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. 395.602, F.S.; providing an
7	additional 3-year transition period for certain hospitals
8	to retain their designation as rural hospitals; amending
9	s. 400.118, F.S.; removing provisions requiring quality-
10	of-care monitors for nursing facilities in agency district
11	offices; amending s. 400.141, F.S.; revising reporting
12	requirements for facility staff-to-resident ratios;
13	deleting a requirement that licensed nursing home
14	facilities provide the agency with a monthly report on the
15	number of vacant beds in the facility; amending s.
16	400.147, F.S.; revising reporting requirements under
17	facility internal risk management and quality assurance
18	programs; revising the definition of the term "adverse
19	incident" for reporting purposes; requiring abuse,
20	neglect, and exploitation to be reported to the agency and
21	the Department of Children and Family Services; deleting a
22	requirement that the agency submit an annual report on
23	nursing home adverse incidents to the Legislature;
24	amending s. 400.162, F.S.; revising provisions relating to
25	procedures and policies regarding the safekeeping of
26	nursing home residents' property; amending s. 400.191,
27	F.S.; eliminating requirements for the agency to publish
28	the Nursing Home Guide annually in printed form; revising
29	information provided on the agency's Internet website;
30	amending s. 400.195, F.S.; conforming a cross-reference;
31	amending s. 400.23, F.S.; deleting provisions relating to
32	minimum staffing requirements for nursing homes; amending
33	s. 400.474, F.S.; providing that specified provisions
34	relating to remuneration do not apply to or preclude
35	certain payment practices permitted under specified
36	federal laws or regulations; amending s. 400.506, F.S.;
37	exempting nurse registries not participating in the
38	Medicaid or Medicare program from certain disciplinary
39	actions for paying remuneration to certain entities in
40	exchange for patient referrals; amending s. 400.9905,
41	F.S.; revising the definition of the term "clinic" to
42	provide that pt. X of ch. 400, F.S., the Health Care
43	Clinic Act, does not apply to entities that do not seek
44	reimbursement from insurance companies for medical
45	services paid pursuant to personal injury protection
46	coverage; amending s. 400.9935, F.S.; revising
47	accreditation requirements for clinics providing magnetic
48	resonance imaging services; providing for a unique
49	identification number for licensed clinics and entities
50	holding certificates of exemption; requiring the agency to
51	assign unique identification numbers, under certain
52	circumstances, and publish the numbers on its Internet
53	website in a specified format; amending s. 400.995, F.S.;
54	revising agency responsibilities with respect to personnel
55	and operations in certain injunctive proceedings; amending
56	s. 408.040, F.S.; extending the period for which a
57	certificate of need is valid for certain entities;
58	providing that the amendment to s. 408.040(2)(a), F.S.,
59	shall control over conflicting provisions; amending s.
60	408.07, F.S.; providing an additional 3-year transition
61	period for certain hospitals to retain their designation
62	as rural hospitals; amending s. 408.803, F.S.; revising
63	definitions applicable to pt. II of ch. 408, F.S., the
64	"Health Care Licensing Procedures Act"; amending s.
65	408.806, F.S.; revising contents of and procedures
66	relating to health care provider applications for
67	licensure; providing an exception from certain licensure
68	inspections for adult family-care homes; authorizing the
69	agency to provide electronic access to certain information
70	and documents; amending s. 408.808, F.S.; providing for a
71	provisional license to be issued to applicants applying
72	for a change of ownership; providing a time limit on
73	provisional licenses; amending s. 408.809, F.S.; revising
74	provisions relating to background screening of specified
75	employees; exempting certain persons from rescreening;
76	permitting certain persons to apply for an exemption from
77	disqualification under certain circumstances; requiring
78	health care providers to submit to the agency an affidavit
79	of compliance with background screening requirements at
80	the time of license renewal; deleting a provision to
81	conform to changes made by the act; amending s. 408.810,
82	F.S.; revising provisions relating to information required
83	for licensure; amending s. 408.811, F.S.; providing for
84	certain inspections to be accepted in lieu of complete
85	licensure inspections; granting agency access to records
86	requested during an offsite review; providing timeframes
87	for correction of certain deficiencies and submission of
88	plans to correct such deficiencies; amending s. 408.813,
89	F.S.; providing classifications of violations of pt. II of
90	ch. 408, F.S.; providing for fines; amending s. 408.820,
91	F.S.; revising applicability of exemptions from specified
92	requirements of pt. II of ch. 408, F.S.; conforming
93	references; creating s. 408.821, F.S.; requiring entities
94	regulated or licensed by the agency to designate a safety
95	liaison for emergency operations; providing that entities
96	regulated or licensed by the agency may temporarily exceed
97	their licensed capacity to act as receiving providers
98	under specified circumstances; providing requirements
99	while such entities are in an overcapacity status;
100	providing for issuance of an inactive license to such
101	licensees under specified conditions; providing
102	requirements and procedures with respect to the issuance
103	and reactivation of an inactive license; authorizing the
104	agency to adopt rules; amending s. 408.831, F.S.; deleting
105	provisions relating to authorization for entities
106	regulated or licensed by the agency to exceed their
107	licensed capacity to act as receiving facilities and
108	issuance and reactivation of inactive licenses; amending
109	s. 408.918, F.S.; requiring accreditation by the National
110	Alliance of Information and Referral Services for
111	participation in the Florida 211 Network; eliminating the
112	requirement that the agency seek certain assistance and
113	guidance in resolving certain disputes; removing certain
114	agency obligations relating to the Florida 211 Network;
115	requiring the Florida Alliance of Information and Referral
116	Services to perform certain functions related to the
117	Florida 211 Network; amending s. 409.221, F.S.; conforming
118	a cross-reference; amending s. 409.901, F.S.; revising a
119	definition applicable to Medicaid providers; repealing s.
120	429.071, F.S., relating to the intergenerational respite
121	care assisted living facility pilot program; amending s.
122	429.08, F.S.; authorizing the agency to provide
123	information regarding licensed assisted living facilities
124	electronically or on its Internet website; abolishing
125	local coordinating workgroups established by agency field
126	offices; deleting a fine; deleting provisions requiring
127	the agency to provide certain information and notice to
128	service providers; amending s. 429.14, F.S.; conforming a
129	reference; amending s. 429.19, F.S.; revising agency
130	procedures for imposition of fines for violations of pt. I
131	of ch. 429, F.S., the "Assisted Living Facilities Act";
132	providing for the posting of certain information
133	electronically or on the agency's Internet website;
134	amending s. 429.23, F.S.; revising the definition of the
135	term "adverse incident" for reporting purposes; requiring
136	abuse, neglect, and exploitation to be reported to the
137	agency and the Department of Children and Family Services;
138	deleting a requirement that the agency submit an annual
139	report on assisted living facility adverse incidents to
140	the Legislature; amending s. 429.26, F.S.; removing
141	requirement for a resident of an assisted living facility
142	to undergo examinations and evaluations under certain
143	circumstances; amending s. 430.80, F.S.; conforming a
144	cross-reference; amending ss. 435.04 and 435.05, F.S.;
145	requiring employers of certain employees to submit an
146	affidavit of compliance with level 2 screening
147	requirements at the time of license renewal; amending s.
148	483.031, F.S.; conforming a reference; amending s.
149	483.041, F.S.; revising a definition applicable to pt. I
150	of ch. 483, F.S., the "Florida Clinical Laboratory Law";
151	repealing s. 483.106, F.S., relating to applications for
152	certificates of exemption by clinical laboratories that
153	perform certain tests; amending s. 483.172, F.S.;
154	conforming a reference; amending s. 627.4239, F.S.;
155	revising the definition of the term "standard reference
156	compendium" for purposes of regulating the insurance
157	coverage of drugs used in the treatment of cancer;
158	amending s. 627.736, F.S.; providing that personal injury
159	protection insurance carriers are not required to pay
160	claims or charges for service or treatment billed by a
161	provider not holding an identification number issued by
162	the agency; amending s. 651.118, F.S.; conforming a cross-
163	reference; providing an effective date.
164
165	Be It Enacted by the Legislature of the State of Florida:
166
167	Section 1.  Section 395.0199, Florida Statutes, is
168	repealed.
169	Section 2.  Section 395.405, Florida Statutes, is amended
170	to read:
171	395.405  Rulemaking.--The department shall adopt and
172	enforce all rules necessary to administer ss. 395.0199, 395.401,
173	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
174	Section 3.  Paragraph (e) of subsection (2) of section
175	395.602, Florida Statutes, is amended to read:
176	395.602  Rural hospitals.--
177	(2)  DEFINITIONS.--As used in this part:
178	(e)  "Rural hospital" means an acute care hospital licensed
179	under this chapter, having 100 or fewer licensed beds and an
180	emergency room, which is:
181	1.  The sole provider within a county with a population
182	density of no greater than 100 persons per square mile;
183	2.  An acute care hospital, in a county with a population
184	density of no greater than 100 persons per square mile, which is
185	at least 30 minutes of travel time, on normally traveled roads
186	under normal traffic conditions, from any other acute care
187	hospital within the same county;
188	3.  A hospital supported by a tax district or subdistrict
189	whose boundaries encompass a population of 100 persons or fewer
190	per square mile;
191	4.  A hospital in a constitutional charter county with a
192	population of over 1 million persons that has imposed a local
193	option health service tax pursuant to law and in an area that
194	was directly impacted by a catastrophic event on August 24,
195	1992, for which the Governor of Florida declared a state of
196	emergency pursuant to chapter 125, and has 120 beds or less that
197	serves an agricultural community with an emergency room
198	utilization of no less than 20,000 visits and a Medicaid
199	inpatient utilization rate greater than 15 percent;
200	5.  A hospital with a service area that has a population of
201	100 persons or fewer per square mile. As used in this
202	subparagraph, the term "service area" means the fewest number of
203	zip codes that account for 75 percent of the hospital's
204	discharges for the most recent 5-year period, based on
205	information available from the hospital inpatient discharge
206	database in the Florida Center for Health Information and Policy
207	Analysis at the Agency for Health Care Administration; or
208	6.  A hospital designated as a critical access hospital, as
209	defined in s. 408.07(15).
210
211	Population densities used in this paragraph must be based upon
212	the most recently completed United States census. A hospital
213	that received funds under s. 409.9116 for a quarter beginning no
214	later than July 1, 2002, is deemed to have been and shall
215	continue to be a rural hospital from that date through June 30,
216	2015 2012, if the hospital continues to have 100 or fewer
217	licensed beds and an emergency room, or meets the criteria of
218	subparagraph 4. An acute care hospital that has not previously
219	been designated as a rural hospital and that meets the criteria
220	of this paragraph shall be granted such designation upon
221	application, including supporting documentation to the Agency
222	for Health Care Administration.
223	Section 4.  Subsection (1) of section 400.0712, Florida
224	Statutes, is amended to read:
225	400.0712  Application for inactive license.--
226	(1)  As specified in s. 408.831(4) and this section, the
227	agency may issue an inactive license to a nursing home facility
228	for all or a portion of its beds. Any request by a licensee that
229	a nursing home or portion of a nursing home become inactive must
230	be submitted to the agency in the approved format. The facility
231	may not initiate any suspension of services, notify residents,
232	or initiate inactivity before receiving approval from the
233	agency; and a licensee that violates this provision may not be
234	issued an inactive license.
235	Section 5.  Subsection (3) of section 400.118, Florida
236	Statutes, is renumbered as subsection (2), and present
237	subsection (2) of that section is amended to read:
238	400.118  Quality assurance; early warning system;
239	monitoring; rapid response teams.--
240	(2)(a)  The agency shall establish within each district
241	office one or more quality-of-care monitors, based on the number
242	of nursing facilities in the district, to monitor all nursing
243	facilities in the district on a regular, unannounced, aperiodic
244	basis, including nights, evenings, weekends, and holidays.
245	Quality-of-care monitors shall visit each nursing facility at
246	least quarterly. Priority for additional monitoring visits shall
247	be given to nursing facilities with a history of resident care
248	deficiencies. Quality-of-care monitors shall be registered
249	nurses who are trained and experienced in nursing facility
250	regulation, standards of practice in long-term care, and
251	evaluation of patient care. Individuals in these positions shall
252	not be deployed by the agency as a part of the district survey
253	team in the conduct of routine, scheduled surveys, but shall
254	function solely and independently as quality-of-care monitors.
255	Quality-of-care monitors shall assess the overall quality of
256	life in the nursing facility and shall assess specific
257	conditions in the facility directly related to resident care,
258	including the operations of internal quality improvement and
259	risk management programs and adverse incident reports. The
260	quality-of-care monitor shall include in an assessment visit
261	observation of the care and services rendered to residents and
262	formal and informal interviews with residents, family members,
263	facility staff, resident guests, volunteers, other regulatory
264	staff, and representatives of a long-term care ombudsman council
265	or Florida advocacy council.
266	(b)  Findings of a monitoring visit, both positive and
267	negative, shall be provided orally and in writing to the
268	facility administrator or, in the absence of the facility
269	administrator, to the administrator on duty or the director of
270	nursing. The quality-of-care monitor may recommend to the
271	facility administrator procedural and policy changes and staff
272	training, as needed, to improve the care or quality of life of
273	facility residents. Conditions observed by the quality-of-care
274	monitor which threaten the health or safety of a resident shall
275	be reported immediately to the agency area office supervisor for
276	appropriate regulatory action and, as appropriate or as required
277	by law, to law enforcement, adult protective services, or other
278	responsible agencies.
279	(c)  Any record, whether written or oral, or any written or
280	oral communication generated pursuant to paragraph (a) or
281	paragraph (b) shall not be subject to discovery or introduction
282	into evidence in any civil or administrative action against a
283	nursing facility arising out of matters which are the subject of
284	quality-of-care monitoring, and a person who was in attendance
285	at a monitoring visit or evaluation may not be permitted or
286	required to testify in any such civil or administrative action
287	as to any evidence or other matters produced or presented during
288	the monitoring visits or evaluations. However, information,
289	documents, or records otherwise available from original sources
290	are not to be construed as immune from discovery or use in any
291	such civil or administrative action merely because they were
292	presented during monitoring visits or evaluations, and any
293	person who participates in such activities may not be prevented
294	from testifying as to matters within his or her knowledge, but
295	such witness may not be asked about his or her participation in
296	such activities. The exclusion from the discovery or
297	introduction of evidence in any civil or administrative action
298	provided for herein shall not apply when the quality-of-care
299	monitor makes a report to the appropriate authorities regarding
300	a threat to the health or safety of a resident.
301	Section 6.  Section 400.141, Florida Statutes, is amended
302	to read:
303	400.141  Administration and management of nursing home
304	facilities.--
305	(1)  Every licensed facility shall comply with all
306	applicable standards and rules of the agency and shall:
307	(a)(1)  Be under the administrative direction and charge of
308	a licensed administrator.
309	(b)(2)  Appoint a medical director licensed pursuant to
310	chapter 458 or chapter 459. The agency may establish by rule
311	more specific criteria for the appointment of a medical
312	director.
313	(c)(3)  Have available the regular, consultative, and
314	emergency services of physicians licensed by the state.
315	(d)(4)  Provide for resident use of a community pharmacy as
316	specified in s. 400.022(1)(q). Any other law to the contrary
317	notwithstanding, a registered pharmacist licensed in Florida,
318	that is under contract with a facility licensed under this
319	chapter or chapter 429, shall repackage a nursing facility
320	resident's bulk prescription medication which has been packaged
321	by another pharmacist licensed in any state in the United States
322	into a unit dose system compatible with the system used by the
323	nursing facility, if the pharmacist is requested to offer such
324	service. In order to be eligible for the repackaging, a resident
325	or the resident's spouse must receive prescription medication
326	benefits provided through a former employer as part of his or
327	her retirement benefits, a qualified pension plan as specified
328	in s. 4972 of the Internal Revenue Code, a federal retirement
329	program as specified under 5 C.F.R. s. 831, or a long-term care
330	policy as defined in s. 627.9404(1). A pharmacist who correctly
331	repackages and relabels the medication and the nursing facility
332	which correctly administers such repackaged medication under the
333	provisions of this paragraph may subsection shall not be held
334	liable in any civil or administrative action arising from the
335	repackaging. In order to be eligible for the repackaging, a
336	nursing facility resident for whom the medication is to be
337	repackaged shall sign an informed consent form provided by the
338	facility which includes an explanation of the repackaging
339	process and which notifies the resident of the immunities from
340	liability provided in this paragraph herein. A pharmacist who
341	repackages and relabels prescription medications, as authorized
342	under this paragraph subsection, may charge a reasonable fee for
343	costs resulting from the implementation of this provision.
344	(e)(5)  Provide for the access of the facility residents to
345	dental and other health-related services, recreational services,
346	rehabilitative services, and social work services appropriate to
347	their needs and conditions and not directly furnished by the
348	licensee. When a geriatric outpatient nurse clinic is conducted
349	in accordance with rules adopted by the agency, outpatients
350	attending such clinic shall not be counted as part of the
351	general resident population of the nursing home facility, nor
352	shall the nursing staff of the geriatric outpatient clinic be
353	counted as part of the nursing staff of the facility, until the
354	outpatient clinic load exceeds 15 a day.
355	(f)(6)  Be allowed and encouraged by the agency to provide
356	other needed services under certain conditions. If the facility
357	has a standard licensure status, and has had no class I or class
358	II deficiencies during the past 2 years or has been awarded a
359	Gold Seal under the program established in s. 400.235, it may be
360	encouraged by the agency to provide services, including, but not
361	limited to, respite and adult day services, which enable
362	individuals to move in and out of the facility. A facility is
363	not subject to any additional licensure requirements for
364	providing these services. Respite care may be offered to persons
365	in need of short-term or temporary nursing home services.
366	Respite care must be provided in accordance with this part and
367	rules adopted by the agency. However, the agency shall, by rule,
368	adopt modified requirements for resident assessment, resident
369	care plans, resident contracts, physician orders, and other
370	provisions, as appropriate, for short-term or temporary nursing
371	home services. The agency shall allow for shared programming and
372	staff in a facility which meets minimum standards and offers
373	services pursuant to this paragraph subsection, but, if the
374	facility is cited for deficiencies in patient care, may require
375	additional staff and programs appropriate to the needs of
376	service recipients. A person who receives respite care may not
377	be counted as a resident of the facility for purposes of the
378	facility's licensed capacity unless that person receives 24-hour
379	respite care. A person receiving either respite care for 24
380	hours or longer or adult day services must be included when
381	calculating minimum staffing for the facility. Any costs and
382	revenues generated by a nursing home facility from
383	nonresidential programs or services shall be excluded from the
384	calculations of Medicaid per diems for nursing home
385	institutional care reimbursement.
386	(g)(7)  If the facility has a standard license or is a Gold
387	Seal facility, exceeds the minimum required hours of licensed
388	nursing and certified nursing assistant direct care per resident
389	per day, and is part of a continuing care facility licensed
390	under chapter 651 or a retirement community that offers other
391	services pursuant to part III of this chapter or part I or part
392	III of chapter 429 on a single campus, be allowed to share
393	programming and staff. At the time of inspection and in the
394	semiannual report required pursuant to paragraph (o) subsection
395	(15), a continuing care facility or retirement community that
396	uses this option must demonstrate through staffing records that
397	minimum staffing requirements for the facility were met.
398	Licensed nurses and certified nursing assistants who work in the
399	nursing home facility may be used to provide services elsewhere
400	on campus if the facility exceeds the minimum number of direct
401	care hours required per resident per day and the total number of
402	residents receiving direct care services from a licensed nurse
403	or a certified nursing assistant does not cause the facility to
404	violate the staffing ratios required under s. 400.23(3)(a).
405	Compliance with the minimum staffing ratios shall be based on
406	total number of residents receiving direct care services,
407	regardless of where they reside on campus. If the facility
408	receives a conditional license, it may not share staff until the
409	conditional license status ends. This paragraph subsection does
410	not restrict the agency's authority under federal or state law
411	to require additional staff if a facility is cited for
412	deficiencies in care which are caused by an insufficient number
413	of certified nursing assistants or licensed nurses. The agency
414	may adopt rules for the documentation necessary to determine
415	compliance with this provision.
416	(h)(8)  Maintain the facility premises and equipment and
417	conduct its operations in a safe and sanitary manner.
418	(i)(9)  If the licensee furnishes food service, provide a
419	wholesome and nourishing diet sufficient to meet generally
420	accepted standards of proper nutrition for its residents and
421	provide such therapeutic diets as may be prescribed by attending
422	physicians. In making rules to implement this paragraph
423	subsection, the agency shall be guided by standards recommended
424	by nationally recognized professional groups and associations
425	with knowledge of dietetics.
426	(j)(10)  Keep full records of resident admissions and
427	discharges; medical and general health status, including medical
428	records, personal and social history, and identity and address
429	of next of kin or other persons who may have responsibility for
430	the affairs of the residents; and individual resident care plans
431	including, but not limited to, prescribed services, service
432	frequency and duration, and service goals. The records shall be
433	open to inspection by the agency.
434	(k)(11)  Keep such fiscal records of its operations and
435	conditions as may be necessary to provide information pursuant
436	to this part.
437	(l)(12)  Furnish copies of personnel records for employees
438	affiliated with such facility, to any other facility licensed by
439	this state requesting this information pursuant to this part.
440	Such information contained in the records may include, but is
441	not limited to, disciplinary matters and any reason for
442	termination. Any facility releasing such records pursuant to
443	this part shall be considered to be acting in good faith and may
444	not be held liable for information contained in such records,
445	absent a showing that the facility maliciously falsified such
446	records.
447	(m)(13)  Publicly display a poster provided by the agency
448	containing the names, addresses, and telephone numbers for the
449	state's abuse hotline, the State Long-Term Care Ombudsman, the
450	Agency for Health Care Administration consumer hotline, the
451	Advocacy Center for Persons with Disabilities, the Florida
452	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
453	with a clear description of the assistance to be expected from
454	each.
455	(n)(14)  Submit to the agency the information specified in
456	s. 400.071(1)(b) for a management company within 30 days after
457	the effective date of the management agreement.
458	(o)1.(15)  Submit semiannually to the agency, or more
459	frequently if requested by the agency, information regarding
460	facility staff-to-resident ratios, staff turnover, and staff
461	stability, including information regarding certified nursing
462	assistants, licensed nurses, the director of nursing, and the
463	facility administrator. For purposes of this reporting:
464	a.(a)  Staff-to-resident ratios must be reported in the
465	categories specified in s. 400.23(3)(a) and applicable rules.
466	The ratio must be reported as an average for the most recent
467	calendar quarter.
468	b.(b)  Staff turnover must be reported for the most recent
469	12-month period ending on the last workday of the most recent
470	calendar quarter prior to the date the information is submitted.
471	The turnover rate must be computed quarterly, with the annual
472	rate being the cumulative sum of the quarterly rates. The
473	turnover rate is the total number of terminations or separations
474	experienced during the quarter, excluding any employee
475	terminated during a probationary period of 3 months or less,
476	divided by the total number of staff employed at the end of the
477	period for which the rate is computed, and expressed as a
478	percentage.
479	c.(c)  The formula for determining staff stability is the
480	total number of employees that have been employed for more than
481	12 months, divided by the total number of employees employed at
482	the end of the most recent calendar quarter, and expressed as a
483	percentage.
484	d.(d)  A nursing facility that has failed to comply with
485	state minimum-staffing requirements for 2 consecutive days is
486	prohibited from accepting new admissions until the facility has
487	achieved the minimum-staffing requirements for a period of 6
488	consecutive days. For the purposes of this sub-subparagraph
489	paragraph, any person who was a resident of the facility and was
490	absent from the facility for the purpose of receiving medical
491	care at a separate location or was on a leave of absence is not
492	considered a new admission. Failure to impose such an admissions
493	moratorium constitutes a class II deficiency.
494	e.(e)  A nursing facility which does not have a conditional
495	license may be cited for failure to comply with the standards in
496	s. 400.23(3)(a)1.a. only if it has failed to meet those
497	standards on 2 consecutive days or if it has failed to meet at
498	least 97 percent of those standards on any one day.
499	f.(f)  A facility which has a conditional license must be
500	in compliance with the standards in s. 400.23(3)(a) at all
501	times.
502	2.  Nothing in This paragraph does not section shall limit
503	the agency's ability to impose a deficiency or take other
504	actions if a facility does not have enough staff to meet the
505	residents' needs.
506	(16)  Report monthly the number of vacant beds in the
507	facility which are available for resident occupancy on the day
508	the information is reported.
509	(p)(17)  Notify a licensed physician when a resident
510	exhibits signs of dementia or cognitive impairment or has a
511	change of condition in order to rule out the presence of an
512	underlying physiological condition that may be contributing to
513	such dementia or impairment. The notification must occur within
514	30 days after the acknowledgment of such signs by facility
515	staff. If an underlying condition is determined to exist, the
516	facility shall arrange, with the appropriate health care
517	provider, the necessary care and services to treat the
518	condition.
519	(q)(18)  If the facility implements a dining and
520	hospitality attendant program, ensure that the program is
521	developed and implemented under the supervision of the facility
522	director of nursing. A licensed nurse, licensed speech or
523	occupational therapist, or a registered dietitian must conduct
524	training of dining and hospitality attendants. A person employed
525	by a facility as a dining and hospitality attendant must perform
526	tasks under the direct supervision of a licensed nurse.
527	(r)(19)  Report to the agency any filing for bankruptcy
528	protection by the facility or its parent corporation,
529	divestiture or spin-off of its assets, or corporate
530	reorganization within 30 days after the completion of such
531	activity.
532	(s)(20)  Maintain general and professional liability
533	insurance coverage that is in force at all times. In lieu of
534	general and professional liability insurance coverage, a state-
535	designated teaching nursing home and its affiliated assisted
536	living facilities created under s. 430.80 may demonstrate proof
537	of financial responsibility as provided in s. 430.80(3)(h).
538	(t)(21)  Maintain in the medical record for each resident a
539	daily chart of certified nursing assistant services provided to
540	the resident. The certified nursing assistant who is caring for
541	the resident must complete this record by the end of his or her
542	shift. This record must indicate assistance with activities of
543	daily living, assistance with eating, and assistance with
544	drinking, and must record each offering of nutrition and
545	hydration for those residents whose plan of care or assessment
546	indicates a risk for malnutrition or dehydration.
547	(u)(22)  Before November 30 of each year, subject to the
548	availability of an adequate supply of the necessary vaccine,
549	provide for immunizations against influenza viruses to all its
550	consenting residents in accordance with the recommendations of
551	the United States Centers for Disease Control and Prevention,
552	subject to exemptions for medical contraindications and
553	religious or personal beliefs. Subject to these exemptions, any
554	consenting person who becomes a resident of the facility after
555	November 30 but before March 31 of the following year must be
556	immunized within 5 working days after becoming a resident.
557	Immunization shall not be provided to any resident who provides
558	documentation that he or she has been immunized as required by
559	this paragraph subsection. This paragraph subsection does not
560	prohibit a resident from receiving the immunization from his or
561	her personal physician if he or she so chooses. A resident who
562	chooses to receive the immunization from his or her personal
563	physician shall provide proof of immunization to the facility.
564	The agency may adopt and enforce any rules necessary to comply
565	with or implement this paragraph subsection.
566	(v)(23)  Assess all residents for eligibility for
567	pneumococcal polysaccharide vaccination (PPV) and vaccinate
568	residents when indicated within 60 days after the effective date
569	of this act in accordance with the recommendations of the United
570	States Centers for Disease Control and Prevention, subject to
571	exemptions for medical contraindications and religious or
572	personal beliefs. Residents admitted after the effective date of
573	this act shall be assessed within 5 working days of admission
574	and, when indicated, vaccinated within 60 days in accordance
575	with the recommendations of the United States Centers for
576	Disease Control and Prevention, subject to exemptions for
577	medical contraindications and religious or personal beliefs.
578	Immunization shall not be provided to any resident who provides
579	documentation that he or she has been immunized as required by
580	this paragraph subsection. This paragraph subsection does not
581	prohibit a resident from receiving the immunization from his or
582	her personal physician if he or she so chooses. A resident who
583	chooses to receive the immunization from his or her personal
584	physician shall provide proof of immunization to the facility.
585	The agency may adopt and enforce any rules necessary to comply
586	with or implement this paragraph subsection.
587	(w)(24)  Annually encourage and promote to its employees
588	the benefits associated with immunizations against influenza
589	viruses in accordance with the recommendations of the United
590	States Centers for Disease Control and Prevention. The agency
591	may adopt and enforce any rules necessary to comply with or
592	implement this paragraph subsection.
593	(2)  Facilities that have been awarded a Gold Seal under
594	the program established in s. 400.235 may develop a plan to
595	provide certified nursing assistant training as prescribed by
596	federal regulations and state rules and may apply to the agency
597	for approval of their program.
598	Section 7.  Present subsections (9) through (13) of section
599	400.147, Florida Statutes, are renumbered as subsections (10)
600	through (14), respectively, subsection (5) and present
601	subsection (14) are amended, and a new subsection (9) is added
602	to that section, to read:
603	400.147  Internal risk management and quality assurance
604	program.--
605	(5)  For purposes of reporting to the agency under this
606	section, the term "adverse incident" means:
607	(a)  An event over which facility personnel could exercise
608	control and which is associated in whole or in part with the
609	facility's intervention, rather than the condition for which
610	such intervention occurred, and which results in one of the
611	following:
612	1.  Death;
613	2.  Brain or spinal damage;
614	3.  Permanent disfigurement;
615	4.  Fracture or dislocation of bones or joints;
616	5.  A limitation of neurological, physical, or sensory
617	function;
618	6.  Any condition that required medical attention to which
619	the resident has not given his or her informed consent,
620	including failure to honor advanced directives; or
621	7.  Any condition that required the transfer of the
622	resident, within or outside the facility, to a unit providing a
623	more acute level of care due to the adverse incident, rather
624	than the resident's condition prior to the adverse incident; or
625	8.  An event that is reported to law enforcement or its
626	personnel for investigation; or
627	(b)  Abuse, neglect, or exploitation as defined in s.
628	415.102;
629	(c)  Abuse, neglect and harm as defined in s. 39.01;
630	(b)(d)  Resident elopement, if the elopement places the
631	resident at risk of harm or injury.; or
632	(e)  An event that is reported to law enforcement.
633	(9)  Abuse, neglect, or exploitation must be reported to
634	the agency as required by 42 C.F.R. s. 483.13(c) and to the
635	department as required by chapters 39 and 415.
636	(14)  The agency shall annually submit to the Legislature a
637	report on nursing home adverse incidents. The report must
638	include the following information arranged by county:
639	(a)  The total number of adverse incidents.
640	(b)  A listing, by category, of the types of adverse
641	incidents, the number of incidents occurring within each
642	category, and the type of staff involved.
643	(c)  A listing, by category, of the types of injury caused
644	and the number of injuries occurring within each category.
645	(d)  Types of liability claims filed based on an adverse
646	incident or reportable injury.
647	(e)  Disciplinary action taken against staff, categorized
648	by type of staff involved.
649	Section 8.  Subsection (3) of section 400.162, Florida
650	Statutes, is amended to read:
651	400.162  Property and personal affairs of residents.--
652	(3)  A licensee shall provide for the safekeeping of
653	personal effects, funds, and other property of the resident in
654	the facility. Whenever necessary for the protection of
655	valuables, or in order to avoid unreasonable responsibility
656	therefor, the licensee may require that such valuables be
657	excluded or removed from the facility and kept at some place not
658	subject to the control of the licensee. At the request of a
659	resident, the facility shall mark the resident's personal
660	property with the resident's name or another type of
661	identification, without defacing the property. Any theft or loss
662	of a resident's personal property shall be documented by the
663	facility. The facility shall develop policies and procedures to
664	minimize the risk of theft or loss of the personal property of
665	residents. A copy of the policy shall be provided to every
666	employee and to each resident and resident's representative, if
667	appropriate, at admission and when revised. Facility policies
668	must include provisions related to reporting theft or loss of a
669	resident's property to law enforcement and any facility waiver
670	of liability for loss or theft. The facility shall post notice
671	of these policies and procedures, and any revision thereof, in
672	places accessible to residents.
673	Section 9.  Subsection (2) of section 400.191, Florida
674	Statutes, is amended to read:
675	400.191  Availability, distribution, and posting of reports
676	and records.--
677	(2)  The agency shall publish the Nursing Home Guide
678	annually in consumer-friendly printed form and quarterly in
679	electronic form to assist consumers and their families in
680	comparing and evaluating nursing home facilities.
681	(a)  The agency shall provide an Internet site which shall
682	include at least the following information either directly or
683	indirectly through a link to another established site or sites
684	of the agency's choosing:
685	1.  A section entitled "Have you considered programs that
686	provide alternatives to nursing home care?" which shall be the
687	first section of the Nursing Home Guide and which shall
688	prominently display information about available alternatives to
689	nursing homes and how to obtain additional information regarding
690	these alternatives. The Nursing Home Guide shall explain that
691	this state offers alternative programs that permit qualified
692	elderly persons to stay in their homes instead of being placed
693	in nursing homes and shall encourage interested persons to call
694	the Comprehensive Assessment Review and Evaluation for Long-Term
695	Care Services (CARES) Program to inquire if they qualify. The
696	Nursing Home Guide shall list available home and community-based
697	programs which shall clearly state the services that are
698	provided and indicate whether nursing home services are included
699	if needed.
700	2.  A list by name and address of all nursing home
701	facilities in this state, including any prior name by which a
702	facility was known during the previous 24-month period.
703	3.  Whether such nursing home facilities are proprietary or
704	nonproprietary.
705	4.  The current owner of the facility's license and the
706	year that that entity became the owner of the license.
707	5.  The name of the owner or owners of each facility and
708	whether the facility is affiliated with a company or other
709	organization owning or managing more than one nursing facility
710	in this state.
711	6.  The total number of beds in each facility and the most
712	recently available occupancy levels.
713	7.  The number of private and semiprivate rooms in each
714	facility.
715	8.  The religious affiliation, if any, of each facility.
716	9.  The languages spoken by the administrator and staff of
717	each facility.
718	10.  Whether or not each facility accepts Medicare or
719	Medicaid recipients or insurance, health maintenance
720	organization, Veterans Administration, CHAMPUS program, or
721	workers' compensation coverage.
722	11.  Recreational and other programs available at each
723	facility.
724	12.  Special care units or programs offered at each
725	facility.
726	13.  Whether the facility is a part of a retirement
727	community that offers other services pursuant to part III of
728	this chapter or part I or part III of chapter 429.
729	14.  Survey and deficiency information, including all
730	federal and state recertification, licensure, revisit, and
731	complaint survey information, for each facility for the past 30
732	months. For noncertified nursing homes, state survey and
733	deficiency information, including licensure, revisit, and
734	complaint survey information for the past 30 months shall be
735	provided.
736	15.  A summary of the deficiency data for each facility
737	over the past 30 months. The summary may include a score,
738	rating, or comparison ranking with respect to other facilities
739	based on the number of citations received by the facility on
740	recertification, licensure, revisit, and complaint surveys; the
741	severity and scope of the citations; and the number of
742	recertification surveys the facility has had during the past 30
743	months. The score, rating, or comparison ranking may be
744	presented in either numeric or symbolic form for the intended
745	consumer audience.
746	(b)  The agency shall provide the following information in
747	printed form:
748	1.  A section entitled "Have you considered programs that
749	provide alternatives to nursing home care?" which shall be the
750	first section of the Nursing Home Guide and which shall
751	prominently display information about available alternatives to
752	nursing homes and how to obtain additional information regarding
753	these alternatives. The Nursing Home Guide shall explain that
754	this state offers alternative programs that permit qualified
755	elderly persons to stay in their homes instead of being placed
756	in nursing homes and shall encourage interested persons to call
757	the Comprehensive Assessment Review and Evaluation for Long-Term
758	Care Services (CARES) Program to inquire if they qualify. The
759	Nursing Home Guide shall list available home and community-based
760	programs which shall clearly state the services that are
761	provided and indicate whether nursing home services are included
762	if needed.
763	2.  A list by name and address of all nursing home
764	facilities in this state.
765	3.  Whether the nursing home facilities are proprietary or
766	nonproprietary.
767	4.  The current owner or owners of the facility's license
768	and the year that entity became the owner of the license.
769	5.  The total number of beds, and of private and
770	semiprivate rooms, in each facility.
771	6.  The religious affiliation, if any, of each facility.
772	7.  The name of the owner of each facility and whether the
773	facility is affiliated with a company or other organization
774	owning or managing more than one nursing facility in this state.
775	8.  The languages spoken by the administrator and staff of
776	each facility.
777	9.  Whether or not each facility accepts Medicare or
778	Medicaid recipients or insurance, health maintenance
779	organization, Veterans Administration, CHAMPUS program, or
780	workers' compensation coverage.
781	10.  Recreational programs, special care units, and other
782	programs available at each facility.
783	11.  The Internet address for the site where more detailed
784	information can be seen.
785	12.  A statement advising consumers that each facility will
786	have its own policies and procedures related to protecting
787	resident property.
788	13.  A summary of the deficiency data for each facility
789	over the past 30 months. The summary may include a score,
790	rating, or comparison ranking with respect to other facilities
791	based on the number of citations received by the facility on
792	recertification, licensure, revisit, and complaint surveys; the
793	severity and scope of the citations; the number of citations;
794	and the number of recertification surveys the facility has had
795	during the past 30 months. The score, rating, or comparison
796	ranking may be presented in either numeric or symbolic form for
797	the intended consumer audience.
798	(b)(c)  The agency may provide the following additional
799	information on an Internet site or in printed form as the
800	information becomes available:
801	1.  The licensure status history of each facility.
802	2.  The rating history of each facility.
803	3.  The regulatory history of each facility, which may
804	include federal sanctions, state sanctions, federal fines, state
805	fines, and other actions.
806	4.  Whether the facility currently possesses the Gold Seal
807	designation awarded pursuant to s. 400.235.
808	5.  Internet links to the Internet sites of the facilities
809	or their affiliates.
810	Section 10.  Paragraph (d) of subsection (1) of section
811	400.195, Florida Statutes, is amended to read:
812	400.195  Agency reporting requirements.--
813	(1)  For the period beginning June 30, 2001, and ending
814	June 30, 2005, the Agency for Health Care Administration shall
815	provide a report to the Governor, the President of the Senate,
816	and the Speaker of the House of Representatives with respect to
817	nursing homes. The first report shall be submitted no later than
818	December 30, 2002, and subsequent reports shall be submitted
819	every 6 months thereafter. The report shall identify facilities
820	based on their ownership characteristics, size, business
821	structure, for-profit or not-for-profit status, and any other
822	characteristics the agency determines useful in analyzing the
823	varied segments of the nursing home industry and shall report:
824	(d)  Information regarding deficiencies cited, including
825	information used to develop the Nursing Home Guide WATCH LIST
826	pursuant to s. 400.191, and applicable rules, a summary of data
827	generated on nursing homes by Centers for Medicare and Medicaid
828	Services Nursing Home Quality Information Project, and
829	information collected pursuant to s. 400.147(10)(9), relating to
830	litigation.
831	Section 11.  Paragraph (b) of subsection (3) of section
832	400.23, Florida Statutes, is amended to read:
833	400.23  Rules; evaluation and deficiencies; licensure
834	status.--
835	(3)
836	(b)  The agency shall adopt rules to allow properly trained
837	staff of a nursing facility, in addition to certified nursing
838	assistants and licensed nurses, to assist residents with eating.
839	The rules shall specify the minimum training requirements and
840	shall specify the physiological conditions or disorders of
841	residents which would necessitate that the eating assistance be
842	provided by nursing personnel of the facility. Nonnursing staff
843	providing eating assistance to residents under the provisions of
844	this subsection shall not count toward compliance with minimum
845	staffing standards.
846	Section 12.  Subsection (6) of section 400.474, Florida
847	Statutes, is amended to read:
848	400.474  Administrative penalties.--
849	(6)  The agency may deny, revoke, or suspend the license of
850	a home health agency and shall impose a fine of $5,000 against a
851	home health agency that:
852	(a)  Gives remuneration for staffing services to:
853	1.  Another home health agency with which it has formal or
854	informal patient-referral transactions or arrangements; or
855	2.  A health services pool with which it has formal or
856	informal patient-referral transactions or arrangements,
857
858	unless the home health agency has activated its comprehensive
859	emergency management plan in accordance with s. 400.492. This
860	paragraph does not apply to a Medicare-certified home health
861	agency that provides fair market value remuneration for staffing
862	services to a non-Medicare-certified home health agency that is
863	part of a continuing care facility licensed under chapter 651
864	for providing services to its own residents if each resident
865	receiving home health services pursuant to this arrangement
866	attests in writing that he or she made a decision without
867	influence from staff of the facility to select, from a list of
868	Medicare-certified home health agencies provided by the
869	facility, that Medicare-certified home health agency to provide
870	the services.
871	(b)  Provides services to residents in an assisted living
872	facility for which the home health agency does not receive fair
873	market value remuneration.
874	(c)  Provides staffing to an assisted living facility for
875	which the home health agency does not receive fair market value
876	remuneration.
877	(d)  Fails to provide the agency, upon request, with copies
878	of all contracts with assisted living facilities which were
879	executed within 5 years before the request.
880	(e)  Gives remuneration to a case manager, discharge
881	planner, facility-based staff member, or third-party vendor who
882	is involved in the discharge planning process of a facility
883	licensed under chapter 395 or this chapter from whom the home
884	health agency receives referrals.
885	(f)  Fails to submit to the agency, within 15 days after
886	the end of each calendar quarter, a written report that includes
887	the following data based on data as it existed on the last day
888	of the quarter:
889	1.  The number of insulin-dependent diabetic patients
890	receiving insulin-injection services from the home health
891	agency;
892	2.  The number of patients receiving both home health
893	services from the home health agency and hospice services;
894	3.  The number of patients receiving home health services
895	from that home health agency; and
896	4.  The names and license numbers of nurses whose primary
897	job responsibility is to provide home health services to
898	patients and who received remuneration from the home health
899	agency in excess of $25,000 during the calendar quarter.
900	(g)  Gives cash, or its equivalent, to a Medicare or
901	Medicaid beneficiary.
902	(h)  Has more than one medical director contract in effect
903	at one time or more than one medical director contract and one
904	contract with a physician-specialist whose services are mandated
905	for the home health agency in order to qualify to participate in
906	a federal or state health care program at one time.
907	(i)  Gives remuneration to a physician without a medical
908	director contract being in effect. The contract must:
909	1.  Be in writing and signed by both parties;
910	2.  Provide for remuneration that is at fair market value
911	for an hourly rate, which must be supported by invoices
912	submitted by the medical director describing the work performed,
913	the dates on which that work was performed, and the duration of
914	that work; and
915	3.  Be for a term of at least 1 year.
916
917	The hourly rate specified in the contract may not be increased
918	during the term of the contract. The home health agency may not
919	execute a subsequent contract with that physician which has an
920	increased hourly rate and covers any portion of the term that
921	was in the original contract.
922	(j)  Gives remuneration to:
923	1.  A physician, and the home health agency is in violation
924	of paragraph (h) or paragraph (i);
925	2.  A member of the physician's office staff; or
926	3.  An immediate family member of the physician,
927
928	if the home health agency has received a patient referral in the
929	preceding 12 months from that physician or physician's office
930	staff.
931	(k)  Fails to provide to the agency, upon request, copies
932	of all contracts with a medical director which were executed
933	within 5 years before the request.
934
935	Nothing in paragraph (e) or paragraph (j) shall be interpreted
936	as applying to or precluding any discount, compensation, waiver
937	of payment, or payment practice permitted by 42 U.S.C. s. 1320a-
938	7b(b) or regulations adopted thereunder, including 42 C.F.R. s.
939	1001.952, or by 42 U.S.C. s. 1395nn or regulations adopted
940	thereunder.
941	Section 13.  Paragraph (a) of subsection (15) of section
942	400.506, Florida Statutes, is amended to read:
943	400.506  Licensure of nurse registries; requirements;
944	penalties.--
945	(15)(a)  The agency may deny, suspend, or revoke the
946	license of a nurse registry and shall impose a fine of $5,000
947	against a nurse registry that:
948	1.  Provides services to residents in an assisted living
949	facility for which the nurse registry does not receive fair
950	market value remuneration.
951	2.  Provides staffing to an assisted living facility for
952	which the nurse registry does not receive fair market value
953	remuneration.
954	3.  Fails to provide the agency, upon request, with copies
955	of all contracts with assisted living facilities which were
956	executed within the last 5 years.
957	4.  Gives remuneration to a case manager, discharge
958	planner, facility-based staff member, or third-party vendor who
959	is involved in the discharge planning process of a facility
960	licensed under chapter 395 or this chapter and from whom the
961	nurse registry receives referrals. This subparagraph does not
962	apply to a nurse registry that does not participate in the
963	Medicaid or Medicare program.
964	5.  Gives remuneration to a physician, a member of the
965	physician's office staff, or an immediate family member of the
966	physician, and the nurse registry received a patient referral in
967	the last 12 months from that physician or the physician's office
968	staff. This subparagraph does not apply to a nurse registry that
969	does not participate in the Medicaid or Medicare program.
970	Section 14.  Paragraph (m) is added to subsection (4) of
971	section 400.9905, Florida Statutes, to read:
972	400.9905  Definitions.--
973	(4)  "Clinic" means an entity at which health care services
974	are provided to individuals and which tenders charges for
975	reimbursement for such services, including a mobile clinic and a
976	portable equipment provider. For purposes of this part, the term
977	does not include and the licensure requirements of this part do
978	not apply to:
979	(m)  Entities that do not seek reimbursement from insurance
980	companies for medical services paid pursuant to personal injury
981	protection coverage required by s. 627.736.
982	Section 15.  Paragraph (a) of subsection (7) of section
983	400.9935, Florida Statutes, is amended, and subsection (10) is
984	added to that section, to read:
985	400.9935  Clinic responsibilities.--
986	(7)(a)  Each clinic engaged in magnetic resonance imaging
987	services must be accredited by the Joint Commission on
988	Accreditation of Healthcare Organizations, the American College
989	of Radiology, or the Accreditation Association for Ambulatory
990	Health Care, within 1 year after licensure. A clinic that is
991	accredited by the American College of Radiology or is within the
992	original 1-year period after licensure and replaces its core
993	magnetic resonance imaging equipment shall be given 1 year after
994	the date upon which the equipment is replaced to attain
995	accreditation. However, a clinic may request a single, 6-month
996	extension if it provides evidence to the agency establishing
997	that, for good cause shown, such clinic cannot can not be
998	accredited within 1 year after licensure, and that such
999	accreditation will be completed within the 6-month extension.
1000	After obtaining accreditation as required by this subsection,
1001	each such clinic must maintain accreditation as a condition of
1002	renewal of its license. A clinic that files a change of
1003	ownership application must comply with the original
1004	accreditation timeframe requirements of the transferor. The
1005	agency shall deny a change of ownership application if the
1006	clinic is not in compliance with the accreditation requirements.
1007	When a clinic adds, replaces, or modifies magnetic resonance
1008	imaging equipment and the accrediting organization requires new
1009	accreditation, the clinic must be accredited within 1 year after
1010	the date of the addition, replacement, or modification but may
1011	request a single, 6-month extension if the clinic provides
1012	evidence of good cause to the agency.
1013	(10)  Any clinic holding an active license and any entity
1014	holding a current certificate of exemption may request a unique
1015	identification number from the agency for the purposes of
1016	submitting claims to personal injury protection insurance
1017	carriers for services or treatment pursuant to part XI of
1018	chapter 627. Upon request, the agency shall assign a unique
1019	identification number to a clinic holding an active license or
1020	an entity holding a current certificate of exemption. The agency
1021	shall publish the identification number of each clinic and
1022	entity on its Internet website in a searchable format that is
1023	readily accessible to personal injury protection insurance
1024	carriers for the purposes of s. 627.736(5)(b)1.g.
1025	Section 16.  Subsection (6) of section 400.995, Florida
1026	Statutes, is amended to read:
1027	400.995  Agency administrative penalties.--
1028	(6)  During an inspection, the agency, as an alternative to
1029	or in conjunction with an administrative action against a clinic
1030	for violations of this part and adopted rules, shall make a
1031	reasonable attempt to discuss each violation and recommended
1032	corrective action with the owner, medical director, or clinic
1033	director of the clinic, prior to written notification. The
1034	agency, instead of fixing a period within which the clinic shall
1035	enter into compliance with standards, may request a plan of
1036	corrective action from the clinic which demonstrates a good
1037	faith effort to remedy each violation by a specific date,
1038	subject to the approval of the agency.
1039	Section 17.  Paragraph (a) of subsection (2) of section
1040	408.040, Florida Statutes, is amended to read:
1041	408.040  Conditions and monitoring.--
1042	(2)(a)  Unless the applicant has commenced construction, if
1043	the project provides for construction, unless the applicant has
1044	incurred an enforceable capital expenditure commitment for a
1045	project, if the project does not provide for construction, or
1046	unless subject to paragraph (b), a certificate of need shall
1047	terminate 18 months after the date of issuance, except an entity
1048	holding a certificate of need issued on or before April 1, 2009,
1049	which shall terminate 36 months after the date of issuance. The
1050	agency shall monitor the progress of the holder of the
1051	certificate of need in meeting the timetable for project
1052	development specified in the application, and may revoke the
1053	certificate of need, if the holder of the certificate is not
1054	meeting such timetable and is not making a good-faith effort, as
1055	defined by rule, to meet it.
1056	Section 18.  The amendment to s. 408.040(2)(a), Florida
1057	Statutes, by this act shall control over any conflicting
1058	amendment to s. 408.040(2)(a), Florida Statutes, that is adopted
1059	during the 2009 Regular Session or an extension thereof and
1060	becomes law.
1061	Section 19.  Subsection (43) of section 408.07, Florida
1062	Statutes, is amended to read:
1063	408.07  Definitions.--As used in this chapter, with the
1064	exception of ss. 408.031-408.045, the term:
1065	(43)  "Rural hospital" means an acute care hospital
1066	licensed under chapter 395, having 100 or fewer licensed beds
1067	and an emergency room, and which is:
1068	(a)  The sole provider within a county with a population
1069	density of no greater than 100 persons per square mile;
1070	(b)  An acute care hospital, in a county with a population
1071	density of no greater than 100 persons per square mile, which is
1072	at least 30 minutes of travel time, on normally traveled roads
1073	under normal traffic conditions, from another acute care
1074	hospital within the same county;
1075	(c)  A hospital supported by a tax district or subdistrict
1076	whose boundaries encompass a population of 100 persons or fewer
1077	per square mile;
1078	(d)  A hospital with a service area that has a population
1079	of 100 persons or fewer per square mile. As used in this
1080	paragraph, the term "service area" means the fewest number of
1081	zip codes that account for 75 percent of the hospital's
1082	discharges for the most recent 5-year period, based on
1083	information available from the hospital inpatient discharge
1084	database in the Florida Center for Health Information and Policy
1085	Analysis at the Agency for Health Care Administration; or
1086	(e)  A critical access hospital.
1087
1088	Population densities used in this subsection must be based upon
1089	the most recently completed United States census. A hospital
1090	that received funds under s. 409.9116 for a quarter beginning no
1091	later than July 1, 2002, is deemed to have been and shall
1092	continue to be a rural hospital from that date through June 30,
1093	2015 2012, if the hospital continues to have 100 or fewer
1094	licensed beds and an emergency room, or meets the criteria of s.
1095	395.602(2)(e)4. An acute care hospital that has not previously
1096	been designated as a rural hospital and that meets the criteria
1097	of this subsection shall be granted such designation upon
1098	application, including supporting documentation, to the Agency
1099	for Health Care Administration.
1100	Section 20.  Subsections (5), (9), and (13) of section
1101	408.803, Florida Statutes, are amended to read:
1102	408.803  Definitions.--As used in this part, the term:
1103	(5)  "Change of ownership" means:
1104	(a)  An event in which the licensee sells or otherwise
1105	transfers its ownership changes to a different individual or
1106	legal entity, as evidenced by a change in federal employer
1107	identification number or taxpayer identification number; or
1108	(b)  An event in which 51 45 percent or more of the
1109	ownership, voting shares, membership, or controlling interest of
1110	a licensee is in any manner transferred or otherwise assigned.
1111	This paragraph does not apply to a licensee that is publicly
1112	traded on a recognized stock exchange. In a corporation whose
1113	shares are not publicly traded on a recognized stock exchange is
1114	transferred or assigned, including the final transfer or
1115	assignment of multiple transfers or assignments over a 2-year
1116	period that cumulatively total 45 percent or greater.
1117
1118	A change solely in the management company or board of directors
1119	is not a change of ownership.
1120	(9)  "Licensee" means an individual, corporation,
1121	partnership, firm, association, or governmental entity, or other
1122	entity that is issued a permit, registration, certificate, or
1123	license by the agency. The licensee is legally responsible for
1124	all aspects of the provider operation.
1125	(13)  "Voluntary board member" means a board member of a
1126	not-for-profit corporation or organization who serves solely in
1127	a voluntary capacity, does not receive any remuneration for his
1128	or her services on the board of directors, and has no financial
1129	interest in the corporation or organization. The agency shall
1130	recognize a person as a voluntary board member following
1131	submission of a statement to the agency by the board member and
1132	the not-for-profit corporation or organization that affirms that
1133	the board member conforms to this definition. The statement
1134	affirming the status of the board member must be submitted to
1135	the agency on a form provided by the agency.
1136	Section 21.  Paragraph (a) of subsection (1), subsection
1137	(2), paragraph (c) of subsection (7), and subsection (8) of
1138	section 408.806, Florida Statutes, are amended to read:
1139	408.806  License application process.--
1140	(1)  An application for licensure must be made to the
1141	agency on forms furnished by the agency, submitted under oath,
1142	and accompanied by the appropriate fee in order to be accepted
1143	and considered timely. The application must contain information
1144	required by authorizing statutes and applicable rules and must
1145	include:
1146	(a)  The name, address, and social security number of:
1147	1.  The applicant;
1148	2.  The administrator or a similarly titled person who is
1149	responsible for the day-to-day operation of the provider;
1150	3.  The financial officer or similarly titled person who is
1151	responsible for the financial operation of the licensee or
1152	provider; and
1153	4.  Each controlling interest if the applicant or
1154	controlling interest is an individual.
1155	(2)(a)  The applicant for a renewal license must submit an
1156	application that must be received by the agency at least 60 days
1157	but no more than 120 days prior to the expiration of the current
1158	license. An application received more than 120 days prior to the
1159	expiration of the current license shall be returned to the
1160	applicant. If the renewal application and fee are received prior
1161	to the license expiration date, the license shall not be deemed
1162	to have expired if the license expiration date occurs during the
1163	agency's review of the renewal application.
1164	(b)  The applicant for initial licensure due to a change of
1165	ownership must submit an application that must be received by
1166	the agency at least 60 days prior to the date of change of
1167	ownership.
1168	(c)  For any other application or request, the applicant
1169	must submit an application or request that must be received by
1170	the agency at least 60 days but no more than 120 days prior to
1171	the requested effective date, unless otherwise specified in
1172	authorizing statutes or applicable rules. An application
1173	received more than 120 days prior to the requested effective
1174	date shall be returned to the applicant.
1175	(d)  The agency shall notify the licensee by mail or
1176	electronically at least 90 days prior to the expiration of a
1177	license that a renewal license is necessary to continue
1178	operation. The failure to timely submit a renewal application
1179	and license fee shall result in a $50 per day late fee charged
1180	to the licensee by the agency; however, the aggregate amount of
1181	the late fee may not exceed 50 percent of the licensure fee or
1182	$500, whichever is less. If an application is received after the
1183	required filing date and exhibits a hand-canceled postmark
1184	obtained from a United States post office dated on or before the
1185	required filing date, no fine will be levied.
1186	(7)
1187	(c)  If an inspection is required by the authorizing
1188	statute for a license application other than an initial
1189	application, the inspection must be unannounced. This paragraph
1190	does not apply to inspections required pursuant to ss. 383.324,
1191	395.0161(4), 429.67(6), and 483.061(2).
1192	(8)  The agency may establish procedures for the electronic
1193	notification and submission of required information, including,
1194	but not limited to:
1195	(a)  Licensure applications.
1196	(b)  Required signatures.
1197	(c)  Payment of fees.
1198	(d)  Notarization of applications.
1199
1200	Requirements for electronic submission of any documents required
1201	by this part or authorizing statutes may be established by rule.
1202	As an alternative to sending documents as required by
1203	authorizing statutes, the agency may provide electronic access
1204	to information or documents.
1205	Section 22.  Subsection (2) of section 408.808, Florida
1206	Statutes, is amended to read:
1207	408.808  License categories.--
1208	(2)  PROVISIONAL LICENSE.--A provisional license may be
1209	issued to an applicant pursuant to s. 408.809(3). An applicant
1210	against whom a proceeding denying or revoking a license is
1211	pending at the time of license renewal may be issued a
1212	provisional license effective until final action not subject to
1213	further appeal. A provisional license may also be issued to an
1214	applicant applying for a change of ownership. A provisional
1215	license shall be limited in duration to a specific period of
1216	time, not to exceed 12 months, as determined by the agency.
1217	Section 23.  Subsection (5) of section 408.809, Florida
1218	Statutes, is amended, and new subsections (5) and (6) are added
1219	to that section, to read:
1220	408.809  Background screening; prohibited offenses.--
1221	(5)  Effective October 1, 2009, in addition to the offenses
1222	listed in ss. 435.03 and 435.04, all persons required to undergo
1223	background screening pursuant to this part or authorizing
1224	statutes must not have been found guilty of, regardless of
1225	adjudication, or entered a plea of nolo contendere or guilty to,
1226	any of the following offenses or any similar offense of another
1227	jurisdiction:
1228	(a)  A violation of any authorizing statutes, if the
1229	offense was a felony.
1230	(b)  A violation of this chapter, if the offense was a
1231	felony.
1232	(c)  A violation of s. 409.920, relating to Medicaid
1233	provider fraud, if the offense was a felony.
1234	(d)  A violation of s. 409.9201, relating to Medicaid
1235	fraud, if the offense was a felony.
1236	(e)  A violation of s. 741.28, relating to domestic
1237	violence.
1238	(f)  A violation of chapter 784, relating to assault,
1239	battery, and culpable negligence, if the offense was a felony.
1240	(g)  A violation of s. 810.02, relating to burglary.
1241	(h)  A violation of s. 817.034, relating to fraudulent acts
1242	through mail, wire, radio, electromagnetic, photoelectronic, or
1243	photooptical systems.
1244	(i)  A violation of s. 817.234, relating to false and
1245	fraudulent insurance claims.
1246	(j)  A violation of s. 817.505, relating to patient
1247	brokering.
1248	(k)  A violation of s. 817.568, relating to criminal use of
1249	personal identification information.
1250	(l)  A violation of s. 817.60, relating to obtaining a
1251	credit card through fraudulent means.
1252	(m)  A violation of s. 817.61, relating to fraudulent use
1253	of credit cards, if the offense was a felony.
1254	(n)  A violation of s. 831.01, relating to forgery.
1255	(o)  A violation of s. 831.02, relating to uttering forged
1256	instruments.
1257	(p)  A violation of s. 831.07, relating to forging bank
1258	bills, checks, drafts, or promissory notes.
1259	(q)  A violation of s. 831.09, relating to uttering forged
1260	bank bills, checks, drafts, or promissory notes.
1261	(r)  A violation of s. 831.30, relating to fraud in
1262	obtaining medicinal drugs.
1263	(s)  A violation of s. 831.31, relating to the sale,
1264	manufacture, delivery, or possession with the intent to sell,
1265	manufacture, or deliver any counterfeit controlled substance, if
1266	the offense was a felony.
1267
1268	A person who serves as a controlling interest of or is employed
1269	by a licensee on September 30, 2009, shall not be required by
1270	law to submit to rescreening if that licensee has in its
1271	possession written evidence that the person has been screened
1272	and qualified according to the standards specified in s. 435.03
1273	or s. 435.04. However, if such person has been convicted of a
1274	disqualifying offense listed in this subsection, he or she may
1275	apply for an exemption from the appropriate licensing agency
1276	before September 30, 2009, and if agreed to by the employer, may
1277	continue to perform his or her duties until the licensing agency
1278	renders a decision on the application for exemption for an
1279	offense listed in this subsection. Exemptions from
1280	disqualification may be granted pursuant to s. 435.07.
1281	(6)  The attestations required under ss. 435.04(5) and
1282	435.05(3) must be submitted at the time of license renewal,
1283	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1284	which require annual submission of an affidavit of compliance
1285	with background screening requirements.
1286	(5)  Background screening is not required to obtain a
1287	certificate of exemption issued under s. 483.106.
1288	Section 24.  Subsection (3) of section 408.810, Florida
1289	Statutes, is amended to read:
1290	408.810  Minimum licensure requirements.--In addition to
1291	the licensure requirements specified in this part, authorizing
1292	statutes, and applicable rules, each applicant and licensee must
1293	comply with the requirements of this section in order to obtain
1294	and maintain a license.
1295	(3)  Unless otherwise specified in this part, authorizing
1296	statutes, or applicable rules, any information required to be
1297	reported to the agency must be submitted within 21 calendar days
1298	after the report period or effective date of the information,
1299	whichever is earlier, including, but not limited to, any change
1300	of:
1301	(a)  Information contained in the most recent application
1302	for licensure.
1303	(b)  Required insurance or bonds.
1304	Section 25.  Present subsection (4) of section 408.811,
1305	Florida Statutes, is renumbered as subsection (6), subsections
1306	(2) and (3) are amended, and new subsections (4) and (5) are
1307	added to that section, to read:
1308	408.811  Right of inspection; copies; inspection reports;
1309	plan for correction of deficiencies.--
1310	(2)  Inspections conducted in conjunction with
1311	certification, comparable licensure requirements, or a
1312	recognized or approved accreditation organization may be
1313	accepted in lieu of a complete licensure inspection. However, a
1314	licensure inspection may also be conducted to review any
1315	licensure requirements that are not also requirements for
1316	certification.
1317	(3)  The agency shall have access to and the licensee shall
1318	provide, or if requested send, copies of all provider records
1319	required during an inspection or other review at no cost to the
1320	agency, including records requested during an offsite review.
1321	(4)  Deficiencies must be corrected within 30 calendar days
1322	after the provider is notified of inspection results unless an
1323	alternative timeframe is required or approved by the agency.
1324	(5)  The agency may require an applicant or licensee to
1325	submit a plan of correction for deficiencies. If required, the
1326	plan of correction must be filed with the agency within 10
1327	calendar days after notification unless an alternative timeframe
1328	is required.
1329	Section 26.  Section 408.813, Florida Statutes, is amended
1330	to read:
1331	408.813  Administrative fines; violations.--As a penalty
1332	for any violation of this part, authorizing statutes, or
1333	applicable rules, the agency may impose an administrative fine.
1334	(1)  Unless the amount or aggregate limitation of the fine
1335	is prescribed by authorizing statutes or applicable rules, the
1336	agency may establish criteria by rule for the amount or
1337	aggregate limitation of administrative fines applicable to this
1338	part, authorizing statutes, and applicable rules. Each day of
1339	violation constitutes a separate violation and is subject to a
1340	separate fine, unless a per-violation fine is prescribed by law.
1341	For fines imposed by final order of the agency and not subject
1342	to further appeal, the violator shall pay the fine plus interest
1343	at the rate specified in s. 55.03 for each day beyond the date
1344	set by the agency for payment of the fine.
1345	(2)  Violations of this part, authorizing statutes, or
1346	applicable rules shall be classified according to the nature of
1347	the violation and the gravity of its probable effect on clients.
1348	The scope of a violation may be cited as an isolated, patterned,
1349	or widespread deficiency. An isolated deficiency is a deficiency
1350	affecting one or a very limited number of clients, or involving
1351	one or a very limited number of staff, or a situation that
1352	occurred only occasionally or in a very limited number of
1353	locations. A patterned deficiency is a deficiency in which more
1354	than a very limited number of clients are affected, or more than
1355	a very limited number of staff are involved, or the situation
1356	has occurred in several locations, or the same client or clients
1357	have been affected by repeated occurrences of the same deficient
1358	practice but the effect of the deficient practice is not found
1359	to be pervasive throughout the provider. A widespread deficiency
1360	is a deficiency in which the problems causing the deficiency are
1361	pervasive in the provider or represent systemic failure that has
1362	affected or has the potential to affect a large portion of the
1363	provider's clients. This subsection does not affect the
1364	legislative determination of the amount of a fine imposed under
1365	authorizing statutes. Violations shall be classified on the
1366	written notice as follows:
1367	(a)  Class "I" violations are those conditions or
1368	occurrences related to the operation and maintenance of a
1369	provider or to the care of clients which the agency determines
1370	present an imminent danger to the clients of the provider or a
1371	substantial probability that death or serious physical or
1372	emotional harm would result therefrom. The condition or practice
1373	constituting a class I violation shall be abated or eliminated
1374	within 24 hours, unless a fixed period, as determined by the
1375	agency, is required for correction. The agency shall impose an
1376	administrative fine as provided by law for a cited class I
1377	violation. A fine shall be levied notwithstanding the correction
1378	of the violation.
1379	(b)  Class "II" violations are those conditions or
1380	occurrences related to the operation and maintenance of a
1381	provider or to the care of clients which the agency determines
1382	directly threaten the physical or emotional health, safety, or
1383	security of the clients, other than class I violations. The
1384	agency shall impose an administrative fine as provided by law
1385	for a cited class II violation. A fine shall be levied
1386	notwithstanding the correction of the violation.
1387	(c)  Class "III" violations are those conditions or
1388	occurrences related to the operation and maintenance of a
1389	provider or to the care of clients which the agency determines
1390	indirectly or potentially threaten the physical or emotional
1391	health, safety, or security of clients, other than class I or
1392	class II violations. The agency shall impose an administrative
1393	fine as provided by law for a cited class III violation. A
1394	citation for a class III violation must specify the time within
1395	which the violation is required to be corrected. If a class III
1396	violation is corrected within the time specified, a fine may not
1397	be imposed.
1398	(d)  Class "IV" violations are those conditions or
1399	occurrences related to the operation and maintenance of a
1400	provider or to required reports, forms, or documents that do not
1401	have the potential of negatively affecting clients. These
1402	violations are of a type that the agency determines do not
1403	threaten the health, safety, or security of clients. The agency
1404	shall impose an administrative fine as provided by law for a
1405	cited class IV violation. A citation for a class IV violation
1406	must specify the time within which the violation is required to
1407	be corrected. If a class IV violation is corrected within the
1408	time specified, a fine may not be imposed.
1409	Section 27.  Subsections (12) through (29) of section
1410	408.820, Florida Statutes, are renumbered as subsections (11)
1411	through (28), respectively, and present subsections (11), (12),
1412	(13), (21), and (26) of that section are amended to read:
1413	408.820  Exemptions.--Except as prescribed in authorizing
1414	statutes, the following exemptions shall apply to specified
1415	requirements of this part:
1416	(11)  Private review agents, as provided under part I of
1417	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1418	408.811.
1419	(11)(12)  Health care risk managers, as provided under part
1420	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1421	(10), and 408.811.
1422	(12)(13)  Nursing homes, as provided under part II of
1423	chapter 400, are exempt from ss. s. 408.810(7) and 408.813(2).
1424	(20)(21)  Transitional living facilities, as provided under
1425	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1426	(25)(26)  Health care clinics, as provided under part X of
1427	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1428	(7), and (10).
1429	Section 28.  Section 408.821, Florida Statutes, is created
1430	to read:
1431	408.821  Emergency management planning; emergency
1432	operations; inactive license.--
1433	(1)  Licensees required by authorizing statutes to have an
1434	emergency operations plan must designate a safety liaison to
1435	serve as the primary contact for emergency operations.
1436	(2)  An entity subject to this part may temporarily exceed
1437	its licensed capacity to act as a receiving provider in
1438	accordance with an approved emergency operations plan for up to
1439	15 days. While in an overcapacity status, each provider must
1440	furnish or arrange for appropriate care and services to all
1441	clients. In addition, the agency may approve requests for
1442	overcapacity in excess of 15 days, which approvals may be based
1443	upon satisfactory justification and need as provided by the
1444	receiving and sending providers.
1445	(3)(a)  An inactive license may be issued to a licensee
1446	subject to this section when the provider is located in a
1447	geographic area in which a state of emergency was declared by
1448	the Governor if the provider:
1449	1.  Suffered damage to its operation during the state of
1450	emergency.
1451	2.  Is currently licensed.
1452	3.  Does not have a provisional license.
1453	4.  Will be temporarily unable to provide services but is
1454	reasonably expected to resume services within 12 months.
1455	(b)  An inactive license may be issued for a period not to
1456	exceed 12 months but may be renewed by the agency for up to 12
1457	additional months upon demonstration to the agency of progress
1458	toward reopening. A request by a licensee for an inactive
1459	license or to extend the previously approved inactive period
1460	must be submitted in writing to the agency, accompanied by
1461	written justification for the inactive license, which states the
1462	beginning and ending dates of inactivity and includes a plan for
1463	the transfer of any clients to other providers and appropriate
1464	licensure fees. Upon agency approval, the licensee shall notify
1465	clients of any necessary discharge or transfer as required by
1466	authorizing statutes or applicable rules. The beginning of the
1467	inactive licensure period shall be the date the provider ceases
1468	operations. The end of the inactive period shall become the
1469	license expiration date, and all licensure fees must be current,
1470	must be paid in full, and may be prorated. Reactivation of an
1471	inactive license requires the prior approval by the agency of a
1472	renewal application, including payment of licensure fees and
1473	agency inspections indicating compliance with all requirements
1474	of this part and applicable rules and statutes.
1475	(4)  The agency may adopt rules relating to emergency
1476	management planning, communications, and operations. Licensees
1477	providing residential or inpatient services must utilize an
1478	online database approved by the agency to report information to
1479	the agency regarding the provider's emergency status, planning,
1480	or operations.
1481	Section 29.  Subsections (3), (4), and (5) of section
1482	408.831, Florida Statutes, are amended to read:
1483	408.831  Denial, suspension, or revocation of a license,
1484	registration, certificate, or application.--
1485	(3)  An entity subject to this section may exceed its
1486	licensed capacity to act as a receiving facility in accordance
1487	with an emergency operations plan for clients of evacuating
1488	providers from a geographic area where an evacuation order has
1489	been issued by a local authority having jurisdiction. While in
1490	an overcapacity status, each provider must furnish or arrange
1491	for appropriate care and services to all clients. In addition,
1492	the agency may approve requests for overcapacity beyond 15 days,
1493	which approvals may be based upon satisfactory justification and
1494	need as provided by the receiving and sending facilities.
1495	(4)(a)  An inactive license may be issued to a licensee
1496	subject to this section when the provider is located in a
1497	geographic area where a state of emergency was declared by the
1498	Governor if the provider:
1499	1.  Suffered damage to its operation during that state of
1500	emergency.
1501	2.  Is currently licensed.
1502	3.  Does not have a provisional license.
1503	4.  Will be temporarily unable to provide services but is
1504	reasonably expected to resume services within 12 months.
1505	(b)  An inactive license may be issued for a period not to
1506	exceed 12 months but may be renewed by the agency for up to 12
1507	additional months upon demonstration to the agency of progress
1508	toward reopening. A request by a licensee for an inactive
1509	license or to extend the previously approved inactive period
1510	must be submitted in writing to the agency, accompanied by
1511	written justification for the inactive license, which states the
1512	beginning and ending dates of inactivity and includes a plan for
1513	the transfer of any clients to other providers and appropriate
1514	licensure fees. Upon agency approval, the licensee shall notify
1515	clients of any necessary discharge or transfer as required by
1516	authorizing statutes or applicable rules. The beginning of the
1517	inactive licensure period shall be the date the provider ceases
1518	operations. The end of the inactive period shall become the
1519	licensee expiration date, and all licensure fees must be
1520	current, paid in full, and may be prorated. Reactivation of an
1521	inactive license requires the prior approval by the agency of a
1522	renewal application, including payment of licensure fees and
1523	agency inspections indicating compliance with all requirements
1524	of this part and applicable rules and statutes.
1525	(3)(5)  This section provides standards of enforcement
1526	applicable to all entities licensed or regulated by the Agency
1527	for Health Care Administration. This section controls over any
1528	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1529	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1530	those chapters.
1531	Section 30.  Subsection (2) of section 408.918, Florida
1532	Statutes, is amended, and subsection (3) is added to that
1533	section, to read:
1534	408.918  Florida 211 Network; uniform certification
1535	requirements.--
1536	(2)  In order to participate in the Florida 211 Network, a
1537	211 provider must be fully accredited by the National certified
1538	by the Agency for Health Care Administration. The agency shall
1539	develop criteria for certification, as recommended by the
1540	Florida Alliance of Information and Referral Services or have
1541	received approval to operate, pending accreditation, from its
1542	affiliate, the Florida Alliance of Information and Referral
1543	Services, and shall adopt the criteria as administrative rules.
1544	(a)  If any provider of information and referral services
1545	or other entity leases a 211 number from a local exchange
1546	company and is not authorized as described in this section,
1547	certified by the agency, the agency shall, after consultation
1548	with the local exchange company and the Public Service
1549	Commission shall, request that the Federal Communications
1550	Commission direct the local exchange company to revoke the use
1551	of the 211 number.
1552	(b)  The agency shall seek the assistance and guidance of
1553	the Public Service Commission and the Federal Communications
1554	Commission in resolving any disputes arising over jurisdiction
1555	related to 211 numbers.
1556	(3)  The Florida Alliance of Information and Referral
1557	Services is the 211 collaborative organization for the state
1558	that is responsible for studying, designing, implementing,
1559	supporting, and coordinating the Florida 211 Network and
1560	receiving federal grants.
1561	Section 31.  Paragraph (e) of subsection (4) of section
1562	409.221, Florida Statutes, is amended to read:
1563	409.221  Consumer-directed care program.--
1564	(4)  CONSUMER-DIRECTED CARE.--
1565	(e)  Services.--Consumers shall use the budget allowance
1566	only to pay for home and community-based services that meet the
1567	consumer's long-term care needs and are a cost-efficient use of
1568	funds. Such services may include, but are not limited to, the
1569	following:
1570	1.  Personal care.
1571	2.  Homemaking and chores, including housework, meals,
1572	shopping, and transportation.
1573	3.  Home modifications and assistive devices which may
1574	increase the consumer's independence or make it possible to
1575	avoid institutional placement.
1576	4.  Assistance in taking self-administered medication.
1577	5.  Day care and respite care services, including those
1578	provided by nursing home facilities pursuant to s.
1579	400.141(1)(f)(6) or by adult day care facilities licensed
1580	pursuant to s. 429.907.
1581	6.  Personal care and support services provided in an
1582	assisted living facility.
1583	Section 32.  Subsection (5) of section 409.901, Florida
1584	Statutes, is amended to read:
1585	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1586	409.901-409.920, except as otherwise specifically provided, the
1587	term:
1588	(5)  "Change of ownership" means:
1589	(a)  An event in which the provider ownership changes to a
1590	different individual legal entity, as evidenced by a change in
1591	federal employer identification number or taxpayer
1592	identification number; or
1593	(b)  An event in which 51 45 percent or more of the
1594	ownership, voting shares, membership, or controlling interest of
1595	a provider is in any manner transferred or otherwise assigned.
1596	This paragraph does not apply to a licensee that is publicly
1597	traded on a recognized stock exchange; or
1598	(c)  When the provider is licensed or registered by the
1599	agency, an event considered a change of ownership for licensure
1600	as defined in s. 408.803 in a corporation whose shares are not
1601	publicly traded on a recognized stock exchange is transferred or
1602	assigned, including the final transfer or assignment of multiple
1603	transfers or assignments over a 2-year period that cumulatively
1604	total 45 percent or more.
1605
1606	A change solely in the management company or board of directors
1607	is not a change of ownership.
1608	Section 33.  Section 429.071, Florida Statutes, is
1609	repealed.
1610	Section 34.  Paragraph (e) of subsection (1) and
1611	subsections (2) and (3) of section 429.08, Florida Statutes, are
1612	amended to read:
1613	429.08  Unlicensed facilities; referral of person for
1614	residency to unlicensed facility; penalties; verification of
1615	licensure status.--
1616	(1)
1617	(e)  The agency shall publish provide to the department's
1618	elder information and referral providers a list, by county, of
1619	licensed assisted living facilities, to assist persons who are
1620	considering an assisted living facility placement in locating a
1621	licensed facility. This information may be provided
1622	electronically or on the agency's Internet website.
1623	(2)  Each field office of the Agency for Health Care
1624	Administration shall establish a local coordinating workgroup
1625	which includes representatives of local law enforcement
1626	agencies, state attorneys, the Medicaid Fraud Control Unit of
1627	the Department of Legal Affairs, local fire authorities, the
1628	Department of Children and Family Services, the district long-
1629	term care ombudsman council, and the district human rights
1630	advocacy committee to assist in identifying the operation of
1631	unlicensed facilities and to develop and implement a plan to
1632	ensure effective enforcement of state laws relating to such
1633	facilities. The workgroup shall report its findings, actions,
1634	and recommendations semiannually to the Director of Health
1635	Quality Assurance of the agency.
1636	(2)(3)  It is unlawful to knowingly refer a person for
1637	residency to an unlicensed assisted living facility; to an
1638	assisted living facility the license of which is under denial or
1639	has been suspended or revoked; or to an assisted living facility
1640	that has a moratorium pursuant to part II of chapter 408. Any
1641	person who violates this subsection commits a noncriminal
1642	violation, punishable by a fine not exceeding $500 as provided
1643	in s. 775.083.
1644	(a)  Any health care practitioner, as defined in s.
1645	456.001, who is aware of the operation of an unlicensed facility
1646	shall report that facility to the agency. Failure to report a
1647	facility that the practitioner knows or has reasonable cause to
1648	suspect is unlicensed shall be reported to the practitioner's
1649	licensing board.
1650	(b)  Any provider as defined in s. 408.803 that hospital or
1651	community mental health center licensed under chapter 395 or
1652	chapter 394 which knowingly discharges a patient or client to an
1653	unlicensed facility is subject to sanction by the agency.
1654	(c)  Any employee of the agency or department, or the
1655	Department of Children and Family Services, who knowingly refers
1656	a person for residency to an unlicensed facility; to a facility
1657	the license of which is under denial or has been suspended or
1658	revoked; or to a facility that has a moratorium pursuant to part
1659	II of chapter 408 is subject to disciplinary action by the
1660	agency or department, or the Department of Children and Family
1661	Services.
1662	(d)  The employer of any person who is under contract with
1663	the agency or department, or the Department of Children and
1664	Family Services, and who knowingly refers a person for residency
1665	to an unlicensed facility; to a facility the license of which is
1666	under denial or has been suspended or revoked; or to a facility
1667	that has a moratorium pursuant to part II of chapter 408 shall
1668	be fined and required to prepare a corrective action plan
1669	designed to prevent such referrals.
1670	(e)  The agency shall provide the department and the
1671	Department of Children and Family Services with a list of
1672	licensed facilities within each county and shall update the list
1673	at least quarterly.
1674	(f)  At least annually, the agency shall notify, in
1675	appropriate trade publications, physicians licensed under
1676	chapter 458 or chapter 459, hospitals licensed under chapter
1677	395, nursing home facilities licensed under part II of chapter
1678	400, and employees of the agency or the department, or the
1679	Department of Children and Family Services, who are responsible
1680	for referring persons for residency, that it is unlawful to
1681	knowingly refer a person for residency to an unlicensed assisted
1682	living facility and shall notify them of the penalty for
1683	violating such prohibition. The department and the Department of
1684	Children and Family Services shall, in turn, notify service
1685	providers under contract to the respective departments who have
1686	responsibility for resident referrals to facilities. Further,
1687	the notice must direct each noticed facility and individual to
1688	contact the appropriate agency office in order to verify the
1689	licensure status of any facility prior to referring any person
1690	for residency. Each notice must include the name, telephone
1691	number, and mailing address of the appropriate office to
1692	contact.
1693	Section 35.  Paragraph (e) of subsection (1) of section
1694	429.14, Florida Statutes, is amended to read:
1695	429.14  Administrative penalties.--
1696	(1)  In addition to the requirements of part II of chapter
1697	408, the agency may deny, revoke, and suspend any license issued
1698	under this part and impose an administrative fine in the manner
1699	provided in chapter 120 against a licensee of an assisted living
1700	facility for a violation of any provision of this part, part II
1701	of chapter 408, or applicable rules, or for any of the following
1702	actions by a licensee of an assisted living facility, for the
1703	actions of any person subject to level 2 background screening
1704	under s. 408.809, or for the actions of any facility employee:
1705	(e)  A citation of any of the following deficiencies as
1706	specified defined in s. 429.19:
1707	1.  One or more cited class I deficiencies.
1708	2.  Three or more cited class II deficiencies.
1709	3.  Five or more cited class III deficiencies that have
1710	been cited on a single survey and have not been corrected within
1711	the times specified.
1712	Section 36.  Subsections (2), (8), and (9) of section
1713	429.19, Florida Statutes, are amended to read:
1714	429.19  Violations; imposition of administrative fines;
1715	grounds.--
1716	(2)  Each violation of this part and adopted rules shall be
1717	classified according to the nature of the violation and the
1718	gravity of its probable effect on facility residents. The agency
1719	shall indicate the classification on the written notice of the
1720	violation as follows:
1721	(a)  Class "I" violations are defined in s. 408.813 those
1722	conditions or occurrences related to the operation and
1723	maintenance of a facility or to the personal care of residents
1724	which the agency determines present an imminent danger to the
1725	residents or guests of the facility or a substantial probability
1726	that death or serious physical or emotional harm would result
1727	therefrom. The condition or practice constituting a class I
1728	violation shall be abated or eliminated within 24 hours, unless
1729	a fixed period, as determined by the agency, is required for
1730	correction. The agency shall impose an administrative fine for a
1731	cited class I violation in an amount not less than $5,000 and
1732	not exceeding $10,000 for each violation. A fine may be levied
1733	notwithstanding the correction of the violation.
1734	(b)  Class "II" violations are defined in s. 408.813 those
1735	conditions or occurrences related to the operation and
1736	maintenance of a facility or to the personal care of residents
1737	which the agency determines directly threaten the physical or
1738	emotional health, safety, or security of the facility residents,
1739	other than class I violations. The agency shall impose an
1740	administrative fine for a cited class II violation in an amount
1741	not less than $1,000 and not exceeding $5,000 for each
1742	violation. A fine shall be levied notwithstanding the correction
1743	of the violation.
1744	(c)  Class "III" violations are defined in s. 408.813 those
1745	conditions or occurrences related to the operation and
1746	maintenance of a facility or to the personal care of residents
1747	which the agency determines indirectly or potentially threaten
1748	the physical or emotional health, safety, or security of
1749	facility residents, other than class I or class II violations.
1750	The agency shall impose an administrative fine for a cited class
1751	III violation in an amount not less than $500 and not exceeding
1752	$1,000 for each violation. A citation for a class III violation
1753	must specify the time within which the violation is required to
1754	be corrected. If a class III violation is corrected within the
1755	time specified, no fine may be imposed, unless it is a repeated
1756	offense.
1757	(d)  Class "IV" violations are defined in s. 408.813 those
1758	conditions or occurrences related to the operation and
1759	maintenance of a building or to required reports, forms, or
1760	documents that do not have the potential of negatively affecting
1761	residents. These violations are of a type that the agency
1762	determines do not threaten the health, safety, or security of
1763	residents of the facility. The agency shall impose an
1764	administrative fine for a cited class IV violation in an amount
1765	not less than $100 and not exceeding $200 for each violation. A
1766	citation for a class IV violation must specify the time within
1767	which the violation is required to be corrected. If a class IV
1768	violation is corrected within the time specified, no fine shall
1769	be imposed. Any class IV violation that is corrected during the
1770	time an agency survey is being conducted will be identified as
1771	an agency finding and not as a violation.
1772	(8)  During an inspection, the agency, as an alternative to
1773	or in conjunction with an administrative action against a
1774	facility for violations of this part and adopted rules, shall
1775	make a reasonable attempt to discuss each violation and
1776	recommended corrective action with the owner or administrator of
1777	the facility, prior to written notification. The agency, instead
1778	of fixing a period within which the facility shall enter into
1779	compliance with standards, may request a plan of corrective
1780	action from the facility which demonstrates a good faith effort
1781	to remedy each violation by a specific date, subject to the
1782	approval of the agency.
1783	(9)  The agency shall develop and disseminate an annual
1784	list of all facilities sanctioned or fined $5,000 or more for
1785	violations of state standards, the number and class of
1786	violations involved, the penalties imposed, and the current
1787	status of cases. The list shall be disseminated, at no charge,
1788	to the Department of Elderly Affairs, the Department of Health,
1789	the Department of Children and Family Services, the Agency for
1790	Persons with Disabilities, the area agencies on aging, the
1791	Florida Statewide Advocacy Council, and the state and local
1792	ombudsman councils. The Department of Children and Family
1793	Services shall disseminate the list to service providers under
1794	contract to the department who are responsible for referring
1795	persons to a facility for residency. The agency may charge a fee
1796	commensurate with the cost of printing and postage to other
1797	interested parties requesting a copy of this list. This
1798	information may be provided electronically or on the agency's
1799	Internet website.
1800	Section 37.  Subsections (2) and (6) of section 429.23,
1801	Florida Statutes, are amended to read:
1802	429.23  Internal risk management and quality assurance
1803	program; adverse incidents and reporting requirements.--
1804	(2)  Every facility licensed under this part is required to
1805	maintain adverse incident reports. For purposes of this section,
1806	the term, "adverse incident" means:
1807	(a)  An event over which facility personnel could exercise
1808	control rather than as a result of the resident's condition and
1809	results in:
1810	1.  Death;
1811	2.  Brain or spinal damage;
1812	3.  Permanent disfigurement;
1813	4.  Fracture or dislocation of bones or joints;
1814	5.  Any condition that required medical attention to which
1815	the resident has not given his or her consent, including failure
1816	to honor advanced directives;
1817	6.  Any condition that requires the transfer of the
1818	resident from the facility to a unit providing more acute care
1819	due to the incident rather than the resident's condition before
1820	the incident; or.
1821	7.  An event that is reported to law enforcement or its
1822	personnel for investigation; or
1823	(b)  Abuse, neglect, or exploitation as defined in s.
1824	415.102;
1825	(c)  Events reported to law enforcement; or
1826	(b)(d)  Resident elopement, if the elopement places the
1827	resident at risk of harm or injury.
1828	(6)  Abuse, neglect, or exploitation must be reported to
1829	the Department of Children and Family Services as required under
1830	chapter 415. The agency shall annually submit to the Legislature
1831	a report on assisted living facility adverse incident reports.
1832	The report must include the following information arranged by
1833	county:
1834	(a)  A total number of adverse incidents;
1835	(b)  A listing, by category, of the type of adverse
1836	incidents occurring within each category and the type of staff
1837	involved;
1838	(c)  A listing, by category, of the types of injuries, if
1839	any, and the number of injuries occurring within each category;
1840	(d)  Types of liability claims filed based on an adverse
1841	incident report or reportable injury; and
1842	(e)  Disciplinary action taken against staff, categorized
1843	by the type of staff involved.
1844	Section 38.  Subsections (10) through (12) of section
1845	429.26, Florida Statutes, are renumbered as subsections (9)
1846	through (11), respectively, and present subsection (9) of that
1847	section is amended to read:
1848	429.26  Appropriateness of placements; examinations of
1849	residents.--
1850	(9)  If, at any time after admission to a facility, a
1851	resident appears to need care beyond that which the facility is
1852	licensed to provide, the agency shall require the resident to be
1853	physically examined by a licensed physician, physician
1854	assistant, or licensed nurse practitioner. This examination
1855	shall, to the extent possible, be performed by the resident's
1856	preferred physician or nurse practitioner and shall be paid for
1857	by the resident with personal funds, except as provided in s.
1858	429.18(2). Following this examination, the examining physician,
1859	physician assistant, or licensed nurse practitioner shall
1860	complete and sign a medical form provided by the agency. The
1861	completed medical form shall be submitted to the agency within
1862	30 days after the date the facility owner or administrator is
1863	notified by the agency that the physical examination is
1864	required. After consultation with the physician, physician
1865	assistant, or licensed nurse practitioner who performed the
1866	examination, a medical review team designated by the agency
1867	shall then determine whether the resident is appropriately
1868	residing in the facility. The medical review team shall base its
1869	decision on a comprehensive review of the resident's physical
1870	and functional status, including the resident's preferences, and
1871	not on an isolated health-related problem. In the case of a
1872	mental health resident, if the resident appears to have needs in
1873	addition to those identified in the community living support
1874	plan, the agency may require an evaluation by a mental health
1875	professional, as determined by the Department of Children and
1876	Family Services. A facility may not be required to retain a
1877	resident who requires more services or care than the facility is
1878	able to provide in accordance with its policies and criteria for
1879	admission and continued residency. Members of the medical review
1880	team making the final determination may not include the agency
1881	personnel who initially questioned the appropriateness of a
1882	resident's placement. Such determination is final and binding
1883	upon the facility and the resident. Any resident who is
1884	determined by the medical review team to be inappropriately
1885	residing in a facility shall be given 30 days' written notice to
1886	relocate by the owner or administrator, unless the resident's
1887	continued residence in the facility presents an imminent danger
1888	to the health, safety, or welfare of the resident or a
1889	substantial probability exists that death or serious physical
1890	harm would result to the resident if allowed to remain in the
1891	facility.
1892	Section 39.  Paragraph (h) of subsection (3) of section
1893	430.80, Florida Statutes, is amended to read:
1894	430.80  Implementation of a teaching nursing home pilot
1895	project.--
1896	(3)  To be designated as a teaching nursing home, a nursing
1897	home licensee must, at a minimum:
1898	(h)  Maintain insurance coverage pursuant to s.
1899	400.141(1)(s)(20) or proof of financial responsibility in a
1900	minimum amount of $750,000. Such proof of financial
1901	responsibility may include:
1902	1.  Maintaining an escrow account consisting of cash or
1903	assets eligible for deposit in accordance with s. 625.52; or
1904	2.  Obtaining and maintaining pursuant to chapter 675 an
1905	unexpired, irrevocable, nontransferable and nonassignable letter
1906	of credit issued by any bank or savings association organized
1907	and existing under the laws of this state or any bank or savings
1908	association organized under the laws of the United States that
1909	has its principal place of business in this state or has a
1910	branch office which is authorized to receive deposits in this
1911	state. The letter of credit shall be used to satisfy the
1912	obligation of the facility to the claimant upon presentment of a
1913	final judgment indicating liability and awarding damages to be
1914	paid by the facility or upon presentment of a settlement
1915	agreement signed by all parties to the agreement when such final
1916	judgment or settlement is a result of a liability claim against
1917	the facility.
1918	Section 40.  Subsection (5) of section 435.04, Florida
1919	Statutes, is amended to read:
1920	435.04  Level 2 screening standards.--
1921	(5)  Under penalty of perjury, all employees in such
1922	positions of trust or responsibility shall attest to meeting the
1923	requirements for qualifying for employment and agreeing to
1924	inform the employer immediately if convicted of any of the
1925	disqualifying offenses while employed by the employer. Each
1926	employer of employees in such positions of trust or
1927	responsibilities which is licensed or registered by a state
1928	agency shall submit to the licensing agency annually or at the
1929	time of license renewal, under penalty of perjury, an affidavit
1930	of compliance with the provisions of this section.
1931	Section 41.  Subsection (3) of section 435.05, Florida
1932	Statutes, is amended to read:
1933	435.05  Requirements for covered employees.--Except as
1934	otherwise provided by law, the following requirements shall
1935	apply to covered employees:
1936	(3)  Each employer required to conduct level 2 background
1937	screening must sign an affidavit annually or at the time of
1938	license renewal, under penalty of perjury, stating that all
1939	covered employees have been screened or are newly hired and are
1940	awaiting the results of the required screening checks.
1941	Section 42.  Subsection (2) of section 483.031, Florida
1942	Statutes, is amended to read:
1943	483.031  Application of part; exemptions.--This part
1944	applies to all clinical laboratories within this state, except:
1945	(2)  A clinical laboratory that performs only waived tests
1946	and has received a certificate of exemption from the agency
1947	under s. 483.106.
1948	Section 43.  Subsection (10) of section 483.041, Florida
1949	Statutes, is amended to read:
1950	483.041  Definitions.--As used in this part, the term:
1951	(10)  "Waived test" means a test that the federal Centers
1952	for Medicare and Medicaid Services Health Care Financing
1953	Administration has determined qualifies for a certificate of
1954	waiver under the federal Clinical Laboratory Improvement
1955	Amendments of 1988, and the federal rules adopted thereunder.
1956	Section 44.  Section 483.106, Florida Statutes, is
1957	repealed.
1958	Section 45.  Subsection (3) of section 483.172, Florida
1959	Statutes, is amended to read:
1960	483.172  License fees.--
1961	(3)  The agency shall assess a biennial fee of $100 for a
1962	certificate of exemption and a $100 biennial license fee under
1963	this section for facilities surveyed by an approved accrediting
1964	organization.
1965	Section 46.  Paragraph (b) of subsection (1) of section
1966	627.4239, Florida Statutes, is amended to read:
1967	627.4239  Coverage for use of drugs in treatment of
1968	cancer.--
1969	(1)  DEFINITIONS.--As used in this section, the term:
1970	(b)  "Standard reference compendium" means authoritative
1971	compendia identified by the Secretary of the United States
1972	Department of Health and Human Services and recognized by the
1973	federal Centers for Medicare and Medicaid Services:
1974	1.  The United States Pharmacopeia Drug Information;
1975	2.  The American Medical Association Drug Evaluations; or
1976	3.  The American Hospital Formulary Service Drug
1977	Information.
1978	Section 47.  Paragraph (b) of subsection (5) of section
1979	627.736, Florida Statutes, is amended to read:
1980	627.736  Required personal injury protection benefits;
1981	exclusions; priority; claims.--
1982	(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
1983	(b)1.  An insurer or insured is not required to pay a claim
1984	or charges:
1985	a.  Made by a broker or by a person making a claim on
1986	behalf of a broker;
1987	b.  For any service or treatment that was not lawful at the
1988	time rendered;
1989	c.  To any person who knowingly submits a false or
1990	misleading statement relating to the claim or charges;
1991	d.  With respect to a bill or statement that does not
1992	substantially meet the applicable requirements of paragraph (d);
1993	e.  For any treatment or service that is upcoded, or that
1994	is unbundled when such treatment or services should be bundled,
1995	in accordance with paragraph (d). To facilitate prompt payment
1996	of lawful services, an insurer may change codes that it
1997	determines to have been improperly or incorrectly upcoded or
1998	unbundled, and may make payment based on the changed codes,
1999	without affecting the right of the provider to dispute the
2000	change by the insurer, provided that before doing so, the
2001	insurer must contact the health care provider and discuss the
2002	reasons for the insurer's change and the health care provider's
2003	reason for the coding, or make a reasonable good faith effort to
2004	do so, as documented in the insurer's file; and
2005	f.  For medical services or treatment billed by a physician
2006	and not provided in a hospital unless such services are rendered
2007	by the physician or are incident to his or her professional
2008	services and are included on the physician's bill, including
2009	documentation verifying that the physician is responsible for
2010	the medical services that were rendered and billed; and
2011	g.  For any service or treatment billed by a provider not
2012	holding an identification number issued by the agency pursuant
2013	to s. 400.9935(10).
2014	2.  The Department of Health, in consultation with the
2015	appropriate professional licensing boards, shall adopt, by rule,
2016	a list of diagnostic tests deemed not to be medically necessary
2017	for use in the treatment of persons sustaining bodily injury
2018	covered by personal injury protection benefits under this
2019	section. The initial list shall be adopted by January 1, 2004,
2020	and shall be revised from time to time as determined by the
2021	Department of Health, in consultation with the respective
2022	professional licensing boards. Inclusion of a test on the list
2023	of invalid diagnostic tests shall be based on lack of
2024	demonstrated medical value and a level of general acceptance by
2025	the relevant provider community and shall not be dependent for
2026	results entirely upon subjective patient response.
2027	Notwithstanding its inclusion on a fee schedule in this
2028	subsection, an insurer or insured is not required to pay any
2029	charges or reimburse claims for any invalid diagnostic test as
2030	determined by the Department of Health.
2031	Section 48.  Subsection (13) of section 651.118, Florida
2032	Statutes, is amended to read:
2033	651.118  Agency for Health Care Administration;
2034	certificates of need; sheltered beds; community beds.--
2035	(13)  Residents, as defined in this chapter, are not
2036	considered new admissions for the purpose of s.
2037	400.141(1)(o)1.d.(15)(d).
2038	Section 49.  This act shall take effect upon becoming a
2039	law.

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