CS/HB 651

1	A bill to be entitled
2	An act relating to the Agency for Health Care
3	Administration; repealing s. 395.0199, F.S., relating to
4	private utilization review of health care services;
5	amending ss. 395.405 and 400.0712, F.S.; conforming cross-
6	references; amending s. 400.118, F.S.; removing provisions
7	requiring quality-of-care monitors for nursing facilities
8	in agency district offices; amending s. 400.141, F.S.;
9	revising reporting requirements for facility staff-to-
10	resident ratios; deleting a requirement that licensed
11	nursing home facilities provide the agency with a monthly
12	report on the number of vacant beds in the facility;
13	amending s. 400.147, F.S.; revising reporting requirements
14	under facility internal risk management and quality
15	assurance programs; revising the definition of the term
16	"adverse incident" for reporting purposes; requiring
17	abuse, neglect, and exploitation to be reported to the
18	agency and the Department of Children and Family Services;
19	deleting a requirement that the agency submit an annual
20	report on nursing home adverse incidents to the
21	Legislature; amending s. 400.162, F.S.; revising
22	provisions relating to procedures and policies regarding
23	the safekeeping of nursing home residents' property;
24	amending s. 400.195, F.S.; conforming a cross-reference;
25	amending s. 400.23, F.S.; deleting provisions relating to
26	minimum staffing requirements for nursing homes; amending
27	s. 400.506, F.S.; exempting nurse registries not
28	participating in the Medicaid or Medicare program from
29	certain disciplinary actions for paying remuneration to
30	certain entities in exchange for patient referrals;
31	amending s. 400.9935, F.S.; revising accreditation
32	requirements for clinics providing magnetic resonance
33	imaging services; amending s. 400.995, F.S.; revising
34	agency responsibilities with respect to personnel and
35	operations in certain injunctive proceedings; amending s.
36	408.803, F.S.; revising definitions applicable to pt. II
37	of ch. 408, F.S., the "Health Care Licensing Procedures
38	Act"; amending s. 408.806, F.S.; revising contents of and
39	procedures relating to health care provider applications
40	for licensure; providing an exception from certain
41	licensure inspections for adult family-care homes;
42	authorizing the agency to provide electronic access to
43	certain information and documents; amending s. 408.808,
44	F.S.; providing for a provisional license to be issued to
45	applicants applying for a change of ownership; providing a
46	time limit on provisional licenses; amending s. 408.809,
47	F.S.; revising provisions relating to background screening
48	of specified employees; exempting certain persons from
49	rescreening; permitting certain persons to apply for an
50	exemption from disqualification under certain
51	circumstances; requiring health care providers to submit
52	to the agency an affidavit of compliance with background
53	screening requirements at the time of license renewal;
54	deleting a provision to conform to changes made by the
55	act; amending s. 408.810, F.S.; revising provisions
56	relating to information required for licensure; amending
57	s. 408.811, F.S.; providing for certain inspections to be
58	accepted in lieu of complete licensure inspections;
59	granting agency access to records requested during an
60	offsite review; providing timeframes for correction of
61	certain deficiencies and submission of plans to correct
62	such deficiencies; amending s. 408.813, F.S.; providing
63	classifications of violations of pt. II of ch. 408, F.S.;
64	providing for fines; amending s. 408.820, F.S.; revising
65	applicability of exemptions from specified requirements of
66	pt. II of ch. 408, F.S.; conforming references; creating
67	s. 408.821, F.S.; requiring entities regulated or licensed
68	by the agency to designate a safety liaison for emergency
69	operations; providing that entities regulated or licensed
70	by the agency may temporarily exceed their licensed
71	capacity to act as receiving providers under specified
72	circumstances; providing requirements while such entities
73	are in an overcapacity status; providing for issuance of
74	an inactive license to such licensees under specified
75	conditions; providing requirements and procedures with
76	respect to the issuance and reactivation of an inactive
77	license; authorizing the agency to adopt rules; amending
78	s. 408.831, F.S.; deleting provisions relating to
79	authorization for entities regulated or licensed by the
80	agency to exceed their licensed capacity to act as
81	receiving facilities and issuance and reactivation of
82	inactive licenses; amending s. 409.221, F.S.; conforming a
83	cross-reference; amending s. 409.901, F.S.; revising a
84	definition applicable to Medicaid providers; repealing s.
85	429.071, F.S., relating to the intergenerational respite
86	care assisted living facility pilot program; amending s.
87	429.08, F.S.; authorizing the agency to provide
88	information regarding licensed assisted living facilities
89	electronically or on its Internet website; abolishing
90	local coordinating workgroups established by agency field
91	offices; deleting a fine; deleting provisions requiring
92	the agency to provide certain information and notice to
93	service providers; amending s. 429.14, F.S.; conforming a
94	reference; amending s. 429.19, F.S.; revising agency
95	procedures for imposition of fines for violations of pt. I
96	of ch. 429, F.S., the "Assisted Living Facilities Act";
97	providing for the posting of certain information
98	electronically or on the agency's Internet website;
99	amending s. 429.23, F.S.; revising the definition of the
100	term "adverse incident" for reporting purposes; requiring
101	abuse, neglect, and exploitation to be reported to the
102	agency and the Department of Children and Family Services;
103	deleting a requirement that the agency submit an annual
104	report on assisted living facility adverse incidents to
105	the Legislature; amending s. 429.26, F.S.; removing
106	requirement for a resident of an assisted living facility
107	to undergo examinations and evaluations under certain
108	circumstances; amending s. 430.80, F.S.; conforming a
109	cross-reference; amending ss. 435.04 and 435.05, F.S.;
110	requiring employers of certain employees to submit an
111	affidavit of compliance with level 2 screening
112	requirements at the time of license renewal; amending s.
113	483.031, F.S.; conforming a reference; amending s.
114	483.041, F.S.; revising a definition applicable to pt. I
115	of ch. 483, F.S., the "Florida Clinical Laboratory Law";
116	repealing s. 483.106, F.S., relating to applications for
117	certificates of exemption by clinical laboratories that
118	perform certain tests; amending s. 483.172, F.S.;
119	conforming a reference; amending s. 651.118, F.S.;
120	conforming a cross-reference; providing an effective date.
121
122	Be It Enacted by the Legislature of the State of Florida:
123
124	Section 1.  Section 395.0199, Florida Statutes, is
125	repealed.
126	Section 2.  Section 395.405, Florida Statutes, is amended
127	to read:
128	395.405  Rulemaking.--The department shall adopt and
129	enforce all rules necessary to administer ss. 395.0199, 395.401,
130	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
131	Section 3.  Subsection (1) of section 400.0712, Florida
132	Statutes, is amended to read:
133	400.0712  Application for inactive license.--
134	(1)  As specified in s. 408.831(4) and this section, the
135	agency may issue an inactive license to a nursing home facility
136	for all or a portion of its beds. Any request by a licensee that
137	a nursing home or portion of a nursing home become inactive must
138	be submitted to the agency in the approved format. The facility
139	may not initiate any suspension of services, notify residents,
140	or initiate inactivity before receiving approval from the
141	agency; and a licensee that violates this provision may not be
142	issued an inactive license.
143	Section 4.  Subsection (3) of section 400.118, Florida
144	Statutes, is renumbered as subsection (2), and present
145	subsection (2) of that section is amended to read:
146	400.118  Quality assurance; early warning system;
147	monitoring; rapid response teams.--
148	(2)(a)  The agency shall establish within each district
149	office one or more quality-of-care monitors, based on the number
150	of nursing facilities in the district, to monitor all nursing
151	facilities in the district on a regular, unannounced, aperiodic
152	basis, including nights, evenings, weekends, and holidays.
153	Quality-of-care monitors shall visit each nursing facility at
154	least quarterly. Priority for additional monitoring visits shall
155	be given to nursing facilities with a history of resident care
156	deficiencies. Quality-of-care monitors shall be registered
157	nurses who are trained and experienced in nursing facility
158	regulation, standards of practice in long-term care, and
159	evaluation of patient care. Individuals in these positions shall
160	not be deployed by the agency as a part of the district survey
161	team in the conduct of routine, scheduled surveys, but shall
162	function solely and independently as quality-of-care monitors.
163	Quality-of-care monitors shall assess the overall quality of
164	life in the nursing facility and shall assess specific
165	conditions in the facility directly related to resident care,
166	including the operations of internal quality improvement and
167	risk management programs and adverse incident reports. The
168	quality-of-care monitor shall include in an assessment visit
169	observation of the care and services rendered to residents and
170	formal and informal interviews with residents, family members,
171	facility staff, resident guests, volunteers, other regulatory
172	staff, and representatives of a long-term care ombudsman council
173	or Florida advocacy council.
174	(b)  Findings of a monitoring visit, both positive and
175	negative, shall be provided orally and in writing to the
176	facility administrator or, in the absence of the facility
177	administrator, to the administrator on duty or the director of
178	nursing. The quality-of-care monitor may recommend to the
179	facility administrator procedural and policy changes and staff
180	training, as needed, to improve the care or quality of life of
181	facility residents. Conditions observed by the quality-of-care
182	monitor which threaten the health or safety of a resident shall
183	be reported immediately to the agency area office supervisor for
184	appropriate regulatory action and, as appropriate or as required
185	by law, to law enforcement, adult protective services, or other
186	responsible agencies.
187	(c)  Any record, whether written or oral, or any written or
188	oral communication generated pursuant to paragraph (a) or
189	paragraph (b) shall not be subject to discovery or introduction
190	into evidence in any civil or administrative action against a
191	nursing facility arising out of matters which are the subject of
192	quality-of-care monitoring, and a person who was in attendance
193	at a monitoring visit or evaluation may not be permitted or
194	required to testify in any such civil or administrative action
195	as to any evidence or other matters produced or presented during
196	the monitoring visits or evaluations. However, information,
197	documents, or records otherwise available from original sources
198	are not to be construed as immune from discovery or use in any
199	such civil or administrative action merely because they were
200	presented during monitoring visits or evaluations, and any
201	person who participates in such activities may not be prevented
202	from testifying as to matters within his or her knowledge, but
203	such witness may not be asked about his or her participation in
204	such activities. The exclusion from the discovery or
205	introduction of evidence in any civil or administrative action
206	provided for herein shall not apply when the quality-of-care
207	monitor makes a report to the appropriate authorities regarding
208	a threat to the health or safety of a resident.
209	Section 5.  Section 400.141, Florida Statutes, is amended
210	to read:
211	400.141  Administration and management of nursing home
212	facilities.--
213	(1)  Every licensed facility shall comply with all
214	applicable standards and rules of the agency and shall:
215	(a)(1)  Be under the administrative direction and charge of
216	a licensed administrator.
217	(b)(2)  Appoint a medical director licensed pursuant to
218	chapter 458 or chapter 459. The agency may establish by rule
219	more specific criteria for the appointment of a medical
220	director.
221	(c)(3)  Have available the regular, consultative, and
222	emergency services of physicians licensed by the state.
223	(d)(4)  Provide for resident use of a community pharmacy as
224	specified in s. 400.022(1)(q). Any other law to the contrary
225	notwithstanding, a registered pharmacist licensed in Florida,
226	that is under contract with a facility licensed under this
227	chapter or chapter 429, shall repackage a nursing facility
228	resident's bulk prescription medication which has been packaged
229	by another pharmacist licensed in any state in the United States
230	into a unit dose system compatible with the system used by the
231	nursing facility, if the pharmacist is requested to offer such
232	service. In order to be eligible for the repackaging, a resident
233	or the resident's spouse must receive prescription medication
234	benefits provided through a former employer as part of his or
235	her retirement benefits, a qualified pension plan as specified
236	in s. 4972 of the Internal Revenue Code, a federal retirement
237	program as specified under 5 C.F.R. s. 831, or a long-term care
238	policy as defined in s. 627.9404(1). A pharmacist who correctly
239	repackages and relabels the medication and the nursing facility
240	which correctly administers such repackaged medication under the
241	provisions of this paragraph may subsection shall not be held
242	liable in any civil or administrative action arising from the
243	repackaging. In order to be eligible for the repackaging, a
244	nursing facility resident for whom the medication is to be
245	repackaged shall sign an informed consent form provided by the
246	facility which includes an explanation of the repackaging
247	process and which notifies the resident of the immunities from
248	liability provided in this paragraph herein. A pharmacist who
249	repackages and relabels prescription medications, as authorized
250	under this paragraph subsection, may charge a reasonable fee for
251	costs resulting from the implementation of this provision.
252	(e)(5)  Provide for the access of the facility residents to
253	dental and other health-related services, recreational services,
254	rehabilitative services, and social work services appropriate to
255	their needs and conditions and not directly furnished by the
256	licensee. When a geriatric outpatient nurse clinic is conducted
257	in accordance with rules adopted by the agency, outpatients
258	attending such clinic shall not be counted as part of the
259	general resident population of the nursing home facility, nor
260	shall the nursing staff of the geriatric outpatient clinic be
261	counted as part of the nursing staff of the facility, until the
262	outpatient clinic load exceeds 15 a day.
263	(f)(6)  Be allowed and encouraged by the agency to provide
264	other needed services under certain conditions. If the facility
265	has a standard licensure status, and has had no class I or class
266	II deficiencies during the past 2 years or has been awarded a
267	Gold Seal under the program established in s. 400.235, it may be
268	encouraged by the agency to provide services, including, but not
269	limited to, respite and adult day services, which enable
270	individuals to move in and out of the facility. A facility is
271	not subject to any additional licensure requirements for
272	providing these services. Respite care may be offered to persons
273	in need of short-term or temporary nursing home services.
274	Respite care must be provided in accordance with this part and
275	rules adopted by the agency. However, the agency shall, by rule,
276	adopt modified requirements for resident assessment, resident
277	care plans, resident contracts, physician orders, and other
278	provisions, as appropriate, for short-term or temporary nursing
279	home services. The agency shall allow for shared programming and
280	staff in a facility which meets minimum standards and offers
281	services pursuant to this paragraph subsection, but, if the
282	facility is cited for deficiencies in patient care, may require
283	additional staff and programs appropriate to the needs of
284	service recipients. A person who receives respite care may not
285	be counted as a resident of the facility for purposes of the
286	facility's licensed capacity unless that person receives 24-hour
287	respite care. A person receiving either respite care for 24
288	hours or longer or adult day services must be included when
289	calculating minimum staffing for the facility. Any costs and
290	revenues generated by a nursing home facility from
291	nonresidential programs or services shall be excluded from the
292	calculations of Medicaid per diems for nursing home
293	institutional care reimbursement.
294	(g)(7)  If the facility has a standard license or is a Gold
295	Seal facility, exceeds the minimum required hours of licensed
296	nursing and certified nursing assistant direct care per resident
297	per day, and is part of a continuing care facility licensed
298	under chapter 651 or a retirement community that offers other
299	services pursuant to part III of this chapter or part I or part
300	III of chapter 429 on a single campus, be allowed to share
301	programming and staff. At the time of inspection and in the
302	semiannual report required pursuant to paragraph (o) subsection
303	(15), a continuing care facility or retirement community that
304	uses this option must demonstrate through staffing records that
305	minimum staffing requirements for the facility were met.
306	Licensed nurses and certified nursing assistants who work in the
307	nursing home facility may be used to provide services elsewhere
308	on campus if the facility exceeds the minimum number of direct
309	care hours required per resident per day and the total number of
310	residents receiving direct care services from a licensed nurse
311	or a certified nursing assistant does not cause the facility to
312	violate the staffing ratios required under s. 400.23(3)(a).
313	Compliance with the minimum staffing ratios shall be based on
314	total number of residents receiving direct care services,
315	regardless of where they reside on campus. If the facility
316	receives a conditional license, it may not share staff until the
317	conditional license status ends. This paragraph subsection does
318	not restrict the agency's authority under federal or state law
319	to require additional staff if a facility is cited for
320	deficiencies in care which are caused by an insufficient number
321	of certified nursing assistants or licensed nurses. The agency
322	may adopt rules for the documentation necessary to determine
323	compliance with this provision.
324	(h)(8)  Maintain the facility premises and equipment and
325	conduct its operations in a safe and sanitary manner.
326	(i)(9)  If the licensee furnishes food service, provide a
327	wholesome and nourishing diet sufficient to meet generally
328	accepted standards of proper nutrition for its residents and
329	provide such therapeutic diets as may be prescribed by attending
330	physicians. In making rules to implement this paragraph
331	subsection, the agency shall be guided by standards recommended
332	by nationally recognized professional groups and associations
333	with knowledge of dietetics.
334	(j)(10)  Keep full records of resident admissions and
335	discharges; medical and general health status, including medical
336	records, personal and social history, and identity and address
337	of next of kin or other persons who may have responsibility for
338	the affairs of the residents; and individual resident care plans
339	including, but not limited to, prescribed services, service
340	frequency and duration, and service goals. The records shall be
341	open to inspection by the agency.
342	(k)(11)  Keep such fiscal records of its operations and
343	conditions as may be necessary to provide information pursuant
344	to this part.
345	(l)(12)  Furnish copies of personnel records for employees
346	affiliated with such facility, to any other facility licensed by
347	this state requesting this information pursuant to this part.
348	Such information contained in the records may include, but is
349	not limited to, disciplinary matters and any reason for
350	termination. Any facility releasing such records pursuant to
351	this part shall be considered to be acting in good faith and may
352	not be held liable for information contained in such records,
353	absent a showing that the facility maliciously falsified such
354	records.
355	(m)(13)  Publicly display a poster provided by the agency
356	containing the names, addresses, and telephone numbers for the
357	state's abuse hotline, the State Long-Term Care Ombudsman, the
358	Agency for Health Care Administration consumer hotline, the
359	Advocacy Center for Persons with Disabilities, the Florida
360	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
361	with a clear description of the assistance to be expected from
362	each.
363	(n)(14)  Submit to the agency the information specified in
364	s. 400.071(1)(b) for a management company within 30 days after
365	the effective date of the management agreement.
366	(o)1.(15)  Submit semiannually to the agency, or more
367	frequently if requested by the agency, information regarding
368	facility staff-to-resident ratios, staff turnover, and staff
369	stability, including information regarding certified nursing
370	assistants, licensed nurses, the director of nursing, and the
371	facility administrator. For purposes of this reporting:
372	a.(a)  Staff-to-resident ratios must be reported in the
373	categories specified in s. 400.23(3)(a) and applicable rules.
374	The ratio must be reported as an average for the most recent
375	calendar quarter.
376	b.(b)  Staff turnover must be reported for the most recent
377	12-month period ending on the last workday of the most recent
378	calendar quarter prior to the date the information is submitted.
379	The turnover rate must be computed quarterly, with the annual
380	rate being the cumulative sum of the quarterly rates. The
381	turnover rate is the total number of terminations or separations
382	experienced during the quarter, excluding any employee
383	terminated during a probationary period of 3 months or less,
384	divided by the total number of staff employed at the end of the
385	period for which the rate is computed, and expressed as a
386	percentage.
387	c.(c)  The formula for determining staff stability is the
388	total number of employees that have been employed for more than
389	12 months, divided by the total number of employees employed at
390	the end of the most recent calendar quarter, and expressed as a
391	percentage.
392	d.(d)  A nursing facility that has failed to comply with
393	state minimum-staffing requirements for 2 consecutive days is
394	prohibited from accepting new admissions until the facility has
395	achieved the minimum-staffing requirements for a period of 6
396	consecutive days. For the purposes of this sub-subparagraph
397	paragraph, any person who was a resident of the facility and was
398	absent from the facility for the purpose of receiving medical
399	care at a separate location or was on a leave of absence is not
400	considered a new admission. Failure to impose such an admissions
401	moratorium constitutes a class II deficiency.
402	e.(e)  A nursing facility which does not have a conditional
403	license may be cited for failure to comply with the standards in
404	s. 400.23(3)(a)1.a. only if it has failed to meet those
405	standards on 2 consecutive days or if it has failed to meet at
406	least 97 percent of those standards on any one day.
407	f.(f)  A facility which has a conditional license must be
408	in compliance with the standards in s. 400.23(3)(a) at all
409	times.
410	2.  Nothing in This paragraph does not section shall limit
411	the agency's ability to impose a deficiency or take other
412	actions if a facility does not have enough staff to meet the
413	residents' needs.
414	(16)  Report monthly the number of vacant beds in the
415	facility which are available for resident occupancy on the day
416	the information is reported.
417	(p)(17)  Notify a licensed physician when a resident
418	exhibits signs of dementia or cognitive impairment or has a
419	change of condition in order to rule out the presence of an
420	underlying physiological condition that may be contributing to
421	such dementia or impairment. The notification must occur within
422	30 days after the acknowledgment of such signs by facility
423	staff. If an underlying condition is determined to exist, the
424	facility shall arrange, with the appropriate health care
425	provider, the necessary care and services to treat the
426	condition.
427	(q)(18)  If the facility implements a dining and
428	hospitality attendant program, ensure that the program is
429	developed and implemented under the supervision of the facility
430	director of nursing. A licensed nurse, licensed speech or
431	occupational therapist, or a registered dietitian must conduct
432	training of dining and hospitality attendants. A person employed
433	by a facility as a dining and hospitality attendant must perform
434	tasks under the direct supervision of a licensed nurse.
435	(r)(19)  Report to the agency any filing for bankruptcy
436	protection by the facility or its parent corporation,
437	divestiture or spin-off of its assets, or corporate
438	reorganization within 30 days after the completion of such
439	activity.
440	(s)(20)  Maintain general and professional liability
441	insurance coverage that is in force at all times. In lieu of
442	general and professional liability insurance coverage, a state-
443	designated teaching nursing home and its affiliated assisted
444	living facilities created under s. 430.80 may demonstrate proof
445	of financial responsibility as provided in s. 430.80(3)(h).
446	(t)(21)  Maintain in the medical record for each resident a
447	daily chart of certified nursing assistant services provided to
448	the resident. The certified nursing assistant who is caring for
449	the resident must complete this record by the end of his or her
450	shift. This record must indicate assistance with activities of
451	daily living, assistance with eating, and assistance with
452	drinking, and must record each offering of nutrition and
453	hydration for those residents whose plan of care or assessment
454	indicates a risk for malnutrition or dehydration.
455	(u)(22)  Before November 30 of each year, subject to the
456	availability of an adequate supply of the necessary vaccine,
457	provide for immunizations against influenza viruses to all its
458	consenting residents in accordance with the recommendations of
459	the United States Centers for Disease Control and Prevention,
460	subject to exemptions for medical contraindications and
461	religious or personal beliefs. Subject to these exemptions, any
462	consenting person who becomes a resident of the facility after
463	November 30 but before March 31 of the following year must be
464	immunized within 5 working days after becoming a resident.
465	Immunization shall not be provided to any resident who provides
466	documentation that he or she has been immunized as required by
467	this paragraph subsection. This paragraph subsection does not
468	prohibit a resident from receiving the immunization from his or
469	her personal physician if he or she so chooses. A resident who
470	chooses to receive the immunization from his or her personal
471	physician shall provide proof of immunization to the facility.
472	The agency may adopt and enforce any rules necessary to comply
473	with or implement this paragraph subsection.
474	(v)(23)  Assess all residents for eligibility for
475	pneumococcal polysaccharide vaccination (PPV) and vaccinate
476	residents when indicated within 60 days after the effective date
477	of this act in accordance with the recommendations of the United
478	States Centers for Disease Control and Prevention, subject to
479	exemptions for medical contraindications and religious or
480	personal beliefs. Residents admitted after the effective date of
481	this act shall be assessed within 5 working days of admission
482	and, when indicated, vaccinated within 60 days in accordance
483	with the recommendations of the United States Centers for
484	Disease Control and Prevention, subject to exemptions for
485	medical contraindications and religious or personal beliefs.
486	Immunization shall not be provided to any resident who provides
487	documentation that he or she has been immunized as required by
488	this paragraph subsection. This paragraph subsection does not
489	prohibit a resident from receiving the immunization from his or
490	her personal physician if he or she so chooses. A resident who
491	chooses to receive the immunization from his or her personal
492	physician shall provide proof of immunization to the facility.
493	The agency may adopt and enforce any rules necessary to comply
494	with or implement this paragraph subsection.
495	(w)(24)  Annually encourage and promote to its employees
496	the benefits associated with immunizations against influenza
497	viruses in accordance with the recommendations of the United
498	States Centers for Disease Control and Prevention. The agency
499	may adopt and enforce any rules necessary to comply with or
500	implement this paragraph subsection.
501	(2)  Facilities that have been awarded a Gold Seal under
502	the program established in s. 400.235 may develop a plan to
503	provide certified nursing assistant training as prescribed by
504	federal regulations and state rules and may apply to the agency
505	for approval of their program.
506	Section 6.  Present subsections (9) through (13) of section
507	400.147, Florida Statutes, are renumbered as subsections (10)
508	through (14), respectively, subsection (5) and present
509	subsection (14) are amended, and a new subsection (9) is added
510	to that section, to read:
511	400.147  Internal risk management and quality assurance
512	program.--
513	(5)  For purposes of reporting to the agency under this
514	section, the term "adverse incident" means:
515	(a)  An event over which facility personnel could exercise
516	control and which is associated in whole or in part with the
517	facility's intervention, rather than the condition for which
518	such intervention occurred, and which results in one of the
519	following:
520	1.  Death;
521	2.  Brain or spinal damage;
522	3.  Permanent disfigurement;
523	4.  Fracture or dislocation of bones or joints;
524	5.  A limitation of neurological, physical, or sensory
525	function;
526	6.  Any condition that required medical attention to which
527	the resident has not given his or her informed consent,
528	including failure to honor advanced directives; or
529	7.  Any condition that required the transfer of the
530	resident, within or outside the facility, to a unit providing a
531	more acute level of care due to the adverse incident, rather
532	than the resident's condition prior to the adverse incident; or
533	8.  An event that is reported to law enforcement or its
534	personnel for investigation; or
535	(b)  Abuse, neglect, or exploitation as defined in s.
536	415.102;
537	(c)  Abuse, neglect and harm as defined in s. 39.01;
538	(b)(d)  Resident elopement, if the elopement places the
539	resident at risk of harm or injury.; or
540	(e)  An event that is reported to law enforcement.
541	(9)  Abuse, neglect, or exploitation must be reported to
542	the agency as required by 42 C.F.R. s. 483.13(c) and to the
543	department as required by chapters 39 and 415.
544	(14)  The agency shall annually submit to the Legislature a
545	report on nursing home adverse incidents. The report must
546	include the following information arranged by county:
547	(a)  The total number of adverse incidents.
548	(b)  A listing, by category, of the types of adverse
549	incidents, the number of incidents occurring within each
550	category, and the type of staff involved.
551	(c)  A listing, by category, of the types of injury caused
552	and the number of injuries occurring within each category.
553	(d)  Types of liability claims filed based on an adverse
554	incident or reportable injury.
555	(e)  Disciplinary action taken against staff, categorized
556	by type of staff involved.
557	Section 7.  Subsection (3) of section 400.162, Florida
558	Statutes, is amended to read:
559	400.162  Property and personal affairs of residents.--
560	(3)  A licensee shall provide for the safekeeping of
561	personal effects, funds, and other property of the resident in
562	the facility. Whenever necessary for the protection of
563	valuables, or in order to avoid unreasonable responsibility
564	therefor, the licensee may require that such valuables be
565	excluded or removed from the facility and kept at some place not
566	subject to the control of the licensee. At the request of a
567	resident, the facility shall mark the resident's personal
568	property with the resident's name or another type of
569	identification, without defacing the property. Any theft or loss
570	of a resident's personal property shall be documented by the
571	facility. The facility shall develop policies and procedures to
572	minimize the risk of theft or loss of the personal property of
573	residents. A copy of the policy shall be provided to every
574	employee and to each resident and resident's representative, if
575	appropriate, at admission and when revised. Facility policies
576	must include provisions related to reporting theft or loss of a
577	resident's property to law enforcement and any facility waiver
578	of liability for loss or theft. The facility shall post notice
579	of these policies and procedures, and any revision thereof, in
580	places accessible to residents.
581	Section 8.  Paragraph (d) of subsection (1) of section
582	400.195, Florida Statutes, is amended to read:
583	400.195  Agency reporting requirements.--
584	(1)  For the period beginning June 30, 2001, and ending
585	June 30, 2005, the Agency for Health Care Administration shall
586	provide a report to the Governor, the President of the Senate,
587	and the Speaker of the House of Representatives with respect to
588	nursing homes. The first report shall be submitted no later than
589	December 30, 2002, and subsequent reports shall be submitted
590	every 6 months thereafter. The report shall identify facilities
591	based on their ownership characteristics, size, business
592	structure, for-profit or not-for-profit status, and any other
593	characteristics the agency determines useful in analyzing the
594	varied segments of the nursing home industry and shall report:
595	(d)  Information regarding deficiencies cited, including
596	information used to develop the Nursing Home Guide WATCH LIST
597	pursuant to s. 400.191, and applicable rules, a summary of data
598	generated on nursing homes by Centers for Medicare and Medicaid
599	Services Nursing Home Quality Information Project, and
600	information collected pursuant to s. 400.147(10)(9), relating to
601	litigation.
602	Section 9.  Paragraph (b) of subsection (3) of section
603	400.23, Florida Statutes, is amended to read:
604	400.23  Rules; evaluation and deficiencies; licensure
605	status.--
606	(3)
607	(b)  The agency shall adopt rules to allow properly trained
608	staff of a nursing facility, in addition to certified nursing
609	assistants and licensed nurses, to assist residents with eating.
610	The rules shall specify the minimum training requirements and
611	shall specify the physiological conditions or disorders of
612	residents which would necessitate that the eating assistance be
613	provided by nursing personnel of the facility. Nonnursing staff
614	providing eating assistance to residents under the provisions of
615	this subsection shall not count toward compliance with minimum
616	staffing standards.
617	Section 10.  Paragraph (a) of subsection (15) of section
618	400.506, Florida Statutes, is amended to read:
619	400.506  Licensure of nurse registries; requirements;
620	penalties.--
621	(15)(a)  The agency may deny, suspend, or revoke the
622	license of a nurse registry and shall impose a fine of $5,000
623	against a nurse registry that:
624	1.  Provides services to residents in an assisted living
625	facility for which the nurse registry does not receive fair
626	market value remuneration.
627	2.  Provides staffing to an assisted living facility for
628	which the nurse registry does not receive fair market value
629	remuneration.
630	3.  Fails to provide the agency, upon request, with copies
631	of all contracts with assisted living facilities which were
632	executed within the last 5 years.
633	4.  Gives remuneration to a case manager, discharge
634	planner, facility-based staff member, or third-party vendor who
635	is involved in the discharge planning process of a facility
636	licensed under chapter 395 or this chapter and from whom the
637	nurse registry receives referrals. This subparagraph does not
638	apply to a nurse registry that does not participate in the
639	Medicaid or Medicare program.
640	5.  Gives remuneration to a physician, a member of the
641	physician's office staff, or an immediate family member of the
642	physician, and the nurse registry received a patient referral in
643	the last 12 months from that physician or the physician's office
644	staff. This subparagraph does not apply to a nurse registry that
645	does not participate in the Medicaid or Medicare program.
646	Section 11.  Paragraph (a) of subsection (7) of section
647	400.9935, Florida Statutes, is amended to read:
648	400.9935  Clinic responsibilities.--
649	(7)(a)  Each clinic engaged in magnetic resonance imaging
650	services must be accredited by the Joint Commission on
651	Accreditation of Healthcare Organizations, the American College
652	of Radiology, or the Accreditation Association for Ambulatory
653	Health Care, within 1 year after licensure. A clinic that is
654	accredited by the American College of Radiology or is within the
655	original 1-year period after licensure and replaces its core
656	magnetic resonance imaging equipment shall be given 1 year after
657	the date upon which the equipment is replaced to attain
658	accreditation. However, a clinic may request a single, 6-month
659	extension if it provides evidence to the agency establishing
660	that, for good cause shown, such clinic cannot can not be
661	accredited within 1 year after licensure, and that such
662	accreditation will be completed within the 6-month extension.
663	After obtaining accreditation as required by this subsection,
664	each such clinic must maintain accreditation as a condition of
665	renewal of its license. A clinic that files a change of
666	ownership application must comply with the original
667	accreditation timeframe requirements of the transferor. The
668	agency shall deny a change of ownership application if the
669	clinic is not in compliance with the accreditation requirements.
670	When a clinic adds, replaces, or modifies magnetic resonance
671	imaging equipment and the accrediting organization requires new
672	accreditation, the clinic must be accredited within 1 year after
673	the date of the addition, replacement, or modification but may
674	request a single, 6-month extension if the clinic provides
675	evidence of good cause to the agency.
676	Section 12.  Subsection (6) of section 400.995, Florida
677	Statutes, is amended to read:
678	400.995  Agency administrative penalties.--
679	(6)  During an inspection, the agency, as an alternative to
680	or in conjunction with an administrative action against a clinic
681	for violations of this part and adopted rules, shall make a
682	reasonable attempt to discuss each violation and recommended
683	corrective action with the owner, medical director, or clinic
684	director of the clinic, prior to written notification. The
685	agency, instead of fixing a period within which the clinic shall
686	enter into compliance with standards, may request a plan of
687	corrective action from the clinic which demonstrates a good
688	faith effort to remedy each violation by a specific date,
689	subject to the approval of the agency.
690	Section 13.  Subsections (5) and (9) of section 408.803,
691	Florida Statutes, are amended to read:
692	408.803  Definitions.--As used in this part, the term:
693	(5)  "Change of ownership" means:
694	(a)  An event in which the licensee sells or otherwise
695	transfers its ownership changes to a different individual or
696	legal entity, as evidenced by a change in federal employer
697	identification number or taxpayer identification number; or
698	(b)  An event in which 51 45 percent or more of the
699	ownership, voting shares, membership, or controlling interest of
700	a licensee is in any manner transferred or otherwise assigned.
701	This paragraph does not apply to a licensee that is publicly
702	traded on a recognized stock exchange. In a corporation whose
703	shares are not publicly traded on a recognized stock exchange is
704	transferred or assigned, including the final transfer or
705	assignment of multiple transfers or assignments over a 2-year
706	period that cumulatively total 45 percent or greater.
707
708	A change solely in the management company or board of directors
709	is not a change of ownership.
710	(9)  "Licensee" means an individual, corporation,
711	partnership, firm, association, or governmental entity, or other
712	entity that is issued a permit, registration, certificate, or
713	license by the agency. The licensee is legally responsible for
714	all aspects of the provider operation.
715	Section 14.  Paragraph (a) of subsection (1), subsection
716	(2), paragraph (c) of subsection (7), and subsection (8) of
717	section 408.806, Florida Statutes, are amended to read:
718	408.806  License application process.--
719	(1)  An application for licensure must be made to the
720	agency on forms furnished by the agency, submitted under oath,
721	and accompanied by the appropriate fee in order to be accepted
722	and considered timely. The application must contain information
723	required by authorizing statutes and applicable rules and must
724	include:
725	(a)  The name, address, and social security number of:
726	1.  The applicant;
727	2.  The administrator or a similarly titled person who is
728	responsible for the day-to-day operation of the provider;
729	3.  The financial officer or similarly titled person who is
730	responsible for the financial operation of the licensee or
731	provider; and
732	4.  Each controlling interest if the applicant or
733	controlling interest is an individual.
734	(2)(a)  The applicant for a renewal license must submit an
735	application that must be received by the agency at least 60 days
736	but no more than 120 days prior to the expiration of the current
737	license. An application received more than 120 days prior to the
738	expiration of the current license shall be returned to the
739	applicant. If the renewal application and fee are received prior
740	to the license expiration date, the license shall not be deemed
741	to have expired if the license expiration date occurs during the
742	agency's review of the renewal application.
743	(b)  The applicant for initial licensure due to a change of
744	ownership must submit an application that must be received by
745	the agency at least 60 days prior to the date of change of
746	ownership.
747	(c)  For any other application or request, the applicant
748	must submit an application or request that must be received by
749	the agency at least 60 days but no more than 120 days prior to
750	the requested effective date, unless otherwise specified in
751	authorizing statutes or applicable rules. An application
752	received more than 120 days prior to the requested effective
753	date shall be returned to the applicant.
754	(d)  The agency shall notify the licensee by mail or
755	electronically at least 90 days prior to the expiration of a
756	license that a renewal license is necessary to continue
757	operation. The failure to timely submit a renewal application
758	and license fee shall result in a $50 per day late fee charged
759	to the licensee by the agency; however, the aggregate amount of
760	the late fee may not exceed 50 percent of the licensure fee or
761	$500, whichever is less. If an application is received after the
762	required filing date and exhibits a hand-canceled postmark
763	obtained from a United States post office dated on or before the
764	required filing date, no fine will be levied.
765	(7)
766	(c)  If an inspection is required by the authorizing
767	statute for a license application other than an initial
768	application, the inspection must be unannounced. This paragraph
769	does not apply to inspections required pursuant to ss. 383.324,
770	395.0161(4), 429.67(6), and 483.061(2).
771	(8)  The agency may establish procedures for the electronic
772	notification and submission of required information, including,
773	but not limited to:
774	(a)  Licensure applications.
775	(b)  Required signatures.
776	(c)  Payment of fees.
777	(d)  Notarization of applications.
778
779	Requirements for electronic submission of any documents required
780	by this part or authorizing statutes may be established by rule.
781	As an alternative to sending documents as required by
782	authorizing statutes, the agency may provide electronic access
783	to information or documents.
784	Section 15.  Subsection (2) of section 408.808, Florida
785	Statutes, is amended to read:
786	408.808  License categories.--
787	(2)  PROVISIONAL LICENSE.--A provisional license may be
788	issued to an applicant pursuant to s. 408.809(3). An applicant
789	against whom a proceeding denying or revoking a license is
790	pending at the time of license renewal may be issued a
791	provisional license effective until final action not subject to
792	further appeal. A provisional license may also be issued to an
793	applicant applying for a change of ownership. A provisional
794	license shall be limited in duration to a specific period of
795	time, not to exceed 12 months, as determined by the agency.
796	Section 16.  Subsection (5) of section 408.809, Florida
797	Statutes, is amended, and new subsections (5) and (6) are added
798	to that section, to read:
799	408.809  Background screening; prohibited offenses.--
800	(5)  Effective October 1, 2009, in addition to the offenses
801	listed in ss. 435.03 and 435.04, all persons required to undergo
802	background screening pursuant to this part or authorizing
803	statutes must not have been found guilty of, regardless of
804	adjudication, or entered a plea of nolo contendere or guilty to,
805	any of the following offenses or any similar offense of another
806	jurisdiction:
807	(a)  A violation of any authorizing statutes, if the
808	offense was a felony.
809	(b)  A violation of this chapter, if the offense was a
810	felony.
811	(c)  A violation of s. 409.920, relating to Medicaid
812	provider fraud, if the offense was a felony.
813	(d)  A violation of s. 409.9201, relating to Medicaid
814	fraud, if the offense was a felony.
815	(e)  A violation of s. 741.28, relating to domestic
816	violence.
817	(f)  A violation of chapter 784, relating to assault,
818	battery, and culpable negligence, if the offense was a felony.
819	(g)  A violation of s. 810.02, relating to burglary.
820	(h)  A violation of s. 817.034, relating to fraudulent acts
821	through mail, wire, radio, electromagnetic, photoelectronic, or
822	photooptical systems.
823	(i)  A violation of s. 817.234, relating to false and
824	fraudulent insurance claims.
825	(j)  A violation of s. 817.505, relating to patient
826	brokering.
827	(k)  A violation of s. 817.568, relating to criminal use of
828	personal identification information.
829	(l)  A violation of s. 817.60, relating to obtaining a
830	credit card through fraudulent means.
831	(m)  A violation of s. 817.61, relating to fraudulent use
832	of credit cards, if the offense was a felony.
833	(n)  A violation of s. 831.01, relating to forgery.
834	(o)  A violation of s. 831.02, relating to uttering forged
835	instruments.
836	(p)  A violation of s. 831.07, relating to forging bank
837	bills, checks, drafts, or promissory notes.
838	(q)  A violation of s. 831.09, relating to uttering forged
839	bank bills, checks, drafts, or promissory notes.
840	(r)  A violation of s. 831.30, relating to fraud in
841	obtaining medicinal drugs.
842	(s)  A violation of s. 831.31, relating to the sale,
843	manufacture, delivery, or possession with the intent to sell,
844	manufacture, or deliver any counterfeit controlled substance, if
845	the offense was a felony.
846
847	A person who serves as a controlling interest of or is employed
848	by a licensee on September 30, 2009, shall not be required by
849	law to submit to rescreening if that licensee has in its
850	possession written evidence that the person has been screened
851	and qualified according to the standards specified in s. 435.03
852	or s. 435.04. However, if such person has been convicted of a
853	disqualifying offense listed in this subsection, he or she may
854	apply for an exemption from the appropriate licensing agency
855	before September 30, 2009, and if agreed to by the employer, may
856	continue to perform his or her duties until the licensing agency
857	renders a decision on the application for exemption for an
858	offense listed in this subsection. Exemptions from
859	disqualification may be granted pursuant to s. 435.07.
860	(6)  The attestations required under ss. 435.04(5) and
861	435.05(3) must be submitted at the time of license renewal,
862	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
863	which require annual submission of an affidavit of compliance
864	with background screening requirements.
865	(5)  Background screening is not required to obtain a
866	certificate of exemption issued under s. 483.106.
867	Section 17.  Subsection (3) of section 408.810, Florida
868	Statutes, is amended to read:
869	408.810  Minimum licensure requirements.--In addition to
870	the licensure requirements specified in this part, authorizing
871	statutes, and applicable rules, each applicant and licensee must
872	comply with the requirements of this section in order to obtain
873	and maintain a license.
874	(3)  Unless otherwise specified in this part, authorizing
875	statutes, or applicable rules, any information required to be
876	reported to the agency must be submitted within 21 calendar days
877	after the report period or effective date of the information,
878	whichever is earlier, including, but not limited to, any change
879	of:
880	(a)  Information contained in the most recent application
881	for licensure.
882	(b)  Required insurance or bonds.
883	Section 18.  Present subsection (4) of section 408.811,
884	Florida Statutes, is renumbered as subsection (6), subsections
885	(2) and (3) are amended, and new subsections (4) and (5) are
886	added to that section, to read:
887	408.811  Right of inspection; copies; inspection reports;
888	plan for correction of deficiencies.--
889	(2)  Inspections conducted in conjunction with
890	certification, comparable licensure requirements, or a
891	recognized or approved accreditation organization may be
892	accepted in lieu of a complete licensure inspection. However, a
893	licensure inspection may also be conducted to review any
894	licensure requirements that are not also requirements for
895	certification.
896	(3)  The agency shall have access to and the licensee shall
897	provide, or if requested send, copies of all provider records
898	required during an inspection or other review at no cost to the
899	agency, including records requested during an offsite review.
900	(4)  Deficiencies must be corrected within 30 calendar days
901	after the provider is notified of inspection results unless an
902	alternative timeframe is required or approved by the agency.
903	(5)  The agency may require an applicant or licensee to
904	submit a plan of correction for deficiencies. If required, the
905	plan of correction must be filed with the agency within 10
906	calendar days after notification unless an alternative timeframe
907	is required.
908	Section 19.  Section 408.813, Florida Statutes, is amended
909	to read:
910	408.813  Administrative fines; violations.--As a penalty
911	for any violation of this part, authorizing statutes, or
912	applicable rules, the agency may impose an administrative fine.
913	(1)  Unless the amount or aggregate limitation of the fine
914	is prescribed by authorizing statutes or applicable rules, the
915	agency may establish criteria by rule for the amount or
916	aggregate limitation of administrative fines applicable to this
917	part, authorizing statutes, and applicable rules. Each day of
918	violation constitutes a separate violation and is subject to a
919	separate fine, unless a per-violation fine is prescribed by law.
920	For fines imposed by final order of the agency and not subject
921	to further appeal, the violator shall pay the fine plus interest
922	at the rate specified in s. 55.03 for each day beyond the date
923	set by the agency for payment of the fine.
924	(2)  Violations of this part, authorizing statutes, or
925	applicable rules shall be classified according to the nature of
926	the violation and the gravity of its probable effect on clients.
927	The scope of a violation may be cited as an isolated, patterned,
928	or widespread deficiency. An isolated deficiency is a deficiency
929	affecting one or a very limited number of clients, or involving
930	one or a very limited number of staff, or a situation that
931	occurred only occasionally or in a very limited number of
932	locations. A patterned deficiency is a deficiency in which more
933	than a very limited number of clients are affected, or more than
934	a very limited number of staff are involved, or the situation
935	has occurred in several locations, or the same client or clients
936	have been affected by repeated occurrences of the same deficient
937	practice but the effect of the deficient practice is not found
938	to be pervasive throughout the provider. A widespread deficiency
939	is a deficiency in which the problems causing the deficiency are
940	pervasive in the provider or represent systemic failure that has
941	affected or has the potential to affect a large portion of the
942	provider's clients. This subsection does not affect the
943	legislative determination of the amount of a fine imposed under
944	authorizing statutes. Violations shall be classified on the
945	written notice as follows:
946	(a)  Class "I" violations are those conditions or
947	occurrences related to the operation and maintenance of a
948	provider or to the care of clients which the agency determines
949	present an imminent danger to the clients of the provider or a
950	substantial probability that death or serious physical or
951	emotional harm would result therefrom. The condition or practice
952	constituting a class I violation shall be abated or eliminated
953	within 24 hours, unless a fixed period, as determined by the
954	agency, is required for correction. The agency shall impose an
955	administrative fine as provided by law for a cited class I
956	violation. A fine shall be levied notwithstanding the correction
957	of the violation.
958	(b)  Class "II" violations are those conditions or
959	occurrences related to the operation and maintenance of a
960	provider or to the care of clients which the agency determines
961	directly threaten the physical or emotional health, safety, or
962	security of the clients, other than class I violations. The
963	agency shall impose an administrative fine as provided by law
964	for a cited class II violation. A fine shall be levied
965	notwithstanding the correction of the violation.
966	(c)  Class "III" violations are those conditions or
967	occurrences related to the operation and maintenance of a
968	provider or to the care of clients which the agency determines
969	indirectly or potentially threaten the physical or emotional
970	health, safety, or security of clients, other than class I or
971	class II violations. The agency shall impose an administrative
972	fine as provided by law for a cited class III violation. A
973	citation for a class III violation must specify the time within
974	which the violation is required to be corrected. If a class III
975	violation is corrected within the time specified, a fine may not
976	be imposed.
977	(d)  Class "IV" violations are those conditions or
978	occurrences related to the operation and maintenance of a
979	provider or to required reports, forms, or documents that do not
980	have the potential of negatively affecting clients. These
981	violations are of a type that the agency determines do not
982	threaten the health, safety, or security of clients. The agency
983	shall impose an administrative fine as provided by law for a
984	cited class IV violation. A citation for a class IV violation
985	must specify the time within which the violation is required to
986	be corrected. If a class IV violation is corrected within the
987	time specified, a fine may not be imposed.
988	Section 20.  Subsections (12) through (16) of section
989	408.820, Florida Statutes, are renumbered as subsections (11)
990	through (15), respectively, subsections (18) through (26) are
991	renumbered as subsections (16) through (24), respectively,
992	subsections (28) and (29) are renumbered as subsections (25) and
993	(26), respectively, and present subsections (11), (12), (17),
994	(21), (26), and (27) of that section are amended to read:
995	408.820  Exemptions.--Except as prescribed in authorizing
996	statutes, the following exemptions shall apply to specified
997	requirements of this part:
998	(11)  Private review agents, as provided under part I of
999	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1000	408.811.
1001	(11)(12)  Health care risk managers, as provided under part
1002	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1003	(10), and 408.811.
1004	(17)  Companion services or homemaker services providers,
1005	as provided under part III of chapter 400, are exempt from s.
1006	408.810(6)-(10).
1007	(19)(21)  Transitional living facilities, as provided under
1008	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1009	(24)(26)  Health care clinics, as provided under part X of
1010	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1011	(7), and (10).
1012	(27)  Clinical laboratories, as provided under part I of
1013	chapter 483, are exempt from s. 408.810(5)-(10).
1014	Section 21.  Section 408.821, Florida Statutes, is created
1015	to read:
1016	408.821  Emergency management planning; emergency
1017	operations; inactive license.--
1018	(1)  Licensees required by authorizing statutes to have an
1019	emergency operations plan must designate a safety liaison to
1020	serve as the primary contact for emergency operations.
1021	(2)  An entity subject to this part may temporarily exceed
1022	its licensed capacity to act as a receiving provider in
1023	accordance with an approved emergency operations plan for up to
1024	15 days. While in an overcapacity status, each provider must
1025	furnish or arrange for appropriate care and services to all
1026	clients. In addition, the agency may approve requests for
1027	overcapacity in excess of 15 days, which approvals may be based
1028	upon satisfactory justification and need as provided by the
1029	receiving and sending providers.
1030	(3)(a)  An inactive license may be issued to a licensee
1031	subject to this section when the provider is located in a
1032	geographic area in which a state of emergency was declared by
1033	the Governor if the provider:
1034	1.  Suffered damage to its operation during the state of
1035	emergency.
1036	2.  Is currently licensed.
1037	3.  Does not have a provisional license.
1038	4.  Will be temporarily unable to provide services but is
1039	reasonably expected to resume services within 12 months.
1040	(b)  An inactive license may be issued for a period not to
1041	exceed 12 months but may be renewed by the agency for up to 12
1042	additional months upon demonstration to the agency of progress
1043	toward reopening. A request by a licensee for an inactive
1044	license or to extend the previously approved inactive period
1045	must be submitted in writing to the agency, accompanied by
1046	written justification for the inactive license, which states the
1047	beginning and ending dates of inactivity and includes a plan for
1048	the transfer of any clients to other providers and appropriate
1049	licensure fees. Upon agency approval, the licensee shall notify
1050	clients of any necessary discharge or transfer as required by
1051	authorizing statutes or applicable rules. The beginning of the
1052	inactive licensure period shall be the date the provider ceases
1053	operations. The end of the inactive period shall become the
1054	license expiration date, and all licensure fees must be current,
1055	must be paid in full, and may be prorated. Reactivation of an
1056	inactive license requires the prior approval by the agency of a
1057	renewal application, including payment of licensure fees and
1058	agency inspections indicating compliance with all requirements
1059	of this part and applicable rules and statutes.
1060	(4)  The agency may adopt rules relating to emergency
1061	management planning, communications, and operations. Licensees
1062	providing residential or inpatient services must utilize an
1063	online database approved by the agency to report information to
1064	the agency regarding the provider's emergency status, planning,
1065	or operations.
1066	Section 22.  Subsections (3), (4), and (5) of section
1067	408.831, Florida Statutes, are amended to read:
1068	408.831  Denial, suspension, or revocation of a license,
1069	registration, certificate, or application.--
1070	(3)  An entity subject to this section may exceed its
1071	licensed capacity to act as a receiving facility in accordance
1072	with an emergency operations plan for clients of evacuating
1073	providers from a geographic area where an evacuation order has
1074	been issued by a local authority having jurisdiction. While in
1075	an overcapacity status, each provider must furnish or arrange
1076	for appropriate care and services to all clients. In addition,
1077	the agency may approve requests for overcapacity beyond 15 days,
1078	which approvals may be based upon satisfactory justification and
1079	need as provided by the receiving and sending facilities.
1080	(4)(a)  An inactive license may be issued to a licensee
1081	subject to this section when the provider is located in a
1082	geographic area where a state of emergency was declared by the
1083	Governor if the provider:
1084	1.  Suffered damage to its operation during that state of
1085	emergency.
1086	2.  Is currently licensed.
1087	3.  Does not have a provisional license.
1088	4.  Will be temporarily unable to provide services but is
1089	reasonably expected to resume services within 12 months.
1090	(b)  An inactive license may be issued for a period not to
1091	exceed 12 months but may be renewed by the agency for up to 12
1092	additional months upon demonstration to the agency of progress
1093	toward reopening. A request by a licensee for an inactive
1094	license or to extend the previously approved inactive period
1095	must be submitted in writing to the agency, accompanied by
1096	written justification for the inactive license, which states the
1097	beginning and ending dates of inactivity and includes a plan for
1098	the transfer of any clients to other providers and appropriate
1099	licensure fees. Upon agency approval, the licensee shall notify
1100	clients of any necessary discharge or transfer as required by
1101	authorizing statutes or applicable rules. The beginning of the
1102	inactive licensure period shall be the date the provider ceases
1103	operations. The end of the inactive period shall become the
1104	licensee expiration date, and all licensure fees must be
1105	current, paid in full, and may be prorated. Reactivation of an
1106	inactive license requires the prior approval by the agency of a
1107	renewal application, including payment of licensure fees and
1108	agency inspections indicating compliance with all requirements
1109	of this part and applicable rules and statutes.
1110	(3)(5)  This section provides standards of enforcement
1111	applicable to all entities licensed or regulated by the Agency
1112	for Health Care Administration. This section controls over any
1113	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1114	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1115	those chapters.
1116	Section 23.  Paragraph (e) of subsection (4) of section
1117	409.221, Florida Statutes, is amended to read:
1118	409.221  Consumer-directed care program.--
1119	(4)  CONSUMER-DIRECTED CARE.--
1120	(e)  Services.--Consumers shall use the budget allowance
1121	only to pay for home and community-based services that meet the
1122	consumer's long-term care needs and are a cost-efficient use of
1123	funds. Such services may include, but are not limited to, the
1124	following:
1125	1.  Personal care.
1126	2.  Homemaking and chores, including housework, meals,
1127	shopping, and transportation.
1128	3.  Home modifications and assistive devices which may
1129	increase the consumer's independence or make it possible to
1130	avoid institutional placement.
1131	4.  Assistance in taking self-administered medication.
1132	5.  Day care and respite care services, including those
1133	provided by nursing home facilities pursuant to s.
1134	400.141(1)(f)(6) or by adult day care facilities licensed
1135	pursuant to s. 429.907.
1136	6.  Personal care and support services provided in an
1137	assisted living facility.
1138	Section 24.  Subsection (5) of section 409.901, Florida
1139	Statutes, is amended to read:
1140	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1141	409.901-409.920, except as otherwise specifically provided, the
1142	term:
1143	(5)  "Change of ownership" means:
1144	(a)  An event in which the provider ownership changes to a
1145	different individual legal entity, as evidenced by a change in
1146	federal employer identification number or taxpayer
1147	identification number; or
1148	(b)  An event in which 51 45 percent or more of the
1149	ownership, voting shares, membership, or controlling interest of
1150	a provider is in any manner transferred or otherwise assigned.
1151	This paragraph does not apply to a licensee that is publicly
1152	traded on a recognized stock exchange; or
1153	(c)  When the provider is licensed or registered by the
1154	agency, an event considered a change of ownership for licensure
1155	as defined in s. 408.803 in a corporation whose shares are not
1156	publicly traded on a recognized stock exchange is transferred or
1157	assigned, including the final transfer or assignment of multiple
1158	transfers or assignments over a 2-year period that cumulatively
1159	total 45 percent or more.
1160
1161	A change solely in the management company or board of directors
1162	is not a change of ownership.
1163	Section 25.  Section 429.071, Florida Statutes, is
1164	repealed.
1165	Section 26.  Paragraph (e) of subsection (1) and
1166	subsections (2) and (3) of section 429.08, Florida Statutes, are
1167	amended to read:
1168	429.08  Unlicensed facilities; referral of person for
1169	residency to unlicensed facility; penalties; verification of
1170	licensure status.--
1171	(1)
1172	(e)  The agency shall publish provide to the department's
1173	elder information and referral providers a list, by county, of
1174	licensed assisted living facilities, to assist persons who are
1175	considering an assisted living facility placement in locating a
1176	licensed facility. This information may be provided
1177	electronically or on the agency's Internet website.
1178	(2)  Each field office of the Agency for Health Care
1179	Administration shall establish a local coordinating workgroup
1180	which includes representatives of local law enforcement
1181	agencies, state attorneys, the Medicaid Fraud Control Unit of
1182	the Department of Legal Affairs, local fire authorities, the
1183	Department of Children and Family Services, the district long-
1184	term care ombudsman council, and the district human rights
1185	advocacy committee to assist in identifying the operation of
1186	unlicensed facilities and to develop and implement a plan to
1187	ensure effective enforcement of state laws relating to such
1188	facilities. The workgroup shall report its findings, actions,
1189	and recommendations semiannually to the Director of Health
1190	Quality Assurance of the agency.
1191	(2)(3)  It is unlawful to knowingly refer a person for
1192	residency to an unlicensed assisted living facility; to an
1193	assisted living facility the license of which is under denial or
1194	has been suspended or revoked; or to an assisted living facility
1195	that has a moratorium pursuant to part II of chapter 408. Any
1196	person who violates this subsection commits a noncriminal
1197	violation, punishable by a fine not exceeding $500 as provided
1198	in s. 775.083.
1199	(a)  Any health care practitioner, as defined in s.
1200	456.001, who is aware of the operation of an unlicensed facility
1201	shall report that facility to the agency. Failure to report a
1202	facility that the practitioner knows or has reasonable cause to
1203	suspect is unlicensed shall be reported to the practitioner's
1204	licensing board.
1205	(b)  Any provider as defined in s. 408.803 that hospital or
1206	community mental health center licensed under chapter 395 or
1207	chapter 394 which knowingly discharges a patient or client to an
1208	unlicensed facility is subject to sanction by the agency.
1209	(c)  Any employee of the agency or department, or the
1210	Department of Children and Family Services, who knowingly refers
1211	a person for residency to an unlicensed facility; to a facility
1212	the license of which is under denial or has been suspended or
1213	revoked; or to a facility that has a moratorium pursuant to part
1214	II of chapter 408 is subject to disciplinary action by the
1215	agency or department, or the Department of Children and Family
1216	Services.
1217	(d)  The employer of any person who is under contract with
1218	the agency or department, or the Department of Children and
1219	Family Services, and who knowingly refers a person for residency
1220	to an unlicensed facility; to a facility the license of which is
1221	under denial or has been suspended or revoked; or to a facility
1222	that has a moratorium pursuant to part II of chapter 408 shall
1223	be fined and required to prepare a corrective action plan
1224	designed to prevent such referrals.
1225	(e)  The agency shall provide the department and the
1226	Department of Children and Family Services with a list of
1227	licensed facilities within each county and shall update the list
1228	at least quarterly.
1229	(f)  At least annually, the agency shall notify, in
1230	appropriate trade publications, physicians licensed under
1231	chapter 458 or chapter 459, hospitals licensed under chapter
1232	395, nursing home facilities licensed under part II of chapter
1233	400, and employees of the agency or the department, or the
1234	Department of Children and Family Services, who are responsible
1235	for referring persons for residency, that it is unlawful to
1236	knowingly refer a person for residency to an unlicensed assisted
1237	living facility and shall notify them of the penalty for
1238	violating such prohibition. The department and the Department of
1239	Children and Family Services shall, in turn, notify service
1240	providers under contract to the respective departments who have
1241	responsibility for resident referrals to facilities. Further,
1242	the notice must direct each noticed facility and individual to
1243	contact the appropriate agency office in order to verify the
1244	licensure status of any facility prior to referring any person
1245	for residency. Each notice must include the name, telephone
1246	number, and mailing address of the appropriate office to
1247	contact.
1248	Section 27.  Paragraph (e) of subsection (1) of section
1249	429.14, Florida Statutes, is amended to read:
1250	429.14  Administrative penalties.--
1251	(1)  In addition to the requirements of part II of chapter
1252	408, the agency may deny, revoke, and suspend any license issued
1253	under this part and impose an administrative fine in the manner
1254	provided in chapter 120 against a licensee of an assisted living
1255	facility for a violation of any provision of this part, part II
1256	of chapter 408, or applicable rules, or for any of the following
1257	actions by a licensee of an assisted living facility, for the
1258	actions of any person subject to level 2 background screening
1259	under s. 408.809, or for the actions of any facility employee:
1260	(e)  A citation of any of the following deficiencies as
1261	specified defined in s. 429.19:
1262	1.  One or more cited class I deficiencies.
1263	2.  Three or more cited class II deficiencies.
1264	3.  Five or more cited class III deficiencies that have
1265	been cited on a single survey and have not been corrected within
1266	the times specified.
1267	Section 28.  Subsections (2), (8), and (9) of section
1268	429.19, Florida Statutes, are amended to read:
1269	429.19  Violations; imposition of administrative fines;
1270	grounds.--
1271	(2)  Each violation of this part and adopted rules shall be
1272	classified according to the nature of the violation and the
1273	gravity of its probable effect on facility residents. The agency
1274	shall indicate the classification on the written notice of the
1275	violation as follows:
1276	(a)  Class "I" violations are defined in s. 408.813 those
1277	conditions or occurrences related to the operation and
1278	maintenance of a facility or to the personal care of residents
1279	which the agency determines present an imminent danger to the
1280	residents or guests of the facility or a substantial probability
1281	that death or serious physical or emotional harm would result
1282	therefrom. The condition or practice constituting a class I
1283	violation shall be abated or eliminated within 24 hours, unless
1284	a fixed period, as determined by the agency, is required for
1285	correction. The agency shall impose an administrative fine for a
1286	cited class I violation in an amount not less than $5,000 and
1287	not exceeding $10,000 for each violation. A fine may be levied
1288	notwithstanding the correction of the violation.
1289	(b)  Class "II" violations are defined in s. 408.813 those
1290	conditions or occurrences related to the operation and
1291	maintenance of a facility or to the personal care of residents
1292	which the agency determines directly threaten the physical or
1293	emotional health, safety, or security of the facility residents,
1294	other than class I violations. The agency shall impose an
1295	administrative fine for a cited class II violation in an amount
1296	not less than $1,000 and not exceeding $5,000 for each
1297	violation. A fine shall be levied notwithstanding the correction
1298	of the violation.
1299	(c)  Class "III" violations are defined in s. 408.813 those
1300	conditions or occurrences related to the operation and
1301	maintenance of a facility or to the personal care of residents
1302	which the agency determines indirectly or potentially threaten
1303	the physical or emotional health, safety, or security of
1304	facility residents, other than class I or class II violations.
1305	The agency shall impose an administrative fine for a cited class
1306	III violation in an amount not less than $500 and not exceeding
1307	$1,000 for each violation. A citation for a class III violation
1308	must specify the time within which the violation is required to
1309	be corrected. If a class III violation is corrected within the
1310	time specified, no fine may be imposed, unless it is a repeated
1311	offense.
1312	(d)  Class "IV" violations are defined in s. 408.813 those
1313	conditions or occurrences related to the operation and
1314	maintenance of a building or to required reports, forms, or
1315	documents that do not have the potential of negatively affecting
1316	residents. These violations are of a type that the agency
1317	determines do not threaten the health, safety, or security of
1318	residents of the facility. The agency shall impose an
1319	administrative fine for a cited class IV violation in an amount
1320	not less than $100 and not exceeding $200 for each violation. A
1321	citation for a class IV violation must specify the time within
1322	which the violation is required to be corrected. If a class IV
1323	violation is corrected within the time specified, no fine shall
1324	be imposed. Any class IV violation that is corrected during the
1325	time an agency survey is being conducted will be identified as
1326	an agency finding and not as a violation.
1327	(8)  During an inspection, the agency, as an alternative to
1328	or in conjunction with an administrative action against a
1329	facility for violations of this part and adopted rules, shall
1330	make a reasonable attempt to discuss each violation and
1331	recommended corrective action with the owner or administrator of
1332	the facility, prior to written notification. The agency, instead
1333	of fixing a period within which the facility shall enter into
1334	compliance with standards, may request a plan of corrective
1335	action from the facility which demonstrates a good faith effort
1336	to remedy each violation by a specific date, subject to the
1337	approval of the agency.
1338	(9)  The agency shall develop and disseminate an annual
1339	list of all facilities sanctioned or fined $5,000 or more for
1340	violations of state standards, the number and class of
1341	violations involved, the penalties imposed, and the current
1342	status of cases. The list shall be disseminated, at no charge,
1343	to the Department of Elderly Affairs, the Department of Health,
1344	the Department of Children and Family Services, the Agency for
1345	Persons with Disabilities, the area agencies on aging, the
1346	Florida Statewide Advocacy Council, and the state and local
1347	ombudsman councils. The Department of Children and Family
1348	Services shall disseminate the list to service providers under
1349	contract to the department who are responsible for referring
1350	persons to a facility for residency. The agency may charge a fee
1351	commensurate with the cost of printing and postage to other
1352	interested parties requesting a copy of this list. This
1353	information may be provided electronically or on the agency's
1354	Internet website.
1355	Section 29.  Subsections (2) and (6) of section 429.23,
1356	Florida Statutes, are amended to read:
1357	429.23  Internal risk management and quality assurance
1358	program; adverse incidents and reporting requirements.--
1359	(2)  Every facility licensed under this part is required to
1360	maintain adverse incident reports. For purposes of this section,
1361	the term, "adverse incident" means:
1362	(a)  An event over which facility personnel could exercise
1363	control rather than as a result of the resident's condition and
1364	results in:
1365	1.  Death;
1366	2.  Brain or spinal damage;
1367	3.  Permanent disfigurement;
1368	4.  Fracture or dislocation of bones or joints;
1369	5.  Any condition that required medical attention to which
1370	the resident has not given his or her consent, including failure
1371	to honor advanced directives;
1372	6.  Any condition that requires the transfer of the
1373	resident from the facility to a unit providing more acute care
1374	due to the incident rather than the resident's condition before
1375	the incident; or.
1376	7.  An event that is reported to law enforcement or its
1377	personnel for investigation; or
1378	(b)  Abuse, neglect, or exploitation as defined in s.
1379	415.102;
1380	(c)  Events reported to law enforcement; or
1381	(b)(d)  Resident elopement, if the elopement places the
1382	resident at risk of harm or injury.
1383	(6)  Abuse, neglect, or exploitation must be reported to
1384	the Department of Children and Family Services as required under
1385	chapter 415. The agency shall annually submit to the Legislature
1386	a report on assisted living facility adverse incident reports.
1387	The report must include the following information arranged by
1388	county:
1389	(a)  A total number of adverse incidents;
1390	(b)  A listing, by category, of the type of adverse
1391	incidents occurring within each category and the type of staff
1392	involved;
1393	(c)  A listing, by category, of the types of injuries, if
1394	any, and the number of injuries occurring within each category;
1395	(d)  Types of liability claims filed based on an adverse
1396	incident report or reportable injury; and
1397	(e)  Disciplinary action taken against staff, categorized
1398	by the type of staff involved.
1399	Section 30.  Subsections (10) through (12) of section
1400	429.26, Florida Statutes, are renumbered as subsections (9)
1401	through (11), respectively, and present subsection (9) of that
1402	section is amended to read:
1403	429.26  Appropriateness of placements; examinations of
1404	residents.--
1405	(9)  If, at any time after admission to a facility, a
1406	resident appears to need care beyond that which the facility is
1407	licensed to provide, the agency shall require the resident to be
1408	physically examined by a licensed physician, physician
1409	assistant, or licensed nurse practitioner. This examination
1410	shall, to the extent possible, be performed by the resident's
1411	preferred physician or nurse practitioner and shall be paid for
1412	by the resident with personal funds, except as provided in s.
1413	429.18(2). Following this examination, the examining physician,
1414	physician assistant, or licensed nurse practitioner shall
1415	complete and sign a medical form provided by the agency. The
1416	completed medical form shall be submitted to the agency within
1417	30 days after the date the facility owner or administrator is
1418	notified by the agency that the physical examination is
1419	required. After consultation with the physician, physician
1420	assistant, or licensed nurse practitioner who performed the
1421	examination, a medical review team designated by the agency
1422	shall then determine whether the resident is appropriately
1423	residing in the facility. The medical review team shall base its
1424	decision on a comprehensive review of the resident's physical
1425	and functional status, including the resident's preferences, and
1426	not on an isolated health-related problem. In the case of a
1427	mental health resident, if the resident appears to have needs in
1428	addition to those identified in the community living support
1429	plan, the agency may require an evaluation by a mental health
1430	professional, as determined by the Department of Children and
1431	Family Services. A facility may not be required to retain a
1432	resident who requires more services or care than the facility is
1433	able to provide in accordance with its policies and criteria for
1434	admission and continued residency. Members of the medical review
1435	team making the final determination may not include the agency
1436	personnel who initially questioned the appropriateness of a
1437	resident's placement. Such determination is final and binding
1438	upon the facility and the resident. Any resident who is
1439	determined by the medical review team to be inappropriately
1440	residing in a facility shall be given 30 days' written notice to
1441	relocate by the owner or administrator, unless the resident's
1442	continued residence in the facility presents an imminent danger
1443	to the health, safety, or welfare of the resident or a
1444	substantial probability exists that death or serious physical
1445	harm would result to the resident if allowed to remain in the
1446	facility.
1447	Section 31.  Paragraph (h) of subsection (3) of section
1448	430.80, Florida Statutes, is amended to read:
1449	430.80  Implementation of a teaching nursing home pilot
1450	project.--
1451	(3)  To be designated as a teaching nursing home, a nursing
1452	home licensee must, at a minimum:
1453	(h)  Maintain insurance coverage pursuant to s.
1454	400.141(1)(s)(20) or proof of financial responsibility in a
1455	minimum amount of $750,000. Such proof of financial
1456	responsibility may include:
1457	1.  Maintaining an escrow account consisting of cash or
1458	assets eligible for deposit in accordance with s. 625.52; or
1459	2.  Obtaining and maintaining pursuant to chapter 675 an
1460	unexpired, irrevocable, nontransferable and nonassignable letter
1461	of credit issued by any bank or savings association organized
1462	and existing under the laws of this state or any bank or savings
1463	association organized under the laws of the United States that
1464	has its principal place of business in this state or has a
1465	branch office which is authorized to receive deposits in this
1466	state. The letter of credit shall be used to satisfy the
1467	obligation of the facility to the claimant upon presentment of a
1468	final judgment indicating liability and awarding damages to be
1469	paid by the facility or upon presentment of a settlement
1470	agreement signed by all parties to the agreement when such final
1471	judgment or settlement is a result of a liability claim against
1472	the facility.
1473	Section 32.  Subsection (5) of section 435.04, Florida
1474	Statutes, is amended to read:
1475	435.04  Level 2 screening standards.--
1476	(5)  Under penalty of perjury, all employees in such
1477	positions of trust or responsibility shall attest to meeting the
1478	requirements for qualifying for employment and agreeing to
1479	inform the employer immediately if convicted of any of the
1480	disqualifying offenses while employed by the employer. Each
1481	employer of employees in such positions of trust or
1482	responsibilities which is licensed or registered by a state
1483	agency shall submit to the licensing agency annually or at the
1484	time of license renewal, under penalty of perjury, an affidavit
1485	of compliance with the provisions of this section.
1486	Section 33.  Subsection (3) of section 435.05, Florida
1487	Statutes, is amended to read:
1488	435.05  Requirements for covered employees.--Except as
1489	otherwise provided by law, the following requirements shall
1490	apply to covered employees:
1491	(3)  Each employer required to conduct level 2 background
1492	screening must sign an affidavit annually or at the time of
1493	license renewal, under penalty of perjury, stating that all
1494	covered employees have been screened or are newly hired and are
1495	awaiting the results of the required screening checks.
1496	Section 34.  Subsection (2) of section 483.031, Florida
1497	Statutes, is amended to read:
1498	483.031  Application of part; exemptions.--This part
1499	applies to all clinical laboratories within this state, except:
1500	(2)  A clinical laboratory that performs only waived tests
1501	and has received a certificate of exemption from the agency
1502	under s. 483.106.
1503	Section 35.  Subsection (10) of section 483.041, Florida
1504	Statutes, is amended to read:
1505	483.041  Definitions.--As used in this part, the term:
1506	(10)  "Waived test" means a test that the federal Centers
1507	for Medicare and Medicaid Services Health Care Financing
1508	Administration has determined qualifies for a certificate of
1509	waiver under the federal Clinical Laboratory Improvement
1510	Amendments of 1988, and the federal rules adopted thereunder.
1511	Section 36.  Section 483.106, Florida Statutes, is
1512	repealed.
1513	Section 37.  Subsection (3) of section 483.172, Florida
1514	Statutes, is amended to read:
1515	483.172  License fees.--
1516	(3)  The agency shall assess a biennial fee of $100 for a
1517	certificate of exemption and a $100 biennial license fee under
1518	this section for facilities surveyed by an approved accrediting
1519	organization.
1520	Section 38.  Subsection (13) of section 651.118, Florida
1521	Statutes, is amended to read:
1522	651.118  Agency for Health Care Administration;
1523	certificates of need; sheltered beds; community beds.--
1524	(13)  Residents, as defined in this chapter, are not
1525	considered new admissions for the purpose of s.
1526	400.141(1)(o)1.d.(15)(d).
1527	Section 39.  This act shall take effect upon becoming a
1528	law.

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