CS/CS/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. 400.191, F.S.; eliminating requirements for
25	the agency to publish the Nursing Home Guide annually in
26	printed form; revising information provided on the
27	agency's Internet website; amending s. 400.195, F.S.;
28	conforming a cross-reference; amending s. 400.23, F.S.;
29	deleting provisions relating to minimum staffing
30	requirements for nursing homes; amending s. 400.474, F.S.;
31	providing that specified provisions relating to
32	remuneration do not apply to or preclude certain payment
33	practices permitted under specified federal laws or
34	regulations; amending s. 400.506, F.S.; exempting nurse
35	registries not participating in the Medicaid or Medicare
36	program from certain disciplinary actions for paying
37	remuneration to certain entities in exchange for patient
38	referrals; amending s. 400.9905, F.S.; revising the
39	definition of the term "clinic" to provide that pt. X of
40	ch. 400, F.S., the Health Care Clinic Act, does not apply
41	to entities that do not seek reimbursement from insurance
42	companies for medical services paid pursuant to personal
43	injury protection coverage; amending s. 400.9935, F.S.;
44	revising accreditation requirements for clinics providing
45	magnetic resonance imaging services; providing for a
46	unique identification number for licensed clinics and
47	entities holding certificates of exemption; requiring the
48	agency to assign unique identification numbers, under
49	certain circumstances, and publish the numbers on its
50	Internet website in a specified format; amending s.
51	400.995, F.S.; revising agency responsibilities with
52	respect to personnel and operations in certain injunctive
53	proceedings; amending s. 408.803, F.S.; revising
54	definitions applicable to pt. II of ch. 408, F.S., the
55	"Health Care Licensing Procedures Act"; amending s.
56	408.806, F.S.; revising contents of and procedures
57	relating to health care provider applications for
58	licensure; providing an exception from certain licensure
59	inspections for adult family-care homes; authorizing the
60	agency to provide electronic access to certain information
61	and documents; amending s. 408.808, F.S.; providing for a
62	provisional license to be issued to applicants applying
63	for a change of ownership; providing a time limit on
64	provisional licenses; amending s. 408.809, F.S.; revising
65	provisions relating to background screening of specified
66	employees; exempting certain persons from rescreening;
67	permitting certain persons to apply for an exemption from
68	disqualification under certain circumstances; requiring
69	health care providers to submit to the agency an affidavit
70	of compliance with background screening requirements at
71	the time of license renewal; deleting a provision to
72	conform to changes made by the act; amending s. 408.810,
73	F.S.; revising provisions relating to information required
74	for licensure; amending s. 408.811, F.S.; providing for
75	certain inspections to be accepted in lieu of complete
76	licensure inspections; granting agency access to records
77	requested during an offsite review; providing timeframes
78	for correction of certain deficiencies and submission of
79	plans to correct such deficiencies; amending s. 408.813,
80	F.S.; providing classifications of violations of pt. II of
81	ch. 408, F.S.; providing for fines; amending s. 408.820,
82	F.S.; revising applicability of exemptions from specified
83	requirements of pt. II of ch. 408, F.S.; conforming
84	references; creating s. 408.821, F.S.; requiring entities
85	regulated or licensed by the agency to designate a safety
86	liaison for emergency operations; providing that entities
87	regulated or licensed by the agency may temporarily exceed
88	their licensed capacity to act as receiving providers
89	under specified circumstances; providing requirements
90	while such entities are in an overcapacity status;
91	providing for issuance of an inactive license to such
92	licensees under specified conditions; providing
93	requirements and procedures with respect to the issuance
94	and reactivation of an inactive license; authorizing the
95	agency to adopt rules; amending s. 408.831, F.S.; deleting
96	provisions relating to authorization for entities
97	regulated or licensed by the agency to exceed their
98	licensed capacity to act as receiving facilities and
99	issuance and reactivation of inactive licenses; amending
100	s. 408.918, F.S.; requiring accreditation by the National
101	Alliance of Information and Referral Services for
102	participation in the Florida 211 Network; eliminating the
103	requirement that the agency seek certain assistance and
104	guidance in resolving certain disputes; removing certain
105	agency obligations relating to the Florida 211 Network;
106	requiring the Florida Alliance of Information and Referral
107	Services to perform certain functions related to the
108	Florida 211 Network; amending s. 409.221, F.S.; conforming
109	a cross-reference; amending s. 409.901, F.S.; revising a
110	definition applicable to Medicaid providers; repealing s.
111	429.071, F.S., relating to the intergenerational respite
112	care assisted living facility pilot program; amending s.
113	429.08, F.S.; authorizing the agency to provide
114	information regarding licensed assisted living facilities
115	electronically or on its Internet website; abolishing
116	local coordinating workgroups established by agency field
117	offices; deleting a fine; deleting provisions requiring
118	the agency to provide certain information and notice to
119	service providers; amending s. 429.14, F.S.; conforming a
120	reference; amending s. 429.19, F.S.; revising agency
121	procedures for imposition of fines for violations of pt. I
122	of ch. 429, F.S., the "Assisted Living Facilities Act";
123	providing for the posting of certain information
124	electronically or on the agency's Internet website;
125	amending s. 429.23, F.S.; revising the definition of the
126	term "adverse incident" for reporting purposes; requiring
127	abuse, neglect, and exploitation to be reported to the
128	agency and the Department of Children and Family Services;
129	deleting a requirement that the agency submit an annual
130	report on assisted living facility adverse incidents to
131	the Legislature; amending s. 429.26, F.S.; removing
132	requirement for a resident of an assisted living facility
133	to undergo examinations and evaluations under certain
134	circumstances; amending s. 430.80, F.S.; conforming a
135	cross-reference; amending ss. 435.04 and 435.05, F.S.;
136	requiring employers of certain employees to submit an
137	affidavit of compliance with level 2 screening
138	requirements at the time of license renewal; amending s.
139	483.031, F.S.; conforming a reference; amending s.
140	483.041, F.S.; revising a definition applicable to pt. I
141	of ch. 483, F.S., the "Florida Clinical Laboratory Law";
142	repealing s. 483.106, F.S., relating to applications for
143	certificates of exemption by clinical laboratories that
144	perform certain tests; amending s. 483.172, F.S.;
145	conforming a reference; amending s. 627.4239, F.S.;
146	revising the definition of the term "standard reference
147	compendium" for purposes of regulating the insurance
148	coverage of drugs used in the treatment of cancer;
149	amending s. 627.736, F.S.; providing that personal injury
150	protection insurance carriers are not required to pay
151	claims or charges for service or treatment billed by a
152	provider not holding an identification number issued by
153	the agency; amending s. 651.118, F.S.; conforming a cross-
154	reference; providing an effective date.
155
156	Be It Enacted by the Legislature of the State of Florida:
157
158	Section 1.  Section 395.0199, Florida Statutes, is
159	repealed.
160	Section 2.  Section 395.405, Florida Statutes, is amended
161	to read:
162	395.405  Rulemaking.--The department shall adopt and
163	enforce all rules necessary to administer ss. 395.0199, 395.401,
164	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
165	Section 3.  Subsection (1) of section 400.0712, Florida
166	Statutes, is amended to read:
167	400.0712  Application for inactive license.--
168	(1)  As specified in s. 408.831(4) and this section, the
169	agency may issue an inactive license to a nursing home facility
170	for all or a portion of its beds. Any request by a licensee that
171	a nursing home or portion of a nursing home become inactive must
172	be submitted to the agency in the approved format. The facility
173	may not initiate any suspension of services, notify residents,
174	or initiate inactivity before receiving approval from the
175	agency; and a licensee that violates this provision may not be
176	issued an inactive license.
177	Section 4.  Subsection (3) of section 400.118, Florida
178	Statutes, is renumbered as subsection (2), and present
179	subsection (2) of that section is amended to read:
180	400.118  Quality assurance; early warning system;
181	monitoring; rapid response teams.--
182	(2)(a)  The agency shall establish within each district
183	office one or more quality-of-care monitors, based on the number
184	of nursing facilities in the district, to monitor all nursing
185	facilities in the district on a regular, unannounced, aperiodic
186	basis, including nights, evenings, weekends, and holidays.
187	Quality-of-care monitors shall visit each nursing facility at
188	least quarterly. Priority for additional monitoring visits shall
189	be given to nursing facilities with a history of resident care
190	deficiencies. Quality-of-care monitors shall be registered
191	nurses who are trained and experienced in nursing facility
192	regulation, standards of practice in long-term care, and
193	evaluation of patient care. Individuals in these positions shall
194	not be deployed by the agency as a part of the district survey
195	team in the conduct of routine, scheduled surveys, but shall
196	function solely and independently as quality-of-care monitors.
197	Quality-of-care monitors shall assess the overall quality of
198	life in the nursing facility and shall assess specific
199	conditions in the facility directly related to resident care,
200	including the operations of internal quality improvement and
201	risk management programs and adverse incident reports. The
202	quality-of-care monitor shall include in an assessment visit
203	observation of the care and services rendered to residents and
204	formal and informal interviews with residents, family members,
205	facility staff, resident guests, volunteers, other regulatory
206	staff, and representatives of a long-term care ombudsman council
207	or Florida advocacy council.
208	(b)  Findings of a monitoring visit, both positive and
209	negative, shall be provided orally and in writing to the
210	facility administrator or, in the absence of the facility
211	administrator, to the administrator on duty or the director of
212	nursing. The quality-of-care monitor may recommend to the
213	facility administrator procedural and policy changes and staff
214	training, as needed, to improve the care or quality of life of
215	facility residents. Conditions observed by the quality-of-care
216	monitor which threaten the health or safety of a resident shall
217	be reported immediately to the agency area office supervisor for
218	appropriate regulatory action and, as appropriate or as required
219	by law, to law enforcement, adult protective services, or other
220	responsible agencies.
221	(c)  Any record, whether written or oral, or any written or
222	oral communication generated pursuant to paragraph (a) or
223	paragraph (b) shall not be subject to discovery or introduction
224	into evidence in any civil or administrative action against a
225	nursing facility arising out of matters which are the subject of
226	quality-of-care monitoring, and a person who was in attendance
227	at a monitoring visit or evaluation may not be permitted or
228	required to testify in any such civil or administrative action
229	as to any evidence or other matters produced or presented during
230	the monitoring visits or evaluations. However, information,
231	documents, or records otherwise available from original sources
232	are not to be construed as immune from discovery or use in any
233	such civil or administrative action merely because they were
234	presented during monitoring visits or evaluations, and any
235	person who participates in such activities may not be prevented
236	from testifying as to matters within his or her knowledge, but
237	such witness may not be asked about his or her participation in
238	such activities. The exclusion from the discovery or
239	introduction of evidence in any civil or administrative action
240	provided for herein shall not apply when the quality-of-care
241	monitor makes a report to the appropriate authorities regarding
242	a threat to the health or safety of a resident.
243	Section 5.  Section 400.141, Florida Statutes, is amended
244	to read:
245	400.141  Administration and management of nursing home
246	facilities.--
247	(1)  Every licensed facility shall comply with all
248	applicable standards and rules of the agency and shall:
249	(a)(1)  Be under the administrative direction and charge of
250	a licensed administrator.
251	(b)(2)  Appoint a medical director licensed pursuant to
252	chapter 458 or chapter 459. The agency may establish by rule
253	more specific criteria for the appointment of a medical
254	director.
255	(c)(3)  Have available the regular, consultative, and
256	emergency services of physicians licensed by the state.
257	(d)(4)  Provide for resident use of a community pharmacy as
258	specified in s. 400.022(1)(q). Any other law to the contrary
259	notwithstanding, a registered pharmacist licensed in Florida,
260	that is under contract with a facility licensed under this
261	chapter or chapter 429, shall repackage a nursing facility
262	resident's bulk prescription medication which has been packaged
263	by another pharmacist licensed in any state in the United States
264	into a unit dose system compatible with the system used by the
265	nursing facility, if the pharmacist is requested to offer such
266	service. In order to be eligible for the repackaging, a resident
267	or the resident's spouse must receive prescription medication
268	benefits provided through a former employer as part of his or
269	her retirement benefits, a qualified pension plan as specified
270	in s. 4972 of the Internal Revenue Code, a federal retirement
271	program as specified under 5 C.F.R. s. 831, or a long-term care
272	policy as defined in s. 627.9404(1). A pharmacist who correctly
273	repackages and relabels the medication and the nursing facility
274	which correctly administers such repackaged medication under the
275	provisions of this paragraph may subsection shall not be held
276	liable in any civil or administrative action arising from the
277	repackaging. In order to be eligible for the repackaging, a
278	nursing facility resident for whom the medication is to be
279	repackaged shall sign an informed consent form provided by the
280	facility which includes an explanation of the repackaging
281	process and which notifies the resident of the immunities from
282	liability provided in this paragraph herein. A pharmacist who
283	repackages and relabels prescription medications, as authorized
284	under this paragraph subsection, may charge a reasonable fee for
285	costs resulting from the implementation of this provision.
286	(e)(5)  Provide for the access of the facility residents to
287	dental and other health-related services, recreational services,
288	rehabilitative services, and social work services appropriate to
289	their needs and conditions and not directly furnished by the
290	licensee. When a geriatric outpatient nurse clinic is conducted
291	in accordance with rules adopted by the agency, outpatients
292	attending such clinic shall not be counted as part of the
293	general resident population of the nursing home facility, nor
294	shall the nursing staff of the geriatric outpatient clinic be
295	counted as part of the nursing staff of the facility, until the
296	outpatient clinic load exceeds 15 a day.
297	(f)(6)  Be allowed and encouraged by the agency to provide
298	other needed services under certain conditions. If the facility
299	has a standard licensure status, and has had no class I or class
300	II deficiencies during the past 2 years or has been awarded a
301	Gold Seal under the program established in s. 400.235, it may be
302	encouraged by the agency to provide services, including, but not
303	limited to, respite and adult day services, which enable
304	individuals to move in and out of the facility. A facility is
305	not subject to any additional licensure requirements for
306	providing these services. Respite care may be offered to persons
307	in need of short-term or temporary nursing home services.
308	Respite care must be provided in accordance with this part and
309	rules adopted by the agency. However, the agency shall, by rule,
310	adopt modified requirements for resident assessment, resident
311	care plans, resident contracts, physician orders, and other
312	provisions, as appropriate, for short-term or temporary nursing
313	home services. The agency shall allow for shared programming and
314	staff in a facility which meets minimum standards and offers
315	services pursuant to this paragraph subsection, but, if the
316	facility is cited for deficiencies in patient care, may require
317	additional staff and programs appropriate to the needs of
318	service recipients. A person who receives respite care may not
319	be counted as a resident of the facility for purposes of the
320	facility's licensed capacity unless that person receives 24-hour
321	respite care. A person receiving either respite care for 24
322	hours or longer or adult day services must be included when
323	calculating minimum staffing for the facility. Any costs and
324	revenues generated by a nursing home facility from
325	nonresidential programs or services shall be excluded from the
326	calculations of Medicaid per diems for nursing home
327	institutional care reimbursement.
328	(g)(7)  If the facility has a standard license or is a Gold
329	Seal facility, exceeds the minimum required hours of licensed
330	nursing and certified nursing assistant direct care per resident
331	per day, and is part of a continuing care facility licensed
332	under chapter 651 or a retirement community that offers other
333	services pursuant to part III of this chapter or part I or part
334	III of chapter 429 on a single campus, be allowed to share
335	programming and staff. At the time of inspection and in the
336	semiannual report required pursuant to paragraph (o) subsection
337	(15), a continuing care facility or retirement community that
338	uses this option must demonstrate through staffing records that
339	minimum staffing requirements for the facility were met.
340	Licensed nurses and certified nursing assistants who work in the
341	nursing home facility may be used to provide services elsewhere
342	on campus if the facility exceeds the minimum number of direct
343	care hours required per resident per day and the total number of
344	residents receiving direct care services from a licensed nurse
345	or a certified nursing assistant does not cause the facility to
346	violate the staffing ratios required under s. 400.23(3)(a).
347	Compliance with the minimum staffing ratios shall be based on
348	total number of residents receiving direct care services,
349	regardless of where they reside on campus. If the facility
350	receives a conditional license, it may not share staff until the
351	conditional license status ends. This paragraph subsection does
352	not restrict the agency's authority under federal or state law
353	to require additional staff if a facility is cited for
354	deficiencies in care which are caused by an insufficient number
355	of certified nursing assistants or licensed nurses. The agency
356	may adopt rules for the documentation necessary to determine
357	compliance with this provision.
358	(h)(8)  Maintain the facility premises and equipment and
359	conduct its operations in a safe and sanitary manner.
360	(i)(9)  If the licensee furnishes food service, provide a
361	wholesome and nourishing diet sufficient to meet generally
362	accepted standards of proper nutrition for its residents and
363	provide such therapeutic diets as may be prescribed by attending
364	physicians. In making rules to implement this paragraph
365	subsection, the agency shall be guided by standards recommended
366	by nationally recognized professional groups and associations
367	with knowledge of dietetics.
368	(j)(10)  Keep full records of resident admissions and
369	discharges; medical and general health status, including medical
370	records, personal and social history, and identity and address
371	of next of kin or other persons who may have responsibility for
372	the affairs of the residents; and individual resident care plans
373	including, but not limited to, prescribed services, service
374	frequency and duration, and service goals. The records shall be
375	open to inspection by the agency.
376	(k)(11)  Keep such fiscal records of its operations and
377	conditions as may be necessary to provide information pursuant
378	to this part.
379	(l)(12)  Furnish copies of personnel records for employees
380	affiliated with such facility, to any other facility licensed by
381	this state requesting this information pursuant to this part.
382	Such information contained in the records may include, but is
383	not limited to, disciplinary matters and any reason for
384	termination. Any facility releasing such records pursuant to
385	this part shall be considered to be acting in good faith and may
386	not be held liable for information contained in such records,
387	absent a showing that the facility maliciously falsified such
388	records.
389	(m)(13)  Publicly display a poster provided by the agency
390	containing the names, addresses, and telephone numbers for the
391	state's abuse hotline, the State Long-Term Care Ombudsman, the
392	Agency for Health Care Administration consumer hotline, the
393	Advocacy Center for Persons with Disabilities, the Florida
394	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
395	with a clear description of the assistance to be expected from
396	each.
397	(n)(14)  Submit to the agency the information specified in
398	s. 400.071(1)(b) for a management company within 30 days after
399	the effective date of the management agreement.
400	(o)1.(15)  Submit semiannually to the agency, or more
401	frequently if requested by the agency, information regarding
402	facility staff-to-resident ratios, staff turnover, and staff
403	stability, including information regarding certified nursing
404	assistants, licensed nurses, the director of nursing, and the
405	facility administrator. For purposes of this reporting:
406	a.(a)  Staff-to-resident ratios must be reported in the
407	categories specified in s. 400.23(3)(a) and applicable rules.
408	The ratio must be reported as an average for the most recent
409	calendar quarter.
410	b.(b)  Staff turnover must be reported for the most recent
411	12-month period ending on the last workday of the most recent
412	calendar quarter prior to the date the information is submitted.
413	The turnover rate must be computed quarterly, with the annual
414	rate being the cumulative sum of the quarterly rates. The
415	turnover rate is the total number of terminations or separations
416	experienced during the quarter, excluding any employee
417	terminated during a probationary period of 3 months or less,
418	divided by the total number of staff employed at the end of the
419	period for which the rate is computed, and expressed as a
420	percentage.
421	c.(c)  The formula for determining staff stability is the
422	total number of employees that have been employed for more than
423	12 months, divided by the total number of employees employed at
424	the end of the most recent calendar quarter, and expressed as a
425	percentage.
426	d.(d)  A nursing facility that has failed to comply with
427	state minimum-staffing requirements for 2 consecutive days is
428	prohibited from accepting new admissions until the facility has
429	achieved the minimum-staffing requirements for a period of 6
430	consecutive days. For the purposes of this sub-subparagraph
431	paragraph, any person who was a resident of the facility and was
432	absent from the facility for the purpose of receiving medical
433	care at a separate location or was on a leave of absence is not
434	considered a new admission. Failure to impose such an admissions
435	moratorium constitutes a class II deficiency.
436	e.(e)  A nursing facility which does not have a conditional
437	license may be cited for failure to comply with the standards in
438	s. 400.23(3)(a)1.a. only if it has failed to meet those
439	standards on 2 consecutive days or if it has failed to meet at
440	least 97 percent of those standards on any one day.
441	f.(f)  A facility which has a conditional license must be
442	in compliance with the standards in s. 400.23(3)(a) at all
443	times.
444	2.  Nothing in This paragraph does not section shall limit
445	the agency's ability to impose a deficiency or take other
446	actions if a facility does not have enough staff to meet the
447	residents' needs.
448	(16)  Report monthly the number of vacant beds in the
449	facility which are available for resident occupancy on the day
450	the information is reported.
451	(p)(17)  Notify a licensed physician when a resident
452	exhibits signs of dementia or cognitive impairment or has a
453	change of condition in order to rule out the presence of an
454	underlying physiological condition that may be contributing to
455	such dementia or impairment. The notification must occur within
456	30 days after the acknowledgment of such signs by facility
457	staff. If an underlying condition is determined to exist, the
458	facility shall arrange, with the appropriate health care
459	provider, the necessary care and services to treat the
460	condition.
461	(q)(18)  If the facility implements a dining and
462	hospitality attendant program, ensure that the program is
463	developed and implemented under the supervision of the facility
464	director of nursing. A licensed nurse, licensed speech or
465	occupational therapist, or a registered dietitian must conduct
466	training of dining and hospitality attendants. A person employed
467	by a facility as a dining and hospitality attendant must perform
468	tasks under the direct supervision of a licensed nurse.
469	(r)(19)  Report to the agency any filing for bankruptcy
470	protection by the facility or its parent corporation,
471	divestiture or spin-off of its assets, or corporate
472	reorganization within 30 days after the completion of such
473	activity.
474	(s)(20)  Maintain general and professional liability
475	insurance coverage that is in force at all times. In lieu of
476	general and professional liability insurance coverage, a state-
477	designated teaching nursing home and its affiliated assisted
478	living facilities created under s. 430.80 may demonstrate proof
479	of financial responsibility as provided in s. 430.80(3)(h).
480	(t)(21)  Maintain in the medical record for each resident a
481	daily chart of certified nursing assistant services provided to
482	the resident. The certified nursing assistant who is caring for
483	the resident must complete this record by the end of his or her
484	shift. This record must indicate assistance with activities of
485	daily living, assistance with eating, and assistance with
486	drinking, and must record each offering of nutrition and
487	hydration for those residents whose plan of care or assessment
488	indicates a risk for malnutrition or dehydration.
489	(u)(22)  Before November 30 of each year, subject to the
490	availability of an adequate supply of the necessary vaccine,
491	provide for immunizations against influenza viruses to all its
492	consenting residents in accordance with the recommendations of
493	the United States Centers for Disease Control and Prevention,
494	subject to exemptions for medical contraindications and
495	religious or personal beliefs. Subject to these exemptions, any
496	consenting person who becomes a resident of the facility after
497	November 30 but before March 31 of the following year must be
498	immunized within 5 working days after becoming a resident.
499	Immunization shall not be provided to any resident who provides
500	documentation that he or she has been immunized as required by
501	this paragraph subsection. This paragraph subsection does not
502	prohibit a resident from receiving the immunization from his or
503	her personal physician if he or she so chooses. A resident who
504	chooses to receive the immunization from his or her personal
505	physician shall provide proof of immunization to the facility.
506	The agency may adopt and enforce any rules necessary to comply
507	with or implement this paragraph subsection.
508	(v)(23)  Assess all residents for eligibility for
509	pneumococcal polysaccharide vaccination (PPV) and vaccinate
510	residents when indicated within 60 days after the effective date
511	of this act in accordance with the recommendations of the United
512	States Centers for Disease Control and Prevention, subject to
513	exemptions for medical contraindications and religious or
514	personal beliefs. Residents admitted after the effective date of
515	this act shall be assessed within 5 working days of admission
516	and, when indicated, vaccinated within 60 days in accordance
517	with the recommendations of the United States Centers for
518	Disease Control and Prevention, subject to exemptions for
519	medical contraindications and religious or personal beliefs.
520	Immunization shall not be provided to any resident who provides
521	documentation that he or she has been immunized as required by
522	this paragraph subsection. This paragraph subsection does not
523	prohibit a resident from receiving the immunization from his or
524	her personal physician if he or she so chooses. A resident who
525	chooses to receive the immunization from his or her personal
526	physician shall provide proof of immunization to the facility.
527	The agency may adopt and enforce any rules necessary to comply
528	with or implement this paragraph subsection.
529	(w)(24)  Annually encourage and promote to its employees
530	the benefits associated with immunizations against influenza
531	viruses in accordance with the recommendations of the United
532	States Centers for Disease Control and Prevention. The agency
533	may adopt and enforce any rules necessary to comply with or
534	implement this paragraph subsection.
535	(2)  Facilities that have been awarded a Gold Seal under
536	the program established in s. 400.235 may develop a plan to
537	provide certified nursing assistant training as prescribed by
538	federal regulations and state rules and may apply to the agency
539	for approval of their program.
540	Section 6.  Present subsections (9) through (13) of section
541	400.147, Florida Statutes, are renumbered as subsections (10)
542	through (14), respectively, subsection (5) and present
543	subsection (14) are amended, and a new subsection (9) is added
544	to that section, to read:
545	400.147  Internal risk management and quality assurance
546	program.--
547	(5)  For purposes of reporting to the agency under this
548	section, the term "adverse incident" means:
549	(a)  An event over which facility personnel could exercise
550	control and which is associated in whole or in part with the
551	facility's intervention, rather than the condition for which
552	such intervention occurred, and which results in one of the
553	following:
554	1.  Death;
555	2.  Brain or spinal damage;
556	3.  Permanent disfigurement;
557	4.  Fracture or dislocation of bones or joints;
558	5.  A limitation of neurological, physical, or sensory
559	function;
560	6.  Any condition that required medical attention to which
561	the resident has not given his or her informed consent,
562	including failure to honor advanced directives; or
563	7.  Any condition that required the transfer of the
564	resident, within or outside the facility, to a unit providing a
565	more acute level of care due to the adverse incident, rather
566	than the resident's condition prior to the adverse incident; or
567	8.  An event that is reported to law enforcement or its
568	personnel for investigation; or
569	(b)  Abuse, neglect, or exploitation as defined in s.
570	415.102;
571	(c)  Abuse, neglect and harm as defined in s. 39.01;
572	(b)(d)  Resident elopement, if the elopement places the
573	resident at risk of harm or injury.; or
574	(e)  An event that is reported to law enforcement.
575	(9)  Abuse, neglect, or exploitation must be reported to
576	the agency as required by 42 C.F.R. s. 483.13(c) and to the
577	department as required by chapters 39 and 415.
578	(14)  The agency shall annually submit to the Legislature a
579	report on nursing home adverse incidents. The report must
580	include the following information arranged by county:
581	(a)  The total number of adverse incidents.
582	(b)  A listing, by category, of the types of adverse
583	incidents, the number of incidents occurring within each
584	category, and the type of staff involved.
585	(c)  A listing, by category, of the types of injury caused
586	and the number of injuries occurring within each category.
587	(d)  Types of liability claims filed based on an adverse
588	incident or reportable injury.
589	(e)  Disciplinary action taken against staff, categorized
590	by type of staff involved.
591	Section 7.  Subsection (3) of section 400.162, Florida
592	Statutes, is amended to read:
593	400.162  Property and personal affairs of residents.--
594	(3)  A licensee shall provide for the safekeeping of
595	personal effects, funds, and other property of the resident in
596	the facility. Whenever necessary for the protection of
597	valuables, or in order to avoid unreasonable responsibility
598	therefor, the licensee may require that such valuables be
599	excluded or removed from the facility and kept at some place not
600	subject to the control of the licensee. At the request of a
601	resident, the facility shall mark the resident's personal
602	property with the resident's name or another type of
603	identification, without defacing the property. Any theft or loss
604	of a resident's personal property shall be documented by the
605	facility. The facility shall develop policies and procedures to
606	minimize the risk of theft or loss of the personal property of
607	residents. A copy of the policy shall be provided to every
608	employee and to each resident and resident's representative, if
609	appropriate, at admission and when revised. Facility policies
610	must include provisions related to reporting theft or loss of a
611	resident's property to law enforcement and any facility waiver
612	of liability for loss or theft. The facility shall post notice
613	of these policies and procedures, and any revision thereof, in
614	places accessible to residents.
615	Section 8.  Subsection (2) of section 400.191, Florida
616	Statutes, is amended to read:
617	400.191  Availability, distribution, and posting of reports
618	and records.--
619	(2)  The agency shall publish the Nursing Home Guide
620	annually in consumer-friendly printed form and quarterly in
621	electronic form to assist consumers and their families in
622	comparing and evaluating nursing home facilities.
623	(a)  The agency shall provide an Internet site which shall
624	include at least the following information either directly or
625	indirectly through a link to another established site or sites
626	of the agency's choosing:
627	1.  A section entitled "Have you considered programs that
628	provide alternatives to nursing home care?" which shall be the
629	first section of the Nursing Home Guide and which shall
630	prominently display information about available alternatives to
631	nursing homes and how to obtain additional information regarding
632	these alternatives. The Nursing Home Guide shall explain that
633	this state offers alternative programs that permit qualified
634	elderly persons to stay in their homes instead of being placed
635	in nursing homes and shall encourage interested persons to call
636	the Comprehensive Assessment Review and Evaluation for Long-Term
637	Care Services (CARES) Program to inquire if they qualify. The
638	Nursing Home Guide shall list available home and community-based
639	programs which shall clearly state the services that are
640	provided and indicate whether nursing home services are included
641	if needed.
642	2.  A list by name and address of all nursing home
643	facilities in this state, including any prior name by which a
644	facility was known during the previous 24-month period.
645	3.  Whether such nursing home facilities are proprietary or
646	nonproprietary.
647	4.  The current owner of the facility's license and the
648	year that that entity became the owner of the license.
649	5.  The name of the owner or owners of each facility and
650	whether the facility is affiliated with a company or other
651	organization owning or managing more than one nursing facility
652	in this state.
653	6.  The total number of beds in each facility and the most
654	recently available occupancy levels.
655	7.  The number of private and semiprivate rooms in each
656	facility.
657	8.  The religious affiliation, if any, of each facility.
658	9.  The languages spoken by the administrator and staff of
659	each facility.
660	10.  Whether or not each facility accepts Medicare or
661	Medicaid recipients or insurance, health maintenance
662	organization, Veterans Administration, CHAMPUS program, or
663	workers' compensation coverage.
664	11.  Recreational and other programs available at each
665	facility.
666	12.  Special care units or programs offered at each
667	facility.
668	13.  Whether the facility is a part of a retirement
669	community that offers other services pursuant to part III of
670	this chapter or part I or part III of chapter 429.
671	14.  Survey and deficiency information, including all
672	federal and state recertification, licensure, revisit, and
673	complaint survey information, for each facility for the past 30
674	months. For noncertified nursing homes, state survey and
675	deficiency information, including licensure, revisit, and
676	complaint survey information for the past 30 months shall be
677	provided.
678	15.  A summary of the deficiency data for each facility
679	over the past 30 months. The summary may include a score,
680	rating, or comparison ranking with respect to other facilities
681	based on the number of citations received by the facility on
682	recertification, licensure, revisit, and complaint surveys; the
683	severity and scope of the citations; and the number of
684	recertification surveys the facility has had during the past 30
685	months. The score, rating, or comparison ranking may be
686	presented in either numeric or symbolic form for the intended
687	consumer audience.
688	(b)  The agency shall provide the following information in
689	printed form:
690	1.  A section entitled "Have you considered programs that
691	provide alternatives to nursing home care?" which shall be the
692	first section of the Nursing Home Guide and which shall
693	prominently display information about available alternatives to
694	nursing homes and how to obtain additional information regarding
695	these alternatives. The Nursing Home Guide shall explain that
696	this state offers alternative programs that permit qualified
697	elderly persons to stay in their homes instead of being placed
698	in nursing homes and shall encourage interested persons to call
699	the Comprehensive Assessment Review and Evaluation for Long-Term
700	Care Services (CARES) Program to inquire if they qualify. The
701	Nursing Home Guide shall list available home and community-based
702	programs which shall clearly state the services that are
703	provided and indicate whether nursing home services are included
704	if needed.
705	2.  A list by name and address of all nursing home
706	facilities in this state.
707	3.  Whether the nursing home facilities are proprietary or
708	nonproprietary.
709	4.  The current owner or owners of the facility's license
710	and the year that entity became the owner of the license.
711	5.  The total number of beds, and of private and
712	semiprivate rooms, in each facility.
713	6.  The religious affiliation, if any, of each facility.
714	7.  The name of the owner of each facility and whether the
715	facility is affiliated with a company or other organization
716	owning or managing more than one nursing facility in this state.
717	8.  The languages spoken by the administrator and staff of
718	each facility.
719	9.  Whether or not each facility accepts Medicare or
720	Medicaid recipients or insurance, health maintenance
721	organization, Veterans Administration, CHAMPUS program, or
722	workers' compensation coverage.
723	10.  Recreational programs, special care units, and other
724	programs available at each facility.
725	11.  The Internet address for the site where more detailed
726	information can be seen.
727	12.  A statement advising consumers that each facility will
728	have its own policies and procedures related to protecting
729	resident property.
730	13.  A summary of the deficiency data for each facility
731	over the past 30 months. The summary may include a score,
732	rating, or comparison ranking with respect to other facilities
733	based on the number of citations received by the facility on
734	recertification, licensure, revisit, and complaint surveys; the
735	severity and scope of the citations; the number of citations;
736	and the number of recertification surveys the facility has had
737	during the past 30 months. The score, rating, or comparison
738	ranking may be presented in either numeric or symbolic form for
739	the intended consumer audience.
740	(b)(c)  The agency may provide the following additional
741	information on an Internet site or in printed form as the
742	information becomes available:
743	1.  The licensure status history of each facility.
744	2.  The rating history of each facility.
745	3.  The regulatory history of each facility, which may
746	include federal sanctions, state sanctions, federal fines, state
747	fines, and other actions.
748	4.  Whether the facility currently possesses the Gold Seal
749	designation awarded pursuant to s. 400.235.
750	5.  Internet links to the Internet sites of the facilities
751	or their affiliates.
752	Section 9.  Paragraph (d) of subsection (1) of section
753	400.195, Florida Statutes, is amended to read:
754	400.195  Agency reporting requirements.--
755	(1)  For the period beginning June 30, 2001, and ending
756	June 30, 2005, the Agency for Health Care Administration shall
757	provide a report to the Governor, the President of the Senate,
758	and the Speaker of the House of Representatives with respect to
759	nursing homes. The first report shall be submitted no later than
760	December 30, 2002, and subsequent reports shall be submitted
761	every 6 months thereafter. The report shall identify facilities
762	based on their ownership characteristics, size, business
763	structure, for-profit or not-for-profit status, and any other
764	characteristics the agency determines useful in analyzing the
765	varied segments of the nursing home industry and shall report:
766	(d)  Information regarding deficiencies cited, including
767	information used to develop the Nursing Home Guide WATCH LIST
768	pursuant to s. 400.191, and applicable rules, a summary of data
769	generated on nursing homes by Centers for Medicare and Medicaid
770	Services Nursing Home Quality Information Project, and
771	information collected pursuant to s. 400.147(10)(9), relating to
772	litigation.
773	Section 10.  Paragraph (b) of subsection (3) of section
774	400.23, Florida Statutes, is amended to read:
775	400.23  Rules; evaluation and deficiencies; licensure
776	status.--
777	(3)
778	(b)  The agency shall adopt rules to allow properly trained
779	staff of a nursing facility, in addition to certified nursing
780	assistants and licensed nurses, to assist residents with eating.
781	The rules shall specify the minimum training requirements and
782	shall specify the physiological conditions or disorders of
783	residents which would necessitate that the eating assistance be
784	provided by nursing personnel of the facility. Nonnursing staff
785	providing eating assistance to residents under the provisions of
786	this subsection shall not count toward compliance with minimum
787	staffing standards.
788	Section 11.  Subsection (6) of section 400.474, Florida
789	Statutes, is amended to read:
790	400.474  Administrative penalties.--
791	(6)  The agency may deny, revoke, or suspend the license of
792	a home health agency and shall impose a fine of $5,000 against a
793	home health agency that:
794	(a)  Gives remuneration for staffing services to:
795	1.  Another home health agency with which it has formal or
796	informal patient-referral transactions or arrangements; or
797	2.  A health services pool with which it has formal or
798	informal patient-referral transactions or arrangements,
799
800	unless the home health agency has activated its comprehensive
801	emergency management plan in accordance with s. 400.492. This
802	paragraph does not apply to a Medicare-certified home health
803	agency that provides fair market value remuneration for staffing
804	services to a non-Medicare-certified home health agency that is
805	part of a continuing care facility licensed under chapter 651
806	for providing services to its own residents if each resident
807	receiving home health services pursuant to this arrangement
808	attests in writing that he or she made a decision without
809	influence from staff of the facility to select, from a list of
810	Medicare-certified home health agencies provided by the
811	facility, that Medicare-certified home health agency to provide
812	the services.
813	(b)  Provides services to residents in an assisted living
814	facility for which the home health agency does not receive fair
815	market value remuneration.
816	(c)  Provides staffing to an assisted living facility for
817	which the home health agency does not receive fair market value
818	remuneration.
819	(d)  Fails to provide the agency, upon request, with copies
820	of all contracts with assisted living facilities which were
821	executed within 5 years before the request.
822	(e)  Gives remuneration to a case manager, discharge
823	planner, facility-based staff member, or third-party vendor who
824	is involved in the discharge planning process of a facility
825	licensed under chapter 395 or this chapter from whom the home
826	health agency receives referrals.
827	(f)  Fails to submit to the agency, within 15 days after
828	the end of each calendar quarter, a written report that includes
829	the following data based on data as it existed on the last day
830	of the quarter:
831	1.  The number of insulin-dependent diabetic patients
832	receiving insulin-injection services from the home health
833	agency;
834	2.  The number of patients receiving both home health
835	services from the home health agency and hospice services;
836	3.  The number of patients receiving home health services
837	from that home health agency; and
838	4.  The names and license numbers of nurses whose primary
839	job responsibility is to provide home health services to
840	patients and who received remuneration from the home health
841	agency in excess of $25,000 during the calendar quarter.
842	(g)  Gives cash, or its equivalent, to a Medicare or
843	Medicaid beneficiary.
844	(h)  Has more than one medical director contract in effect
845	at one time or more than one medical director contract and one
846	contract with a physician-specialist whose services are mandated
847	for the home health agency in order to qualify to participate in
848	a federal or state health care program at one time.
849	(i)  Gives remuneration to a physician without a medical
850	director contract being in effect. The contract must:
851	1.  Be in writing and signed by both parties;
852	2.  Provide for remuneration that is at fair market value
853	for an hourly rate, which must be supported by invoices
854	submitted by the medical director describing the work performed,
855	the dates on which that work was performed, and the duration of
856	that work; and
857	3.  Be for a term of at least 1 year.
858
859	The hourly rate specified in the contract may not be increased
860	during the term of the contract. The home health agency may not
861	execute a subsequent contract with that physician which has an
862	increased hourly rate and covers any portion of the term that
863	was in the original contract.
864	(j)  Gives remuneration to:
865	1.  A physician, and the home health agency is in violation
866	of paragraph (h) or paragraph (i);
867	2.  A member of the physician's office staff; or
868	3.  An immediate family member of the physician,
869
870	if the home health agency has received a patient referral in the
871	preceding 12 months from that physician or physician's office
872	staff.
873	(k)  Fails to provide to the agency, upon request, copies
874	of all contracts with a medical director which were executed
875	within 5 years before the request.
876
877	Nothing in paragraph (e) or paragraph (j) shall be interpreted
878	as applying to or precluding any discount, compensation, waiver
879	of payment, or payment practice permitted by 42 U.S.C. s. 1320a-
880	7b(b) or regulations adopted thereunder, including 42 C.F.R. s.
881	1001.952, or by 42 U.S.C. s. 1395nn or regulations adopted
882	thereunder.
883	Section 12.  Paragraph (a) of subsection (15) of section
884	400.506, Florida Statutes, is amended to read:
885	400.506  Licensure of nurse registries; requirements;
886	penalties.--
887	(15)(a)  The agency may deny, suspend, or revoke the
888	license of a nurse registry and shall impose a fine of $5,000
889	against a nurse registry that:
890	1.  Provides services to residents in an assisted living
891	facility for which the nurse registry does not receive fair
892	market value remuneration.
893	2.  Provides staffing to an assisted living facility for
894	which the nurse registry does not receive fair market value
895	remuneration.
896	3.  Fails to provide the agency, upon request, with copies
897	of all contracts with assisted living facilities which were
898	executed within the last 5 years.
899	4.  Gives remuneration to a case manager, discharge
900	planner, facility-based staff member, or third-party vendor who
901	is involved in the discharge planning process of a facility
902	licensed under chapter 395 or this chapter and from whom the
903	nurse registry receives referrals. This subparagraph does not
904	apply to a nurse registry that does not participate in the
905	Medicaid or Medicare program.
906	5.  Gives remuneration to a physician, a member of the
907	physician's office staff, or an immediate family member of the
908	physician, and the nurse registry received a patient referral in
909	the last 12 months from that physician or the physician's office
910	staff. This subparagraph does not apply to a nurse registry that
911	does not participate in the Medicaid or Medicare program.
912	Section 13.  Paragraph (m) is added to subsection (4) of
913	section 400.9905, Florida Statutes, to read:
914	400.9905  Definitions.--
915	(4)  "Clinic" means an entity at which health care services
916	are provided to individuals and which tenders charges for
917	reimbursement for such services, including a mobile clinic and a
918	portable equipment provider. For purposes of this part, the term
919	does not include and the licensure requirements of this part do
920	not apply to:
921	(m)  Entities that do not seek reimbursement from insurance
922	companies for medical services paid pursuant to personal injury
923	protection coverage required by s. 627.736.
924	Section 14.  Paragraph (a) of subsection (7) of section
925	400.9935, Florida Statutes, is amended, and subsection (10) is
926	added to that section, to read:
927	400.9935  Clinic responsibilities.--
928	(7)(a)  Each clinic engaged in magnetic resonance imaging
929	services must be accredited by the Joint Commission on
930	Accreditation of Healthcare Organizations, the American College
931	of Radiology, or the Accreditation Association for Ambulatory
932	Health Care, within 1 year after licensure. A clinic that is
933	accredited by the American College of Radiology or is within the
934	original 1-year period after licensure and replaces its core
935	magnetic resonance imaging equipment shall be given 1 year after
936	the date upon which the equipment is replaced to attain
937	accreditation. However, a clinic may request a single, 6-month
938	extension if it provides evidence to the agency establishing
939	that, for good cause shown, such clinic cannot can not be
940	accredited within 1 year after licensure, and that such
941	accreditation will be completed within the 6-month extension.
942	After obtaining accreditation as required by this subsection,
943	each such clinic must maintain accreditation as a condition of
944	renewal of its license. A clinic that files a change of
945	ownership application must comply with the original
946	accreditation timeframe requirements of the transferor. The
947	agency shall deny a change of ownership application if the
948	clinic is not in compliance with the accreditation requirements.
949	When a clinic adds, replaces, or modifies magnetic resonance
950	imaging equipment and the accrediting organization requires new
951	accreditation, the clinic must be accredited within 1 year after
952	the date of the addition, replacement, or modification but may
953	request a single, 6-month extension if the clinic provides
954	evidence of good cause to the agency.
955	(10)  Any clinic holding an active license and any entity
956	holding a current certificate of exemption may request a unique
957	identification number from the agency for the purposes of
958	submitting claims to personal injury protection insurance
959	carriers for services or treatment pursuant to part XI of
960	chapter 627. Upon request, the agency shall assign a unique
961	identification number to a clinic holding an active license or
962	an entity holding a current certificate of exemption. The agency
963	shall publish the identification number of each clinic and
964	entity on its Internet website in a searchable format that is
965	readily accessible to personal injury protection insurance
966	carriers for the purposes of s. 627.736(5)(b)1.g.
967	Section 15.  Subsection (6) of section 400.995, Florida
968	Statutes, is amended to read:
969	400.995  Agency administrative penalties.--
970	(6)  During an inspection, the agency, as an alternative to
971	or in conjunction with an administrative action against a clinic
972	for violations of this part and adopted rules, shall make a
973	reasonable attempt to discuss each violation and recommended
974	corrective action with the owner, medical director, or clinic
975	director of the clinic, prior to written notification. The
976	agency, instead of fixing a period within which the clinic shall
977	enter into compliance with standards, may request a plan of
978	corrective action from the clinic which demonstrates a good
979	faith effort to remedy each violation by a specific date,
980	subject to the approval of the agency.
981	Section 16.  Subsections (5), (9), and (13) of section
982	408.803, Florida Statutes, are amended to read:
983	408.803  Definitions.--As used in this part, the term:
984	(5)  "Change of ownership" means:
985	(a)  An event in which the licensee sells or otherwise
986	transfers its ownership changes to a different individual or
987	legal entity, as evidenced by a change in federal employer
988	identification number or taxpayer identification number; or
989	(b)  An event in which 51 45 percent or more of the
990	ownership, voting shares, membership, or controlling interest of
991	a licensee is in any manner transferred or otherwise assigned.
992	This paragraph does not apply to a licensee that is publicly
993	traded on a recognized stock exchange. In a corporation whose
994	shares are not publicly traded on a recognized stock exchange is
995	transferred or assigned, including the final transfer or
996	assignment of multiple transfers or assignments over a 2-year
997	period that cumulatively total 45 percent or greater.
998
999	A change solely in the management company or board of directors
1000	is not a change of ownership.
1001	(9)  "Licensee" means an individual, corporation,
1002	partnership, firm, association, or governmental entity, or other
1003	entity that is issued a permit, registration, certificate, or
1004	license by the agency. The licensee is legally responsible for
1005	all aspects of the provider operation.
1006	(13)  "Voluntary board member" means a board member of a
1007	not-for-profit corporation or organization who serves solely in
1008	a voluntary capacity, does not receive any remuneration for his
1009	or her services on the board of directors, and has no financial
1010	interest in the corporation or organization. The agency shall
1011	recognize a person as a voluntary board member following
1012	submission of a statement to the agency by the board member and
1013	the not-for-profit corporation or organization that affirms that
1014	the board member conforms to this definition. The statement
1015	affirming the status of the board member must be submitted to
1016	the agency on a form provided by the agency.
1017	Section 17.  Paragraph (a) of subsection (1), subsection
1018	(2), paragraph (c) of subsection (7), and subsection (8) of
1019	section 408.806, Florida Statutes, are amended to read:
1020	408.806  License application process.--
1021	(1)  An application for licensure must be made to the
1022	agency on forms furnished by the agency, submitted under oath,
1023	and accompanied by the appropriate fee in order to be accepted
1024	and considered timely. The application must contain information
1025	required by authorizing statutes and applicable rules and must
1026	include:
1027	(a)  The name, address, and social security number of:
1028	1.  The applicant;
1029	2.  The administrator or a similarly titled person who is
1030	responsible for the day-to-day operation of the provider;
1031	3.  The financial officer or similarly titled person who is
1032	responsible for the financial operation of the licensee or
1033	provider; and
1034	4.  Each controlling interest if the applicant or
1035	controlling interest is an individual.
1036	(2)(a)  The applicant for a renewal license must submit an
1037	application that must be received by the agency at least 60 days
1038	but no more than 120 days prior to the expiration of the current
1039	license. An application received more than 120 days prior to the
1040	expiration of the current license shall be returned to the
1041	applicant. If the renewal application and fee are received prior
1042	to the license expiration date, the license shall not be deemed
1043	to have expired if the license expiration date occurs during the
1044	agency's review of the renewal application.
1045	(b)  The applicant for initial licensure due to a change of
1046	ownership must submit an application that must be received by
1047	the agency at least 60 days prior to the date of change of
1048	ownership.
1049	(c)  For any other application or request, the applicant
1050	must submit an application or request that must be received by
1051	the agency at least 60 days but no more than 120 days prior to
1052	the requested effective date, unless otherwise specified in
1053	authorizing statutes or applicable rules. An application
1054	received more than 120 days prior to the requested effective
1055	date shall be returned to the applicant.
1056	(d)  The agency shall notify the licensee by mail or
1057	electronically at least 90 days prior to the expiration of a
1058	license that a renewal license is necessary to continue
1059	operation. The failure to timely submit a renewal application
1060	and license fee shall result in a $50 per day late fee charged
1061	to the licensee by the agency; however, the aggregate amount of
1062	the late fee may not exceed 50 percent of the licensure fee or
1063	$500, whichever is less. If an application is received after the
1064	required filing date and exhibits a hand-canceled postmark
1065	obtained from a United States post office dated on or before the
1066	required filing date, no fine will be levied.
1067	(7)
1068	(c)  If an inspection is required by the authorizing
1069	statute for a license application other than an initial
1070	application, the inspection must be unannounced. This paragraph
1071	does not apply to inspections required pursuant to ss. 383.324,
1072	395.0161(4), 429.67(6), and 483.061(2).
1073	(8)  The agency may establish procedures for the electronic
1074	notification and submission of required information, including,
1075	but not limited to:
1076	(a)  Licensure applications.
1077	(b)  Required signatures.
1078	(c)  Payment of fees.
1079	(d)  Notarization of applications.
1080
1081	Requirements for electronic submission of any documents required
1082	by this part or authorizing statutes may be established by rule.
1083	As an alternative to sending documents as required by
1084	authorizing statutes, the agency may provide electronic access
1085	to information or documents.
1086	Section 18.  Subsection (2) of section 408.808, Florida
1087	Statutes, is amended to read:
1088	408.808  License categories.--
1089	(2)  PROVISIONAL LICENSE.--A provisional license may be
1090	issued to an applicant pursuant to s. 408.809(3). An applicant
1091	against whom a proceeding denying or revoking a license is
1092	pending at the time of license renewal may be issued a
1093	provisional license effective until final action not subject to
1094	further appeal. A provisional license may also be issued to an
1095	applicant applying for a change of ownership. A provisional
1096	license shall be limited in duration to a specific period of
1097	time, not to exceed 12 months, as determined by the agency.
1098	Section 19.  Subsection (5) of section 408.809, Florida
1099	Statutes, is amended, and new subsections (5) and (6) are added
1100	to that section, to read:
1101	408.809  Background screening; prohibited offenses.--
1102	(5)  Effective October 1, 2009, in addition to the offenses
1103	listed in ss. 435.03 and 435.04, all persons required to undergo
1104	background screening pursuant to this part or authorizing
1105	statutes must not have been found guilty of, regardless of
1106	adjudication, or entered a plea of nolo contendere or guilty to,
1107	any of the following offenses or any similar offense of another
1108	jurisdiction:
1109	(a)  A violation of any authorizing statutes, if the
1110	offense was a felony.
1111	(b)  A violation of this chapter, if the offense was a
1112	felony.
1113	(c)  A violation of s. 409.920, relating to Medicaid
1114	provider fraud, if the offense was a felony.
1115	(d)  A violation of s. 409.9201, relating to Medicaid
1116	fraud, if the offense was a felony.
1117	(e)  A violation of s. 741.28, relating to domestic
1118	violence.
1119	(f)  A violation of chapter 784, relating to assault,
1120	battery, and culpable negligence, if the offense was a felony.
1121	(g)  A violation of s. 810.02, relating to burglary.
1122	(h)  A violation of s. 817.034, relating to fraudulent acts
1123	through mail, wire, radio, electromagnetic, photoelectronic, or
1124	photooptical systems.
1125	(i)  A violation of s. 817.234, relating to false and
1126	fraudulent insurance claims.
1127	(j)  A violation of s. 817.505, relating to patient
1128	brokering.
1129	(k)  A violation of s. 817.568, relating to criminal use of
1130	personal identification information.
1131	(l)  A violation of s. 817.60, relating to obtaining a
1132	credit card through fraudulent means.
1133	(m)  A violation of s. 817.61, relating to fraudulent use
1134	of credit cards, if the offense was a felony.
1135	(n)  A violation of s. 831.01, relating to forgery.
1136	(o)  A violation of s. 831.02, relating to uttering forged
1137	instruments.
1138	(p)  A violation of s. 831.07, relating to forging bank
1139	bills, checks, drafts, or promissory notes.
1140	(q)  A violation of s. 831.09, relating to uttering forged
1141	bank bills, checks, drafts, or promissory notes.
1142	(r)  A violation of s. 831.30, relating to fraud in
1143	obtaining medicinal drugs.
1144	(s)  A violation of s. 831.31, relating to the sale,
1145	manufacture, delivery, or possession with the intent to sell,
1146	manufacture, or deliver any counterfeit controlled substance, if
1147	the offense was a felony.
1148
1149	A person who serves as a controlling interest of or is employed
1150	by a licensee on September 30, 2009, shall not be required by
1151	law to submit to rescreening if that licensee has in its
1152	possession written evidence that the person has been screened
1153	and qualified according to the standards specified in s. 435.03
1154	or s. 435.04. However, if such person has been convicted of a
1155	disqualifying offense listed in this subsection, he or she may
1156	apply for an exemption from the appropriate licensing agency
1157	before September 30, 2009, and if agreed to by the employer, may
1158	continue to perform his or her duties until the licensing agency
1159	renders a decision on the application for exemption for an
1160	offense listed in this subsection. Exemptions from
1161	disqualification may be granted pursuant to s. 435.07.
1162	(6)  The attestations required under ss. 435.04(5) and
1163	435.05(3) must be submitted at the time of license renewal,
1164	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1165	which require annual submission of an affidavit of compliance
1166	with background screening requirements.
1167	(5)  Background screening is not required to obtain a
1168	certificate of exemption issued under s. 483.106.
1169	Section 20.  Subsection (3) of section 408.810, Florida
1170	Statutes, is amended to read:
1171	408.810  Minimum licensure requirements.--In addition to
1172	the licensure requirements specified in this part, authorizing
1173	statutes, and applicable rules, each applicant and licensee must
1174	comply with the requirements of this section in order to obtain
1175	and maintain a license.
1176	(3)  Unless otherwise specified in this part, authorizing
1177	statutes, or applicable rules, any information required to be
1178	reported to the agency must be submitted within 21 calendar days
1179	after the report period or effective date of the information,
1180	whichever is earlier, including, but not limited to, any change
1181	of:
1182	(a)  Information contained in the most recent application
1183	for licensure.
1184	(b)  Required insurance or bonds.
1185	Section 21.  Present subsection (4) of section 408.811,
1186	Florida Statutes, is renumbered as subsection (6), subsections
1187	(2) and (3) are amended, and new subsections (4) and (5) are
1188	added to that section, to read:
1189	408.811  Right of inspection; copies; inspection reports;
1190	plan for correction of deficiencies.--
1191	(2)  Inspections conducted in conjunction with
1192	certification, comparable licensure requirements, or a
1193	recognized or approved accreditation organization may be
1194	accepted in lieu of a complete licensure inspection. However, a
1195	licensure inspection may also be conducted to review any
1196	licensure requirements that are not also requirements for
1197	certification.
1198	(3)  The agency shall have access to and the licensee shall
1199	provide, or if requested send, copies of all provider records
1200	required during an inspection or other review at no cost to the
1201	agency, including records requested during an offsite review.
1202	(4)  Deficiencies must be corrected within 30 calendar days
1203	after the provider is notified of inspection results unless an
1204	alternative timeframe is required or approved by the agency.
1205	(5)  The agency may require an applicant or licensee to
1206	submit a plan of correction for deficiencies. If required, the
1207	plan of correction must be filed with the agency within 10
1208	calendar days after notification unless an alternative timeframe
1209	is required.
1210	Section 22.  Section 408.813, Florida Statutes, is amended
1211	to read:
1212	408.813  Administrative fines; violations.--As a penalty
1213	for any violation of this part, authorizing statutes, or
1214	applicable rules, the agency may impose an administrative fine.
1215	(1)  Unless the amount or aggregate limitation of the fine
1216	is prescribed by authorizing statutes or applicable rules, the
1217	agency may establish criteria by rule for the amount or
1218	aggregate limitation of administrative fines applicable to this
1219	part, authorizing statutes, and applicable rules. Each day of
1220	violation constitutes a separate violation and is subject to a
1221	separate fine, unless a per-violation fine is prescribed by law.
1222	For fines imposed by final order of the agency and not subject
1223	to further appeal, the violator shall pay the fine plus interest
1224	at the rate specified in s. 55.03 for each day beyond the date
1225	set by the agency for payment of the fine.
1226	(2)  Violations of this part, authorizing statutes, or
1227	applicable rules shall be classified according to the nature of
1228	the violation and the gravity of its probable effect on clients.
1229	The scope of a violation may be cited as an isolated, patterned,
1230	or widespread deficiency. An isolated deficiency is a deficiency
1231	affecting one or a very limited number of clients, or involving
1232	one or a very limited number of staff, or a situation that
1233	occurred only occasionally or in a very limited number of
1234	locations. A patterned deficiency is a deficiency in which more
1235	than a very limited number of clients are affected, or more than
1236	a very limited number of staff are involved, or the situation
1237	has occurred in several locations, or the same client or clients
1238	have been affected by repeated occurrences of the same deficient
1239	practice but the effect of the deficient practice is not found
1240	to be pervasive throughout the provider. A widespread deficiency
1241	is a deficiency in which the problems causing the deficiency are
1242	pervasive in the provider or represent systemic failure that has
1243	affected or has the potential to affect a large portion of the
1244	provider's clients. This subsection does not affect the
1245	legislative determination of the amount of a fine imposed under
1246	authorizing statutes. Violations shall be classified on the
1247	written notice as follows:
1248	(a)  Class "I" violations are those conditions or
1249	occurrences related to the operation and maintenance of a
1250	provider or to the care of clients which the agency determines
1251	present an imminent danger to the clients of the provider or a
1252	substantial probability that death or serious physical or
1253	emotional harm would result therefrom. The condition or practice
1254	constituting a class I violation shall be abated or eliminated
1255	within 24 hours, unless a fixed period, as determined by the
1256	agency, is required for correction. The agency shall impose an
1257	administrative fine as provided by law for a cited class I
1258	violation. A fine shall be levied notwithstanding the correction
1259	of the violation.
1260	(b)  Class "II" violations are those conditions or
1261	occurrences related to the operation and maintenance of a
1262	provider or to the care of clients which the agency determines
1263	directly threaten the physical or emotional health, safety, or
1264	security of the clients, other than class I violations. The
1265	agency shall impose an administrative fine as provided by law
1266	for a cited class II violation. A fine shall be levied
1267	notwithstanding the correction of the violation.
1268	(c)  Class "III" violations are those conditions or
1269	occurrences related to the operation and maintenance of a
1270	provider or to the care of clients which the agency determines
1271	indirectly or potentially threaten the physical or emotional
1272	health, safety, or security of clients, other than class I or
1273	class II violations. The agency shall impose an administrative
1274	fine as provided by law for a cited class III violation. A
1275	citation for a class III violation must specify the time within
1276	which the violation is required to be corrected. If a class III
1277	violation is corrected within the time specified, a fine may not
1278	be imposed.
1279	(d)  Class "IV" violations are those conditions or
1280	occurrences related to the operation and maintenance of a
1281	provider or to required reports, forms, or documents that do not
1282	have the potential of negatively affecting clients. These
1283	violations are of a type that the agency determines do not
1284	threaten the health, safety, or security of clients. The agency
1285	shall impose an administrative fine as provided by law for a
1286	cited class IV violation. A citation for a class IV violation
1287	must specify the time within which the violation is required to
1288	be corrected. If a class IV violation is corrected within the
1289	time specified, a fine may not be imposed.
1290	Section 23.  Subsections (12) through (29) of section
1291	408.820, Florida Statutes, are renumbered as subsections (11)
1292	through (28), respectively, and present subsections (11), (12),
1293	(13), (21), and (26) of that section are amended to read:
1294	408.820  Exemptions.--Except as prescribed in authorizing
1295	statutes, the following exemptions shall apply to specified
1296	requirements of this part:
1297	(11)  Private review agents, as provided under part I of
1298	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1299	408.811.
1300	(11)(12)  Health care risk managers, as provided under part
1301	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1302	(10), and 408.811.
1303	(12)(13)  Nursing homes, as provided under part II of
1304	chapter 400, are exempt from ss. s. 408.810(7) and 408.813(2).
1305	(20)(21)  Transitional living facilities, as provided under
1306	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1307	(25)(26)  Health care clinics, as provided under part X of
1308	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1309	(7), and (10).
1310	Section 24.  Section 408.821, Florida Statutes, is created
1311	to read:
1312	408.821  Emergency management planning; emergency
1313	operations; inactive license.--
1314	(1)  Licensees required by authorizing statutes to have an
1315	emergency operations plan must designate a safety liaison to
1316	serve as the primary contact for emergency operations.
1317	(2)  An entity subject to this part may temporarily exceed
1318	its licensed capacity to act as a receiving provider in
1319	accordance with an approved emergency operations plan for up to
1320	15 days. While in an overcapacity status, each provider must
1321	furnish or arrange for appropriate care and services to all
1322	clients. In addition, the agency may approve requests for
1323	overcapacity in excess of 15 days, which approvals may be based
1324	upon satisfactory justification and need as provided by the
1325	receiving and sending providers.
1326	(3)(a)  An inactive license may be issued to a licensee
1327	subject to this section when the provider is located in a
1328	geographic area in which a state of emergency was declared by
1329	the Governor if the provider:
1330	1.  Suffered damage to its operation during the state of
1331	emergency.
1332	2.  Is currently licensed.
1333	3.  Does not have a provisional license.
1334	4.  Will be temporarily unable to provide services but is
1335	reasonably expected to resume services within 12 months.
1336	(b)  An inactive license may be issued for a period not to
1337	exceed 12 months but may be renewed by the agency for up to 12
1338	additional months upon demonstration to the agency of progress
1339	toward reopening. A request by a licensee for an inactive
1340	license or to extend the previously approved inactive period
1341	must be submitted in writing to the agency, accompanied by
1342	written justification for the inactive license, which states the
1343	beginning and ending dates of inactivity and includes a plan for
1344	the transfer of any clients to other providers and appropriate
1345	licensure fees. Upon agency approval, the licensee shall notify
1346	clients of any necessary discharge or transfer as required by
1347	authorizing statutes or applicable rules. The beginning of the
1348	inactive licensure period shall be the date the provider ceases
1349	operations. The end of the inactive period shall become the
1350	license expiration date, and all licensure fees must be current,
1351	must be paid in full, and may be prorated. Reactivation of an
1352	inactive license requires the prior approval by the agency of a
1353	renewal application, including payment of licensure fees and
1354	agency inspections indicating compliance with all requirements
1355	of this part and applicable rules and statutes.
1356	(4)  The agency may adopt rules relating to emergency
1357	management planning, communications, and operations. Licensees
1358	providing residential or inpatient services must utilize an
1359	online database approved by the agency to report information to
1360	the agency regarding the provider's emergency status, planning,
1361	or operations.
1362	Section 25.  Subsections (3), (4), and (5) of section
1363	408.831, Florida Statutes, are amended to read:
1364	408.831  Denial, suspension, or revocation of a license,
1365	registration, certificate, or application.--
1366	(3)  An entity subject to this section may exceed its
1367	licensed capacity to act as a receiving facility in accordance
1368	with an emergency operations plan for clients of evacuating
1369	providers from a geographic area where an evacuation order has
1370	been issued by a local authority having jurisdiction. While in
1371	an overcapacity status, each provider must furnish or arrange
1372	for appropriate care and services to all clients. In addition,
1373	the agency may approve requests for overcapacity beyond 15 days,
1374	which approvals may be based upon satisfactory justification and
1375	need as provided by the receiving and sending facilities.
1376	(4)(a)  An inactive license may be issued to a licensee
1377	subject to this section when the provider is located in a
1378	geographic area where a state of emergency was declared by the
1379	Governor if the provider:
1380	1.  Suffered damage to its operation during that state of
1381	emergency.
1382	2.  Is currently licensed.
1383	3.  Does not have a provisional license.
1384	4.  Will be temporarily unable to provide services but is
1385	reasonably expected to resume services within 12 months.
1386	(b)  An inactive license may be issued for a period not to
1387	exceed 12 months but may be renewed by the agency for up to 12
1388	additional months upon demonstration to the agency of progress
1389	toward reopening. A request by a licensee for an inactive
1390	license or to extend the previously approved inactive period
1391	must be submitted in writing to the agency, accompanied by
1392	written justification for the inactive license, which states the
1393	beginning and ending dates of inactivity and includes a plan for
1394	the transfer of any clients to other providers and appropriate
1395	licensure fees. Upon agency approval, the licensee shall notify
1396	clients of any necessary discharge or transfer as required by
1397	authorizing statutes or applicable rules. The beginning of the
1398	inactive licensure period shall be the date the provider ceases
1399	operations. The end of the inactive period shall become the
1400	licensee expiration date, and all licensure fees must be
1401	current, paid in full, and may be prorated. Reactivation of an
1402	inactive license requires the prior approval by the agency of a
1403	renewal application, including payment of licensure fees and
1404	agency inspections indicating compliance with all requirements
1405	of this part and applicable rules and statutes.
1406	(3)(5)  This section provides standards of enforcement
1407	applicable to all entities licensed or regulated by the Agency
1408	for Health Care Administration. This section controls over any
1409	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1410	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1411	those chapters.
1412	Section 26.  Subsection (2) of section 408.918, Florida
1413	Statutes, is amended, and subsection (3) is added to that
1414	section, to read:
1415	408.918  Florida 211 Network; uniform certification
1416	requirements.--
1417	(2)  In order to participate in the Florida 211 Network, a
1418	211 provider must be fully accredited by the National certified
1419	by the Agency for Health Care Administration. The agency shall
1420	develop criteria for certification, as recommended by the
1421	Florida Alliance of Information and Referral Services or have
1422	received approval to operate, pending accreditation, from its
1423	affiliate, the Florida Alliance of Information and Referral
1424	Services, and shall adopt the criteria as administrative rules.
1425	(a)  If any provider of information and referral services
1426	or other entity leases a 211 number from a local exchange
1427	company and is not authorized as described in this section,
1428	certified by the agency, the agency shall, after consultation
1429	with the local exchange company and the Public Service
1430	Commission shall, request that the Federal Communications
1431	Commission direct the local exchange company to revoke the use
1432	of the 211 number.
1433	(b)  The agency shall seek the assistance and guidance of
1434	the Public Service Commission and the Federal Communications
1435	Commission in resolving any disputes arising over jurisdiction
1436	related to 211 numbers.
1437	(3)  The Florida Alliance of Information and Referral
1438	Services is the 211 collaborative organization for the state
1439	that is responsible for studying, designing, implementing,
1440	supporting, and coordinating the Florida 211 Network and
1441	receiving federal grants.
1442	Section 27.  Paragraph (e) of subsection (4) of section
1443	409.221, Florida Statutes, is amended to read:
1444	409.221  Consumer-directed care program.--
1445	(4)  CONSUMER-DIRECTED CARE.--
1446	(e)  Services.--Consumers shall use the budget allowance
1447	only to pay for home and community-based services that meet the
1448	consumer's long-term care needs and are a cost-efficient use of
1449	funds. Such services may include, but are not limited to, the
1450	following:
1451	1.  Personal care.
1452	2.  Homemaking and chores, including housework, meals,
1453	shopping, and transportation.
1454	3.  Home modifications and assistive devices which may
1455	increase the consumer's independence or make it possible to
1456	avoid institutional placement.
1457	4.  Assistance in taking self-administered medication.
1458	5.  Day care and respite care services, including those
1459	provided by nursing home facilities pursuant to s.
1460	400.141(1)(f)(6) or by adult day care facilities licensed
1461	pursuant to s. 429.907.
1462	6.  Personal care and support services provided in an
1463	assisted living facility.
1464	Section 28.  Subsection (5) of section 409.901, Florida
1465	Statutes, is amended to read:
1466	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1467	409.901-409.920, except as otherwise specifically provided, the
1468	term:
1469	(5)  "Change of ownership" means:
1470	(a)  An event in which the provider ownership changes to a
1471	different individual legal entity, as evidenced by a change in
1472	federal employer identification number or taxpayer
1473	identification number; or
1474	(b)  An event in which 51 45 percent or more of the
1475	ownership, voting shares, membership, or controlling interest of
1476	a provider is in any manner transferred or otherwise assigned.
1477	This paragraph does not apply to a licensee that is publicly
1478	traded on a recognized stock exchange; or
1479	(c)  When the provider is licensed or registered by the
1480	agency, an event considered a change of ownership for licensure
1481	as defined in s. 408.803 in a corporation whose shares are not
1482	publicly traded on a recognized stock exchange is transferred or
1483	assigned, including the final transfer or assignment of multiple
1484	transfers or assignments over a 2-year period that cumulatively
1485	total 45 percent or more.
1486
1487	A change solely in the management company or board of directors
1488	is not a change of ownership.
1489	Section 29.  Section 429.071, Florida Statutes, is
1490	repealed.
1491	Section 30.  Paragraph (e) of subsection (1) and
1492	subsections (2) and (3) of section 429.08, Florida Statutes, are
1493	amended to read:
1494	429.08  Unlicensed facilities; referral of person for
1495	residency to unlicensed facility; penalties; verification of
1496	licensure status.--
1497	(1)
1498	(e)  The agency shall publish provide to the department's
1499	elder information and referral providers a list, by county, of
1500	licensed assisted living facilities, to assist persons who are
1501	considering an assisted living facility placement in locating a
1502	licensed facility. This information may be provided
1503	electronically or on the agency's Internet website.
1504	(2)  Each field office of the Agency for Health Care
1505	Administration shall establish a local coordinating workgroup
1506	which includes representatives of local law enforcement
1507	agencies, state attorneys, the Medicaid Fraud Control Unit of
1508	the Department of Legal Affairs, local fire authorities, the
1509	Department of Children and Family Services, the district long-
1510	term care ombudsman council, and the district human rights
1511	advocacy committee to assist in identifying the operation of
1512	unlicensed facilities and to develop and implement a plan to
1513	ensure effective enforcement of state laws relating to such
1514	facilities. The workgroup shall report its findings, actions,
1515	and recommendations semiannually to the Director of Health
1516	Quality Assurance of the agency.
1517	(2)(3)  It is unlawful to knowingly refer a person for
1518	residency to an unlicensed assisted living facility; to an
1519	assisted living facility the license of which is under denial or
1520	has been suspended or revoked; or to an assisted living facility
1521	that has a moratorium pursuant to part II of chapter 408. Any
1522	person who violates this subsection commits a noncriminal
1523	violation, punishable by a fine not exceeding $500 as provided
1524	in s. 775.083.
1525	(a)  Any health care practitioner, as defined in s.
1526	456.001, who is aware of the operation of an unlicensed facility
1527	shall report that facility to the agency. Failure to report a
1528	facility that the practitioner knows or has reasonable cause to
1529	suspect is unlicensed shall be reported to the practitioner's
1530	licensing board.
1531	(b)  Any provider as defined in s. 408.803 that hospital or
1532	community mental health center licensed under chapter 395 or
1533	chapter 394 which knowingly discharges a patient or client to an
1534	unlicensed facility is subject to sanction by the agency.
1535	(c)  Any employee of the agency or department, or the
1536	Department of Children and Family Services, who knowingly refers
1537	a person for residency to an unlicensed facility; to a facility
1538	the license of which is under denial or has been suspended or
1539	revoked; or to a facility that has a moratorium pursuant to part
1540	II of chapter 408 is subject to disciplinary action by the
1541	agency or department, or the Department of Children and Family
1542	Services.
1543	(d)  The employer of any person who is under contract with
1544	the agency or department, or the Department of Children and
1545	Family Services, and who knowingly refers a person for residency
1546	to an unlicensed facility; to a facility the license of which is
1547	under denial or has been suspended or revoked; or to a facility
1548	that has a moratorium pursuant to part II of chapter 408 shall
1549	be fined and required to prepare a corrective action plan
1550	designed to prevent such referrals.
1551	(e)  The agency shall provide the department and the
1552	Department of Children and Family Services with a list of
1553	licensed facilities within each county and shall update the list
1554	at least quarterly.
1555	(f)  At least annually, the agency shall notify, in
1556	appropriate trade publications, physicians licensed under
1557	chapter 458 or chapter 459, hospitals licensed under chapter
1558	395, nursing home facilities licensed under part II of chapter
1559	400, and employees of the agency or the department, or the
1560	Department of Children and Family Services, who are responsible
1561	for referring persons for residency, that it is unlawful to
1562	knowingly refer a person for residency to an unlicensed assisted
1563	living facility and shall notify them of the penalty for
1564	violating such prohibition. The department and the Department of
1565	Children and Family Services shall, in turn, notify service
1566	providers under contract to the respective departments who have
1567	responsibility for resident referrals to facilities. Further,
1568	the notice must direct each noticed facility and individual to
1569	contact the appropriate agency office in order to verify the
1570	licensure status of any facility prior to referring any person
1571	for residency. Each notice must include the name, telephone
1572	number, and mailing address of the appropriate office to
1573	contact.
1574	Section 31.  Paragraph (e) of subsection (1) of section
1575	429.14, Florida Statutes, is amended to read:
1576	429.14  Administrative penalties.--
1577	(1)  In addition to the requirements of part II of chapter
1578	408, the agency may deny, revoke, and suspend any license issued
1579	under this part and impose an administrative fine in the manner
1580	provided in chapter 120 against a licensee of an assisted living
1581	facility for a violation of any provision of this part, part II
1582	of chapter 408, or applicable rules, or for any of the following
1583	actions by a licensee of an assisted living facility, for the
1584	actions of any person subject to level 2 background screening
1585	under s. 408.809, or for the actions of any facility employee:
1586	(e)  A citation of any of the following deficiencies as
1587	specified defined in s. 429.19:
1588	1.  One or more cited class I deficiencies.
1589	2.  Three or more cited class II deficiencies.
1590	3.  Five or more cited class III deficiencies that have
1591	been cited on a single survey and have not been corrected within
1592	the times specified.
1593	Section 32.  Subsections (2), (8), and (9) of section
1594	429.19, Florida Statutes, are amended to read:
1595	429.19  Violations; imposition of administrative fines;
1596	grounds.--
1597	(2)  Each violation of this part and adopted rules shall be
1598	classified according to the nature of the violation and the
1599	gravity of its probable effect on facility residents. The agency
1600	shall indicate the classification on the written notice of the
1601	violation as follows:
1602	(a)  Class "I" violations are defined in s. 408.813 those
1603	conditions or occurrences related to the operation and
1604	maintenance of a facility or to the personal care of residents
1605	which the agency determines present an imminent danger to the
1606	residents or guests of the facility or a substantial probability
1607	that death or serious physical or emotional harm would result
1608	therefrom. The condition or practice constituting a class I
1609	violation shall be abated or eliminated within 24 hours, unless
1610	a fixed period, as determined by the agency, is required for
1611	correction. The agency shall impose an administrative fine for a
1612	cited class I violation in an amount not less than $5,000 and
1613	not exceeding $10,000 for each violation. A fine may be levied
1614	notwithstanding the correction of the violation.
1615	(b)  Class "II" violations are defined in s. 408.813 those
1616	conditions or occurrences related to the operation and
1617	maintenance of a facility or to the personal care of residents
1618	which the agency determines directly threaten the physical or
1619	emotional health, safety, or security of the facility residents,
1620	other than class I violations. The agency shall impose an
1621	administrative fine for a cited class II violation in an amount
1622	not less than $1,000 and not exceeding $5,000 for each
1623	violation. A fine shall be levied notwithstanding the correction
1624	of the violation.
1625	(c)  Class "III" violations are defined in s. 408.813 those
1626	conditions or occurrences related to the operation and
1627	maintenance of a facility or to the personal care of residents
1628	which the agency determines indirectly or potentially threaten
1629	the physical or emotional health, safety, or security of
1630	facility residents, other than class I or class II violations.
1631	The agency shall impose an administrative fine for a cited class
1632	III violation in an amount not less than $500 and not exceeding
1633	$1,000 for each violation. A citation for a class III violation
1634	must specify the time within which the violation is required to
1635	be corrected. If a class III violation is corrected within the
1636	time specified, no fine may be imposed, unless it is a repeated
1637	offense.
1638	(d)  Class "IV" violations are defined in s. 408.813 those
1639	conditions or occurrences related to the operation and
1640	maintenance of a building or to required reports, forms, or
1641	documents that do not have the potential of negatively affecting
1642	residents. These violations are of a type that the agency
1643	determines do not threaten the health, safety, or security of
1644	residents of the facility. The agency shall impose an
1645	administrative fine for a cited class IV violation in an amount
1646	not less than $100 and not exceeding $200 for each violation. A
1647	citation for a class IV violation must specify the time within
1648	which the violation is required to be corrected. If a class IV
1649	violation is corrected within the time specified, no fine shall
1650	be imposed. Any class IV violation that is corrected during the
1651	time an agency survey is being conducted will be identified as
1652	an agency finding and not as a violation.
1653	(8)  During an inspection, the agency, as an alternative to
1654	or in conjunction with an administrative action against a
1655	facility for violations of this part and adopted rules, shall
1656	make a reasonable attempt to discuss each violation and
1657	recommended corrective action with the owner or administrator of
1658	the facility, prior to written notification. The agency, instead
1659	of fixing a period within which the facility shall enter into
1660	compliance with standards, may request a plan of corrective
1661	action from the facility which demonstrates a good faith effort
1662	to remedy each violation by a specific date, subject to the
1663	approval of the agency.
1664	(9)  The agency shall develop and disseminate an annual
1665	list of all facilities sanctioned or fined $5,000 or more for
1666	violations of state standards, the number and class of
1667	violations involved, the penalties imposed, and the current
1668	status of cases. The list shall be disseminated, at no charge,
1669	to the Department of Elderly Affairs, the Department of Health,
1670	the Department of Children and Family Services, the Agency for
1671	Persons with Disabilities, the area agencies on aging, the
1672	Florida Statewide Advocacy Council, and the state and local
1673	ombudsman councils. The Department of Children and Family
1674	Services shall disseminate the list to service providers under
1675	contract to the department who are responsible for referring
1676	persons to a facility for residency. The agency may charge a fee
1677	commensurate with the cost of printing and postage to other
1678	interested parties requesting a copy of this list. This
1679	information may be provided electronically or on the agency's
1680	Internet website.
1681	Section 33.  Subsections (2) and (6) of section 429.23,
1682	Florida Statutes, are amended to read:
1683	429.23  Internal risk management and quality assurance
1684	program; adverse incidents and reporting requirements.--
1685	(2)  Every facility licensed under this part is required to
1686	maintain adverse incident reports. For purposes of this section,
1687	the term, "adverse incident" means:
1688	(a)  An event over which facility personnel could exercise
1689	control rather than as a result of the resident's condition and
1690	results in:
1691	1.  Death;
1692	2.  Brain or spinal damage;
1693	3.  Permanent disfigurement;
1694	4.  Fracture or dislocation of bones or joints;
1695	5.  Any condition that required medical attention to which
1696	the resident has not given his or her consent, including failure
1697	to honor advanced directives;
1698	6.  Any condition that requires the transfer of the
1699	resident from the facility to a unit providing more acute care
1700	due to the incident rather than the resident's condition before
1701	the incident; or.
1702	7.  An event that is reported to law enforcement or its
1703	personnel for investigation; or
1704	(b)  Abuse, neglect, or exploitation as defined in s.
1705	415.102;
1706	(c)  Events reported to law enforcement; or
1707	(b)(d)  Resident elopement, if the elopement places the
1708	resident at risk of harm or injury.
1709	(6)  Abuse, neglect, or exploitation must be reported to
1710	the Department of Children and Family Services as required under
1711	chapter 415. The agency shall annually submit to the Legislature
1712	a report on assisted living facility adverse incident reports.
1713	The report must include the following information arranged by
1714	county:
1715	(a)  A total number of adverse incidents;
1716	(b)  A listing, by category, of the type of adverse
1717	incidents occurring within each category and the type of staff
1718	involved;
1719	(c)  A listing, by category, of the types of injuries, if
1720	any, and the number of injuries occurring within each category;
1721	(d)  Types of liability claims filed based on an adverse
1722	incident report or reportable injury; and
1723	(e)  Disciplinary action taken against staff, categorized
1724	by the type of staff involved.
1725	Section 34.  Subsections (10) through (12) of section
1726	429.26, Florida Statutes, are renumbered as subsections (9)
1727	through (11), respectively, and present subsection (9) of that
1728	section is amended to read:
1729	429.26  Appropriateness of placements; examinations of
1730	residents.--
1731	(9)  If, at any time after admission to a facility, a
1732	resident appears to need care beyond that which the facility is
1733	licensed to provide, the agency shall require the resident to be
1734	physically examined by a licensed physician, physician
1735	assistant, or licensed nurse practitioner. This examination
1736	shall, to the extent possible, be performed by the resident's
1737	preferred physician or nurse practitioner and shall be paid for
1738	by the resident with personal funds, except as provided in s.
1739	429.18(2). Following this examination, the examining physician,
1740	physician assistant, or licensed nurse practitioner shall
1741	complete and sign a medical form provided by the agency. The
1742	completed medical form shall be submitted to the agency within
1743	30 days after the date the facility owner or administrator is
1744	notified by the agency that the physical examination is
1745	required. After consultation with the physician, physician
1746	assistant, or licensed nurse practitioner who performed the
1747	examination, a medical review team designated by the agency
1748	shall then determine whether the resident is appropriately
1749	residing in the facility. The medical review team shall base its
1750	decision on a comprehensive review of the resident's physical
1751	and functional status, including the resident's preferences, and
1752	not on an isolated health-related problem. In the case of a
1753	mental health resident, if the resident appears to have needs in
1754	addition to those identified in the community living support
1755	plan, the agency may require an evaluation by a mental health
1756	professional, as determined by the Department of Children and
1757	Family Services. A facility may not be required to retain a
1758	resident who requires more services or care than the facility is
1759	able to provide in accordance with its policies and criteria for
1760	admission and continued residency. Members of the medical review
1761	team making the final determination may not include the agency
1762	personnel who initially questioned the appropriateness of a
1763	resident's placement. Such determination is final and binding
1764	upon the facility and the resident. Any resident who is
1765	determined by the medical review team to be inappropriately
1766	residing in a facility shall be given 30 days' written notice to
1767	relocate by the owner or administrator, unless the resident's
1768	continued residence in the facility presents an imminent danger
1769	to the health, safety, or welfare of the resident or a
1770	substantial probability exists that death or serious physical
1771	harm would result to the resident if allowed to remain in the
1772	facility.
1773	Section 35.  Paragraph (h) of subsection (3) of section
1774	430.80, Florida Statutes, is amended to read:
1775	430.80  Implementation of a teaching nursing home pilot
1776	project.--
1777	(3)  To be designated as a teaching nursing home, a nursing
1778	home licensee must, at a minimum:
1779	(h)  Maintain insurance coverage pursuant to s.
1780	400.141(1)(s)(20) or proof of financial responsibility in a
1781	minimum amount of $750,000. Such proof of financial
1782	responsibility may include:
1783	1.  Maintaining an escrow account consisting of cash or
1784	assets eligible for deposit in accordance with s. 625.52; or
1785	2.  Obtaining and maintaining pursuant to chapter 675 an
1786	unexpired, irrevocable, nontransferable and nonassignable letter
1787	of credit issued by any bank or savings association organized
1788	and existing under the laws of this state or any bank or savings
1789	association organized under the laws of the United States that
1790	has its principal place of business in this state or has a
1791	branch office which is authorized to receive deposits in this
1792	state. The letter of credit shall be used to satisfy the
1793	obligation of the facility to the claimant upon presentment of a
1794	final judgment indicating liability and awarding damages to be
1795	paid by the facility or upon presentment of a settlement
1796	agreement signed by all parties to the agreement when such final
1797	judgment or settlement is a result of a liability claim against
1798	the facility.
1799	Section 36.  Subsection (5) of section 435.04, Florida
1800	Statutes, is amended to read:
1801	435.04  Level 2 screening standards.--
1802	(5)  Under penalty of perjury, all employees in such
1803	positions of trust or responsibility shall attest to meeting the
1804	requirements for qualifying for employment and agreeing to
1805	inform the employer immediately if convicted of any of the
1806	disqualifying offenses while employed by the employer. Each
1807	employer of employees in such positions of trust or
1808	responsibilities which is licensed or registered by a state
1809	agency shall submit to the licensing agency annually or at the
1810	time of license renewal, under penalty of perjury, an affidavit
1811	of compliance with the provisions of this section.
1812	Section 37.  Subsection (3) of section 435.05, Florida
1813	Statutes, is amended to read:
1814	435.05  Requirements for covered employees.--Except as
1815	otherwise provided by law, the following requirements shall
1816	apply to covered employees:
1817	(3)  Each employer required to conduct level 2 background
1818	screening must sign an affidavit annually or at the time of
1819	license renewal, under penalty of perjury, stating that all
1820	covered employees have been screened or are newly hired and are
1821	awaiting the results of the required screening checks.
1822	Section 38.  Subsection (2) of section 483.031, Florida
1823	Statutes, is amended to read:
1824	483.031  Application of part; exemptions.--This part
1825	applies to all clinical laboratories within this state, except:
1826	(2)  A clinical laboratory that performs only waived tests
1827	and has received a certificate of exemption from the agency
1828	under s. 483.106.
1829	Section 39.  Subsection (10) of section 483.041, Florida
1830	Statutes, is amended to read:
1831	483.041  Definitions.--As used in this part, the term:
1832	(10)  "Waived test" means a test that the federal Centers
1833	for Medicare and Medicaid Services Health Care Financing
1834	Administration has determined qualifies for a certificate of
1835	waiver under the federal Clinical Laboratory Improvement
1836	Amendments of 1988, and the federal rules adopted thereunder.
1837	Section 40.  Section 483.106, Florida Statutes, is
1838	repealed.
1839	Section 41.  Subsection (3) of section 483.172, Florida
1840	Statutes, is amended to read:
1841	483.172  License fees.--
1842	(3)  The agency shall assess a biennial fee of $100 for a
1843	certificate of exemption and a $100 biennial license fee under
1844	this section for facilities surveyed by an approved accrediting
1845	organization.
1846	Section 42.  Paragraph (b) of subsection (1) of section
1847	627.4239, Florida Statutes, is amended to read:
1848	627.4239  Coverage for use of drugs in treatment of
1849	cancer.--
1850	(1)  DEFINITIONS.--As used in this section, the term:
1851	(b)  "Standard reference compendium" means authoritative
1852	compendia identified by the Secretary of the United States
1853	Department of Health and Human Services and recognized by the
1854	federal Centers for Medicare and Medicaid Services:
1855	1.  The United States Pharmacopeia Drug Information;
1856	2.  The American Medical Association Drug Evaluations; or
1857	3.  The American Hospital Formulary Service Drug
1858	Information.
1859	Section 43.  Paragraph (b) of subsection (5) of section
1860	627.736, Florida Statutes, is amended to read:
1861	627.736  Required personal injury protection benefits;
1862	exclusions; priority; claims.--
1863	(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
1864	(b)1.  An insurer or insured is not required to pay a claim
1865	or charges:
1866	a.  Made by a broker or by a person making a claim on
1867	behalf of a broker;
1868	b.  For any service or treatment that was not lawful at the
1869	time rendered;
1870	c.  To any person who knowingly submits a false or
1871	misleading statement relating to the claim or charges;
1872	d.  With respect to a bill or statement that does not
1873	substantially meet the applicable requirements of paragraph (d);
1874	e.  For any treatment or service that is upcoded, or that
1875	is unbundled when such treatment or services should be bundled,
1876	in accordance with paragraph (d). To facilitate prompt payment
1877	of lawful services, an insurer may change codes that it
1878	determines to have been improperly or incorrectly upcoded or
1879	unbundled, and may make payment based on the changed codes,
1880	without affecting the right of the provider to dispute the
1881	change by the insurer, provided that before doing so, the
1882	insurer must contact the health care provider and discuss the
1883	reasons for the insurer's change and the health care provider's
1884	reason for the coding, or make a reasonable good faith effort to
1885	do so, as documented in the insurer's file; and
1886	f.  For medical services or treatment billed by a physician
1887	and not provided in a hospital unless such services are rendered
1888	by the physician or are incident to his or her professional
1889	services and are included on the physician's bill, including
1890	documentation verifying that the physician is responsible for
1891	the medical services that were rendered and billed; and
1892	g.  For any service or treatment billed by a provider not
1893	holding an identification number issued by the agency pursuant
1894	to s. 400.9935(10).
1895	2.  The Department of Health, in consultation with the
1896	appropriate professional licensing boards, shall adopt, by rule,
1897	a list of diagnostic tests deemed not to be medically necessary
1898	for use in the treatment of persons sustaining bodily injury
1899	covered by personal injury protection benefits under this
1900	section. The initial list shall be adopted by January 1, 2004,
1901	and shall be revised from time to time as determined by the
1902	Department of Health, in consultation with the respective
1903	professional licensing boards. Inclusion of a test on the list
1904	of invalid diagnostic tests shall be based on lack of
1905	demonstrated medical value and a level of general acceptance by
1906	the relevant provider community and shall not be dependent for
1907	results entirely upon subjective patient response.
1908	Notwithstanding its inclusion on a fee schedule in this
1909	subsection, an insurer or insured is not required to pay any
1910	charges or reimburse claims for any invalid diagnostic test as
1911	determined by the Department of Health.
1912	Section 44.  Subsection (13) of section 651.118, Florida
1913	Statutes, is amended to read:
1914	651.118  Agency for Health Care Administration;
1915	certificates of need; sheltered beds; community beds.--
1916	(13)  Residents, as defined in this chapter, are not
1917	considered new admissions for the purpose of s.
1918	400.141(1)(o)1.d.(15)(d).
1919	Section 45.  This act shall take effect upon becoming a
1920	law.

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