
2024 effective July 1, 1999, a physician licensed pursuant to chapter
2025 458, chapter 459, chapter 460, or chapter 461 may refer a
2026 patient to a sole provider or group practice for diagnostic
2027 imaging services, excluding radiation therapy services, for
2028 which the sole provider or group practice billed both the
2029 technical and the professional fee for or on behalf of the
2030 patient, if the referring physician has no investment interest
2031 in the practice. The diagnostic imaging service referred to a
2032 group practice or sole provider must be a diagnostic imaging
2033 service normally provided within the scope of practice to the
2034 patients of the group practice or sole provider. The group
2035 practice or sole provider may accept no more than 15 percent of
2036 their patients receiving diagnostic imaging services from
2037 outside referrals, excluding radiation therapy services.
2038 g. By a health care provider for services provided by an
2039 ambulatory surgical center licensed under chapter 395.
2040 h. By a urologist for lithotripsy services.
2041 i. By a dentist for dental services performed by an
2042 employee of or health care provider who is an independent
2043 contractor with the dentist or group practice of which the
2044 dentist is a member.
2045 j. By a physician for infusion therapy services to a
2046 patient of that physician or a member of that physician’s group
2047 practice.
2048 k. By a nephrologist for renal dialysis services and
2049 supplies, except laboratory services.
2050 l. By a health care provider whose principal professional
2051 practice consists of treating patients in their private
2052 residences for services to be rendered in such private
2053 residences, except for services rendered by a home health agency
2054 licensed under chapter 400. For purposes of this sub
2055 subparagraph, the term “private residences” includes patient’s
2056 private homes, independent living centers, and assisted living
2057 facilities, but does not include skilled nursing facilities.
2058 m. By a health care provider for sleep related testing.
2059 Section 23. Section 456.0635, Florida Statutes, is created
2060 to read:
2061 456.0635 Medicaid fraud; disqualification for license,
2062 certificate, or registration.—
2063 (1) Medicaid fraud in the practice of a health care
2064 profession is prohibited.
2065 (2) Each board within the jurisdiction of the department,
2066 or the department if there is no board, shall refuse to admit a
2067 candidate to any examination and refuse to issue or renew a
2068 license, certificate, or registration to any applicant if the
2069 candidate or applicant or any principle, officer, agent,
2070 managing employee, or affiliated person of the applicant, has
2071 been:
2072 (a) Convicted of, or entered a plea of guilty or nolo
2073 contendere to, regardless of adjudication, a felony under
2074 chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
2075 42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent
2076 period of probation for such conviction or pleas ended more than
2077 fifteen years prior to the date of the application;
2078 (b) Terminated for cause from the Florida Medicaid program
2079 pursuant to s. 409.913, unless the applicant has been in good
2080 standing with the Florida Medicaid program for the most recent
2081 five years;
2082 (c) Terminated for cause, pursuant to the appeals
2083 procedures established by the state or Federal Government, from
2084 any other state Medicaid program or the federal Medicare
2085 program, unless the applicant has been in good standing with a
2086 state Medicaid program or the federal Medicare program for the
2087 most recent five years and the termination occurred at least 20
2088 years prior to the date of the application.
2089 (3) Licensed health care practitioners shall report
2090 allegations of Medicaid fraud to the department, regardless of
2091 the practice setting in which the alleged Medicaid fraud
2092 occurred.
2093 (4) The acceptance by a licensing authority of a
2094 candidate’s relinquishment of a license which is offered in
2095 response to or anticipation of the filing of administrative
2096 charges alleging Medicaid fraud or similar charges constitutes
2097 the permanent revocation of the license.
2098 Section 24. Paragraphs (ii), (jj), (kk), and (ll) are added
2099 to subsection (1) of section 456.072, Florida Statutes, to read:
2100 456.072 Grounds for discipline; penalties; enforcement.—
2101 (1) The following acts shall constitute grounds for which
2102 the disciplinary actions specified in subsection (2) may be
2103 taken:
2104 (ii) Being convicted of, or entering a plea of guilty or
2105 nolo contendere to, any misdemeanor or felony, regardless of
2106 adjudication, under 18 U.S.C. s. 669, ss. 285-287, s. 371, s.
2107 1001, s. 1035, s. 1341, s. 1343, s. 1347, s. 1349, or s. 1518,
2108 or 42 U.S.C. ss. 1320a-7b, relating to the Medicaid program.
2109 (jj) Failing to remit the sum owed to the state for an
2110 overpayment from the Medicaid program pursuant to a final order,
2111 judgment, or stipulation or settlement.
2112 (kk) Being terminated from the state Medicaid program
2113 pursuant to s. 409.913, any other state Medicaid program, or the
2114 federal Medicare program, unless eligibility to participate in
2115 the program from which the practitioner was terminated has been
2116 restored.
2117 (ll) Being convicted of, or entering a plea of guilty or
2118 nolo contendere to, any misdemeanor or felony, regardless of
2119 adjudication, a crime in any jurisdiction which relates to
2120 health care fraud.
2121 Section 25. Subsection (1) of section 456.074, Florida
2122 Statutes, is amended to read:
2123 456.074 Certain health care practitioners; immediate
2124 suspension of license.—
2125 (1) The department shall issue an emergency order
2126 suspending the license of any person licensed under chapter 458,
2127 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
2128 chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
2129 guilty to, is convicted or found guilty of, or who enters a plea
2130 of nolo contendere to, regardless of adjudication, to:
2131 (a) A felony under chapter 409, chapter 817, or chapter 893
2132 or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
2133 or.
2134 (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
2135 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
2136 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
2137 Medicaid program.
2138 Section 26. Subsections (2) and (3) of section 465.022,
2139 Florida Statutes, are amended, present subsections (4), (5),
2140 (6), and (7) of that section are renumbered as subsections (5),
2141 (6), (7), and (8), respectively, and a new subsection (4) is
2142 added to that section, to read:
2143 465.022 Pharmacies; general requirements; fees.—
2144 (2) A pharmacy permit shall be issued only to a person who
2145 is at least 18 years of age, a partnership whose partners are
2146 all at least 18 years of age, or to a corporation that which is
2147 registered pursuant to chapter 607 or chapter 617 whose
2148 officers, directors, and shareholders are at least 18 years of
2149 age.
2150 (3) Any person, partnership, or corporation before engaging
2151 in the operation of a pharmacy shall file with the board a sworn
2152 application on forms provided by the department.
2153 (a) An application for a pharmacy permit must include a set
2154 of fingerprints from each person having an ownership interest of
2155 5 percent or greater and from any person who, directly or
2156 indirectly, manages, oversees, or controls the operation of the
2157 applicant, including officers and members of the board of
2158 directors of an applicant that is a corporation. The applicant
2159 must provide payment in the application for the cost of state
2160 and national criminal history records checks.
2161 1. For corporations having more than $100 million of
2162 business taxable assets in this state, in lieu of these
2163 fingerprint requirements, the department shall require the
2164 prescription department manager who will be directly involved in
2165 the management and operation of the pharmacy to submit a set of
2166 fingerprints.
2167 2. A representative of a corporation described in
2168 subparagraph 1. satisfies the requirement to submit a set of his
2169 or her fingerprints if the fingerprints are on file with the
2170 department or the Agency for Health Care Administration, meet
2171 the fingerprint specifications for submission by the Department
2172 of Law Enforcement, and are available to the department.
2173 (b) The department shall submit the fingerprints provided
2174 by the applicant to the Department of Law Enforcement for a
2175 state criminal history records check. The Department of Law
2176 Enforcement shall forward the fingerprints to the Federal Bureau
2177 of Investigation for a national criminal history records check.
2178 (4) The department or board shall deny an application for a
2179 pharmacy permit if the applicant or an affiliated person,
2180 partner, officer, director, or prescription department manager
2181 of the applicant has:
2182 (a) Obtained a permit by misrepresentation or fraud;
2183 (b) Attempted to procure, or has procured, a permit for any
2184 other person by making, or causing to be made, any false
2185 representation;
2186 (c) Been convicted of, or entered a plea of guilty or nolo
2187 contendere to, regardless of adjudication, a crime in any
2188 jurisdiction which relates to the practice of, or the ability to
2189 practice, the profession of pharmacy;
2190 (d) Been convicted of, or entered a plea of guilty or nolo
2191 contendere to, regardless of adjudication, a crime in any
2192 jurisdiction which relates to health care fraud;
2193 (e) Been terminated for cause, pursuant to the appeals
2194 procedures established by the state or Federal Government, from
2195 any state Medicaid program or the federal Medicare program,
2196 unless the applicant has been in good standing with a state
2197 Medicaid program or the federal Medicare program for the most
2198 recent five years and the termination occurred at least 20 years
2199 ago; or
2200 (f) Dispensed any medicinal drug based upon a communication
2201 that purports to be a prescription as defined by s. 465.003(14)
2202 or s. 893.02 when the pharmacist knows or has reason to believe
2203 that the purported prescription is not based upon a valid
2204 practitioner-patient relationship that includes a documented
2205 patient evaluation, including history and a physical examination
2206 adequate to establish the diagnosis for which any drug is
2207 prescribed and any other requirement established by board rule
2208 under chapter 458, chapter 459, chapter 461, chapter 463,
2209 chapter 464, or chapter 466.
2210 Section 27. Subsection (1) of section 465.023, Florida
2211 Statutes, is amended to read:
2212 465.023 Pharmacy permittee; disciplinary action.—
2213 (1) The department or the board may revoke or suspend the
2214 permit of any pharmacy permittee, and may fine, place on
2215 probation, or otherwise discipline any pharmacy permittee if the
2216 permittee, or any affiliated person, partner, officer, director,
2217 or agent of the permittee, including a person fingerprinted
2218 under s. 465.022(3), who has:
2219 (a) Obtained a permit by misrepresentation or fraud or
2220 through an error of the department or the board;
2221 (b) Attempted to procure, or has procured, a permit for any
2222 other person by making, or causing to be made, any false
2223 representation;
2224 (c) Violated any of the requirements of this chapter or any
2225 of the rules of the Board of Pharmacy; of chapter 499, known as
2226 the “Florida Drug and Cosmetic Act”; of 21 U.S.C. ss. 301-392,
2227 known as the “Federal Food, Drug, and Cosmetic Act”; of 21
2228 U.S.C. ss. 821 et seq., known as the Comprehensive Drug Abuse
2229 Prevention and Control Act; or of chapter 893;
2230 (d) Been convicted or found guilty, regardless of
2231 adjudication, of a felony or any other crime involving moral
2232 turpitude in any of the courts of this state, of any other
2233 state, or of the United States; or
2234 (e) Been convicted or disciplined by a regulatory agency of
2235 the Federal Government or a regulatory agency of another state
2236 for any offense that would constitute a violation of this
2237 chapter;
2238 (f) Been convicted of, or entered a plea of guilty or nolo
2239 contendere to, regardless of adjudication, a crime in any
2240 jurisdiction which relates to the practice of, or the ability to
2241 practice, the profession of pharmacy;
2242 (g) Been convicted of, or entered a plea of guilty or nolo
2243 contendere to, regardless of adjudication, a crime in any
2244 jurisdiction which relates to health care fraud; or
2245 (h)(e) Dispensed any medicinal drug based upon a
2246 communication that purports to be a prescription as defined by
2247 s. 465.003(14) or s. 893.02 when the pharmacist knows or has
2248 reason to believe that the purported prescription is not based
2249 upon a valid practitioner-patient relationship that includes a
2250 documented patient evaluation, including history and a physical
2251 examination adequate to establish the diagnosis for which any
2252 drug is prescribed and any other requirement established by
2253 board rule under chapter 458, chapter 459, chapter 461, chapter
2254 463, chapter 464, or chapter 466.
2255 Section 28. Section 825.103, Florida Statutes, is amended
2256 to read:
2257 825.103 Exploitation of an elderly person or disabled
2258 adult; penalties.—
2259 (1) “Exploitation of an elderly person or disabled adult”
2260 means:
2261 (a) Knowingly, by deception or intimidation, obtaining or
2262 using, or endeavoring to obtain or use, an elderly person’s or
2263 disabled adult’s funds, assets, or property with the intent to
2264 temporarily or permanently deprive the elderly person or
2265 disabled adult of the use, benefit, or possession of the funds,
2266 assets, or property, or to benefit someone other than the
2267 elderly person or disabled adult, by a person who:
2268 1. Stands in a position of trust and confidence with the
2269 elderly person or disabled adult; or
2270 2. Has a business relationship with the elderly person or
2271 disabled adult; or
2272 (b) Obtaining or using, endeavoring to obtain or use, or
2273 conspiring with another to obtain or use an elderly person’s or
2274 disabled adult’s funds, assets, or property with the intent to
2275 temporarily or permanently deprive the elderly person or
2276 disabled adult of the use, benefit, or possession of the funds,
2277 assets, or property, or to benefit someone other than the
2278 elderly person or disabled adult, by a person who knows or
2279 reasonably should know that the elderly person or disabled adult
2280 lacks the capacity to consent; or.
2281 (c) Breach of a fiduciary duty to an elderly person or
2282 disabled adult by the person’s guardian or agent under a power
2283 of attorney which results in an unauthorized appropriation,
2284 sale, or transfer of property.
2285 (2)(a) If the funds, assets, or property involved in the
2286 exploitation of the elderly person or disabled adult is valued
2287 at $100,000 or more, the offender commits a felony of the first
2288 degree, punishable as provided in s. 775.082, s. 775.083, or s.
2289 775.084.
2290 (b) If the funds, assets, or property involved in the
2291 exploitation of the elderly person or disabled adult is valued
2292 at $20,000 or more, but less than $100,000, the offender commits
2293 a felony of the second degree, punishable as provided in s.
2294 775.082, s. 775.083, or s. 775.084.
2295 (c) If the funds, assets, or property involved in the
2296 exploitation of an elderly person or disabled adult is valued at
2297 less than $20,000, the offender commits a felony of the third
2298 degree, punishable as provided in s. 775.082, s. 775.083, or s.
2299 775.084.
2300 Section 29. Paragraphs (g) and (i) of subsection (3) of
2301 section 921.0022, Florida Statutes, are amended to read:
2302 921.0022 Criminal Punishment Code; offense severity ranking
2303 chart.—
2304 (3) OFFENSE SEVERITY RANKING CHART
2305 (g) LEVEL 7
2306 FloridaStatute FelonyDegree Description
2307 316.027(1)(b) 1st Accident involving death, failure to stop; leaving scene.
2308 316.193(3)(c)2. 3rd DUI resulting in serious bodily injury.
2309 316.1935(3)(b) 1st Causing serious bodily injury or death to another person; driving at high speed or with wanton disregard for safety while fleeing or attempting to elude law enforcement officer who is in a patrol vehicle with siren and lights activated.
2310 327.35(3)(c)2. 3rd Vessel BUI resulting in serious bodily injury.
2311 402.319(2) 2nd Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.
2312 409.920(2)(b)1.a. 3rd Medicaid provider fraud; $10,000 or less.
2313 409.920(2)(b)1.b. 2nd Medicaid provider fraud; more than $10,000, but less than $50,000.
2314 456.065(2) 3rd Practicing a health care profession without a license.
2315 456.065(2) 2nd Practicing a health care profession without a license which results in serious bodily injury.
2316 458.327(1) 3rd Practicing medicine without a license.
2317 459.013(1) 3rd Practicing osteopathic medicine without a license.
2318 460.411(1) 3rd Practicing chiropractic medicine without a license.
2319 461.012(1) 3rd Practicing podiatric medicine without a license.
2320 462.17 3rd Practicing naturopathy without a license.
2321 463.015(1) 3rd Practicing optometry without a license.
2322 464.016(1) 3rd Practicing nursing without a license.
2323 465.015(2) 3rd Practicing pharmacy without a license.
2324 466.026(1) 3rd Practicing dentistry or dental hygiene without a license.
2325 467.201 3rd Practicing midwifery without a license.
2326 468.366 3rd Delivering respiratory care services without a license.
2327 483.828(1) 3rd Practicing as clinical laboratory personnel without a license.
2328 483.901(9) 3rd Practicing medical physics without a license.
2329 484.013(1)(c) 3rd Preparing or dispensing optical devices without a prescription.
2330 484.053 3rd Dispensing hearing aids without a license.
2331 494.0018(2) 1st Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.
2332 560.123(8)(b)1. 3rd Failure to report currency or payment instruments exceeding $300 but less than $20,000 by a money services business.
2333 560.125(5)(a) 3rd Money services business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.
2334 655.50(10)(b)1. 3rd Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.
2335 775.21(10)(a) 3rd Sexual predator; failure to register; failure to renew driver’s license or identification card; other registration violations.
2336 775.21(10)(b) 3rd Sexual predator working where children regularly congregate.
2337 775.21(10)(g) 3rd Failure to report or providing false information about a sexual predator; harbor or conceal a sexual predator.
2338 782.051(3) 2nd Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.
2339 782.07(1) 2nd Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).
2340 782.071 2nd Killing of a human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).
2341 782.072 2nd Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).
2342 784.045(1)(a)1. 2nd Aggravated battery; intentionally causing great bodily harm or disfigurement.
2343 784.045(1)(a)2. 2nd Aggravated battery; using deadly weapon.
2344 784.045(1)(b) 2nd Aggravated battery; perpetrator aware victim pregnant.
2345 784.048(4) 3rd Aggravated stalking; violation of injunction or court order.
2346 784.048(7) 3rd Aggravated stalking; violation of court order.
2347 784.07(2)(d) 1st Aggravated battery on law enforcement officer.
2348 784.074(1)(a) 1st Aggravated battery on sexually violent predators facility staff.
2349 784.08(2)(a) 1st Aggravated battery on a person 65 years of age or older.
2350 784.081(1) 1st Aggravated battery on specified official or employee.
2351 784.082(1) 1st Aggravated battery by detained person on visitor or other detainee.
2352 784.083(1) 1st Aggravated battery on code inspector.
2353 790.07(4) 1st Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).
2354 790.16(1) 1st Discharge of a machine gun under specified circumstances.
2355 790.165(2) 2nd Manufacture, sell, possess, or deliver hoax bomb.
2356 790.165(3) 2nd Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.
2357 790.166(3) 2nd Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.
2358 790.166(4) 2nd Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.
2359 790.23 1st,PBL Possession of a firearm by a person who qualifies for the penalty enhancements provided for in s. 874.04.
2360 794.08(4) 3rd Female genital mutilation; consent by a parent, guardian, or a person in custodial authority to a victim younger than 18 years of age.
2361 796.03 2nd Procuring any person under 16 years for prostitution.
2362 800.04(5)(c)1. 2nd Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.
2363 800.04(5)(c)2. 2nd Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.
2364 806.01(2) 2nd Maliciously damage structure by fire or explosive.
2365 810.02(3)(a) 2nd Burglary of occupied dwelling; unarmed; no assault or battery.
2366 810.02(3)(b) 2nd Burglary of unoccupied dwelling; unarmed; no assault or battery.
2367 810.02(3)(d) 2nd Burglary of occupied conveyance; unarmed; no assault or battery.
2368 810.02(3)(e) 2nd Burglary of authorized emergency vehicle.
2369 812.014(2)(a)1. 1st Property stolen, valued at $100,000 or more or a semitrailer deployed by a law enforcement officer; property stolen while causing other property damage; 1st degree grand theft.
2370 812.014(2)(b)2. 2nd Property stolen, cargo valued at less than $50,000, grand theft in 2nd degree.
2371 812.014(2)(b)3. 2nd Property stolen, emergency medical equipment; 2nd degree grand theft.
2372 812.014(2)(b)4. 2nd Property stolen, law enforcement equipment from authorized emergency vehicle.
2373 812.0145(2)(a) 1st Theft from person 65 years of age or older; $50,000 or more.
2374 812.019(2) 1st Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.
2375 812.131(2)(a) 2nd Robbery by sudden snatching.
2376 812.133(2)(b) 1st Carjacking; no firearm, deadly weapon, or other weapon.
2377 817.234(8)(a) 2nd Solicitation of motor vehicle accident victims with intent to defraud.
2378 817.234(9) 2nd Organizing, planning, or participating in an intentional motor vehicle collision.
2379 817.234(11)(c) 1st Insurance fraud; property value $100,000 or more.
2380 817.2341(2)(b) & (3)(b)1st Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.
2381 825.102(3)(b) 2nd Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.
2382 825.103(2)(b) 2nd Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.
2383 827.03(3)(b) 2nd Neglect of a child causing great bodily harm, disability, or disfigurement.
2384 827.04(3) 3rd Impregnation of a child under 16 years of age by person 21 years of age or older.
2385 837.05(2) 3rd Giving false information about alleged capital felony to a law enforcement officer.
2386 838.015 2nd Bribery.
2387 838.016 2nd Unlawful compensation or reward for official behavior.
2388 838.021(3)(a) 2nd Unlawful harm to a public servant.
2389 838.22 2nd Bid tampering.
2390 847.0135(3) 3rd Solicitation of a child, via a computer service, to commit an unlawful sex act.
2391 847.0135(4) 2nd Traveling to meet a minor to commit an unlawful sex act.
2392 872.06 2nd Abuse of a dead human body.
2393 874.10 1st,PBL Knowingly initiates, organizes, plans, finances, directs, manages, or supervises criminal gang-related activity.
2394 893.13(1)(c)1. 1st Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.
2395 893.13(1)(e)1. 1st Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.
2396 893.13(4)(a) 1st Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).
2397 893.135(1)(a)1. 1st Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.
2398 893.135(1)(b)1.a. 1st Trafficking in cocaine, more than 28 grams, less than 200 grams.
2399 893.135(1)(c)1.a. 1st Trafficking in illegal drugs, more than 4 grams, less than 14 grams.
2400 893.135(1)(d)1. 1st Trafficking in phencyclidine, more than 28 grams, less than 200 grams.
2401 893.135(1)(e)1. 1st Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.
2402 893.135(1)(f)1. 1st Trafficking in amphetamine, more than 14 grams, less than 28 grams.
2403 893.135(1)(g)1.a. 1st Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.
2404 893.135(1)(h)1.a. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.
2405 893.135(1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.
2406 893.135(1)(k)2.a. 1st Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.
2407 893.1351(2) 2nd Possession of place for trafficking in or manufacturing of controlled substance.
2408 896.101(5)(a) 3rd Money laundering, financial transactions exceeding $300 but less than $20,000.
2409 896.104(4)(a)1. 3rd Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.
2410 943.0435(4)(c) 2nd Sexual offender vacating permanent residence; failure to comply with reporting requirements.
2411 943.0435(8) 2nd Sexual offender; remains in state after indicating intent to leave; failure to comply with reporting requirements.
2412 943.0435(9)(a) 3rd Sexual offender; failure to comply with reporting requirements.
2413 943.0435(13) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
2414 943.0435(14) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
2415 944.607(9) 3rd Sexual offender; failure to comply with reporting requirements.
2416 944.607(10)(a) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
2417 944.607(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
2418 944.607(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
2419 985.4815(10) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
2420 985.4815(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
2421 985.4815(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
2422 (i) LEVEL 9
2423 FloridaStatute FelonyDegree Description
2424 316.193(3)(c)3.b. 1st DUI manslaughter; failing to render aid or give information.
2425 327.35(3)(c)3.b. 1st BUI manslaughter; failing to render aid or give information.
2426 409.920(2)(b)1.c. 1st Medicaid provider fraud; $50,000 or more.
2427 499.0051(9) 1st Knowing sale or purchase of contraband prescription drugs resulting in great bodily harm.
2428 560.123(8)(b)3. 1st Failure to report currency or payment instruments totaling or exceeding $100,000 by money transmitter.
2429 560.125(5)(c) 1st Money transmitter business by unauthorized person, currency, or payment instruments totaling or exceeding $100,000.
2430 655.50(10)(b)3. 1st Failure to report financial transactions totaling or exceeding $100,000 by financial institution.
2431 775.0844 1st Aggravated white collar crime.
2432 782.04(1) 1st Attempt, conspire, or solicit to commit premeditated murder.
2433 782.04(3) 1st,PBL Accomplice to murder in connection with arson, sexual battery, robbery, burglary, and other specified felonies.
2434 782.051(1) 1st Attempted felony murder while perpetrating or attempting to perpetrate a felony enumerated in s. 782.04(3).
2435 782.07(2) 1st Aggravated manslaughter of an elderly person or disabled adult.
2436 787.01(1)(a)1. 1st,PBL Kidnapping; hold for ransom or reward or as a shield or hostage.
2437 787.01(1)(a)2. 1st,PBL Kidnapping with intent to commit or facilitate commission of any felony.
2438 787.01(1)(a)4. 1st,PBL Kidnapping with intent to interfere with performance of any governmental or political function.
2439 787.02(3)(a) 1st False imprisonment; child under age 13; perpetrator also commits aggravated child abuse, sexual battery, or lewd or lascivious battery, molestation, conduct, or exhibition.
2440 790.161 1st Attempted capital destructive device offense.
2441 790.166(2) 1st,PBL Possessing, selling, using, or attempting to use a weapon of mass destruction.
2442 794.011(2) 1st Attempted sexual battery; victim less than 12 years of age.
2443 794.011(2) Life Sexual battery; offender younger than 18 years and commits sexual battery on a person less than 12 years.
2444 794.011(4) 1st Sexual battery; victim 12 years or older, certain circumstances.
2445 794.011(8)(b) 1st Sexual battery; engage in sexual conduct with minor 12 to 18 years by person in familial or custodial authority.
2446 794.08(2) 1st Female genital mutilation; victim younger than 18 years of age.
2447 800.04(5)(b) Life Lewd or lascivious molestation; victim less than 12 years; offender 18 years or older.
2448 812.13(2)(a) 1st,PBL Robbery with firearm or other deadly weapon.
2449 812.133(2)(a) 1st,PBL Carjacking; firearm or other deadly weapon.
2450 812.135(2)(b) 1st Home-invasion robbery with weapon.
2451 817.568(7) 2nd,PBL Fraudulent use of personal identification information of an individual under the age of 18 by his or her parent, legal guardian, or person exercising custodial authority.
2452 827.03(2) 1st Aggravated child abuse.
2453 847.0145(1) 1st Selling, or otherwise transferring custody or control, of a minor.
2454 847.0145(2) 1st Purchasing, or otherwise obtaining custody or control, of a minor.
2455 859.01 1st Poisoning or introducing bacteria, radioactive materials, viruses, or chemical compounds into food, drink, medicine, or water with intent to kill or injure another person.
2456 893.135 1st Attempted capital trafficking offense.
2457 893.135(1)(a)3. 1st Trafficking in cannabis, more than 10,000 lbs.
2458 893.135(1)(b)1.c. 1st Trafficking in cocaine, more than 400 grams, less than 150 kilograms.
2459 893.135(1)(c)1.c. 1st Trafficking in illegal drugs, more than 28 grams, less than 30 kilograms.
2460 893.135(1)(d)1.c. 1st Trafficking in phencyclidine, more than 400 grams.
2461 893.135(1)(e)1.c. 1st Trafficking in methaqualone, more than 25 kilograms.
2462 893.135(1)(f)1.c. 1st Trafficking in amphetamine, more than 200 grams.
2463 893.135(1)(h)1.c. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 10 kilograms or more.
2464 893.135(1)(j)1.c. 1st Trafficking in 1,4-Butanediol, 10 kilograms or more.
2465 893.135(1)(k)2.c. 1st Trafficking in Phenethylamines, 400 grams or more.
2466 896.101(5)(c) 1st Money laundering, financial instruments totaling or exceeding $100,000.
2467 896.104(4)(a)3. 1st Structuring transactions to evade reporting or registration requirements, financial transactions totaling or exceeding $100,000.
2468 Section 30. Pilot project to monitor home health services.
2469 The Agency for Health Care Administration shall develop and
2470 implement a home health agency monitoring pilot project in
2471 Miami-Dade County by January 1, 2010. The agency shall contract
2472 with a vendor to verify the utilization and delivery of home
2473 health services and provide an electronic billing interface for
2474 home health services. The contract must require the creation of
2475 a program to submit claims electronically for the delivery of
2476 home health services. The program must verify telephonically
2477 visits for the delivery of home health services using voice
2478 biometrics. The agency may seek amendments to the Medicaid state
2479 plan and waivers of federal laws, as necessary, to implement the
2480 pilot project. Notwithstanding s. 287.057(5)(f), Florida
2481 Statutes, the agency must award the contract through the
2482 competitive solicitation process. The agency shall submit a
2483 report to the Governor, the President of the Senate, and the
2484 Speaker of the House of Representatives evaluating the pilot
2485 project by February 1, 2011.
2486 Section 31. Pilot project for home health care management.
2487 The Agency for Health Care Administration shall implement a
2488 comprehensive care management pilot project for home health
2489 services by January 1, 2010, which includes face-to-face
2490 assessments by a nurse licensed pursuant to chapter 464, Florida
2491 Statutes, consultation with physicians ordering services to
2492 substantiate the medical necessity for services, and on-site or
2493 desk reviews of recipients’ medical records in Miami-Dade
2494 County. The agency may enter into a contract with a qualified
2495 organization to implement the pilot project. The agency may seek
2496 amendments to the Medicaid state plan and waivers of federal
2497 laws, as necessary, to implement the pilot project.
2498 Section 32. Subsection (6) of section 400.0077, Florida
2499 Statutes, is amended to read:
2500 400.0077 Confidentiality.—
2501 (6) This section does not limit the subpoena power of the
2502 Attorney General pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
2503 Section 33. Subsection (2) of section 430.608, Florida
2504 Statutes, is amended to read:
2505 430.608 Confidentiality of information.—
2506 (2) This section does not, however, limit the subpoena
2507 authority of the Medicaid Fraud Control Unit of the Department
2508 of Legal Affairs pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
2509 Section 34. Section 395.0199, Florida Statutes, is
2510 repealed.
2511 Section 35. Section 395.405, Florida Statutes, is amended
2512 to read:
2513 395.405 Rulemaking.—The department shall adopt and enforce
2514 all rules necessary to administer ss. 395.0199, 395.401,
2515 395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
2516 Section 36. Subsection (1) of section 400.0712, Florida
2517 Statutes, is amended to read:
2518 400.0712 Application for inactive license.—
2519 (1) As specified in s. 408.831(4) and this section, the
2520 agency may issue an inactive license to a nursing home facility
2521 for all or a portion of its beds. Any request by a licensee that
2522 a nursing home or portion of a nursing home become inactive must
2523 be submitted to the agency in the approved format. The facility
2524 may not initiate any suspension of services, notify residents,
2525 or initiate inactivity before receiving approval from the
2526 agency; and a licensee that violates this provision may not be
2527 issued an inactive license.
2528 Section 37. Subsection (2) of section 400.118, Florida
2529 Statutes, is repealed.
2530 Section 38. Section 400.141, Florida Statutes, is amended
2531 to read:
2532 400.141 Administration and management of nursing home
2533 facilities.—
2534 (1) Every licensed facility shall comply with all
2535 applicable standards and rules of the agency and shall:
2536 (a)(1) Be under the administrative direction and charge of
2537 a licensed administrator.
2538 (b)(2) Appoint a medical director licensed pursuant to
2539 chapter 458 or chapter 459. The agency may establish by rule
2540 more specific criteria for the appointment of a medical
2541 director.
2542 (c)(3) Have available the regular, consultative, and
2543 emergency services of physicians licensed by the state.
2544 (d)(4) Provide for resident use of a community pharmacy as
2545 specified in s. 400.022(1)(q). Any other law to the contrary
2546 notwithstanding, a registered pharmacist licensed in Florida,
2547 that is under contract with a facility licensed under this
2548 chapter or chapter 429, shall repackage a nursing facility
2549 resident’s bulk prescription medication which has been packaged
2550 by another pharmacist licensed in any state in the United States
2551 into a unit dose system compatible with the system used by the
2552 nursing facility, if the pharmacist is requested to offer such
2553 service. In order to be eligible for the repackaging, a resident
2554 or the resident’s spouse must receive prescription medication
2555 benefits provided through a former employer as part of his or
2556 her retirement benefits, a qualified pension plan as specified
2557 in s. 4972 of the Internal Revenue Code, a federal retirement
2558 program as specified under 5 C.F.R. s. 831, or a long-term care
2559 policy as defined in s. 627.9404(1). A pharmacist who correctly
2560 repackages and relabels the medication and the nursing facility
2561 which correctly administers such repackaged medication under the
2562 provisions of this paragraph may subsection shall not be held
2563 liable in any civil or administrative action arising from the
2564 repackaging. In order to be eligible for the repackaging, a
2565 nursing facility resident for whom the medication is to be
2566 repackaged shall sign an informed consent form provided by the
2567 facility which includes an explanation of the repackaging
2568 process and which notifies the resident of the immunities from
2569 liability provided in this paragraph herein. A pharmacist who
2570 repackages and relabels prescription medications, as authorized
2571 under this paragraph subsection, may charge a reasonable fee for
2572 costs resulting from the implementation of this provision.
2573 (e)(5) Provide for the access of the facility residents to
2574 dental and other health-related services, recreational services,
2575 rehabilitative services, and social work services appropriate to
2576 their needs and conditions and not directly furnished by the
2577 licensee. When a geriatric outpatient nurse clinic is conducted
2578 in accordance with rules adopted by the agency, outpatients
2579 attending such clinic shall not be counted as part of the
2580 general resident population of the nursing home facility, nor
2581 shall the nursing staff of the geriatric outpatient clinic be
2582 counted as part of the nursing staff of the facility, until the
2583 outpatient clinic load exceeds 15 a day.
2584 (f)(6) Be allowed and encouraged by the agency to provide
2585 other needed services under certain conditions. If the facility
2586 has a standard licensure status, and has had no class I or class
2587 II deficiencies during the past 2 years or has been awarded a
2588 Gold Seal under the program established in s. 400.235, it may be
2589 encouraged by the agency to provide services, including, but not
2590 limited to, respite and adult day services, which enable
2591 individuals to move in and out of the facility. A facility is
2592 not subject to any additional licensure requirements for
2593 providing these services. Respite care may be offered to persons
2594 in need of short-term or temporary nursing home services.
2595 Respite care must be provided in accordance with this part and
2596 rules adopted by the agency. However, the agency shall, by rule,
2597 adopt modified requirements for resident assessment, resident
2598 care plans, resident contracts, physician orders, and other
2599 provisions, as appropriate, for short-term or temporary nursing
2600 home services. The agency shall allow for shared programming and
2601 staff in a facility which meets minimum standards and offers
2602 services pursuant to this paragraph subsection, but, if the
2603 facility is cited for deficiencies in patient care, may require
2604 additional staff and programs appropriate to the needs of
2605 service recipients. A person who receives respite care may not
2606 be counted as a resident of the facility for purposes of the
2607 facility’s licensed capacity unless that person receives 24-hour
2608 respite care. A person receiving either respite care for 24
2609 hours or longer or adult day services must be included when
2610 calculating minimum staffing for the facility. Any costs and
2611 revenues generated by a nursing home facility from
2612 nonresidential programs or services shall be excluded from the
2613 calculations of Medicaid per diems for nursing home
2614 institutional care reimbursement.
2615 (g)(7) If the facility has a standard license or is a Gold
2616 Seal facility, exceeds the minimum required hours of licensed
2617 nursing and certified nursing assistant direct care per resident
2618 per day, and is part of a continuing care facility licensed
2619 under chapter 651 or a retirement community that offers other
2620 services pursuant to part III of this chapter or part I or part
2621 III of chapter 429 on a single campus, be allowed to share
2622 programming and staff. At the time of inspection and in the
2623 semiannual report required pursuant to paragraph (o) subsection
2624 (15), a continuing care facility or retirement community that
2625 uses this option must demonstrate through staffing records that
2626 minimum staffing requirements for the facility were met.
2627 Licensed nurses and certified nursing assistants who work in the
2628 nursing home facility may be used to provide services elsewhere
2629 on campus if the facility exceeds the minimum number of direct
2630 care hours required per resident per day and the total number of
2631 residents receiving direct care services from a licensed nurse
2632 or a certified nursing assistant does not cause the facility to
2633 violate the staffing ratios required under s. 400.23(3)(a).
2634 Compliance with the minimum staffing ratios shall be based on
2635 total number of residents receiving direct care services,
2636 regardless of where they reside on campus. If the facility
2637 receives a conditional license, it may not share staff until the
2638 conditional license status ends. This paragraph subsection does
2639 not restrict the agency’s authority under federal or state law
2640 to require additional staff if a facility is cited for
2641 deficiencies in care which are caused by an insufficient number
2642 of certified nursing assistants or licensed nurses. The agency
2643 may adopt rules for the documentation necessary to determine
2644 compliance with this provision.
2645 (h)(8) Maintain the facility premises and equipment and
2646 conduct its operations in a safe and sanitary manner.
2647 (i)(9) If the licensee furnishes food service, provide a
2648 wholesome and nourishing diet sufficient to meet generally
2649 accepted standards of proper nutrition for its residents and
2650 provide such therapeutic diets as may be prescribed by attending
2651 physicians. In making rules to implement this paragraph
2652 subsection, the agency shall be guided by standards recommended
2653 by nationally recognized professional groups and associations
2654 with knowledge of dietetics.
2655 (j)(10) Keep full records of resident admissions and
2656 discharges; medical and general health status, including medical
2657 records, personal and social history, and identity and address
2658 of next of kin or other persons who may have responsibility for
2659 the affairs of the residents; and individual resident care plans
2660 including, but not limited to, prescribed services, service
2661 frequency and duration, and service goals. The records shall be
2662 open to inspection by the agency.
2663 (k)(11) Keep such fiscal records of its operations and
2664 conditions as may be necessary to provide information pursuant
2665 to this part.
2666 (l)(12) Furnish copies of personnel records for employees
2667 affiliated with such facility, to any other facility licensed by
2668 this state requesting this information pursuant to this part.
2669 Such information contained in the records may include, but is
2670 not limited to, disciplinary matters and any reason for
2671 termination. Any facility releasing such records pursuant to
2672 this part shall be considered to be acting in good faith and may
2673 not be held liable for information contained in such records,
2674 absent a showing that the facility maliciously falsified such
2675 records.
2676 (m)(13) Publicly display a poster provided by the agency
2677 containing the names, addresses, and telephone numbers for the
2678 state’s abuse hotline, the State Long-Term Care Ombudsman, the
2679 Agency for Health Care Administration consumer hotline, the
2680 Advocacy Center for Persons with Disabilities, the Florida
2681 Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
2682 with a clear description of the assistance to be expected from
2683 each.
2684 (n)(14) Submit to the agency the information specified in
2685 s. 400.071(1)(b) for a management company within 30 days after
2686 the effective date of the management agreement.
2687 (o)1.(15) Submit semiannually to the agency, or more
2688 frequently if requested by the agency, information regarding
2689 facility staff-to-resident ratios, staff turnover, and staff
2690 stability, including information regarding certified nursing
2691 assistants, licensed nurses, the director of nursing, and the
2692 facility administrator. For purposes of this reporting:
2693 a.(a) Staff-to-resident ratios must be reported in the
2694 categories specified in s. 400.23(3)(a) and applicable rules.
2695 The ratio must be reported as an average for the most recent
2696 calendar quarter.
2697 b.(b) Staff turnover must be reported for the most recent
2698 12-month period ending on the last workday of the most recent
2699 calendar quarter prior to the date the information is submitted.
2700 The turnover rate must be computed quarterly, with the annual
2701 rate being the cumulative sum of the quarterly rates. The
2702 turnover rate is the total number of terminations or separations
2703 experienced during the quarter, excluding any employee
2704 terminated during a probationary period of 3 months or less,
2705 divided by the total number of staff employed at the end of the
2706 period for which the rate is computed, and expressed as a
2707 percentage.
2708 c.(c) The formula for determining staff stability is the
2709 total number of employees that have been employed for more than
2710 12 months, divided by the total number of employees employed at
2711 the end of the most recent calendar quarter, and expressed as a
2712 percentage.
2713 d.(d) A nursing facility that has failed to comply with
2714 state minimum-staffing requirements for 2 consecutive days is
2715 prohibited from accepting new admissions until the facility has
2716 achieved the minimum-staffing requirements for a period of 6
2717 consecutive days. For the purposes of this sub-subparagraph
2718 paragraph, any person who was a resident of the facility and was
2719 absent from the facility for the purpose of receiving medical
2720 care at a separate location or was on a leave of absence is not
2721 considered a new admission. Failure to impose such an admissions
2722 moratorium constitutes a class II deficiency.
2723 e.(e) A nursing facility which does not have a conditional
2724 license may be cited for failure to comply with the standards in
2725 s. 400.23(3)(a)1.a. only if it has failed to meet those
2726 standards on 2 consecutive days or if it has failed to meet at
2727 least 97 percent of those standards on any one day.
2728 f.(f) A facility which has a conditional license must be in
2729 compliance with the standards in s. 400.23(3)(a) at all times.
2730
2731 2. Nothing in This paragraph does not section shall limit
2732 the agency’s ability to impose a deficiency or take other
2733 actions if a facility does not have enough staff to meet the
2734 residents’ needs.
2735 (16) Report monthly the number of vacant beds in the
2736 facility which are available for resident occupancy on the day
2737 the information is reported.
2738 (p)(17) Notify a licensed physician when a resident
2739 exhibits signs of dementia or cognitive impairment or has a
2740 change of condition in order to rule out the presence of an
2741 underlying physiological condition that may be contributing to
2742 such dementia or impairment. The notification must occur within
2743 30 days after the acknowledgment of such signs by facility
2744 staff. If an underlying condition is determined to exist, the
2745 facility shall arrange, with the appropriate health care
2746 provider, the necessary care and services to treat the
2747 condition.
2748 (q)(18) If the facility implements a dining and hospitality
2749 attendant program, ensure that the program is developed and
2750 implemented under the supervision of the facility director of
2751 nursing. A licensed nurse, licensed speech or occupational
2752 therapist, or a registered dietitian must conduct training of
2753 dining and hospitality attendants. A person employed by a
2754 facility as a dining and hospitality attendant must perform
2755 tasks under the direct supervision of a licensed nurse.
2756 (r)(19) Report to the agency any filing for bankruptcy
2757 protection by the facility or its parent corporation,
2758 divestiture or spin-off of its assets, or corporate
2759 reorganization within 30 days after the completion of such
2760 activity.
2761 (s)(20) Maintain general and professional liability
2762 insurance coverage that is in force at all times. In lieu of
2763 general and professional liability insurance coverage, a state
2764 designated teaching nursing home and its affiliated assisted
2765 living facilities created under s. 430.80 may demonstrate proof
2766 of financial responsibility as provided in s. 430.80(3)(h).
2767 (t)(21) Maintain in the medical record for each resident a
2768 daily chart of certified nursing assistant services provided to
2769 the resident. The certified nursing assistant who is caring for
2770 the resident must complete this record by the end of his or her
2771 shift. This record must indicate assistance with activities of
2772 daily living, assistance with eating, and assistance with
2773 drinking, and must record each offering of nutrition and
2774 hydration for those residents whose plan of care or assessment
2775 indicates a risk for malnutrition or dehydration.
2776 (u)(22) Before November 30 of each year, subject to the
2777 availability of an adequate supply of the necessary vaccine,
2778 provide for immunizations against influenza viruses to all its
2779 consenting residents in accordance with the recommendations of
2780 the United States Centers for Disease Control and Prevention,
2781 subject to exemptions for medical contraindications and
2782 religious or personal beliefs. Subject to these exemptions, any
2783 consenting person who becomes a resident of the facility after
2784 November 30 but before March 31 of the following year must be
2785 immunized within 5 working days after becoming a resident.
2786 Immunization shall not be provided to any resident who provides
2787 documentation that he or she has been immunized as required by
2788 this paragraph subsection. This paragraph subsection does not
2789 prohibit a resident from receiving the immunization from his or
2790 her personal physician if he or she so chooses. A resident who
2791 chooses to receive the immunization from his or her personal
2792 physician shall provide proof of immunization to the facility.
2793 The agency may adopt and enforce any rules necessary to comply
2794 with or implement this subsection.
2795 (v)(23) Assess all residents for eligibility for
2796 pneumococcal polysaccharide vaccination (PPV) and vaccinate
2797 residents when indicated within 60 days after the effective date
2798 of this act in accordance with the recommendations of the United
2799 States Centers for Disease Control and Prevention, subject to
2800 exemptions for medical contraindications and religious or
2801 personal beliefs. Residents admitted after the effective date of
2802 this act shall be assessed within 5 working days of admission
2803 and, when indicated, vaccinated within 60 days in accordance
2804 with the recommendations of the United States Centers for
2805 Disease Control and Prevention, subject to exemptions for
2806 medical contraindications and religious or personal beliefs.
2807 Immunization shall not be provided to any resident who provides
2808 documentation that he or she has been immunized as required by
2809 this paragraph subsection. This paragraph subsection does not
2810 prohibit a resident from receiving the immunization from his or
2811 her personal physician if he or she so chooses. A resident who
2812 chooses to receive the immunization from his or her personal
2813 physician shall provide proof of immunization to the facility.
2814 The agency may adopt and enforce any rules necessary to comply
2815 with or implement this paragraph subsection.
2816 (w)(24) Annually encourage and promote to its employees the
2817 benefits associated with immunizations against influenza viruses
2818 in accordance with the recommendations of the United States
2819 Centers for Disease Control and Prevention. The agency may adopt
2820 and enforce any rules necessary to comply with or implement this
2821 paragraph subsection.
2822 (2) Facilities that have been awarded a Gold Seal under the
2823 program established in s. 400.235 may develop a plan to provide
2824 certified nursing assistant training as prescribed by federal
2825 regulations and state rules and may apply to the agency for
2826 approval of their program.
2827 Section 39. Subsections (5), (9), (10), (11), (12), (13),
2828 (14), and (15) of section 400.147, Florida Statutes, are amended
2829 to read:
2830 400.147 Internal risk management and quality assurance
2831 program.—
2832 (5) For purposes of reporting to the agency under this
2833 section, the term “adverse incident” means:
2834 (a) An event over which facility personnel could exercise
2835 control and which is associated in whole or in part with the
2836 facility’s intervention, rather than the condition for which
2837 such intervention occurred, and which results in one of the
2838 following:
2839 1. Death;
2840 2. Brain or spinal damage;
2841 3. Permanent disfigurement;
2842 4. Fracture or dislocation of bones or joints;
2843 5. A limitation of neurological, physical, or sensory
2844 function;
2845 6. Any condition that required medical attention to which
2846 the resident has not given his or her informed consent,
2847 including failure to honor advanced directives; or
2848 7. Any condition that required the transfer of the
2849 resident, within or outside the facility, to a unit providing a
2850 more acute level of care due to the adverse incident, rather
2851 than the resident’s condition prior to the adverse incident; or
2852 8. An event that is reported to law enforcement or its
2853 personnel for investigation; or
2854 (b) Abuse, neglect, or exploitation as defined in s.
2855 415.102;
2856 (c) Abuse, neglect and harm as defined in s. 39.01;
2857 (b)(d) Resident elopement, if the elopement places the
2858 resident at risk of harm or injury.; or
2859 (e) An event that is reported to law enforcement.
2860 (9) Abuse, neglect, or exploitation must be reported to the
2861 agency as required by 42 C.F.R. s. 483.13(c) and to the
2862 department as required by chapters 39 and 415.
2863 (10)(9) By the 10th of each month, each facility subject to
2864 this section shall report any notice received pursuant to s.
2865 400.0233(2) and each initial complaint that was filed with the
2866 clerk of the court and served on the facility during the
2867 previous month by a resident or a resident’s family member,
2868 guardian, conservator, or personal legal representative. The
2869 report must include the name of the resident, the resident’s
2870 date of birth and social security number, the Medicaid
2871 identification number for Medicaid-eligible persons, the date or
2872 dates of the incident leading to the claim or dates of
2873 residency, if applicable, and the type of injury or violation of
2874 rights alleged to have occurred. Each facility shall also submit
2875 a copy of the notices received pursuant to s. 400.0233(2) and
2876 complaints filed with the clerk of the court. This report is
2877 confidential as provided by law and is not discoverable or
2878 admissible in any civil or administrative action, except in such
2879 actions brought by the agency to enforce the provisions of this
2880 part.
2881 (11)(10) The agency shall review, as part of its licensure
2882 inspection process, the internal risk management and quality
2883 assurance program at each facility regulated by this section to
2884 determine whether the program meets standards established in
2885 statutory laws and rules, is being conducted in a manner
2886 designed to reduce adverse incidents, and is appropriately
2887 reporting incidents as required by this section.
2888 (12)(11) There is no monetary liability on the part of, and
2889 a cause of action for damages may not arise against, any risk
2890 manager for the implementation and oversight of the internal
2891 risk management and quality assurance program in a facility
2892 licensed under this part as required by this section, or for any
2893 act or proceeding undertaken or performed within the scope of
2894 the functions of such internal risk management and quality
2895 assurance program if the risk manager acts without intentional
2896 fraud.
2897 (13)(12) If the agency, through its receipt of the adverse
2898 incident reports prescribed in subsection (7), or through any
2899 investigation, has a reasonable belief that conduct by a staff
2900 member or employee of a facility is grounds for disciplinary
2901 action by the appropriate regulatory board, the agency shall
2902 report this fact to the regulatory board.
2903 (14)(13) The agency may adopt rules to administer this
2904 section.
2905 (14) The agency shall annually submit to the Legislature a
2906 report on nursing home adverse incidents. The report must
2907 include the following information arranged by county:
2908 (a) The total number of adverse incidents.
2909 (b) A listing, by category, of the types of adverse
2910 incidents, the number of incidents occurring within each
2911 category, and the type of staff involved.
2912 (c) A listing, by category, of the types of injury caused
2913 and the number of injuries occurring within each category.
2914 (d) Types of liability claims filed based on an adverse
2915 incident or reportable injury.
2916 (e) Disciplinary action taken against staff, categorized by
2917 type of staff involved.
2918 (15) Information gathered by a credentialing organization
2919 under a quality assurance program is not discoverable from the
2920 credentialing organization. This subsection does not limit
2921 discovery of, access to, or use of facility records, including
2922 those records from which the credentialing organization gathered
2923 its information.
2924 Section 40. Subsection (3) of section 400.162, Florida
2925 Statutes, is amended to read:
2926 400.162 Property and personal affairs of residents.—
2927 (3) A licensee shall provide for the safekeeping of
2928 personal effects, funds, and other property of the resident in
2929 the facility. Whenever necessary for the protection of
2930 valuables, or in order to avoid unreasonable responsibility
2931 therefor, the licensee may require that such valuables be
2932 excluded or removed from the facility and kept at some place not
2933 subject to the control of the licensee. At the request of a
2934 resident, the facility shall mark the resident’s personal
2935 property with the resident’s name or another type of
2936 identification, without defacing the property. Any theft or loss
2937 of a resident’s personal property shall be documented by the
2938 facility. The facility shall develop policies and procedures to
2939 minimize the risk of theft or loss of the personal property of
2940 residents. A copy of the policy shall be provided to every
2941 employee and to each resident and the resident’s representative
2942 if appropriate at admission and when revised. Facility policies
2943 must include provisions related to reporting theft or loss of a
2944 resident’s property to law enforcement and any facility waiver
2945 of liability for loss or theft. The facility shall post notice
2946 of these policies and procedures, and any revision thereof, in
2947 places accessible to residents.
2948 Section 41. Paragraphs (a) and (b) of subsection (2) of
2949 section 400.191, Florida Statutes, are amended to read:
2950 400.191 Availability, distribution, and posting of reports
2951 and records.—
2952 (2) The agency shall publish the Nursing Home Guide
2953 annually in consumer-friendly printed form and quarterly in
2954 electronic form to assist consumers and their families in
2955 comparing and evaluating nursing home facilities.
2956 (a) The agency shall provide an Internet site which shall
2957 include at least the following information either directly or
2958 indirectly through a link to another established site or sites
2959 of the agency’s choosing:
2960 1. A section entitled “Have you considered programs that
2961 provide alternatives to nursing home care?” which shall be the
2962 first section of the Nursing Home Guide and which shall
2963 prominently display information about available alternatives to
2964 nursing homes and how to obtain additional information regarding
2965 these alternatives. The Nursing Home Guide shall explain that
2966 this state offers alternative programs that permit qualified
2967 elderly persons to stay in their homes instead of being placed
2968 in nursing homes and shall encourage interested persons to call
2969 the Comprehensive Assessment Review and Evaluation for Long-Term
2970 Care Services (CARES) Program to inquire if they qualify. The
2971 Nursing Home Guide shall list available home and community-based
2972 programs which shall clearly state the services that are
2973 provided and indicate whether nursing home services are included
2974 if needed.
2975 2. A list by name and address of all nursing home
2976 facilities in this state, including any prior name by which a
2977 facility was known during the previous 24-month period.
2978 3. Whether such nursing home facilities are proprietary or
2979 nonproprietary.
2980 4. The current owner of the facility’s license and the year
2981 that that entity became the owner of the license.
2982 5. The name of the owner or owners of each facility and
2983 whether the facility is affiliated with a company or other
2984 organization owning or managing more than one nursing facility
2985 in this state.
2986 6. The total number of beds in each facility and the most
2987 recently available occupancy levels.
2988 7. The number of private and semiprivate rooms in each
2989 facility.
2990 8. The religious affiliation, if any, of each facility.
2991 9. The languages spoken by the administrator and staff of
2992 each facility.
2993 10. Whether or not each facility accepts Medicare or
2994 Medicaid recipients or insurance, health maintenance
2995 organization, Veterans Administration, CHAMPUS program, or
2996 workers’ compensation coverage.
2997 11. Recreational and other programs available at each
2998 facility.
2999 12. Special care units or programs offered at each
3000 facility.
3001 13. Whether the facility is a part of a retirement
3002 community that offers other services pursuant to part III of
3003 this chapter or part I or part III of chapter 429.
3004 14. Survey and deficiency information, including all
3005 federal and state recertification, licensure, revisit, and
3006 complaint survey information, for each facility for the past 30
3007 months. For noncertified nursing homes, state survey and
3008 deficiency information, including licensure, revisit, and
3009 complaint survey information for the past 30 months shall be
3010 provided.
3011 15. A summary of the deficiency data for each facility over
3012 the past 30 months. The summary may include a score, rating, or
3013 comparison ranking with respect to other facilities based on the
3014 number of citations received by the facility on recertification,
3015 licensure, revisit, and complaint surveys; the severity and
3016 scope of the citations; and the number of recertification
3017 surveys the facility has had during the past 30 months. The
3018 score, rating, or comparison ranking may be presented in either
3019 numeric or symbolic form for the intended consumer audience.
3020 (b) The agency shall provide the following information in
3021 printed form:
3022 1. A section entitled “Have you considered programs that
3023 provide alternatives to nursing home care?” which shall be the
3024 first section of the Nursing Home Guide and which shall
3025 prominently display information about available alternatives to
3026 nursing homes and how to obtain additional information regarding
3027 these alternatives. The Nursing Home Guide shall explain that
3028 this state offers alternative programs that permit qualified
3029 elderly persons to stay in their homes instead of being placed
3030 in nursing homes and shall encourage interested persons to call
3031 the Comprehensive Assessment Review and Evaluation for Long-Term
3032 Care Services (CARES) Program to inquire if they qualify. The
3033 Nursing Home Guide shall list available home and community-based
3034 programs which shall clearly state the services that are
3035 provided and indicate whether nursing home services are included
3036 if needed.
3037 2. A list by name and address of all nursing home
3038 facilities in this state.
3039 3. Whether the nursing home facilities are proprietary or
3040 nonproprietary.
3041 4. The current owner or owners of the facility’s license
3042 and the year that entity became the owner of the license.
3043 5. The total number of beds, and of private and semiprivate
3044 rooms, in each facility.
3045 6. The religious affiliation, if any, of each facility.
3046 7. The name of the owner of each facility and whether the
3047 facility is affiliated with a company or other organization
3048 owning or managing more than one nursing facility in this state.
3049 8. The languages spoken by the administrator and staff of
3050 each facility.
3051 9. Whether or not each facility accepts Medicare or
3052 Medicaid recipients or insurance, health maintenance
3053 organization, Veterans Administration, CHAMPUS program, or
3054 workers’ compensation coverage.
3055 10. Recreational programs, special care units, and other
3056 programs available at each facility.
3057 11. The Internet address for the site where more detailed
3058 information can be seen.
3059 12. A statement advising consumers that each facility will
3060 have its own policies and procedures related to protecting
3061 resident property.
3062 13. A summary of the deficiency data for each facility over
3063 the past 30 months. The summary may include a score, rating, or
3064 comparison ranking with respect to other facilities based on the
3065 number of citations received by the facility on recertification,
3066 licensure, revisit, and complaint surveys; the severity and
3067 scope of the citations; the number of citations; and the number
3068 of recertification surveys the facility has had during the past
3069 30 months. The score, rating, or comparison ranking may be
3070 presented in either numeric or symbolic form for the intended
3071 consumer audience.
3072 Section 42. Paragraph (d) of subsection (1) of section
3073 400.195, Florida Statutes, is amended to read:
3074 400.195 Agency reporting requirements.—
3075 (1) For the period beginning June 30, 2001, and ending June
3076 30, 2005, the Agency for Health Care Administration shall
3077 provide a report to the Governor, the President of the Senate,
3078 and the Speaker of the House of Representatives with respect to
3079 nursing homes. The first report shall be submitted no later than
3080 December 30, 2002, and subsequent reports shall be submitted
3081 every 6 months thereafter. The report shall identify facilities
3082 based on their ownership characteristics, size, business
3083 structure, for-profit or not-for-profit status, and any other
3084 characteristics the agency determines useful in analyzing the
3085 varied segments of the nursing home industry and shall report:
3086 (d) Information regarding deficiencies cited, including
3087 information used to develop the Nursing Home Guide WATCH LIST
3088 pursuant to s. 400.191, and applicable rules, a summary of data
3089 generated on nursing homes by Centers for Medicare and Medicaid
3090 Services Nursing Home Quality Information Project, and
3091 information collected pursuant to s. 400.147(10) s. 400.147(9),
3092 relating to litigation.
3093 Section 43. Subsection (3) of section 400.23, Florida
3094 Statutes, is amended to read:
3095 400.23 Rules; evaluation and deficiencies; licensure
3096 status.—
3097 (3)(a)1. The agency shall adopt rules providing minimum
3098 staffing requirements for nursing homes. These requirements
3099 shall include, for each nursing home facility:
3100 a. A minimum certified nursing assistant staffing of 2.6
3101 hours of direct care per resident per day beginning January 1,
3102 2003, and increasing to 2.7 hours of direct care per resident
3103 per day beginning January 1, 2007. Beginning January 1, 2002, no
3104 facility shall staff below one certified nursing assistant per
3105 20 residents, and a minimum licensed nursing staffing of 1.0
3106 hour of direct care per resident per day but never below one
3107 licensed nurse per 40 residents.
3108 b. Beginning January 1, 2007, a minimum weekly average
3109 certified nursing assistant staffing of 2.9 hours of direct care
3110 per resident per day. For the purpose of this sub-subparagraph,
3111 a week is defined as Sunday through Saturday.
3112 2. Nursing assistants employed under s. 400.211(2) may be
3113 included in computing the staffing ratio for certified nursing
3114 assistants only if their job responsibilities include only
3115 nursing-assistant-related duties.
3116 3. Each nursing home must document compliance with staffing
3117 standards as required under this paragraph and post daily the
3118 names of staff on duty for the benefit of facility residents and
3119 the public.
3120 4. The agency shall recognize the use of licensed nurses
3121 for compliance with minimum staffing requirements for certified
3122 nursing assistants, provided that the facility otherwise meets
3123 the minimum staffing requirements for licensed nurses and that
3124 the licensed nurses are performing the duties of a certified
3125 nursing assistant. Unless otherwise approved by the agency,
3126 licensed nurses counted toward the minimum staffing requirements
3127 for certified nursing assistants must exclusively perform the
3128 duties of a certified nursing assistant for the entire shift and
3129 not also be counted toward the minimum staffing requirements for
3130 licensed nurses. If the agency approved a facility’s request to
3131 use a licensed nurse to perform both licensed nursing and
3132 certified nursing assistant duties, the facility must allocate
3133 the amount of staff time specifically spent on certified nursing
3134 assistant duties for the purpose of documenting compliance with
3135 minimum staffing requirements for certified and licensed nursing
3136 staff. In no event may the hours of a licensed nurse with dual
3137 job responsibilities be counted twice.
3138 (b) The agency shall adopt rules to allow properly trained
3139 staff of a nursing facility, in addition to certified nursing
3140 assistants and licensed nurses, to assist residents with eating.
3141 The rules shall specify the minimum training requirements and
3142 shall specify the physiological conditions or disorders of
3143 residents which would necessitate that the eating assistance be
3144 provided by nursing personnel of the facility. Nonnursing staff
3145 providing eating assistance to residents under the provisions of
3146 this subsection shall not count toward compliance with minimum
3147 staffing standards.
3148 (c) Licensed practical nurses licensed under chapter 464
3149 who are providing nursing services in nursing home facilities
3150 under this part may supervise the activities of other licensed
3151 practical nurses, certified nursing assistants, and other
3152 unlicensed personnel providing services in such facilities in
3153 accordance with rules adopted by the Board of Nursing.
3154 Section 44. Paragraph (a) of subsection (7) of section
3155 400.9935, Florida Statutes, is amended to read:
3156 400.9935 Clinic responsibilities.—
3157 (7)(a) Each clinic engaged in magnetic resonance imaging
3158 services must be accredited by the Joint Commission on
3159 Accreditation of Healthcare Organizations, the American College
3160 of Radiology, or the Accreditation Association for Ambulatory
3161 Health Care, within 1 year after licensure. A clinic that is
3162 accredited by the American College of Radiology or is within the
3163 original 1-year period after licensure and replaces its core
3164 magnetic resonance imaging equipment shall be given 1 year after
3165 the date on which the equipment is replaced to attain
3166 accreditation. However, a clinic may request a single, 6-month
3167 extension if it provides evidence to the agency establishing
3168 that, for good cause shown, such clinic cannot can not be
3169 accredited within 1 year after licensure, and that such
3170 accreditation will be completed within the 6-month extension.
3171 After obtaining accreditation as required by this subsection,
3172 each such clinic must maintain accreditation as a condition of
3173 renewal of its license. A clinic that files a change of
3174 ownership application must comply with the original
3175 accreditation timeframe requirements of the transferor. The
3176 agency shall deny a change of ownership application if the
3177 clinic is not in compliance with the accreditation requirements.
3178 When a clinic adds, replaces, or modifies magnetic resonance
3179 imaging equipment and the accreditation agency requires new
3180 accreditation, the clinic must be accredited within 1 year after
3181 the date of the addition, replacement, or modification but may
3182 request a single, 6-month extension if the clinic provides
3183 evidence of good cause to the agency.
3184 Section 45. Subsection (6) of section 400.995, Florida
3185 Statutes, is amended to read:
3186 400.995 Agency administrative penalties.—
3187 (6) During an inspection, the agency, as an alternative to
3188 or in conjunction with an administrative action against a clinic
3189 for violations of this part and adopted rules, shall make a
3190 reasonable attempt to discuss each violation and recommended
3191 corrective action with the owner, medical director, or clinic
3192 director of the clinic, prior to written notification. The
3193 agency, instead of fixing a period within which the clinic shall
3194 enter into compliance with standards, may request a plan of
3195 corrective action from the clinic which demonstrates a good
3196 faith effort to remedy each violation by a specific date,
3197 subject to the approval of the agency.
3198 Section 46. Subsections (5), (9), and (13) of section
3199 408.803, Florida Statutes, are amended to read:
3200 408.803 Definitions.—As used in this part, the term:
3201 (5) “Change of ownership” means:
3202 (a) An event in which the licensee sells or otherwise
3203 transfers its ownership changes to a different individual or
3204 legal entity as evidenced by a change in federal employer
3205 identification number or taxpayer identification number; or
3206 (b) An event in which 51 45 percent or more of the
3207 ownership, voting shares, membership, or controlling interest of
3208 a licensee is in any manner transferred or otherwise assigned.
3209 This paragraph does not apply to a licensee that is publicly
3210 traded on a recognized stock exchange in a corporation whose
3211 shares are not publicly traded on a recognized stock exchange is
3212 transferred or assigned, including the final transfer or
3213 assignment of multiple transfers or assignments over a 2-year
3214 period that cumulatively total 45 percent or greater.
3215
3216 A change solely in the management company or board of directors
3217 is not a change of ownership.
3218 (9) “Licensee” means an individual, corporation,
3219 partnership, firm, association, or governmental entity, or other
3220 entity that is issued a permit, registration, certificate, or
3221 license by the agency. The licensee is legally responsible for
3222 all aspects of the provider operation.
3223 (13) “Voluntary board member” means a board member or
3224 officer of a not-for-profit corporation or organization who
3225 serves solely in a voluntary capacity, does not receive any
3226 remuneration for his or her services on the board of directors,
3227 and has no financial interest in the corporation or
3228 organization. The agency shall recognize a person as a voluntary
3229 board member following submission of a statement to the agency
3230 by the board member and the not-for-profit corporation or
3231 organization that affirms that the board member conforms to this
3232 definition. The statement affirming the status of the board
3233 member must be submitted to the agency on a form provided by the
3234 agency.
3235 Section 47. Paragraph (a) of subsection (1), subsection
3236 (2), paragraph (c) of subsection (7), and subsection (8) of
3237 section 408.806, Florida Statutes, are amended to read:
3238 408.806 License application process.—
3239 (1) An application for licensure must be made to the agency
3240 on forms furnished by the agency, submitted under oath, and
3241 accompanied by the appropriate fee in order to be accepted and
3242 considered timely. The application must contain information
3243 required by authorizing statutes and applicable rules and must
3244 include:
3245 (a) The name, address, and social security number of:
3246 1. The applicant;
3247 2. The administrator or a similarly titled person who is
3248 responsible for the day-to-day operation of the provider;
3249 3. The financial officer or similarly titled person who is
3250 responsible for the financial operation of the licensee or
3251 provider; and
3252 4. Each controlling interest if the applicant or
3253 controlling interest is an individual.
3254 (2)(a) The applicant for a renewal license must submit an
3255 application that must be received by the agency at least 60 days
3256 but no more than 120 days before prior to the expiration of the
3257 current license. An application received more than 120 days
3258 before the expiration of the current license shall be returned
3259 to the applicant. If the renewal application and fee are
3260 received prior to the license expiration date, the license shall
3261 not be deemed to have expired if the license expiration date
3262 occurs during the agency’s review of the renewal application.
3263 (b) The applicant for initial licensure due to a change of
3264 ownership must submit an application that must be received by
3265 the agency at least 60 days prior to the date of change of
3266 ownership.
3267 (c) For any other application or request, the applicant
3268 must submit an application or request that must be received by
3269 the agency at least 60 days but no more than 120 days before
3270 prior to the requested effective date, unless otherwise
3271 specified in authorizing statutes or applicable rules. An
3272 application received more than 120 days before the requested
3273 effective date shall be returned to the applicant.
3274 (d) The agency shall notify the licensee by mail or
3275 electronically at least 90 days before prior to the expiration
3276 of a license that a renewal license is necessary to continue
3277 operation. The failure to timely submit a renewal application
3278 and license fee shall result in a $50 per day late fee charged
3279 to the licensee by the agency; however, the aggregate amount of
3280 the late fee may not exceed 50 percent of the licensure fee or
3281 $500, whichever is less. If an application is received after the
3282 required filing date and exhibits a hand-canceled postmark
3283 obtained from a United States post office dated on or before the
3284 required filing date, no fine will be levied.
3285 (7)
3286 (c) If an inspection is required by the authorizing statute
3287 for a license application other than an initial application, the
3288 inspection must be unannounced. This paragraph does not apply to
3289 inspections required pursuant to ss. 383.324, 395.0161(4),
3290 429.67(6), and 483.061(2).
3291 (8) The agency may establish procedures for the electronic
3292 notification and submission of required information, including,
3293 but not limited to:
3294 (a) Licensure applications.
3295 (b) Required signatures.
3296 (c) Payment of fees.
3297 (d) Notarization of applications.
3298
3299 Requirements for electronic submission of any documents required
3300 by this part or authorizing statutes may be established by rule.
3301 As an alternative to sending documents as required by
3302 authorizing statutes, the agency may provide electronic access
3303 to information or documents.
3304 Section 48. Subsection (2) of section 408.808, Florida
3305 Statutes, is amended to read:
3306 408.808 License categories.—
3307 (2) PROVISIONAL LICENSE.—A provisional license may be
3308 issued to an applicant pursuant to s. 408.809(3). An applicant
3309 against whom a proceeding denying or revoking a license is
3310 pending at the time of license renewal may be issued a
3311 provisional license effective until final action not subject to
3312 further appeal. A provisional license may also be issued to an
3313 applicant applying for a change of ownership. A provisional
3314 license shall be limited in duration to a specific period of
3315 time, not to exceed 12 months, as determined by the agency.
3316 Section 49. Subsection (5) of section 408.809, Florida
3317 Statutes, is amended, and subsection (6) is added to that
3318 section, to read:
3319 408.809 Background screening; prohibited offenses.—
3320 (5) Effective October 1, 2009, in addition to the offenses
3321 listed in ss. 435.03 and 435.04, all persons required to undergo
3322 background screening pursuant to this part or authorizing
3323 statutes must not have been found guilty of, regardless of
3324 adjudication, or entered a plea of nolo contendere or guilty to,
3325 any of the following offenses or any similar offense of another
3326 jurisdiction:
3327 (a) Any authorizing statutes, if the offense was a felony.
3328 (b) This chapter, if the offense was a felony.
3329 (c) Section 409.920, relating to Medicaid provider fraud,
3330 if the offense was a felony.
3331 (d) Section 409.9201, relating to Medicaid fraud, if the
3332 offense was a felony.
3333 (e) Section 741.28, relating to domestic violence.
3334 (f) Chapter 784, relating to assault, battery, and culpable
3335 negligence, if the offense was a felony.
3336 (g) Section 810.02, relating to burglary.
3337 (h) Section 817.034, relating to fraudulent acts through
3338 mail, wire, radio, electromagnetic, photoelectronic, or
3339 photooptical systems.
3340 (i) Section 817.234, relating to false and fraudulent
3341 insurance claims.
3342 (j) Section 817.505, relating to patient brokering.
3343 (k) Section 817.568, relating to criminal use of personal
3344 identification information.
3345 (l) Section 817.60, relating to obtaining a credit card
3346 through fraudulent means.
3347 (m) Section 817.61, relating to fraudulent use of credit
3348 cards, if the offense was a felony.
3349 (n) Section 831.01, relating to forgery.
3350 (o) Section 831.02, relating to uttering forged
3351 instruments.
3352 (p) Section 831.07, relating to forging bank bills, checks,
3353 drafts, or promissory notes.
3354 (q) Section 831.09, relating to uttering forged bank bills,
3355 checks, drafts, or promissory notes.
3356 (r) Section 831.30, relating to fraud in obtaining
3357 medicinal drugs.
3358 (s) Section 831.31, relating to the sale, manufacture,
3359 delivery, or possession with the intent to sell, manufacture, or
3360 deliver any counterfeit controlled substance, if the offense was
3361 a felony.
3362
3363 A person who serves as a controlling interest of or is employed
3364 by a licensee on September 30, 2009, is not required by law to
3365 submit to rescreening if that licensee has in its possession
3366 written evidence that the person has been screened and qualified
3367 according to the standards specified in s. 435.03 or s. 435.04.
3368 However, if such person has a disqualifying offense listed in
3369 this section, he or she may apply for an exemption from the
3370 appropriate licensing agency before September 30, 2009, and if
3371 agreed to by the employer, may continue to perform his or her
3372 duties until the licensing agency renders a decision on the
3373 application for exemption for offenses listed in this section.
3374 Exemptions from disqualification may be granted pursuant to s.
3375 435.07. Background screening is not required to obtain a
3376 certificate of exemption issued under s. 483.106.
3377 (6) The attestations required under ss. 435.04(5) and
3378 435.05(3) must be submitted at the time of license renewal,
3379 notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
3380 which require annual submission of an affidavit of compliance
3381 with background screening requirements.
3382 Section 50. Section 408.811, Florida Statutes, is amended
3383 to read:
3384 408.811 Right of inspection; copies; inspection reports;
3385 plan for correction of deficiencies.—
3386 (1) An authorized officer or employee of the agency may
3387 make or cause to be made any inspection or investigation deemed
3388 necessary by the agency to determine the state of compliance
3389 with this part, authorizing statutes, and applicable rules. The
3390 right of inspection extends to any business that the agency has
3391 reason to believe is being operated as a provider without a
3392 license, but inspection of any business suspected of being
3393 operated without the appropriate license may not be made without
3394 the permission of the owner or person in charge unless a warrant
3395 is first obtained from a circuit court. Any application for a
3396 license issued under this part, authorizing statutes, or
3397 applicable rules constitutes permission for an appropriate
3398 inspection to verify the information submitted on or in
3399 connection with the application.
3400 (a) All inspections shall be unannounced, except as
3401 specified in s. 408.806.
3402 (b) Inspections for relicensure shall be conducted
3403 biennially unless otherwise specified by authorizing statutes or
3404 applicable rules.
3405 (2) Inspections conducted in conjunction with
3406 certification, comparable licensure requirements, or a
3407 recognized or approved accreditation organization may be
3408 accepted in lieu of a complete licensure inspection. However, a
3409 licensure inspection may also be conducted to review any
3410 licensure requirements that are not also requirements for
3411 certification.
3412 (3) The agency shall have access to and the licensee shall
3413 provide, or if requested send, copies of all provider records
3414 required during an inspection or other review at no cost to the
3415 agency, including records requested during an offsite review.
3416 (4) A deficiency must be corrected within 30 calendar days
3417 after the provider is notified of inspection results unless an
3418 alternative timeframe is required or approved by the agency.
3419 (5) The agency may require an applicant or licensee to
3420 submit a plan of correction for deficiencies. If required, the
3421 plan of correction must be filed with the agency within 10
3422 calendar days after notification unless an alternative timeframe
3423 is required.
3424 (6)(a)(4)(a) Each licensee shall maintain as public
3425 information, available upon request, records of all inspection
3426 reports pertaining to that provider that have been filed by the
3427 agency unless those reports are exempt from or contain
3428 information that is exempt from s. 119.07(1) and s. 24(a), Art.
3429 I of the State Constitution or is otherwise made confidential by
3430 law. Effective October 1, 2006, copies of such reports shall be
3431 retained in the records of the provider for at least 3 years
3432 following the date the reports are filed and issued, regardless
3433 of a change of ownership.
3434 (b) A licensee shall, upon the request of any person who
3435 has completed a written application with intent to be admitted
3436 by such provider, any person who is a client of such provider,
3437 or any relative, spouse, or guardian of any such person, furnish
3438 to the requester a copy of the last inspection report pertaining
3439 to the licensed provider that was issued by the agency or by an
3440 accrediting organization if such report is used in lieu of a
3441 licensure inspection.
3442 Section 51. Section 408.813, Florida Statutes, is amended
3443 to read:
3444 408.813 Administrative fines; violations.—As a penalty for
3445 any violation of this part, authorizing statutes, or applicable
3446 rules, the agency may impose an administrative fine.
3447 (1) Unless the amount or aggregate limitation of the fine
3448 is prescribed by authorizing statutes or applicable rules, the
3449 agency may establish criteria by rule for the amount or
3450 aggregate limitation of administrative fines applicable to this
3451 part, authorizing statutes, and applicable rules. Each day of
3452 violation constitutes a separate violation and is subject to a
3453 separate fine. For fines imposed by final order of the agency
3454 and not subject to further appeal, the violator shall pay the
3455 fine plus interest at the rate specified in s. 55.03 for each
3456 day beyond the date set by the agency for payment of the fine.
3457 (2) Violations of this part, authorizing statutes, or
3458 applicable rules shall be classified according to the nature of
3459 the violation and the gravity of its probable effect on clients.
3460 The scope of a violation may be cited as an isolated, patterned,
3461 or widespread deficiency. An isolated deficiency is a deficiency
3462 affecting one or a very limited number of clients, or involving
3463 one or a very limited number of staff, or a situation that
3464 occurred only occasionally or in a very limited number of
3465 locations. A patterned deficiency is a deficiency in which more
3466 than a very limited number of clients are affected, or more than
3467 a very limited number of staff are involved, or the situation
3468 has occurred in several locations, or the same client or clients
3469 have been affected by repeated occurrences of the same deficient
3470 practice but the effect of the deficient practice is not found
3471 to be pervasive throughout the provider. A widespread deficiency
3472 is a deficiency in which the problems causing the deficiency are
3473 pervasive in the provider or represent systemic failure that has
3474 affected or has the potential to affect a large portion of the
3475 provider’s clients. This subsection does not affect the
3476 legislative determination of the amount of a fine imposed under
3477 authorizing statutes. Violations shall be classified on the
3478 written notice as follows:
3479 (a) Class “I” violations are those conditions or
3480 occurrences related to the operation and maintenance of a
3481 provider or to the care of clients which the agency determines
3482 present an imminent danger to the clients of the provider or a
3483 substantial probability that death or serious physical or
3484 emotional harm would result therefrom. The condition or practice
3485 constituting a class I violation shall be abated or eliminated
3486 within 24 hours, unless a fixed period, as determined by the
3487 agency, is required for correction. The agency shall impose an
3488 administrative fine as provided by law for a cited class I
3489 violation. A fine shall be levied notwithstanding the correction
3490 of the violation.
3491 (b) Class “II” violations are those conditions or
3492 occurrences related to the operation and maintenance of a
3493 provider or to the care of clients which the agency determines
3494 directly threaten the physical or emotional health, safety, or
3495 security of the clients, other than class I violations. The
3496 agency shall impose an administrative fine as provided by law
3497 for a cited class II violation. A fine shall be levied
3498 notwithstanding the correction of the violation.
3499 (c) Class “III” violations are those conditions or
3500 occurrences related to the operation and maintenance of a
3501 provider or to the care of clients which the agency determines
3502 indirectly or potentially threaten the physical or emotional
3503 health, safety, or security of clients, other than class I or
3504 class II violations. The agency shall impose an administrative
3505 fine as provided in this section for a cited class III
3506 violation. A citation for a class III violation must specify the
3507 time within which the violation is required to be corrected. If
3508 a class III violation is corrected within the time specified, a
3509 fine may not be imposed.
3510 (d) Class “IV” violations are those conditions or
3511 occurrences related to the operation and maintenance of a
3512 provider or to required reports, forms, or documents that do not
3513 have the potential of negatively affecting clients. These
3514 violations are of a type that the agency determines do not
3515 threaten the health, safety, or security of clients. The agency
3516 shall impose an administrative fine as provided in this section
3517 for a cited class IV violation. A citation for a class IV
3518 violation must specify the time within which the violation is
3519 required to be corrected. If a class IV violation is corrected
3520 within the time specified, a fine may not be imposed.
3521 Section 52. Subsections (11), (12), (13), (14), (15), (16),
3522 (17), (18), (19), (20), (21), (22), (23), (24), (25), (26),
3523 (27), (28), and (29) of section 408.820, Florida Statutes, are
3524 amended to read:
3525 408.820 Exemptions.—Except as prescribed in authorizing
3526 statutes, the following exemptions shall apply to specified
3527 requirements of this part:
3528 (11) Private review agents, as provided under part I of
3529 chapter 395, are exempt from ss. 408.806(7), 408.810, and
3530 408.811.
3531 (11)(12) Health care risk managers, as provided under part
3532 I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)
3533 (10) 408.810, and 408.811.
3534 (12)(13) Nursing homes, as provided under part II of
3535 chapter 400, are exempt from ss. 408.810(7) and 408.813(2) s.
3536 408.810(7).
3537 (13)(14) Assisted living facilities, as provided under part
3538 I of chapter 429, are exempt from s. 408.810(10).
3539 (14)(15) Home health agencies, as provided under part III
3540 of chapter 400, are exempt from s. 408.810(10).
3541 (15)(16) Nurse registries, as provided under part III of
3542 chapter 400, are exempt from s. 408.810(6) and (10).
3543 (16)(17) Companion services or homemaker services
3544 providers, as provided under part III of chapter 400, are exempt
3545 from s. 408.810(6)-(10).
3546 (17)(18) Adult day care centers, as provided under part III
3547 of chapter 429, are exempt from s. 408.810(10).
3548 (18)(19) Adult family-care homes, as provided under part II
3549 of chapter 429, are exempt from s. 408.810(7)-(10).
3550 (18)(20) Homes for special services, as provided under part
3551 V of chapter 400, are exempt from s. 408.810(7)-(10).
3552 (20)(21) Transitional living facilities, as provided under
3553 part V of chapter 400, are exempt from s. 408.810(10) s.
3554 408.810(7)-(10).
3555 (21)(22) Prescribed pediatric extended care centers, as
3556 provided under part VI of chapter 400, are exempt from s.
3557 408.810(10).
3558 (22)(23) Home medical equipment providers, as provided
3559 under part VII of chapter 400, are exempt from s. 408.810(10).
3560 (23)(24) Intermediate care facilities for persons with
3561 developmental disabilities, as provided under part VIII of
3562 chapter 400, are exempt from s. 408.810(7).
3563 (24)(25) Health care services pools, as provided under part
3564 IX of chapter 400, are exempt from s. 408.810(6)-(10).
3565 (25)(26) Health care clinics, as provided under part X of
3566 chapter 400, are exempt from s. 408.810(6), (7), (10) ss.
3567 408.809 and 408.810(1), (6), (7), and (10).
3568 (26)(27) Clinical laboratories, as provided under part I of
3569 chapter 483, are exempt from s. 408.810(5)-(10).
3570 (27)(28) Multiphasic health testing centers, as provided
3571 under part II of chapter 483, are exempt from s. 408.810(5)
3572 (10).
3573 (28)(29) Organ and tissue procurement agencies, as provided
3574 under chapter 765, are exempt from s. 408.810(5)-(10).
3575 Section 53. Section 408.821, Florida Statutes, is created
3576 to read:
3577 408.821 Emergency management planning; emergency
3578 operations; inactive license.—
3579 (1) A licensee required by authorizing statutes to have an
3580 emergency operations plan must designate a safety liaison to
3581 serve as the primary contact for emergency operations.
3582 (2) An entity subject to this part may temporarily exceed
3583 its licensed capacity to act as a receiving provider in
3584 accordance with an approved emergency operations plan for up to
3585 15 days. While in an overcapacity status, each provider must
3586 furnish or arrange for appropriate care and services to all
3587 clients. In addition, the agency may approve requests for
3588 overcapacity in excess of 15 days, which approvals may be based
3589 upon satisfactory justification and need as provided by the
3590 receiving and sending providers.
3591 (3)(a) An inactive license may be issued to a licensee
3592 subject to this section when the provider is located in a
3593 geographic area in which a state of emergency was declared by
3594 the Governor if the provider:
3595 1. Suffered damage to its operation during the state of
3596 emergency.
3597 2. Is currently licensed.
3598 3. Does not have a provisional license.
3599 4. Will be temporarily unable to provide services but is
3600 reasonably expected to resume services within 12 months.
3601 (b) An inactive license may be issued for a period not to
3602 exceed 12 months but may be renewed by the agency for up to 12
3603 additional months upon demonstration to the agency of progress
3604 toward reopening. A request by a licensee for an inactive
3605 license or to extend the previously approved inactive period
3606 must be submitted in writing to the agency, accompanied by
3607 written justification for the inactive license, which states the
3608 beginning and ending dates of inactivity and includes a plan for
3609 the transfer of any clients to other providers and appropriate
3610 licensure fees. Upon agency approval, the licensee shall notify
3611 clients of any necessary discharge or transfer as required by
3612 authorizing statutes or applicable rules. The beginning of the
3613 inactive licensure period shall be the date the provider ceases
3614 operations. The end of the inactive period shall become the
3615 license expiration date, and all licensure fees must be current,
3616 must be paid in full, and may be prorated. Reactivation of an
3617 inactive license requires the prior approval by the agency of a
3618 renewal application, including payment of licensure fees and
3619 agency inspections indicating compliance with all requirements
3620 of this part and applicable rules and statutes.
3621 (4) The agency may adopt rules relating to emergency
3622 management planning, communications, and operations. Licensees
3623 providing residential or inpatient services must utilize an
3624 online database approved by the agency to report information to
3625 the agency regarding the provider’s emergency status, planning,
3626 or operations.
3627 Section 54. Section 408.831, Florida Statutes, is amended
3628 to read:
3629 408.831 Denial, suspension, or revocation of a license,
3630 registration, certificate, or application.—
3631 (1) In addition to any other remedies provided by law, the
3632 agency may deny each application or suspend or revoke each
3633 license, registration, or certificate of entities regulated or
3634 licensed by it:
3635 (a) If the applicant, licensee, or a licensee subject to
3636 this part which shares a common controlling interest with the
3637 applicant has failed to pay all outstanding fines, liens, or
3638 overpayments assessed by final order of the agency or final
3639 order of the Centers for Medicare and Medicaid Services, not
3640 subject to further appeal, unless a repayment plan is approved
3641 by the agency; or
3642 (b) For failure to comply with any repayment plan.
3643 (2) In reviewing any application requesting a change of
3644 ownership or change of the licensee, registrant, or
3645 certificateholder, the transferor shall, prior to agency
3646 approval of the change, repay or make arrangements to repay any
3647 amounts owed to the agency. Should the transferor fail to repay
3648 or make arrangements to repay the amounts owed to the agency,
3649 the issuance of a license, registration, or certificate to the
3650 transferee shall be delayed until repayment or until
3651 arrangements for repayment are made.
3652 (3) An entity subject to this section may exceed its
3653 licensed capacity to act as a receiving facility in accordance
3654 with an emergency operations plan for clients of evacuating
3655 providers from a geographic area where an evacuation order has
3656 been issued by a local authority having jurisdiction. While in
3657 an overcapacity status, each provider must furnish or arrange
3658 for appropriate care and services to all clients. In addition,
3659 the agency may approve requests for overcapacity beyond 15 days,
3660 which approvals may be based upon satisfactory justification and
3661 need as provided by the receiving and sending facilities.
3662 (4)(a) An inactive license may be issued to a licensee
3663 subject to this section when the provider is located in a
3664 geographic area where a state of emergency was declared by the
3665 Governor if the provider:
3666 1. Suffered damage to its operation during that state of
3667 emergency.
3668 2. Is currently licensed.
3669 3. Does not have a provisional license.
3670 4. Will be temporarily unable to provide services but is
3671 reasonably expected to resume services within 12 months.
3672 (b) An inactive license may be issued for a period not to
3673 exceed 12 months but may be renewed by the agency for up to 12
3674 additional months upon demonstration to the agency of progress
3675 toward reopening. A request by a licensee for an inactive
3676 license or to extend the previously approved inactive period
3677 must be submitted in writing to the agency, accompanied by
3678 written justification for the inactive license, which states the
3679 beginning and ending dates of inactivity and includes a plan for
3680 the transfer of any clients to other providers and appropriate
3681 licensure fees. Upon agency approval, the licensee shall notify
3682 clients of any necessary discharge or transfer as required by
3683 authorizing statutes or applicable rules. The beginning of the
3684 inactive licensure period shall be the date the provider ceases
3685 operations. The end of the inactive period shall become the
3686 licensee expiration date, and all licensure fees must be
3687 current, paid in full, and may be prorated. Reactivation of an
3688 inactive license requires the prior approval by the agency of a
3689 renewal application, including payment of licensure fees and
3690 agency inspections indicating compliance with all requirements
3691 of this part and applicable rules and statutes.
3692 (3)(5) This section provides standards of enforcement
3693 applicable to all entities licensed or regulated by the Agency
3694 for Health Care Administration. This section controls over any
3695 conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
3696 400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
3697 those chapters.
3698 Section 55. Subsection (2) of section 408.918, Florida
3699 Statutes, is amended, and subsection (3) is added to that
3700 section, to read:
3701 408.918 Florida 211 Network; uniform certification
3702 requirements.—
3703 (2) In order to participate in the Florida 211 Network, a
3704 211 provider must be fully accredited by the National certified
3705 by the Agency for Health Care Administration. The agency shall
3706 develop criteria for certification, as recommended by the
3707 Florida Alliance of Information and Referral Services or have
3708 received approval to operate, pending accreditation, from its
3709 affiliate, the Florida Alliance of Information and Referral
3710 Services, and shall adopt the criteria as administrative rules.
3711 (a) If any provider of information and referral services or
3712 other entity leases a 211 number from a local exchange company
3713 and is not authorized as described in this section, certified by
3714 the agency, the agency shall, after consultation with the local
3715 exchange company and the Public Service Commission shall,
3716 request that the Federal Communications Commission direct the
3717 local exchange company to revoke the use of the 211 number.
3718 (b) The agency shall seek the assistance and guidance of
3719 the Public Service Commission and the Federal Communications
3720 Commission in resolving any disputes arising over jurisdiction
3721 related to 211 numbers.
3722 (3) The Florida Alliance of Information and Referral
3723 Services is the 211 collaborative organization for the state
3724 which is responsible for studying, designing, implementing,
3725 supporting, and coordinating the Florida 211 Network and for
3726 receiving federal grants.
3727 Section 56. Paragraph (e) of subsection (4) of section
3728 409.221, Florida Statutes, is amended to read:
3729 409.221 Consumer-directed care program.—
3730 (4) CONSUMER-DIRECTED CARE.—
3731 (e) Services.—Consumers shall use the budget allowance only
3732 to pay for home and community-based services that meet the
3733 consumer’s long-term care needs and are a cost-efficient use of
3734 funds. Such services may include, but are not limited to, the
3735 following:
3736 1. Personal care.
3737 2. Homemaking and chores, including housework, meals,
3738 shopping, and transportation.
3739 3. Home modifications and assistive devices which may
3740 increase the consumer’s independence or make it possible to
3741 avoid institutional placement.
3742 4. Assistance in taking self-administered medication.
3743 5. Day care and respite care services, including those
3744 provided by nursing home facilities pursuant to s. 400.141(1)(f)
3745 s. 400.141(6) or by adult day care facilities licensed pursuant
3746 to s. 429.907.
3747 6. Personal care and support services provided in an
3748 assisted living facility.
3749 Section 57. Subsection (5) of section 409.901, Florida
3750 Statutes, is amended to read:
3751 409.901 Definitions; ss. 409.901-409.920.—As used in ss.
3752 409.901-409.920, except as otherwise specifically provided, the
3753 term:
3754 (5) “Change of ownership” means:
3755 (a) An event in which the provider ownership changes to a
3756 different individual legal entity as evidenced by a change in
3757 federal employer identification number or taxpayer
3758 identification number; or
3759 (b) An event in which 51 45 percent or more of the
3760 ownership, voting shares, membership, or controlling interest of
3761 a provider is in any manner transferred or otherwise assigned.
3762 This paragraph does not apply to a licensee that is publicly
3763 traded on a recognized stock exchange; or
3764 (c) When the provider is licensed or registered by the
3765 agency, an event considered a change of ownership for licensure
3766 as defined in s. 408.803 in a corporation whose shares are not
3767 publicly traded on a recognized stock exchange is transferred or
3768 assigned, including the final transfer or assignment of multiple
3769 transfers or assignments over a 2-year period that cumulatively
3770 total 45 percent or more.
3771
3772 A change solely in the management company or board of directors
3773 is not a change of ownership.
3774 Section 58. Section 429.071, Florida Statutes, is repealed.
3775 Section 59. Paragraph (e) of subsection (1) and subsections
3776 (2) and (3) of section 429.08, Florida Statutes, are amended to
3777 read:
3778 429.08 Unlicensed facilities; referral of person for
3779 residency to unlicensed facility; penalties; verification of
3780 licensure status.—
3781 (1)
3782 (e) The agency shall publish provide to the department’s
3783 elder information and referral providers a list, by county, of
3784 licensed assisted living facilities, to assist persons who are
3785 considering an assisted living facility placement in locating a
3786 licensed facility. This information may be provided
3787 electronically or through the agency’s Internet site.
3788 (2) Each field office of the Agency for Health Care
3789 Administration shall establish a local coordinating workgroup
3790 which includes representatives of local law enforcement
3791 agencies, state attorneys, the Medicaid Fraud Control Unit of
3792 the Department of Legal Affairs, local fire authorities, the
3793 Department of Children and Family Services, the district long
3794 term care ombudsman council, and the district human rights
3795 advocacy committee to assist in identifying the operation of
3796 unlicensed facilities and to develop and implement a plan to
3797 ensure effective enforcement of state laws relating to such
3798 facilities. The workgroup shall report its findings, actions,
3799 and recommendations semiannually to the Director of Health
3800 Quality Assurance of the agency.
3801 (2)(3) It is unlawful to knowingly refer a person for
3802 residency to an unlicensed assisted living facility; to an
3803 assisted living facility the license of which is under denial or
3804 has been suspended or revoked; or to an assisted living facility
3805 that has a moratorium pursuant to part II of chapter 408. Any
3806 person who violates this subsection commits a noncriminal
3807 violation, punishable by a fine not exceeding $500 as provided
3808 in s. 775.083.
3809 (a) Any health care practitioner, as defined in s. 456.001,
3810 who is aware of the operation of an unlicensed facility shall
3811 report that facility to the agency. Failure to report a facility
3812 that the practitioner knows or has reasonable cause to suspect
3813 is unlicensed shall be reported to the practitioner’s licensing
3814 board.
3815 (b) Any provider as defined in s. 408.803 hospital or
3816 community mental health center licensed under chapter 395 or
3817 chapter 394 which knowingly discharges a patient or client to an
3818 unlicensed facility is subject to sanction by the agency.
3819 (c) Any employee of the agency or department, or the
3820 Department of Children and Family Services, who knowingly refers
3821 a person for residency to an unlicensed facility; to a facility
3822 the license of which is under denial or has been suspended or
3823 revoked; or to a facility that has a moratorium pursuant to part
3824 II of chapter 408 is subject to disciplinary action by the
3825 agency or department, or the Department of Children and Family
3826 Services.
3827 (d) The employer of any person who is under contract with
3828 the agency or department, or the Department of Children and
3829 Family Services, and who knowingly refers a person for residency
3830 to an unlicensed facility; to a facility the license of which is
3831 under denial or has been suspended or revoked; or to a facility
3832 that has a moratorium pursuant to part II of chapter 408 shall
3833 be fined and required to prepare a corrective action plan
3834 designed to prevent such referrals.
3835 (e) The agency shall provide the department and the
3836 Department of Children and Family Services with a list of
3837 licensed facilities within each county and shall update the list
3838 at least quarterly.
3839 (f) At least annually, the agency shall notify, in
3840 appropriate trade publications, physicians licensed under
3841 chapter 458 or chapter 459, hospitals licensed under chapter
3842 395, nursing home facilities licensed under part II of chapter
3843 400, and employees of the agency or the department, or the
3844 Department of Children and Family Services, who are responsible
3845 for referring persons for residency, that it is unlawful to
3846 knowingly refer a person for residency to an unlicensed assisted
3847 living facility and shall notify them of the penalty for
3848 violating such prohibition. The department and the Department of
3849 Children and Family Services shall, in turn, notify service
3850 providers under contract to the respective departments who have
3851 responsibility for resident referrals to facilities. Further,
3852 the notice must direct each noticed facility and individual to
3853 contact the appropriate agency office in order to verify the
3854 licensure status of any facility prior to referring any person
3855 for residency. Each notice must include the name, telephone
3856 number, and mailing address of the appropriate office to
3857 contact.
3858 Section 60. Paragraph (e) of subsection (1) of section
3859 429.14, Florida Statutes, is amended to read:
3860 429.14 Administrative penalties.—
3861 (1) In addition to the requirements of part II of chapter
3862 408, the agency may deny, revoke, and suspend any license issued
3863 under this part and impose an administrative fine in the manner
3864 provided in chapter 120 against a licensee of an assisted living
3865 facility for a violation of any provision of this part, part II
3866 of chapter 408, or applicable rules, or for any of the following
3867 actions by a licensee of an assisted living facility, for the
3868 actions of any person subject to level 2 background screening
3869 under s. 408.809, or for the actions of any facility employee:
3870 (e) A citation of any of the following deficiencies as
3871 specified defined in s. 429.19:
3872 1. One or more cited class I deficiencies.
3873 2. Three or more cited class II deficiencies.
3874 3. Five or more cited class III deficiencies that have been
3875 cited on a single survey and have not been corrected within the
3876 times specified.
3877 Section 61. Section 429.19, Florida Statutes, is amended to
3878 read:
3879 429.19 Violations; imposition of administrative fines;
3880 grounds.—
3881 (1) In addition to the requirements of part II of chapter
3882 408, the agency shall impose an administrative fine in the
3883 manner provided in chapter 120 for the violation of any
3884 provision of this part, part II of chapter 408, and applicable
3885 rules by an assisted living facility, for the actions of any
3886 person subject to level 2 background screening under s. 408.809,
3887 for the actions of any facility employee, or for an intentional
3888 or negligent act seriously affecting the health, safety, or
3889 welfare of a resident of the facility.
3890 (2) Each violation of this part and adopted rules shall be
3891 classified according to the nature of the violation and the
3892 gravity of its probable effect on facility residents. The agency
3893 shall indicate the classification on the written notice of the
3894 violation as follows:
3895 (a) Class “I” violations are defined in s. 408.813 those
3896 conditions or occurrences related to the operation and
3897 maintenance of a facility or to the personal care of residents
3898 which the agency determines present an imminent danger to the
3899 residents or guests of the facility or a substantial probability
3900 that death or serious physical or emotional harm would result
3901 therefrom. The condition or practice constituting a class I
3902 violation shall be abated or eliminated within 24 hours, unless
3903 a fixed period, as determined by the agency, is required for
3904 correction. The agency shall impose an administrative fine for a
3905 cited class I violation in an amount not less than $5,000 and
3906 not exceeding $10,000 for each violation. A fine may be levied
3907 notwithstanding the correction of the violation.
3908 (b) Class “II” violations are defined in s. 408.813 those
3909 conditions or occurrences related to the operation and
3910 maintenance of a facility or to the personal care of residents
3911 which the agency determines directly threaten the physical or
3912 emotional health, safety, or security of the facility residents,
3913 other than class I violations. The agency shall impose an
3914 administrative fine for a cited class II violation in an amount
3915 not less than $1,000 and not exceeding $5,000 for each
3916 violation. A fine shall be levied notwithstanding the correction
3917 of the violation.
3918 (c) Class “III” violations are defined in s. 408.813 those
3919 conditions or occurrences related to the operation and
3920 maintenance of a facility or to the personal care of residents
3921 which the agency determines indirectly or potentially threaten
3922 the physical or emotional health, safety, or security of
3923 facility residents, other than class I or class II violations.
3924 The agency shall impose an administrative fine for a cited class
3925 III violation in an amount not less than $500 and not exceeding
3926 $1,000 for each violation. A citation for a class III violation
3927 must specify the time within which the violation is required to
3928 be corrected. If a class III violation is corrected within the
3929 time specified, no fine may be imposed, unless it is a repeated
3930 offense.
3931 (d) Class “IV” violations are defined in s. 408.813 those
3932 conditions or occurrences related to the operation and
3933 maintenance of a building or to required reports, forms, or
3934 documents that do not have the potential of negatively affecting
3935 residents. These violations are of a type that the agency
3936 determines do not threaten the health, safety, or security of
3937 residents of the facility. The agency shall impose an
3938 administrative fine for a cited class IV violation in an amount
3939 not less than $100 and not exceeding $200 for each violation. A
3940 citation for a class IV violation must specify the time within
3941 which the violation is required to be corrected. If a class IV
3942 violation is corrected within the time specified, no fine shall
3943 be imposed. Any class IV violation that is corrected during the
3944 time an agency survey is being conducted will be identified as
3945 an agency finding and not as a violation.
3946 (3) For purposes of this section, in determining if a
3947 penalty is to be imposed and in fixing the amount of the fine,
3948 the agency shall consider the following factors:
3949 (a) The gravity of the violation, including the probability
3950 that death or serious physical or emotional harm to a resident
3951 will result or has resulted, the severity of the action or
3952 potential harm, and the extent to which the provisions of the
3953 applicable laws or rules were violated.
3954 (b) Actions taken by the owner or administrator to correct
3955 violations.
3956 (c) Any previous violations.
3957 (d) The financial benefit to the facility of committing or
3958 continuing the violation.
3959 (e) The licensed capacity of the facility.
3960 (4) Each day of continuing violation after the date fixed
3961 for termination of the violation, as ordered by the agency,
3962 constitutes an additional, separate, and distinct violation.
3963 (5) Any action taken to correct a violation shall be
3964 documented in writing by the owner or administrator of the
3965 facility and verified through followup visits by agency
3966 personnel. The agency may impose a fine and, in the case of an
3967 owner-operated facility, revoke or deny a facility’s license
3968 when a facility administrator fraudulently misrepresents action
3969 taken to correct a violation.
3970 (6) Any facility whose owner fails to apply for a change
3971 of-ownership license in accordance with part II of chapter 408
3972 and operates the facility under the new ownership is subject to
3973 a fine of $5,000.
3974 (7) In addition to any administrative fines imposed, the
3975 agency may assess a survey fee, equal to the lesser of one half
3976 of the facility’s biennial license and bed fee or $500, to cover
3977 the cost of conducting initial complaint investigations that
3978 result in the finding of a violation that was the subject of the
3979 complaint or monitoring visits conducted under s. 429.28(3)(c)
3980 to verify the correction of the violations.
3981 (8) During an inspection, the agency, as an alternative to
3982 or in conjunction with an administrative action against a
3983 facility for violations of this part and adopted rules, shall
3984 make a reasonable attempt to discuss each violation and
3985 recommended corrective action with the owner or administrator of
3986 the facility, prior to written notification. The agency, instead
3987 of fixing a period within which the facility shall enter into
3988 compliance with standards, may request a plan of corrective
3989 action from the facility which demonstrates a good faith effort
3990 to remedy each violation by a specific date, subject to the
3991 approval of the agency.
3992 (9) The agency shall develop and disseminate an annual list
3993 of all facilities sanctioned or fined $5,000 or more for
3994 violations of state standards, the number and class of
3995 violations involved, the penalties imposed, and the current
3996 status of cases. The list shall be disseminated, at no charge,
3997 to the Department of Elderly Affairs, the Department of Health,
3998 the Department of Children and Family Services, the Agency for
3999 Persons with Disabilities, the area agencies on aging, the
4000 Florida Statewide Advocacy Council, and the state and local
4001 ombudsman councils. The Department of Children and Family
4002 Services shall disseminate the list to service providers under
4003 contract to the department who are responsible for referring
4004 persons to a facility for residency. The agency may charge a fee
4005 commensurate with the cost of printing and postage to other
4006 interested parties requesting a copy of this list. This
4007 information may be provided electronically or through the
4008 agency’s Internet site.
4009 Section 62. Subsections (2) and (6) of section 429.23,
4010 Florida Statutes, are amended to read:
4011 429.23 Internal risk management and quality assurance
4012 program; adverse incidents and reporting requirements.—
4013 (2) Every facility licensed under this part is required to
4014 maintain adverse incident reports. For purposes of this section,
4015 the term, “adverse incident” means:
4016 (a) An event over which facility personnel could exercise
4017 control rather than as a result of the resident’s condition and
4018 results in:
4019 1. Death;
4020 2. Brain or spinal damage;
4021 3. Permanent disfigurement;
4022 4. Fracture or dislocation of bones or joints;
4023 5. Any condition that required medical attention to which
4024 the resident has not given his or her consent, including failure
4025 to honor advanced directives;
4026 6. Any condition that requires the transfer of the resident
4027 from the facility to a unit providing more acute care due to the
4028 incident rather than the resident’s condition before the
4029 incident; or.
4030 7. An event that is reported to law enforcement or its
4031 personnel for investigation; or
4032 (b) Abuse, neglect, or exploitation as defined in s.
4033 415.102;
4034 (c) Events reported to law enforcement; or
4035 (b)(d) Resident elopement, if the elopement places the
4036 resident at risk of harm or injury.
4037 (6) Abuse, neglect, or exploitation must be reported to the
4038 Department of Children and Family Services as required under
4039 chapter 415 The agency shall annually submit to the Legislature
4040 a report on assisted living facility adverse incident reports.
4041 The report must include the following information arranged by
4042 county:
4043 (a) A total number of adverse incidents;
4044 (b) A listing, by category, of the type of adverse
4045 incidents occurring within each category and the type of staff
4046 involved;
4047 (c) A listing, by category, of the types of injuries, if
4048 any, and the number of injuries occurring within each category;
4049 (d) Types of liability claims filed based on an adverse
4050 incident report or reportable injury; and
4051 (e) Disciplinary action taken against staff, categorized by
4052 the type of staff involved.
4053 Section 63. Subsection (9) of section 429.26, Florida
4054 Statutes, is repealed.
4055 Section 64. Subsection (3) of section 430.80, Florida
4056 Statutes, is amended to read:
4057 430.80 Implementation of a teaching nursing home pilot
4058 project.—
4059 (3) To be designated as a teaching nursing home, a nursing
4060 home licensee must, at a minimum:
4061 (a) Provide a comprehensive program of integrated senior
4062 services that include institutional services and community-based
4063 services;
4064 (b) Participate in a nationally recognized accreditation
4065 program and hold a valid accreditation, such as the
4066 accreditation awarded by the Joint Commission on Accreditation
4067 of Healthcare Organizations;
4068 (c) Have been in business in this state for a minimum of 10
4069 consecutive years;
4070 (d) Demonstrate an active program in multidisciplinary
4071 education and research that relates to gerontology;
4072 (e) Have a formalized contractual relationship with at
4073 least one accredited health profession education program located
4074 in this state;
4075 (f) Have a formalized contractual relationship with an
4076 accredited hospital that is designated by law as a teaching
4077 hospital; and
4078 (g) Have senior staff members who hold formal faculty
4079 appointments at universities, which must include at least one
4080 accredited health profession education program.
4081 (h) Maintain insurance coverage pursuant to s.
4082 400.141(1)(s) s. 400.141(20) or proof of financial
4083 responsibility in a minimum amount of $750,000. Such proof of
4084 financial responsibility may include:
4085 1. Maintaining an escrow account consisting of cash or
4086 assets eligible for deposit in accordance with s. 625.52; or
4087 2. Obtaining and maintaining pursuant to chapter 675 an
4088 unexpired, irrevocable, nontransferable and nonassignable letter
4089 of credit issued by any bank or savings association organized
4090 and existing under the laws of this state or any bank or savings
4091 association organized under the laws of the United States that
4092 has its principal place of business in this state or has a
4093 branch office which is authorized to receive deposits in this
4094 state. The letter of credit shall be used to satisfy the
4095 obligation of the facility to the claimant upon presentment of a
4096 final judgment indicating liability and awarding damages to be
4097 paid by the facility or upon presentment of a settlement
4098 agreement signed by all parties to the agreement when such final
4099 judgment or settlement is a result of a liability claim against
4100 the facility.
4101 Section 65. Subsection (5) of section 435.04, Florida
4102 Statutes, is amended to read:
4103 435.04 Level 2 screening standards.—
4104 (5) Under penalty of perjury, all employees in such
4105 positions of trust or responsibility shall attest to meeting the
4106 requirements for qualifying for employment and agreeing to
4107 inform the employer immediately if convicted of any of the
4108 disqualifying offenses while employed by the employer. Each
4109 employer of employees in such positions of trust or
4110 responsibilities which is licensed or registered by a state
4111 agency shall submit to the licensing agency annually or at the
4112 time of license renewal, under penalty of perjury, an affidavit
4113 of compliance with the provisions of this section.
4114 Section 66. Subsection (3) of section 435.05, Florida
4115 Statutes, is amended to read:
4116 435.05 Requirements for covered employees.—Except as
4117 otherwise provided by law, the following requirements shall
4118 apply to covered employees:
4119 (3) Each employer required to conduct level 2 background
4120 screening must sign an affidavit annually or at the time of
4121 license renewal, under penalty of perjury, stating that all
4122 covered employees have been screened or are newly hired and are
4123 awaiting the results of the required screening checks.
4124 Section 67. Subsection (2) of section 483.031, Florida
4125 Statutes, is amended to read:
4126 483.031 Application of part; exemptions.—This part applies
4127 to all clinical laboratories within this state, except:
4128 (2) A clinical laboratory that performs only waived tests
4129 and has received a certificate of exemption from the agency
4130 under s. 483.106.
4131 Section 68. Subsection (10) of section 483.041, Florida
4132 Statutes, is amended to read:
4133 483.041 Definitions.—As used in this part, the term:
4134 (10) “Waived test” means a test that the federal Centers
4135 for Medicare and Medicaid Services Health Care Financing
4136 Administration has determined qualifies for a certificate of
4137 waiver under the federal Clinical Laboratory Improvement
4138 Amendments of 1988, and the federal rules adopted thereunder.
4139 Section 69. Section 483.106, Florida Statutes, is repealed.
4140 Section 70. Subsection (3) of section 483.172, Florida
4141 Statutes, is amended to read:
4142 483.172 License fees.—
4143 (3) The agency shall assess a biennial fee of $100 for a
4144 certificate of exemption and a $100 biennial license fee under
4145 this section for facilities surveyed by an approved accrediting
4146 organization.
4147 Section 71. Paragraph (b) of subsection (1) of section
4148 627.4239, Florida Statutes, is amended, present subsection (4)
4149 is renumbered as subsection (5), and a new subsection (4) is
4150 added to that section to read:
4151 627.4239 Coverage for use of drugs in treatment of cancer.—
4152 (1) DEFINITIONS.—As used in this section, the term:
4153 (b) “Standard reference compendium” means authoritative
4154 compendia identified by the Secretary of the United States
4155 Department of Health and Human Services and recognized by the
4156 federal Centers for Medicare and Medicaid Services:
4157 1. The United States Pharmacopeia Drug Information;
4158 2. The American Medical Association Drug Evaluations; or
4159 3. The American Hospital Formulary Service Drug
4160 Information.
4161 (4) ANNUAL REPORTS.—
4162 (a) Where coverage for routine patient care costs
4163 associated with care provided in a phase 1, phase 2, phase 3, or
4164 phase 4 cancer clinical trial is denied, a carrier shall, after
4165 consulting academic and community oncologists involved in cancer
4166 care and clinical research, submit to the Office of Insurance
4167 Regulation in a format prescribed by rule, an annual report that
4168 shall include:
4169 1. The number of denials for coverage of routine patient
4170 care cost as defined in paragraph (c) in cancer clinical trials;
4171 and
4172 2. A comparison of the costs of routine patient care
4173 provided in the trials in question compared to the costs of
4174 standard therapies for the same diagnosis.
4175 (b) The Office of Insurance Regulation shall provide annual
4176 reports required under paragraph (a) to the Governor, President
4177 of the Senate, the Speaker of the House of Representatives, and
4178 the Secretary for Health Care Administration no later than 30
4179 days before the regular legislative session.
4180 (c) For purposes of this section, the term “routine patient
4181 care cost” means physician fees, laboratory expenses, and
4182 expenses associated with the hospitalization, administration of
4183 treatment, and evaluation of a patient during the course of
4184 treatment which are consistent with usual and customary patterns
4185 and standards of care incurred whenever an enrollee, subscriber,
4186 or insured receives medical care associated with an approved
4187 cancer clinical trial, and which would be covered if such items
4188 and services were provided other than in connection with an
4189 approved cancer clinical trial but does not include the direct
4190 cost of the clinical trial.
4191 Section 72. Subsection (13) of section 651.118, Florida
4192 Statutes, is amended to read:
4193 651.118 Agency for Health Care Administration; certificates
4194 of need; sheltered beds; community beds.—
4195 (13) Residents, as defined in this chapter, are not
4196 considered new admissions for the purpose of s. 400.141
4197 (1)(o)1.d. s. 400.141(15)(d).
4198 Section 73. This act shall take effect July 1, 2009.