CS/CS/CS/HB 651

1	A bill to be entitled
2	An act relating to health care; amending s. 381.0203,
3	F.S., relating to pharmacy services; revising terminology;
4	repealing s. 395.0199, F.S., relating to private
5	utilization review of health care services; amending ss.
6	395.405 and 400.0712, F.S.; conforming cross-references;
7	amending s. 395.602, F.S.; providing an additional 3-year
8	transition period for certain hospitals to retain their
9	designation as rural hospitals; amending s. 400.118, F.S.;
10	removing provisions requiring quality-of-care monitors for
11	nursing facilities in agency district offices; amending s.
12	400.141, F.S.; revising reporting requirements for
13	facility staff-to-resident ratios; deleting a requirement
14	that licensed nursing home facilities provide the agency
15	with a monthly report on the number of vacant beds in the
16	facility; conforming a cross-reference; amending s.
17	400.147, F.S.; revising reporting requirements under
18	facility internal risk management and quality assurance
19	programs; revising the definition of the term "adverse
20	incident" for reporting purposes; requiring abuse,
21	neglect, and exploitation to be reported to the agency and
22	the Department of Children and Family Services; deleting a
23	requirement that the agency submit an annual report on
24	nursing home adverse incidents to the Legislature;
25	amending s. 400.162, F.S.; revising provisions relating to
26	procedures and policies regarding the safekeeping of
27	nursing home residents' property; amending s. 400.191,
28	F.S.; eliminating requirements for the agency to publish
29	the Nursing Home Guide annually in printed form; revising
30	information provided on the agency's Internet website;
31	amending s. 400.195, F.S.; conforming a cross-reference;
32	amending s. 400.23, F.S.; deleting provisions relating to
33	minimum staffing requirements for nursing homes; amending
34	s. 400.474, F.S.; providing that specified provisions
35	relating to remuneration do not apply to or preclude
36	certain payment practices permitted under specified
37	federal laws or regulations; amending s. 400.506, F.S.;
38	exempting nurse registries not participating in the
39	Medicaid or Medicare program from certain disciplinary
40	actions for paying remuneration to certain entities in
41	exchange for patient referrals; amending s. 400.9905,
42	F.S.; revising the definition of the term "clinic" to
43	provide that pt. X of ch. 400, F.S., the Health Care
44	Clinic Act, does not apply to entities that do not seek
45	reimbursement from insurance companies for medical
46	services paid pursuant to personal injury protection
47	coverage; amending s. 400.9935, F.S.; revising
48	accreditation requirements for clinics providing magnetic
49	resonance imaging services; providing for a unique
50	identification number for licensed clinics and entities
51	holding certificates of exemption; requiring the agency to
52	assign unique identification numbers, under certain
53	circumstances, and publish the numbers on its Internet
54	website in a specified format; amending s. 400.995, F.S.;
55	revising agency responsibilities with respect to personnel
56	and operations in certain injunctive proceedings; amending
57	s. 408.040, F.S.; extending the period for which a
58	certificate of need is valid for certain entities;
59	providing that the amendment to s. 408.040(2)(a), F.S.,
60	shall control over conflicting provisions; amending s.
61	408.07, F.S.; providing an additional 3-year transition
62	period for certain hospitals to retain their designation
63	as rural hospitals; amending s. 408.803, F.S.; revising
64	definitions applicable to pt. II of ch. 408, F.S., the
65	"Health Care Licensing Procedures Act"; amending s.
66	408.806, F.S.; revising contents of and procedures
67	relating to health care provider applications for
68	licensure; providing an exception from certain licensure
69	inspections for adult family-care homes; authorizing the
70	agency to provide electronic access to certain information
71	and documents; amending s. 408.808, F.S.; providing for a
72	provisional license to be issued to applicants applying
73	for a change of ownership; providing a time limit on
74	provisional licenses; amending s. 408.809, F.S.; revising
75	provisions relating to background screening of specified
76	employees; exempting certain persons from rescreening;
77	permitting certain persons to apply for an exemption from
78	disqualification under certain circumstances; requiring
79	health care providers to submit to the agency an affidavit
80	of compliance with background screening requirements at
81	the time of license renewal; deleting a provision to
82	conform to changes made by the act; amending s. 408.810,
83	F.S.; revising provisions relating to information required
84	for licensure; amending s. 408.811, F.S.; providing for
85	certain inspections to be accepted in lieu of complete
86	licensure inspections; granting agency access to records
87	requested during an offsite review; providing timeframes
88	for correction of certain deficiencies and submission of
89	plans to correct such deficiencies; amending s. 408.813,
90	F.S.; providing classifications of violations of pt. II of
91	ch. 408, F.S.; providing for fines; amending s. 408.820,
92	F.S.; revising applicability of exemptions from specified
93	requirements of pt. II of ch. 408, F.S.; conforming
94	references; creating s. 408.821, F.S.; requiring entities
95	regulated or licensed by the agency to designate a safety
96	liaison for emergency operations; providing that entities
97	regulated or licensed by the agency may temporarily exceed
98	their licensed capacity to act as receiving providers
99	under specified circumstances; providing requirements
100	while such entities are in an overcapacity status;
101	providing for issuance of an inactive license to such
102	licensees under specified conditions; providing
103	requirements and procedures with respect to the issuance
104	and reactivation of an inactive license; authorizing the
105	agency to adopt rules; amending s. 408.831, F.S.; deleting
106	provisions relating to authorization for entities
107	regulated or licensed by the agency to exceed their
108	licensed capacity to act as receiving facilities and
109	issuance and reactivation of inactive licenses; amending
110	s. 408.918, F.S.; requiring accreditation by the National
111	Alliance of Information and Referral Services for
112	participation in the Florida 211 Network; eliminating the
113	requirement that the agency seek certain assistance and
114	guidance in resolving certain disputes; removing certain
115	agency obligations relating to the Florida 211 Network;
116	requiring the Florida Alliance of Information and Referral
117	Services to perform certain functions related to the
118	Florida 211 Network; amending s. 409.221, F.S.; conforming
119	a cross-reference; amending s. 409.901, F.S.; revising a
120	definition applicable to Medicaid providers; repealing s.
121	429.071, F.S., relating to the intergenerational respite
122	care assisted living facility pilot program; amending s.
123	429.08, F.S.; authorizing the agency to provide
124	information regarding licensed assisted living facilities
125	electronically or on its Internet website; abolishing
126	local coordinating workgroups established by agency field
127	offices; deleting a fine; deleting provisions requiring
128	the agency to provide certain information and notice to
129	service providers; amending s. 429.14, F.S.; conforming a
130	reference; amending s. 429.19, F.S.; revising agency
131	procedures for imposition of fines for violations of pt. I
132	of ch. 429, F.S., the "Assisted Living Facilities Act";
133	providing for the posting of certain information
134	electronically or on the agency's Internet website;
135	amending s. 429.23, F.S.; revising the definition of the
136	term "adverse incident" for reporting purposes; requiring
137	abuse, neglect, and exploitation to be reported to the
138	agency and the Department of Children and Family Services;
139	deleting a requirement that the agency submit an annual
140	report on assisted living facility adverse incidents to
141	the Legislature; amending s. 430.80, F.S.; revising the
142	definition of the term "teaching nursing home," relating
143	to implementation of a teaching nursing home pilot
144	project, and requirements for designation as a teaching
145	nursing home; conforming a cross-reference; amending ss.
146	435.04 and 435.05, F.S.; requiring employers of certain
147	employees to submit an affidavit of compliance with level
148	2 screening requirements at the time of license renewal;
149	amending s. 483.031, F.S.; conforming a reference;
150	amending s. 483.041, F.S.; revising a definition
151	applicable to pt. I of ch. 483, F.S., the "Florida
152	Clinical Laboratory Law"; repealing s. 483.106, F.S.,
153	relating to applications for certificates of exemption by
154	clinical laboratories that perform certain tests; amending
155	s. 483.172, F.S.; conforming a reference; amending s.
156	627.4239, F.S.; revising the definition of the term
157	"standard reference compendium" for purposes of regulating
158	the insurance coverage of drugs used in the treatment of
159	cancer; amending s. 651.105, F.S.; revising the timeframe
160	for certain examinations by the Office of Insurance
161	Regulation relating to the provision of continuing care;
162	amending s. 641.407, F.S.; revising minimum surplus
163	requirements for prepaid health clinics; amending s.
164	651.118, F.S.; conforming a cross-reference; providing an
165	effective date.
166
167	Be It Enacted by the Legislature of the State of Florida:
168
169	Section 1.  Section 381.0203, Florida Statutes, is amended
170	to read:
171	381.0203  Pharmacy services.--
172	(1)  The department may contract on a statewide basis for
173	the purchase of drugs, as defined in s. 499.003, for utilization
174	to be used by state agencies and political subdivisions, and may
175	adopt rules to administer this section.
176	(2)  The department may establish and maintain a pharmacy
177	services program that includes, including, but is not limited
178	to:
179	(a)  A central pharmacy to support pharmaceutical services
180	provided by the county health departments, including
181	pharmaceutical repackaging, dispensing, and the purchase and
182	distribution of immunizations and other pharmaceuticals.
183	(b)  Regulation of drugs, cosmetics, and household products
184	pursuant to chapter 499.
185	(c)  Consultation to county health departments as required
186	by s. 154.04(1)(c).
187	(d)  A contraception distribution program which shall be
188	implemented, to the extent resources permit, through the
189	licensed pharmacies of county health departments. A woman who is
190	eligible for participation in the contraceptive distribution
191	program is deemed a patient of the county health department.
192	1.  To be eligible for participation in the program a woman
193	must:
194	a.  Be a client of the department or the Department of
195	Children and Family Services.
196	b.  Be of childbearing age with undesired fertility.
197	c.  Have an income between 150 and 200 percent of the
198	federal poverty level.
199	d.  Have no Medicaid benefits or applicable health
200	insurance benefits.
201	e.  Have had a medical examination by a licensed health
202	care provider within the past 6 months.
203	f.  Have a valid prescription for contraceptives that are
204	available through the contraceptive distribution program.
205	g.  Consent to the release of necessary medical information
206	to the county health department.
207	2.  Fees charged for the contraceptives under the program
208	must cover the cost of purchasing and providing contraceptives
209	to women participating in the program.
210	3.  The department may adopt rules to administer this
211	program.
212	Section 2.  Section 395.0199, Florida Statutes, is
213	repealed.
214	Section 3.  Section 395.405, Florida Statutes, is amended
215	to read:
216	395.405  Rulemaking.--The department shall adopt and
217	enforce all rules necessary to administer ss. 395.0199, 395.401,
218	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
219	Section 4.  Paragraph (e) of subsection (2) of section
220	395.602, Florida Statutes, is amended to read:
221	395.602  Rural hospitals.--
222	(2)  DEFINITIONS.--As used in this part:
223	(e)  "Rural hospital" means an acute care hospital licensed
224	under this chapter, having 100 or fewer licensed beds and an
225	emergency room, which is:
226	1.  The sole provider within a county with a population
227	density of no greater than 100 persons per square mile;
228	2.  An acute care hospital, in a county with a population
229	density of no greater than 100 persons per square mile, which is
230	at least 30 minutes of travel time, on normally traveled roads
231	under normal traffic conditions, from any other acute care
232	hospital within the same county;
233	3.  A hospital supported by a tax district or subdistrict
234	whose boundaries encompass a population of 100 persons or fewer
235	per square mile;
236	4.  A hospital in a constitutional charter county with a
237	population of over 1 million persons that has imposed a local
238	option health service tax pursuant to law and in an area that
239	was directly impacted by a catastrophic event on August 24,
240	1992, for which the Governor of Florida declared a state of
241	emergency pursuant to chapter 125, and has 120 beds or less that
242	serves an agricultural community with an emergency room
243	utilization of no less than 20,000 visits and a Medicaid
244	inpatient utilization rate greater than 15 percent;
245	5.  A hospital with a service area that has a population of
246	100 persons or fewer per square mile. As used in this
247	subparagraph, the term "service area" means the fewest number of
248	zip codes that account for 75 percent of the hospital's
249	discharges for the most recent 5-year period, based on
250	information available from the hospital inpatient discharge
251	database in the Florida Center for Health Information and Policy
252	Analysis at the Agency for Health Care Administration; or
253	6.  A hospital designated as a critical access hospital, as
254	defined in s. 408.07(15).
255
256	Population densities used in this paragraph must be based upon
257	the most recently completed United States census. A hospital
258	that received funds under s. 409.9116 for a quarter beginning no
259	later than July 1, 2002, is deemed to have been and shall
260	continue to be a rural hospital from that date through June 30,
261	2015 2012, if the hospital continues to have 100 or fewer
262	licensed beds and an emergency room, or meets the criteria of
263	subparagraph 4. An acute care hospital that has not previously
264	been designated as a rural hospital and that meets the criteria
265	of this paragraph shall be granted such designation upon
266	application, including supporting documentation to the Agency
267	for Health Care Administration.
268	Section 5.  Subsection (1) of section 400.0712, Florida
269	Statutes, is amended to read:
270	400.0712  Application for inactive license.--
271	(1)  As specified in s. 408.831(4) and this section, the
272	agency may issue an inactive license to a nursing home facility
273	for all or a portion of its beds. Any request by a licensee that
274	a nursing home or portion of a nursing home become inactive must
275	be submitted to the agency in the approved format. The facility
276	may not initiate any suspension of services, notify residents,
277	or initiate inactivity before receiving approval from the
278	agency; and a licensee that violates this provision may not be
279	issued an inactive license.
280	Section 6.  Subsection (3) of section 400.118, Florida
281	Statutes, is renumbered as subsection (2), and present
282	subsection (2) of that section is amended to read:
283	400.118  Quality assurance; early warning system;
284	monitoring; rapid response teams.--
285	(2)(a)  The agency shall establish within each district
286	office one or more quality-of-care monitors, based on the number
287	of nursing facilities in the district, to monitor all nursing
288	facilities in the district on a regular, unannounced, aperiodic
289	basis, including nights, evenings, weekends, and holidays.
290	Quality-of-care monitors shall visit each nursing facility at
291	least quarterly. Priority for additional monitoring visits shall
292	be given to nursing facilities with a history of resident care
293	deficiencies. Quality-of-care monitors shall be registered
294	nurses who are trained and experienced in nursing facility
295	regulation, standards of practice in long-term care, and
296	evaluation of patient care. Individuals in these positions shall
297	not be deployed by the agency as a part of the district survey
298	team in the conduct of routine, scheduled surveys, but shall
299	function solely and independently as quality-of-care monitors.
300	Quality-of-care monitors shall assess the overall quality of
301	life in the nursing facility and shall assess specific
302	conditions in the facility directly related to resident care,
303	including the operations of internal quality improvement and
304	risk management programs and adverse incident reports. The
305	quality-of-care monitor shall include in an assessment visit
306	observation of the care and services rendered to residents and
307	formal and informal interviews with residents, family members,
308	facility staff, resident guests, volunteers, other regulatory
309	staff, and representatives of a long-term care ombudsman council
310	or Florida advocacy council.
311	(b)  Findings of a monitoring visit, both positive and
312	negative, shall be provided orally and in writing to the
313	facility administrator or, in the absence of the facility
314	administrator, to the administrator on duty or the director of
315	nursing. The quality-of-care monitor may recommend to the
316	facility administrator procedural and policy changes and staff
317	training, as needed, to improve the care or quality of life of
318	facility residents. Conditions observed by the quality-of-care
319	monitor which threaten the health or safety of a resident shall
320	be reported immediately to the agency area office supervisor for
321	appropriate regulatory action and, as appropriate or as required
322	by law, to law enforcement, adult protective services, or other
323	responsible agencies.
324	(c)  Any record, whether written or oral, or any written or
325	oral communication generated pursuant to paragraph (a) or
326	paragraph (b) shall not be subject to discovery or introduction
327	into evidence in any civil or administrative action against a
328	nursing facility arising out of matters which are the subject of
329	quality-of-care monitoring, and a person who was in attendance
330	at a monitoring visit or evaluation may not be permitted or
331	required to testify in any such civil or administrative action
332	as to any evidence or other matters produced or presented during
333	the monitoring visits or evaluations. However, information,
334	documents, or records otherwise available from original sources
335	are not to be construed as immune from discovery or use in any
336	such civil or administrative action merely because they were
337	presented during monitoring visits or evaluations, and any
338	person who participates in such activities may not be prevented
339	from testifying as to matters within his or her knowledge, but
340	such witness may not be asked about his or her participation in
341	such activities. The exclusion from the discovery or
342	introduction of evidence in any civil or administrative action
343	provided for herein shall not apply when the quality-of-care
344	monitor makes a report to the appropriate authorities regarding
345	a threat to the health or safety of a resident.
346	Section 7.  Section 400.141, Florida Statutes, is amended
347	to read:
348	400.141  Administration and management of nursing home
349	facilities.--
350	(1)  Every licensed facility shall comply with all
351	applicable standards and rules of the agency and shall:
352	(a)(1)  Be under the administrative direction and charge of
353	a licensed administrator.
354	(b)(2)  Appoint a medical director licensed pursuant to
355	chapter 458 or chapter 459. The agency may establish by rule
356	more specific criteria for the appointment of a medical
357	director.
358	(c)(3)  Have available the regular, consultative, and
359	emergency services of physicians licensed by the state.
360	(d)(4)  Provide for resident use of a community pharmacy as
361	specified in s. 400.022(1)(q). Any other law to the contrary
362	notwithstanding, a registered pharmacist licensed in Florida,
363	that is under contract with a facility licensed under this
364	chapter or chapter 429, shall repackage a nursing facility
365	resident's bulk prescription medication which has been packaged
366	by another pharmacist licensed in any state in the United States
367	into a unit dose system compatible with the system used by the
368	nursing facility, if the pharmacist is requested to offer such
369	service. In order to be eligible for the repackaging, a resident
370	or the resident's spouse must receive prescription medication
371	benefits provided through a former employer as part of his or
372	her retirement benefits, a qualified pension plan as specified
373	in s. 4972 of the Internal Revenue Code, a federal retirement
374	program as specified under 5 C.F.R. s. 831, or a long-term care
375	policy as defined in s. 627.9404(1). A pharmacist who correctly
376	repackages and relabels the medication and the nursing facility
377	which correctly administers such repackaged medication under the
378	provisions of this paragraph may subsection shall not be held
379	liable in any civil or administrative action arising from the
380	repackaging. In order to be eligible for the repackaging, a
381	nursing facility resident for whom the medication is to be
382	repackaged shall sign an informed consent form provided by the
383	facility which includes an explanation of the repackaging
384	process and which notifies the resident of the immunities from
385	liability provided in this paragraph herein. A pharmacist who
386	repackages and relabels prescription medications, as authorized
387	under this paragraph subsection, may charge a reasonable fee for
388	costs resulting from the implementation of this provision.
389	(e)(5)  Provide for the access of the facility residents to
390	dental and other health-related services, recreational services,
391	rehabilitative services, and social work services appropriate to
392	their needs and conditions and not directly furnished by the
393	licensee. When a geriatric outpatient nurse clinic is conducted
394	in accordance with rules adopted by the agency, outpatients
395	attending such clinic shall not be counted as part of the
396	general resident population of the nursing home facility, nor
397	shall the nursing staff of the geriatric outpatient clinic be
398	counted as part of the nursing staff of the facility, until the
399	outpatient clinic load exceeds 15 a day.
400	(f)(6)  Be allowed and encouraged by the agency to provide
401	other needed services under certain conditions. If the facility
402	has a standard licensure status, and has had no class I or class
403	II deficiencies during the past 2 years or has been awarded a
404	Gold Seal under the program established in s. 400.235, it may be
405	encouraged by the agency to provide services, including, but not
406	limited to, respite and adult day services, which enable
407	individuals to move in and out of the facility. A facility is
408	not subject to any additional licensure requirements for
409	providing these services. Respite care may be offered to persons
410	in need of short-term or temporary nursing home services.
411	Respite care must be provided in accordance with this part and
412	rules adopted by the agency. However, the agency shall, by rule,
413	adopt modified requirements for resident assessment, resident
414	care plans, resident contracts, physician orders, and other
415	provisions, as appropriate, for short-term or temporary nursing
416	home services. The agency shall allow for shared programming and
417	staff in a facility which meets minimum standards and offers
418	services pursuant to this paragraph subsection, but, if the
419	facility is cited for deficiencies in patient care, may require
420	additional staff and programs appropriate to the needs of
421	service recipients. A person who receives respite care may not
422	be counted as a resident of the facility for purposes of the
423	facility's licensed capacity unless that person receives 24-hour
424	respite care. A person receiving either respite care for 24
425	hours or longer or adult day services must be included when
426	calculating minimum staffing for the facility. Any costs and
427	revenues generated by a nursing home facility from
428	nonresidential programs or services shall be excluded from the
429	calculations of Medicaid per diems for nursing home
430	institutional care reimbursement.
431	(g)(7)  If the facility has a standard license or is a Gold
432	Seal facility, exceeds the minimum required hours of licensed
433	nursing and certified nursing assistant direct care per resident
434	per day, and is part of a continuing care facility licensed
435	under chapter 651 or a retirement community that offers other
436	services pursuant to part III of this chapter or part I or part
437	III of chapter 429 on a single campus, be allowed to share
438	programming and staff. At the time of inspection and in the
439	semiannual report required pursuant to paragraph (o) subsection
440	(15), a continuing care facility or retirement community that
441	uses this option must demonstrate through staffing records that
442	minimum staffing requirements for the facility were met.
443	Licensed nurses and certified nursing assistants who work in the
444	nursing home facility may be used to provide services elsewhere
445	on campus if the facility exceeds the minimum number of direct
446	care hours required per resident per day and the total number of
447	residents receiving direct care services from a licensed nurse
448	or a certified nursing assistant does not cause the facility to
449	violate the staffing ratios required under s. 400.23(3)(a).
450	Compliance with the minimum staffing ratios shall be based on
451	total number of residents receiving direct care services,
452	regardless of where they reside on campus. If the facility
453	receives a conditional license, it may not share staff until the
454	conditional license status ends. This paragraph subsection does
455	not restrict the agency's authority under federal or state law
456	to require additional staff if a facility is cited for
457	deficiencies in care which are caused by an insufficient number
458	of certified nursing assistants or licensed nurses. The agency
459	may adopt rules for the documentation necessary to determine
460	compliance with this provision.
461	(h)(8)  Maintain the facility premises and equipment and
462	conduct its operations in a safe and sanitary manner.
463	(i)(9)  If the licensee furnishes food service, provide a
464	wholesome and nourishing diet sufficient to meet generally
465	accepted standards of proper nutrition for its residents and
466	provide such therapeutic diets as may be prescribed by attending
467	physicians. In making rules to implement this paragraph
468	subsection, the agency shall be guided by standards recommended
469	by nationally recognized professional groups and associations
470	with knowledge of dietetics.
471	(j)(10)  Keep full records of resident admissions and
472	discharges; medical and general health status, including medical
473	records, personal and social history, and identity and address
474	of next of kin or other persons who may have responsibility for
475	the affairs of the residents; and individual resident care plans
476	including, but not limited to, prescribed services, service
477	frequency and duration, and service goals. The records shall be
478	open to inspection by the agency.
479	(k)(11)  Keep such fiscal records of its operations and
480	conditions as may be necessary to provide information pursuant
481	to this part.
482	(l)(12)  Furnish copies of personnel records for employees
483	affiliated with such facility, to any other facility licensed by
484	this state requesting this information pursuant to this part.
485	Such information contained in the records may include, but is
486	not limited to, disciplinary matters and any reason for
487	termination. Any facility releasing such records pursuant to
488	this part shall be considered to be acting in good faith and may
489	not be held liable for information contained in such records,
490	absent a showing that the facility maliciously falsified such
491	records.
492	(m)(13)  Publicly display a poster provided by the agency
493	containing the names, addresses, and telephone numbers for the
494	state's abuse hotline, the State Long-Term Care Ombudsman, the
495	Agency for Health Care Administration consumer hotline, the
496	Advocacy Center for Persons with Disabilities, the Florida
497	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
498	with a clear description of the assistance to be expected from
499	each.
500	(n)(14)  Submit to the agency the information specified in
501	s. 400.071(1)(b) for a management company within 30 days after
502	the effective date of the management agreement.
503	(o)1.(15)  Submit semiannually to the agency, or more
504	frequently if requested by the agency, information regarding
505	facility staff-to-resident ratios, staff turnover, and staff
506	stability, including information regarding certified nursing
507	assistants, licensed nurses, the director of nursing, and the
508	facility administrator. For purposes of this reporting:
509	a.(a)  Staff-to-resident ratios must be reported in the
510	categories specified in s. 400.23(3)(a) and applicable rules.
511	The ratio must be reported as an average for the most recent
512	calendar quarter.
513	b.(b)  Staff turnover must be reported for the most recent
514	12-month period ending on the last workday of the most recent
515	calendar quarter prior to the date the information is submitted.
516	The turnover rate must be computed quarterly, with the annual
517	rate being the cumulative sum of the quarterly rates. The
518	turnover rate is the total number of terminations or separations
519	experienced during the quarter, excluding any employee
520	terminated during a probationary period of 3 months or less,
521	divided by the total number of staff employed at the end of the
522	period for which the rate is computed, and expressed as a
523	percentage.
524	c.(c)  The formula for determining staff stability is the
525	total number of employees that have been employed for more than
526	12 months, divided by the total number of employees employed at
527	the end of the most recent calendar quarter, and expressed as a
528	percentage.
529	d.(d)  A nursing facility that has failed to comply with
530	state minimum-staffing requirements for 2 consecutive days is
531	prohibited from accepting new admissions until the facility has
532	achieved the minimum-staffing requirements for a period of 6
533	consecutive days. For the purposes of this sub-subparagraph
534	paragraph, any person who was a resident of the facility and was
535	absent from the facility for the purpose of receiving medical
536	care at a separate location or was on a leave of absence is not
537	considered a new admission. Failure to impose such an admissions
538	moratorium constitutes a class II deficiency.
539	e.(e)  A nursing facility which does not have a conditional
540	license may be cited for failure to comply with the standards in
541	s. 400.23(3)(a)1.a. only if it has failed to meet those
542	standards on 2 consecutive days or if it has failed to meet at
543	least 97 percent of those standards on any one day.
544	f.(f)  A facility which has a conditional license must be
545	in compliance with the standards in s. 400.23(3)(a) at all
546	times.
547	2.  Nothing in This paragraph does not section shall limit
548	the agency's ability to impose a deficiency or take other
549	actions if a facility does not have enough staff to meet the
550	residents' needs.
551	(16)  Report monthly the number of vacant beds in the
552	facility which are available for resident occupancy on the day
553	the information is reported.
554	(p)(17)  Notify a licensed physician when a resident
555	exhibits signs of dementia or cognitive impairment or has a
556	change of condition in order to rule out the presence of an
557	underlying physiological condition that may be contributing to
558	such dementia or impairment. The notification must occur within
559	30 days after the acknowledgment of such signs by facility
560	staff. If an underlying condition is determined to exist, the
561	facility shall arrange, with the appropriate health care
562	provider, the necessary care and services to treat the
563	condition.
564	(q)(18)  If the facility implements a dining and
565	hospitality attendant program, ensure that the program is
566	developed and implemented under the supervision of the facility
567	director of nursing. A licensed nurse, licensed speech or
568	occupational therapist, or a registered dietitian must conduct
569	training of dining and hospitality attendants. A person employed
570	by a facility as a dining and hospitality attendant must perform
571	tasks under the direct supervision of a licensed nurse.
572	(r)(19)  Report to the agency any filing for bankruptcy
573	protection by the facility or its parent corporation,
574	divestiture or spin-off of its assets, or corporate
575	reorganization within 30 days after the completion of such
576	activity.
577	(s)(20)  Maintain general and professional liability
578	insurance coverage that is in force at all times. In lieu of
579	general and professional liability insurance coverage, a state-
580	designated teaching nursing home and its affiliated assisted
581	living facilities created under s. 430.80 may demonstrate proof
582	of financial responsibility as provided in s. 430.80(3)(g) s.
583	430.80(3)(h).
584	(t)(21)  Maintain in the medical record for each resident a
585	daily chart of certified nursing assistant services provided to
586	the resident. The certified nursing assistant who is caring for
587	the resident must complete this record by the end of his or her
588	shift. This record must indicate assistance with activities of
589	daily living, assistance with eating, and assistance with
590	drinking, and must record each offering of nutrition and
591	hydration for those residents whose plan of care or assessment
592	indicates a risk for malnutrition or dehydration.
593	(u)(22)  Before November 30 of each year, subject to the
594	availability of an adequate supply of the necessary vaccine,
595	provide for immunizations against influenza viruses to all its
596	consenting residents in accordance with the recommendations of
597	the United States Centers for Disease Control and Prevention,
598	subject to exemptions for medical contraindications and
599	religious or personal beliefs. Subject to these exemptions, any
600	consenting person who becomes a resident of the facility after
601	November 30 but before March 31 of the following year must be
602	immunized within 5 working days after becoming a resident.
603	Immunization shall not be provided to any resident who provides
604	documentation that he or she has been immunized as required by
605	this paragraph subsection. This paragraph subsection does not
606	prohibit a resident from receiving the immunization from his or
607	her personal physician if he or she so chooses. A resident who
608	chooses to receive the immunization from his or her personal
609	physician shall provide proof of immunization to the facility.
610	The agency may adopt and enforce any rules necessary to comply
611	with or implement this paragraph subsection.
612	(v)(23)  Assess all residents for eligibility for
613	pneumococcal polysaccharide vaccination (PPV) and vaccinate
614	residents when indicated within 60 days after the effective date
615	of this act in accordance with the recommendations of the United
616	States Centers for Disease Control and Prevention, subject to
617	exemptions for medical contraindications and religious or
618	personal beliefs. Residents admitted after the effective date of
619	this act shall be assessed within 5 working days of admission
620	and, when indicated, vaccinated within 60 days in accordance
621	with the recommendations of the United States Centers for
622	Disease Control and Prevention, subject to exemptions for
623	medical contraindications and religious or personal beliefs.
624	Immunization shall not be provided to any resident who provides
625	documentation that he or she has been immunized as required by
626	this paragraph subsection. This paragraph subsection does not
627	prohibit a resident from receiving the immunization from his or
628	her personal physician if he or she so chooses. A resident who
629	chooses to receive the immunization from his or her personal
630	physician shall provide proof of immunization to the facility.
631	The agency may adopt and enforce any rules necessary to comply
632	with or implement this paragraph subsection.
633	(w)(24)  Annually encourage and promote to its employees
634	the benefits associated with immunizations against influenza
635	viruses in accordance with the recommendations of the United
636	States Centers for Disease Control and Prevention. The agency
637	may adopt and enforce any rules necessary to comply with or
638	implement this paragraph subsection.
639	(2)  Facilities that have been awarded a Gold Seal under
640	the program established in s. 400.235 may develop a plan to
641	provide certified nursing assistant training as prescribed by
642	federal regulations and state rules and may apply to the agency
643	for approval of their program.
644	Section 8.  Present subsections (9) through (13) of section
645	400.147, Florida Statutes, are renumbered as subsections (10)
646	through (14), respectively, subsection (5) and present
647	subsection (14) are amended, and a new subsection (9) is added
648	to that section, to read:
649	400.147  Internal risk management and quality assurance
650	program.--
651	(5)  For purposes of reporting to the agency under this
652	section, the term "adverse incident" means:
653	(a)  An event over which facility personnel could exercise
654	control and which is associated in whole or in part with the
655	facility's intervention, rather than the condition for which
656	such intervention occurred, and which results in one of the
657	following:
658	1.  Death;
659	2.  Brain or spinal damage;
660	3.  Permanent disfigurement;
661	4.  Fracture or dislocation of bones or joints;
662	5.  A limitation of neurological, physical, or sensory
663	function;
664	6.  Any condition that required medical attention to which
665	the resident has not given his or her informed consent,
666	including failure to honor advanced directives; or
667	7.  Any condition that required the transfer of the
668	resident, within or outside the facility, to a unit providing a
669	more acute level of care due to the adverse incident, rather
670	than the resident's condition prior to the adverse incident; or
671	8.  An event that is reported to law enforcement or its
672	personnel for investigation; or
673	(b)  Abuse, neglect, or exploitation as defined in s.
674	415.102;
675	(c)  Abuse, neglect and harm as defined in s. 39.01;
676	(b)(d)  Resident elopement, if the elopement places the
677	resident at risk of harm or injury.; or
678	(e)  An event that is reported to law enforcement.
679	(9)  Abuse, neglect, or exploitation must be reported to
680	the agency as required by 42 C.F.R. s. 483.13(c) and to the
681	department as required by chapters 39 and 415.
682	(14)  The agency shall annually submit to the Legislature a
683	report on nursing home adverse incidents. The report must
684	include the following information arranged by county:
685	(a)  The total number of adverse incidents.
686	(b)  A listing, by category, of the types of adverse
687	incidents, the number of incidents occurring within each
688	category, and the type of staff involved.
689	(c)  A listing, by category, of the types of injury caused
690	and the number of injuries occurring within each category.
691	(d)  Types of liability claims filed based on an adverse
692	incident or reportable injury.
693	(e)  Disciplinary action taken against staff, categorized
694	by type of staff involved.
695	Section 9.  Subsection (3) of section 400.162, Florida
696	Statutes, is amended to read:
697	400.162  Property and personal affairs of residents.--
698	(3)  A licensee shall provide for the safekeeping of
699	personal effects, funds, and other property of the resident in
700	the facility. Whenever necessary for the protection of
701	valuables, or in order to avoid unreasonable responsibility
702	therefor, the licensee may require that such valuables be
703	excluded or removed from the facility and kept at some place not
704	subject to the control of the licensee. At the request of a
705	resident, the facility shall mark the resident's personal
706	property with the resident's name or another type of
707	identification, without defacing the property. Any theft or loss
708	of a resident's personal property shall be documented by the
709	facility. The facility shall develop policies and procedures to
710	minimize the risk of theft or loss of the personal property of
711	residents. A copy of the policy shall be provided to every
712	employee and to each resident and resident's representative, if
713	appropriate, at admission and when revised. Facility policies
714	must include provisions related to reporting theft or loss of a
715	resident's property to law enforcement and any facility waiver
716	of liability for loss or theft. The facility shall post notice
717	of these policies and procedures, and any revision thereof, in
718	places accessible to residents.
719	Section 10.  Subsection (2) of section 400.191, Florida
720	Statutes, is amended to read:
721	400.191  Availability, distribution, and posting of reports
722	and records.--
723	(2)  The agency shall publish the Nursing Home Guide
724	annually in consumer-friendly printed form and quarterly in
725	electronic form to assist consumers and their families in
726	comparing and evaluating nursing home facilities.
727	(a)  The agency shall provide an Internet site which shall
728	include at least the following information either directly or
729	indirectly through a link to another established site or sites
730	of the agency's choosing:
731	1.  A section entitled "Have you considered programs that
732	provide alternatives to nursing home care?" which shall be the
733	first section of the Nursing Home Guide and which shall
734	prominently display information about available alternatives to
735	nursing homes and how to obtain additional information regarding
736	these alternatives. The Nursing Home Guide shall explain that
737	this state offers alternative programs that permit qualified
738	elderly persons to stay in their homes instead of being placed
739	in nursing homes and shall encourage interested persons to call
740	the Comprehensive Assessment Review and Evaluation for Long-Term
741	Care Services (CARES) Program to inquire if they qualify. The
742	Nursing Home Guide shall list available home and community-based
743	programs which shall clearly state the services that are
744	provided and indicate whether nursing home services are included
745	if needed.
746	2.  A list by name and address of all nursing home
747	facilities in this state, including any prior name by which a
748	facility was known during the previous 24-month period.
749	3.  Whether such nursing home facilities are proprietary or
750	nonproprietary.
751	4.  The current owner of the facility's license and the
752	year that that entity became the owner of the license.
753	5.  The name of the owner or owners of each facility and
754	whether the facility is affiliated with a company or other
755	organization owning or managing more than one nursing facility
756	in this state.
757	6.  The total number of beds in each facility and the most
758	recently available occupancy levels.
759	7.  The number of private and semiprivate rooms in each
760	facility.
761	8.  The religious affiliation, if any, of each facility.
762	9.  The languages spoken by the administrator and staff of
763	each facility.
764	10.  Whether or not each facility accepts Medicare or
765	Medicaid recipients or insurance, health maintenance
766	organization, Veterans Administration, CHAMPUS program, or
767	workers' compensation coverage.
768	11.  Recreational and other programs available at each
769	facility.
770	12.  Special care units or programs offered at each
771	facility.
772	13.  Whether the facility is a part of a retirement
773	community that offers other services pursuant to part III of
774	this chapter or part I or part III of chapter 429.
775	14.  Survey and deficiency information, including all
776	federal and state recertification, licensure, revisit, and
777	complaint survey information, for each facility for the past 30
778	months. For noncertified nursing homes, state survey and
779	deficiency information, including licensure, revisit, and
780	complaint survey information for the past 30 months shall be
781	provided.
782	15.  A summary of the deficiency data for each facility
783	over the past 30 months. The summary may include a score,
784	rating, or comparison ranking with respect to other facilities
785	based on the number of citations received by the facility on
786	recertification, licensure, revisit, and complaint surveys; the
787	severity and scope of the citations; and the number of
788	recertification surveys the facility has had during the past 30
789	months. The score, rating, or comparison ranking may be
790	presented in either numeric or symbolic form for the intended
791	consumer audience.
792	(b)  The agency shall provide the following information in
793	printed form:
794	1.  A section entitled "Have you considered programs that
795	provide alternatives to nursing home care?" which shall be the
796	first section of the Nursing Home Guide and which shall
797	prominently display information about available alternatives to
798	nursing homes and how to obtain additional information regarding
799	these alternatives. The Nursing Home Guide shall explain that
800	this state offers alternative programs that permit qualified
801	elderly persons to stay in their homes instead of being placed
802	in nursing homes and shall encourage interested persons to call
803	the Comprehensive Assessment Review and Evaluation for Long-Term
804	Care Services (CARES) Program to inquire if they qualify. The
805	Nursing Home Guide shall list available home and community-based
806	programs which shall clearly state the services that are
807	provided and indicate whether nursing home services are included
808	if needed.
809	2.  A list by name and address of all nursing home
810	facilities in this state.
811	3.  Whether the nursing home facilities are proprietary or
812	nonproprietary.
813	4.  The current owner or owners of the facility's license
814	and the year that entity became the owner of the license.
815	5.  The total number of beds, and of private and
816	semiprivate rooms, in each facility.
817	6.  The religious affiliation, if any, of each facility.
818	7.  The name of the owner of each facility and whether the
819	facility is affiliated with a company or other organization
820	owning or managing more than one nursing facility in this state.
821	8.  The languages spoken by the administrator and staff of
822	each facility.
823	9.  Whether or not each facility accepts Medicare or
824	Medicaid recipients or insurance, health maintenance
825	organization, Veterans Administration, CHAMPUS program, or
826	workers' compensation coverage.
827	10.  Recreational programs, special care units, and other
828	programs available at each facility.
829	11.  The Internet address for the site where more detailed
830	information can be seen.
831	12.  A statement advising consumers that each facility will
832	have its own policies and procedures related to protecting
833	resident property.
834	13.  A summary of the deficiency data for each facility
835	over the past 30 months. The summary may include a score,
836	rating, or comparison ranking with respect to other facilities
837	based on the number of citations received by the facility on
838	recertification, licensure, revisit, and complaint surveys; the
839	severity and scope of the citations; the number of citations;
840	and the number of recertification surveys the facility has had
841	during the past 30 months. The score, rating, or comparison
842	ranking may be presented in either numeric or symbolic form for
843	the intended consumer audience.
844	(b)(c)  The agency may provide the following additional
845	information on an Internet site or in printed form as the
846	information becomes available:
847	1.  The licensure status history of each facility.
848	2.  The rating history of each facility.
849	3.  The regulatory history of each facility, which may
850	include federal sanctions, state sanctions, federal fines, state
851	fines, and other actions.
852	4.  Whether the facility currently possesses the Gold Seal
853	designation awarded pursuant to s. 400.235.
854	5.  Internet links to the Internet sites of the facilities
855	or their affiliates.
856	Section 11.  Paragraph (d) of subsection (1) of section
857	400.195, Florida Statutes, is amended to read:
858	400.195  Agency reporting requirements.--
859	(1)  For the period beginning June 30, 2001, and ending
860	June 30, 2005, the Agency for Health Care Administration shall
861	provide a report to the Governor, the President of the Senate,
862	and the Speaker of the House of Representatives with respect to
863	nursing homes. The first report shall be submitted no later than
864	December 30, 2002, and subsequent reports shall be submitted
865	every 6 months thereafter. The report shall identify facilities
866	based on their ownership characteristics, size, business
867	structure, for-profit or not-for-profit status, and any other
868	characteristics the agency determines useful in analyzing the
869	varied segments of the nursing home industry and shall report:
870	(d)  Information regarding deficiencies cited, including
871	information used to develop the Nursing Home Guide WATCH LIST
872	pursuant to s. 400.191, and applicable rules, a summary of data
873	generated on nursing homes by Centers for Medicare and Medicaid
874	Services Nursing Home Quality Information Project, and
875	information collected pursuant to s. 400.147(10)(9), relating to
876	litigation.
877	Section 12.  Paragraph (b) of subsection (3) of section
878	400.23, Florida Statutes, is amended to read:
879	400.23  Rules; evaluation and deficiencies; licensure
880	status.--
881	(3)
882	(b)  The agency shall adopt rules to allow properly trained
883	staff of a nursing facility, in addition to certified nursing
884	assistants and licensed nurses, to assist residents with eating.
885	The rules shall specify the minimum training requirements and
886	shall specify the physiological conditions or disorders of
887	residents which would necessitate that the eating assistance be
888	provided by nursing personnel of the facility. Nonnursing staff
889	providing eating assistance to residents under the provisions of
890	this subsection shall not count toward compliance with minimum
891	staffing standards.
892	Section 13.  Subsection (6) of section 400.474, Florida
893	Statutes, is amended to read:
894	400.474  Administrative penalties.--
895	(6)  The agency may deny, revoke, or suspend the license of
896	a home health agency and shall impose a fine of $5,000 against a
897	home health agency that:
898	(a)  Gives remuneration for staffing services to:
899	1.  Another home health agency with which it has formal or
900	informal patient-referral transactions or arrangements; or
901	2.  A health services pool with which it has formal or
902	informal patient-referral transactions or arrangements,
903
904	unless the home health agency has activated its comprehensive
905	emergency management plan in accordance with s. 400.492. This
906	paragraph does not apply to a Medicare-certified home health
907	agency that provides fair market value remuneration for staffing
908	services to a non-Medicare-certified home health agency that is
909	part of a continuing care facility licensed under chapter 651
910	for providing services to its own residents if each resident
911	receiving home health services pursuant to this arrangement
912	attests in writing that he or she made a decision without
913	influence from staff of the facility to select, from a list of
914	Medicare-certified home health agencies provided by the
915	facility, that Medicare-certified home health agency to provide
916	the services.
917	(b)  Provides services to residents in an assisted living
918	facility for which the home health agency does not receive fair
919	market value remuneration.
920	(c)  Provides staffing to an assisted living facility for
921	which the home health agency does not receive fair market value
922	remuneration.
923	(d)  Fails to provide the agency, upon request, with copies
924	of all contracts with assisted living facilities which were
925	executed within 5 years before the request.
926	(e)  Gives remuneration to a case manager, discharge
927	planner, facility-based staff member, or third-party vendor who
928	is involved in the discharge planning process of a facility
929	licensed under chapter 395 or this chapter from whom the home
930	health agency receives referrals.
931	(f)  Fails to submit to the agency, within 15 days after
932	the end of each calendar quarter, a written report that includes
933	the following data based on data as it existed on the last day
934	of the quarter:
935	1.  The number of insulin-dependent diabetic patients
936	receiving insulin-injection services from the home health
937	agency;
938	2.  The number of patients receiving both home health
939	services from the home health agency and hospice services;
940	3.  The number of patients receiving home health services
941	from that home health agency; and
942	4.  The names and license numbers of nurses whose primary
943	job responsibility is to provide home health services to
944	patients and who received remuneration from the home health
945	agency in excess of $25,000 during the calendar quarter.
946	(g)  Gives cash, or its equivalent, to a Medicare or
947	Medicaid beneficiary.
948	(h)  Has more than one medical director contract in effect
949	at one time or more than one medical director contract and one
950	contract with a physician-specialist whose services are mandated
951	for the home health agency in order to qualify to participate in
952	a federal or state health care program at one time.
953	(i)  Gives remuneration to a physician without a medical
954	director contract being in effect. The contract must:
955	1.  Be in writing and signed by both parties;
956	2.  Provide for remuneration that is at fair market value
957	for an hourly rate, which must be supported by invoices
958	submitted by the medical director describing the work performed,
959	the dates on which that work was performed, and the duration of
960	that work; and
961	3.  Be for a term of at least 1 year.
962
963	The hourly rate specified in the contract may not be increased
964	during the term of the contract. The home health agency may not
965	execute a subsequent contract with that physician which has an
966	increased hourly rate and covers any portion of the term that
967	was in the original contract.
968	(j)  Gives remuneration to:
969	1.  A physician, and the home health agency is in violation
970	of paragraph (h) or paragraph (i);
971	2.  A member of the physician's office staff; or
972	3.  An immediate family member of the physician,
973
974	if the home health agency has received a patient referral in the
975	preceding 12 months from that physician or physician's office
976	staff.
977	(k)  Fails to provide to the agency, upon request, copies
978	of all contracts with a medical director which were executed
979	within 5 years before the request.
980
981	Nothing in paragraph (e) or paragraph (j) shall be interpreted
982	as applying to or precluding any discount, compensation, waiver
983	of payment, or payment practice permitted by 42 U.S.C. s. 1320a-
984	7b(b) or regulations adopted thereunder, including 42 C.F.R. s.
985	1001.952, or by 42 U.S.C. s. 1395nn or regulations adopted
986	thereunder.
987	Section 14.  Paragraph (a) of subsection (15) of section
988	400.506, Florida Statutes, is amended to read:
989	400.506  Licensure of nurse registries; requirements;
990	penalties.--
991	(15)(a)  The agency may deny, suspend, or revoke the
992	license of a nurse registry and shall impose a fine of $5,000
993	against a nurse registry that:
994	1.  Provides services to residents in an assisted living
995	facility for which the nurse registry does not receive fair
996	market value remuneration.
997	2.  Provides staffing to an assisted living facility for
998	which the nurse registry does not receive fair market value
999	remuneration.
1000	3.  Fails to provide the agency, upon request, with copies
1001	of all contracts with assisted living facilities which were
1002	executed within the last 5 years.
1003	4.  Gives remuneration to a case manager, discharge
1004	planner, facility-based staff member, or third-party vendor who
1005	is involved in the discharge planning process of a facility
1006	licensed under chapter 395 or this chapter and from whom the
1007	nurse registry receives referrals. This subparagraph does not
1008	apply to a nurse registry that does not participate in the
1009	Medicaid or Medicare program.
1010	5.  Gives remuneration to a physician, a member of the
1011	physician's office staff, or an immediate family member of the
1012	physician, and the nurse registry received a patient referral in
1013	the last 12 months from that physician or the physician's office
1014	staff. This subparagraph does not apply to a nurse registry that
1015	does not participate in the Medicaid or Medicare program.
1016	Section 15.  Paragraph (m) is added to subsection (4) of
1017	section 400.9905, Florida Statutes, to read:
1018	400.9905  Definitions.--
1019	(4)  "Clinic" means an entity at which health care services
1020	are provided to individuals and which tenders charges for
1021	reimbursement for such services, including a mobile clinic and a
1022	portable equipment provider. For purposes of this part, the term
1023	does not include and the licensure requirements of this part do
1024	not apply to:
1025	(m)  Entities that do not seek reimbursement from insurance
1026	companies for medical services paid pursuant to personal injury
1027	protection coverage required by s. 627.736.
1028	Section 16.  Paragraph (a) of subsection (7) of section
1029	400.9935, Florida Statutes, is amended, and subsection (10) is
1030	added to that section, to read:
1031	400.9935  Clinic responsibilities.--
1032	(7)(a)  Each clinic engaged in magnetic resonance imaging
1033	services must be accredited by the Joint Commission on
1034	Accreditation of Healthcare Organizations, the American College
1035	of Radiology, or the Accreditation Association for Ambulatory
1036	Health Care, within 1 year after licensure. A clinic that is
1037	accredited by the American College of Radiology or is within the
1038	original 1-year period after licensure and replaces its core
1039	magnetic resonance imaging equipment shall be given 1 year after
1040	the date upon which the equipment is replaced to attain
1041	accreditation. However, a clinic may request a single, 6-month
1042	extension if it provides evidence to the agency establishing
1043	that, for good cause shown, such clinic cannot can not be
1044	accredited within 1 year after licensure, and that such
1045	accreditation will be completed within the 6-month extension.
1046	After obtaining accreditation as required by this subsection,
1047	each such clinic must maintain accreditation as a condition of
1048	renewal of its license. A clinic that files a change of
1049	ownership application must comply with the original
1050	accreditation timeframe requirements of the transferor. The
1051	agency shall deny a change of ownership application if the
1052	clinic is not in compliance with the accreditation requirements.
1053	When a clinic adds, replaces, or modifies magnetic resonance
1054	imaging equipment and the accrediting organization requires new
1055	accreditation, the clinic must be accredited within 1 year after
1056	the date of the addition, replacement, or modification but may
1057	request a single, 6-month extension if the clinic provides
1058	evidence of good cause to the agency.
1059	(10)  Any clinic holding an active license and any entity
1060	holding a current certificate of exemption may request a unique
1061	identification number from the agency for the purposes of
1062	submitting claims to personal injury protection insurance
1063	carriers for services or treatment pursuant to part XI of
1064	chapter 627. Upon request, the agency shall assign a unique
1065	identification number to a clinic holding an active license or
1066	an entity holding a current certificate of exemption. The agency
1067	shall publish the identification number of each clinic and
1068	entity on its Internet website in a searchable format that is
1069	readily accessible to personal injury protection insurance
1070	carriers for the purposes of s. 627.736(5)(b)1.g.
1071	Section 17.  Subsection (6) of section 400.995, Florida
1072	Statutes, is amended to read:
1073	400.995  Agency administrative penalties.--
1074	(6)  During an inspection, the agency, as an alternative to
1075	or in conjunction with an administrative action against a clinic
1076	for violations of this part and adopted rules, shall make a
1077	reasonable attempt to discuss each violation and recommended
1078	corrective action with the owner, medical director, or clinic
1079	director of the clinic, prior to written notification. The
1080	agency, instead of fixing a period within which the clinic shall
1081	enter into compliance with standards, may request a plan of
1082	corrective action from the clinic which demonstrates a good
1083	faith effort to remedy each violation by a specific date,
1084	subject to the approval of the agency.
1085	Section 18.  Paragraph (a) of subsection (2) of section
1086	408.040, Florida Statutes, is amended to read:
1087	408.040  Conditions and monitoring.--
1088	(2)(a)  Unless the applicant has commenced construction, if
1089	the project provides for construction, unless the applicant has
1090	incurred an enforceable capital expenditure commitment for a
1091	project, if the project does not provide for construction, or
1092	unless subject to paragraph (b), a certificate of need shall
1093	terminate 18 months after the date of issuance, except an entity
1094	holding a certificate of need issued on or before April 1, 2009,
1095	which shall terminate 36 months after the date of issuance. The
1096	agency shall monitor the progress of the holder of the
1097	certificate of need in meeting the timetable for project
1098	development specified in the application, and may revoke the
1099	certificate of need, if the holder of the certificate is not
1100	meeting such timetable and is not making a good-faith effort, as
1101	defined by rule, to meet it.
1102	Section 19.  The amendment to s. 408.040(2)(a), Florida
1103	Statutes, by this act shall control over any conflicting
1104	amendment to s. 408.040(2)(a), Florida Statutes, that is adopted
1105	during the 2009 Regular Session or an extension thereof and
1106	becomes law.
1107	Section 20.  Subsection (43) of section 408.07, Florida
1108	Statutes, is amended to read:
1109	408.07  Definitions.--As used in this chapter, with the
1110	exception of ss. 408.031-408.045, the term:
1111	(43)  "Rural hospital" means an acute care hospital
1112	licensed under chapter 395, having 100 or fewer licensed beds
1113	and an emergency room, and which is:
1114	(a)  The sole provider within a county with a population
1115	density of no greater than 100 persons per square mile;
1116	(b)  An acute care hospital, in a county with a population
1117	density of no greater than 100 persons per square mile, which is
1118	at least 30 minutes of travel time, on normally traveled roads
1119	under normal traffic conditions, from another acute care
1120	hospital within the same county;
1121	(c)  A hospital supported by a tax district or subdistrict
1122	whose boundaries encompass a population of 100 persons or fewer
1123	per square mile;
1124	(d)  A hospital with a service area that has a population
1125	of 100 persons or fewer per square mile. As used in this
1126	paragraph, the term "service area" means the fewest number of
1127	zip codes that account for 75 percent of the hospital's
1128	discharges for the most recent 5-year period, based on
1129	information available from the hospital inpatient discharge
1130	database in the Florida Center for Health Information and Policy
1131	Analysis at the Agency for Health Care Administration; or
1132	(e)  A critical access hospital.
1133
1134	Population densities used in this subsection must be based upon
1135	the most recently completed United States census. A hospital
1136	that received funds under s. 409.9116 for a quarter beginning no
1137	later than July 1, 2002, is deemed to have been and shall
1138	continue to be a rural hospital from that date through June 30,
1139	2015 2012, if the hospital continues to have 100 or fewer
1140	licensed beds and an emergency room, or meets the criteria of s.
1141	395.602(2)(e)4. An acute care hospital that has not previously
1142	been designated as a rural hospital and that meets the criteria
1143	of this subsection shall be granted such designation upon
1144	application, including supporting documentation, to the Agency
1145	for Health Care Administration.
1146	Section 21.  Subsections (5), (9), and (13) of section
1147	408.803, Florida Statutes, are amended to read:
1148	408.803  Definitions.--As used in this part, the term:
1149	(5)  "Change of ownership" means:
1150	(a)  An event in which the licensee sells or otherwise
1151	transfers its ownership changes to a different individual or
1152	legal entity, as evidenced by a change in federal employer
1153	identification number or taxpayer identification number; or
1154	(b)  An event in which 51 45 percent or more of the
1155	ownership, voting shares, membership, or controlling interest of
1156	a licensee is in any manner transferred or otherwise assigned.
1157	This paragraph does not apply to a licensee that is publicly
1158	traded on a recognized stock exchange. In a corporation whose
1159	shares are not publicly traded on a recognized stock exchange is
1160	transferred or assigned, including the final transfer or
1161	assignment of multiple transfers or assignments over a 2-year
1162	period that cumulatively total 45 percent or greater.
1163
1164	A change solely in the management company or board of directors
1165	is not a change of ownership.
1166	(9)  "Licensee" means an individual, corporation,
1167	partnership, firm, association, or governmental entity, or other
1168	entity that is issued a permit, registration, certificate, or
1169	license by the agency. The licensee is legally responsible for
1170	all aspects of the provider operation.
1171	(13)  "Voluntary board member" means a board member of a
1172	not-for-profit corporation or organization who serves solely in
1173	a voluntary capacity, does not receive any remuneration for his
1174	or her services on the board of directors, and has no financial
1175	interest in the corporation or organization. The agency shall
1176	recognize a person as a voluntary board member following
1177	submission of a statement to the agency by the board member and
1178	the not-for-profit corporation or organization that affirms that
1179	the board member conforms to this definition. The statement
1180	affirming the status of the board member must be submitted to
1181	the agency on a form provided by the agency.
1182	Section 22.  Paragraph (a) of subsection (1), subsection
1183	(2), paragraph (c) of subsection (7), and subsection (8) of
1184	section 408.806, Florida Statutes, are amended to read:
1185	408.806  License application process.--
1186	(1)  An application for licensure must be made to the
1187	agency on forms furnished by the agency, submitted under oath,
1188	and accompanied by the appropriate fee in order to be accepted
1189	and considered timely. The application must contain information
1190	required by authorizing statutes and applicable rules and must
1191	include:
1192	(a)  The name, address, and social security number of:
1193	1.  The applicant;
1194	2.  The administrator or a similarly titled person who is
1195	responsible for the day-to-day operation of the provider;
1196	3.  The financial officer or similarly titled person who is
1197	responsible for the financial operation of the licensee or
1198	provider; and
1199	4.  Each controlling interest if the applicant or
1200	controlling interest is an individual.
1201	(2)(a)  The applicant for a renewal license must submit an
1202	application that must be received by the agency at least 60 days
1203	but no more than 120 days prior to the expiration of the current
1204	license. An application received more than 120 days prior to the
1205	expiration of the current license shall be returned to the
1206	applicant. If the renewal application and fee are received prior
1207	to the license expiration date, the license shall not be deemed
1208	to have expired if the license expiration date occurs during the
1209	agency's review of the renewal application.
1210	(b)  The applicant for initial licensure due to a change of
1211	ownership must submit an application that must be received by
1212	the agency at least 60 days prior to the date of change of
1213	ownership.
1214	(c)  For any other application or request, the applicant
1215	must submit an application or request that must be received by
1216	the agency at least 60 days but no more than 120 days prior to
1217	the requested effective date, unless otherwise specified in
1218	authorizing statutes or applicable rules. An application
1219	received more than 120 days prior to the requested effective
1220	date shall be returned to the applicant.
1221	(d)  The agency shall notify the licensee by mail or
1222	electronically at least 90 days prior to the expiration of a
1223	license that a renewal license is necessary to continue
1224	operation. The failure to timely submit a renewal application
1225	and license fee shall result in a $50 per day late fee charged
1226	to the licensee by the agency; however, the aggregate amount of
1227	the late fee may not exceed 50 percent of the licensure fee or
1228	$500, whichever is less. If an application is received after the
1229	required filing date and exhibits a hand-canceled postmark
1230	obtained from a United States post office dated on or before the
1231	required filing date, no fine will be levied.
1232	(7)
1233	(c)  If an inspection is required by the authorizing
1234	statute for a license application other than an initial
1235	application, the inspection must be unannounced. This paragraph
1236	does not apply to inspections required pursuant to ss. 383.324,
1237	395.0161(4), 429.67(6), and 483.061(2).
1238	(8)  The agency may establish procedures for the electronic
1239	notification and submission of required information, including,
1240	but not limited to:
1241	(a)  Licensure applications.
1242	(b)  Required signatures.
1243	(c)  Payment of fees.
1244	(d)  Notarization of applications.
1245
1246	Requirements for electronic submission of any documents required
1247	by this part or authorizing statutes may be established by rule.
1248	As an alternative to sending documents as required by
1249	authorizing statutes, the agency may provide electronic access
1250	to information or documents.
1251	Section 23.  Subsection (2) of section 408.808, Florida
1252	Statutes, is amended to read:
1253	408.808  License categories.--
1254	(2)  PROVISIONAL LICENSE.--A provisional license may be
1255	issued to an applicant pursuant to s. 408.809(3). An applicant
1256	against whom a proceeding denying or revoking a license is
1257	pending at the time of license renewal may be issued a
1258	provisional license effective until final action not subject to
1259	further appeal. A provisional license may also be issued to an
1260	applicant applying for a change of ownership. A provisional
1261	license shall be limited in duration to a specific period of
1262	time, not to exceed 12 months, as determined by the agency.
1263	Section 24.  Subsection (5) of section 408.809, Florida
1264	Statutes, is amended, and new subsections (5) and (6) are added
1265	to that section, to read:
1266	408.809  Background screening; prohibited offenses.--
1267	(5)  Effective October 1, 2009, in addition to the offenses
1268	listed in ss. 435.03 and 435.04, all persons required to undergo
1269	background screening pursuant to this part or authorizing
1270	statutes must not have been found guilty of, regardless of
1271	adjudication, or entered a plea of nolo contendere or guilty to,
1272	any of the following offenses or any similar offense of another
1273	jurisdiction:
1274	(a)  A violation of any authorizing statutes, if the
1275	offense was a felony.
1276	(b)  A violation of this chapter, if the offense was a
1277	felony.
1278	(c)  A violation of s. 409.920, relating to Medicaid
1279	provider fraud, if the offense was a felony.
1280	(d)  A violation of s. 409.9201, relating to Medicaid
1281	fraud, if the offense was a felony.
1282	(e)  A violation of s. 741.28, relating to domestic
1283	violence.
1284	(f)  A violation of chapter 784, relating to assault,
1285	battery, and culpable negligence, if the offense was a felony.
1286	(g)  A violation of s. 810.02, relating to burglary.
1287	(h)  A violation of s. 817.034, relating to fraudulent acts
1288	through mail, wire, radio, electromagnetic, photoelectronic, or
1289	photooptical systems.
1290	(i)  A violation of s. 817.234, relating to false and
1291	fraudulent insurance claims.
1292	(j)  A violation of s. 817.505, relating to patient
1293	brokering.
1294	(k)  A violation of s. 817.568, relating to criminal use of
1295	personal identification information.
1296	(l)  A violation of s. 817.60, relating to obtaining a
1297	credit card through fraudulent means.
1298	(m)  A violation of s. 817.61, relating to fraudulent use
1299	of credit cards, if the offense was a felony.
1300	(n)  A violation of s. 831.01, relating to forgery.
1301	(o)  A violation of s. 831.02, relating to uttering forged
1302	instruments.
1303	(p)  A violation of s. 831.07, relating to forging bank
1304	bills, checks, drafts, or promissory notes.
1305	(q)  A violation of s. 831.09, relating to uttering forged
1306	bank bills, checks, drafts, or promissory notes.
1307	(r)  A violation of s. 831.30, relating to fraud in
1308	obtaining medicinal drugs.
1309	(s)  A violation of s. 831.31, relating to the sale,
1310	manufacture, delivery, or possession with the intent to sell,
1311	manufacture, or deliver any counterfeit controlled substance, if
1312	the offense was a felony.
1313
1314	A person who serves as a controlling interest of or is employed
1315	by a licensee on September 30, 2009, shall not be required by
1316	law to submit to rescreening if that licensee has in its
1317	possession written evidence that the person has been screened
1318	and qualified according to the standards specified in s. 435.03
1319	or s. 435.04. However, if such person has been convicted of a
1320	disqualifying offense listed in this subsection, he or she may
1321	apply for an exemption from the appropriate licensing agency
1322	before September 30, 2009, and if agreed to by the employer, may
1323	continue to perform his or her duties until the licensing agency
1324	renders a decision on the application for exemption for an
1325	offense listed in this subsection. Exemptions from
1326	disqualification may be granted pursuant to s. 435.07.
1327	(6)  The attestations required under ss. 435.04(5) and
1328	435.05(3) must be submitted at the time of license renewal,
1329	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1330	which require annual submission of an affidavit of compliance
1331	with background screening requirements.
1332	(5)  Background screening is not required to obtain a
1333	certificate of exemption issued under s. 483.106.
1334	Section 25.  Subsection (3) of section 408.810, Florida
1335	Statutes, is amended to read:
1336	408.810  Minimum licensure requirements.--In addition to
1337	the licensure requirements specified in this part, authorizing
1338	statutes, and applicable rules, each applicant and licensee must
1339	comply with the requirements of this section in order to obtain
1340	and maintain a license.
1341	(3)  Unless otherwise specified in this part, authorizing
1342	statutes, or applicable rules, any information required to be
1343	reported to the agency must be submitted within 21 calendar days
1344	after the report period or effective date of the information,
1345	whichever is earlier, including, but not limited to, any change
1346	of:
1347	(a)  Information contained in the most recent application
1348	for licensure.
1349	(b)  Required insurance or bonds.
1350	Section 26.  Present subsection (4) of section 408.811,
1351	Florida Statutes, is renumbered as subsection (6), subsections
1352	(2) and (3) are amended, and new subsections (4) and (5) are
1353	added to that section, to read:
1354	408.811  Right of inspection; copies; inspection reports;
1355	plan for correction of deficiencies.--
1356	(2)  Inspections conducted in conjunction with
1357	certification, comparable licensure requirements, or a
1358	recognized or approved accreditation organization may be
1359	accepted in lieu of a complete licensure inspection. However, a
1360	licensure inspection may also be conducted to review any
1361	licensure requirements that are not also requirements for
1362	certification.
1363	(3)  The agency shall have access to and the licensee shall
1364	provide, or if requested send, copies of all provider records
1365	required during an inspection or other review at no cost to the
1366	agency, including records requested during an offsite review.
1367	(4)  Deficiencies must be corrected within 30 calendar days
1368	after the provider is notified of inspection results unless an
1369	alternative timeframe is required or approved by the agency.
1370	(5)  The agency may require an applicant or licensee to
1371	submit a plan of correction for deficiencies. If required, the
1372	plan of correction must be filed with the agency within 10
1373	calendar days after notification unless an alternative timeframe
1374	is required.
1375	Section 27.  Section 408.813, Florida Statutes, is amended
1376	to read:
1377	408.813  Administrative fines; violations.--As a penalty
1378	for any violation of this part, authorizing statutes, or
1379	applicable rules, the agency may impose an administrative fine.
1380	(1)  Unless the amount or aggregate limitation of the fine
1381	is prescribed by authorizing statutes or applicable rules, the
1382	agency may establish criteria by rule for the amount or
1383	aggregate limitation of administrative fines applicable to this
1384	part, authorizing statutes, and applicable rules. Each day of
1385	violation constitutes a separate violation and is subject to a
1386	separate fine, unless a per-violation fine is prescribed by law.
1387	For fines imposed by final order of the agency and not subject
1388	to further appeal, the violator shall pay the fine plus interest
1389	at the rate specified in s. 55.03 for each day beyond the date
1390	set by the agency for payment of the fine.
1391	(2)  Violations of this part, authorizing statutes, or
1392	applicable rules shall be classified according to the nature of
1393	the violation and the gravity of its probable effect on clients.
1394	The scope of a violation may be cited as an isolated, patterned,
1395	or widespread deficiency. An isolated deficiency is a deficiency
1396	affecting one or a very limited number of clients, or involving
1397	one or a very limited number of staff, or a situation that
1398	occurred only occasionally or in a very limited number of
1399	locations. A patterned deficiency is a deficiency in which more
1400	than a very limited number of clients are affected, or more than
1401	a very limited number of staff are involved, or the situation
1402	has occurred in several locations, or the same client or clients
1403	have been affected by repeated occurrences of the same deficient
1404	practice but the effect of the deficient practice is not found
1405	to be pervasive throughout the provider. A widespread deficiency
1406	is a deficiency in which the problems causing the deficiency are
1407	pervasive in the provider or represent systemic failure that has
1408	affected or has the potential to affect a large portion of the
1409	provider's clients. This subsection does not affect the
1410	legislative determination of the amount of a fine imposed under
1411	authorizing statutes. Violations shall be classified on the
1412	written notice as follows:
1413	(a)  Class "I" violations are those conditions or
1414	occurrences related to the operation and maintenance of a
1415	provider or to the care of clients which the agency determines
1416	present an imminent danger to the clients of the provider or a
1417	substantial probability that death or serious physical or
1418	emotional harm would result therefrom. The condition or practice
1419	constituting a class I violation shall be abated or eliminated
1420	within 24 hours, unless a fixed period, as determined by the
1421	agency, is required for correction. The agency shall impose an
1422	administrative fine as provided by law for a cited class I
1423	violation. A fine shall be levied notwithstanding the correction
1424	of the violation.
1425	(b)  Class "II" violations are those conditions or
1426	occurrences related to the operation and maintenance of a
1427	provider or to the care of clients which the agency determines
1428	directly threaten the physical or emotional health, safety, or
1429	security of the clients, other than class I violations. The
1430	agency shall impose an administrative fine as provided by law
1431	for a cited class II violation. A fine shall be levied
1432	notwithstanding the correction of the violation.
1433	(c)  Class "III" violations are those conditions or
1434	occurrences related to the operation and maintenance of a
1435	provider or to the care of clients which the agency determines
1436	indirectly or potentially threaten the physical or emotional
1437	health, safety, or security of clients, other than class I or
1438	class II violations. The agency shall impose an administrative
1439	fine as provided by law for a cited class III violation. A
1440	citation for a class III violation must specify the time within
1441	which the violation is required to be corrected. If a class III
1442	violation is corrected within the time specified, a fine may not
1443	be imposed.
1444	(d)  Class "IV" violations are those conditions or
1445	occurrences related to the operation and maintenance of a
1446	provider or to required reports, forms, or documents that do not
1447	have the potential of negatively affecting clients. These
1448	violations are of a type that the agency determines do not
1449	threaten the health, safety, or security of clients. The agency
1450	shall impose an administrative fine as provided by law for a
1451	cited class IV violation. A citation for a class IV violation
1452	must specify the time within which the violation is required to
1453	be corrected. If a class IV violation is corrected within the
1454	time specified, a fine may not be imposed.
1455	Section 28.  Subsections (12) through (29) of section
1456	408.820, Florida Statutes, are renumbered as subsections (11)
1457	through (28), respectively, and present subsections (11), (12),
1458	(13), (21), and (26) of that section are amended to read:
1459	408.820  Exemptions.--Except as prescribed in authorizing
1460	statutes, the following exemptions shall apply to specified
1461	requirements of this part:
1462	(11)  Private review agents, as provided under part I of
1463	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1464	408.811.
1465	(11)(12)  Health care risk managers, as provided under part
1466	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1467	(10), and 408.811.
1468	(12)(13)  Nursing homes, as provided under part II of
1469	chapter 400, are exempt from ss. s. 408.810(7) and 408.813(2).
1470	(20)(21)  Transitional living facilities, as provided under
1471	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1472	(25)(26)  Health care clinics, as provided under part X of
1473	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1474	(7), and (10).
1475	Section 29.  Section 408.821, Florida Statutes, is created
1476	to read:
1477	408.821  Emergency management planning; emergency
1478	operations; inactive license.--
1479	(1)  Licensees required by authorizing statutes to have an
1480	emergency operations plan must designate a safety liaison to
1481	serve as the primary contact for emergency operations.
1482	(2)  An entity subject to this part may temporarily exceed
1483	its licensed capacity to act as a receiving provider in
1484	accordance with an approved emergency operations plan for up to
1485	15 days. While in an overcapacity status, each provider must
1486	furnish or arrange for appropriate care and services to all
1487	clients. In addition, the agency may approve requests for
1488	overcapacity in excess of 15 days, which approvals may be based
1489	upon satisfactory justification and need as provided by the
1490	receiving and sending providers.
1491	(3)(a)  An inactive license may be issued to a licensee
1492	subject to this section when the provider is located in a
1493	geographic area in which a state of emergency was declared by
1494	the Governor if the provider:
1495	1.  Suffered damage to its operation during the state of
1496	emergency.
1497	2.  Is currently licensed.
1498	3.  Does not have a provisional license.
1499	4.  Will be temporarily unable to provide services but is
1500	reasonably expected to resume services within 12 months.
1501	(b)  An inactive license may be issued for a period not to
1502	exceed 12 months but may be renewed by the agency for up to 12
1503	additional months upon demonstration to the agency of progress
1504	toward reopening. A request by a licensee for an inactive
1505	license or to extend the previously approved inactive period
1506	must be submitted in writing to the agency, accompanied by
1507	written justification for the inactive license, which states the
1508	beginning and ending dates of inactivity and includes a plan for
1509	the transfer of any clients to other providers and appropriate
1510	licensure fees. Upon agency approval, the licensee shall notify
1511	clients of any necessary discharge or transfer as required by
1512	authorizing statutes or applicable rules. The beginning of the
1513	inactive licensure period shall be the date the provider ceases
1514	operations. The end of the inactive period shall become the
1515	license expiration date, and all licensure fees must be current,
1516	must be paid in full, and may be prorated. Reactivation of an
1517	inactive license requires the prior approval by the agency of a
1518	renewal application, including payment of licensure fees and
1519	agency inspections indicating compliance with all requirements
1520	of this part and applicable rules and statutes.
1521	(4)  The agency may adopt rules relating to emergency
1522	management planning, communications, and operations. Licensees
1523	providing residential or inpatient services must utilize an
1524	online database approved by the agency to report information to
1525	the agency regarding the provider's emergency status, planning,
1526	or operations.
1527	Section 30.  Subsections (3), (4), and (5) of section
1528	408.831, Florida Statutes, are amended to read:
1529	408.831  Denial, suspension, or revocation of a license,
1530	registration, certificate, or application.--
1531	(3)  An entity subject to this section may exceed its
1532	licensed capacity to act as a receiving facility in accordance
1533	with an emergency operations plan for clients of evacuating
1534	providers from a geographic area where an evacuation order has
1535	been issued by a local authority having jurisdiction. While in
1536	an overcapacity status, each provider must furnish or arrange
1537	for appropriate care and services to all clients. In addition,
1538	the agency may approve requests for overcapacity beyond 15 days,
1539	which approvals may be based upon satisfactory justification and
1540	need as provided by the receiving and sending facilities.
1541	(4)(a)  An inactive license may be issued to a licensee
1542	subject to this section when the provider is located in a
1543	geographic area where a state of emergency was declared by the
1544	Governor if the provider:
1545	1.  Suffered damage to its operation during that state of
1546	emergency.
1547	2.  Is currently licensed.
1548	3.  Does not have a provisional license.
1549	4.  Will be temporarily unable to provide services but is
1550	reasonably expected to resume services within 12 months.
1551	(b)  An inactive license may be issued for a period not to
1552	exceed 12 months but may be renewed by the agency for up to 12
1553	additional months upon demonstration to the agency of progress
1554	toward reopening. A request by a licensee for an inactive
1555	license or to extend the previously approved inactive period
1556	must be submitted in writing to the agency, accompanied by
1557	written justification for the inactive license, which states the
1558	beginning and ending dates of inactivity and includes a plan for
1559	the transfer of any clients to other providers and appropriate
1560	licensure fees. Upon agency approval, the licensee shall notify
1561	clients of any necessary discharge or transfer as required by
1562	authorizing statutes or applicable rules. The beginning of the
1563	inactive licensure period shall be the date the provider ceases
1564	operations. The end of the inactive period shall become the
1565	licensee expiration date, and all licensure fees must be
1566	current, paid in full, and may be prorated. Reactivation of an
1567	inactive license requires the prior approval by the agency of a
1568	renewal application, including payment of licensure fees and
1569	agency inspections indicating compliance with all requirements
1570	of this part and applicable rules and statutes.
1571	(3)(5)  This section provides standards of enforcement
1572	applicable to all entities licensed or regulated by the Agency
1573	for Health Care Administration. This section controls over any
1574	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1575	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1576	those chapters.
1577	Section 31.  Subsection (2) of section 408.918, Florida
1578	Statutes, is amended, and subsection (3) is added to that
1579	section, to read:
1580	408.918  Florida 211 Network; uniform certification
1581	requirements.--
1582	(2)  In order to participate in the Florida 211 Network, a
1583	211 provider must be fully accredited by the National certified
1584	by the Agency for Health Care Administration. The agency shall
1585	develop criteria for certification, as recommended by the
1586	Florida Alliance of Information and Referral Services or have
1587	received approval to operate, pending accreditation, from its
1588	affiliate, the Florida Alliance of Information and Referral
1589	Services, and shall adopt the criteria as administrative rules.
1590	(a)  If any provider of information and referral services
1591	or other entity leases a 211 number from a local exchange
1592	company and is not authorized as described in this section,
1593	certified by the agency, the agency shall, after consultation
1594	with the local exchange company and the Public Service
1595	Commission shall, request that the Federal Communications
1596	Commission direct the local exchange company to revoke the use
1597	of the 211 number.
1598	(b)  The agency shall seek the assistance and guidance of
1599	the Public Service Commission and the Federal Communications
1600	Commission in resolving any disputes arising over jurisdiction
1601	related to 211 numbers.
1602	(3)  The Florida Alliance of Information and Referral
1603	Services is the 211 collaborative organization for the state
1604	that is responsible for studying, designing, implementing,
1605	supporting, and coordinating the Florida 211 Network and
1606	receiving federal grants.
1607	Section 32.  Paragraph (e) of subsection (4) of section
1608	409.221, Florida Statutes, is amended to read:
1609	409.221  Consumer-directed care program.--
1610	(4)  CONSUMER-DIRECTED CARE.--
1611	(e)  Services.--Consumers shall use the budget allowance
1612	only to pay for home and community-based services that meet the
1613	consumer's long-term care needs and are a cost-efficient use of
1614	funds. Such services may include, but are not limited to, the
1615	following:
1616	1.  Personal care.
1617	2.  Homemaking and chores, including housework, meals,
1618	shopping, and transportation.
1619	3.  Home modifications and assistive devices which may
1620	increase the consumer's independence or make it possible to
1621	avoid institutional placement.
1622	4.  Assistance in taking self-administered medication.
1623	5.  Day care and respite care services, including those
1624	provided by nursing home facilities pursuant to s.
1625	400.141(1)(f)(6) or by adult day care facilities licensed
1626	pursuant to s. 429.907.
1627	6.  Personal care and support services provided in an
1628	assisted living facility.
1629	Section 33.  Subsection (5) of section 409.901, Florida
1630	Statutes, is amended to read:
1631	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1632	409.901-409.920, except as otherwise specifically provided, the
1633	term:
1634	(5)  "Change of ownership" means:
1635	(a)  An event in which the provider ownership changes to a
1636	different individual legal entity, as evidenced by a change in
1637	federal employer identification number or taxpayer
1638	identification number; or
1639	(b)  An event in which 51 45 percent or more of the
1640	ownership, voting shares, membership, or controlling interest of
1641	a provider is in any manner transferred or otherwise assigned.
1642	This paragraph does not apply to a licensee that is publicly
1643	traded on a recognized stock exchange; or
1644	(c)  When the provider is licensed or registered by the
1645	agency, an event considered a change of ownership for licensure
1646	as defined in s. 408.803 in a corporation whose shares are not
1647	publicly traded on a recognized stock exchange is transferred or
1648	assigned, including the final transfer or assignment of multiple
1649	transfers or assignments over a 2-year period that cumulatively
1650	total 45 percent or more.
1651
1652	A change solely in the management company or board of directors
1653	is not a change of ownership.
1654	Section 34.  Section 429.071, Florida Statutes, is
1655	repealed.
1656	Section 35.  Paragraph (e) of subsection (1) and
1657	subsections (2) and (3) of section 429.08, Florida Statutes, are
1658	amended to read:
1659	429.08  Unlicensed facilities; referral of person for
1660	residency to unlicensed facility; penalties; verification of
1661	licensure status.--
1662	(1)
1663	(e)  The agency shall publish provide to the department's
1664	elder information and referral providers a list, by county, of
1665	licensed assisted living facilities, to assist persons who are
1666	considering an assisted living facility placement in locating a
1667	licensed facility. This information may be provided
1668	electronically or on the agency's Internet website.
1669	(2)  Each field office of the Agency for Health Care
1670	Administration shall establish a local coordinating workgroup
1671	which includes representatives of local law enforcement
1672	agencies, state attorneys, the Medicaid Fraud Control Unit of
1673	the Department of Legal Affairs, local fire authorities, the
1674	Department of Children and Family Services, the district long-
1675	term care ombudsman council, and the district human rights
1676	advocacy committee to assist in identifying the operation of
1677	unlicensed facilities and to develop and implement a plan to
1678	ensure effective enforcement of state laws relating to such
1679	facilities. The workgroup shall report its findings, actions,
1680	and recommendations semiannually to the Director of Health
1681	Quality Assurance of the agency.
1682	(2)(3)  It is unlawful to knowingly refer a person for
1683	residency to an unlicensed assisted living facility; to an
1684	assisted living facility the license of which is under denial or
1685	has been suspended or revoked; or to an assisted living facility
1686	that has a moratorium pursuant to part II of chapter 408. Any
1687	person who violates this subsection commits a noncriminal
1688	violation, punishable by a fine not exceeding $500 as provided
1689	in s. 775.083.
1690	(a)  Any health care practitioner, as defined in s.
1691	456.001, who is aware of the operation of an unlicensed facility
1692	shall report that facility to the agency. Failure to report a
1693	facility that the practitioner knows or has reasonable cause to
1694	suspect is unlicensed shall be reported to the practitioner's
1695	licensing board.
1696	(b)  Any provider as defined in s. 408.803 that hospital or
1697	community mental health center licensed under chapter 395 or
1698	chapter 394 which knowingly discharges a patient or client to an
1699	unlicensed facility is subject to sanction by the agency.
1700	(c)  Any employee of the agency or department, or the
1701	Department of Children and Family Services, who knowingly refers
1702	a person for residency to an unlicensed facility; to a facility
1703	the license of which is under denial or has been suspended or
1704	revoked; or to a facility that has a moratorium pursuant to part
1705	II of chapter 408 is subject to disciplinary action by the
1706	agency or department, or the Department of Children and Family
1707	Services.
1708	(d)  The employer of any person who is under contract with
1709	the agency or department, or the Department of Children and
1710	Family Services, and who knowingly refers a person for residency
1711	to an unlicensed facility; to a facility the license of which is
1712	under denial or has been suspended or revoked; or to a facility
1713	that has a moratorium pursuant to part II of chapter 408 shall
1714	be fined and required to prepare a corrective action plan
1715	designed to prevent such referrals.
1716	(e)  The agency shall provide the department and the
1717	Department of Children and Family Services with a list of
1718	licensed facilities within each county and shall update the list
1719	at least quarterly.
1720	(f)  At least annually, the agency shall notify, in
1721	appropriate trade publications, physicians licensed under
1722	chapter 458 or chapter 459, hospitals licensed under chapter
1723	395, nursing home facilities licensed under part II of chapter
1724	400, and employees of the agency or the department, or the
1725	Department of Children and Family Services, who are responsible
1726	for referring persons for residency, that it is unlawful to
1727	knowingly refer a person for residency to an unlicensed assisted
1728	living facility and shall notify them of the penalty for
1729	violating such prohibition. The department and the Department of
1730	Children and Family Services shall, in turn, notify service
1731	providers under contract to the respective departments who have
1732	responsibility for resident referrals to facilities. Further,
1733	the notice must direct each noticed facility and individual to
1734	contact the appropriate agency office in order to verify the
1735	licensure status of any facility prior to referring any person
1736	for residency. Each notice must include the name, telephone
1737	number, and mailing address of the appropriate office to
1738	contact.
1739	Section 36.  Paragraph (e) of subsection (1) of section
1740	429.14, Florida Statutes, is amended to read:
1741	429.14  Administrative penalties.--
1742	(1)  In addition to the requirements of part II of chapter
1743	408, the agency may deny, revoke, and suspend any license issued
1744	under this part and impose an administrative fine in the manner
1745	provided in chapter 120 against a licensee of an assisted living
1746	facility for a violation of any provision of this part, part II
1747	of chapter 408, or applicable rules, or for any of the following
1748	actions by a licensee of an assisted living facility, for the
1749	actions of any person subject to level 2 background screening
1750	under s. 408.809, or for the actions of any facility employee:
1751	(e)  A citation of any of the following deficiencies as
1752	specified defined in s. 429.19:
1753	1.  One or more cited class I deficiencies.
1754	2.  Three or more cited class II deficiencies.
1755	3.  Five or more cited class III deficiencies that have
1756	been cited on a single survey and have not been corrected within
1757	the times specified.
1758	Section 37.  Subsections (2), (8), and (9) of section
1759	429.19, Florida Statutes, are amended to read:
1760	429.19  Violations; imposition of administrative fines;
1761	grounds.--
1762	(2)  Each violation of this part and adopted rules shall be
1763	classified according to the nature of the violation and the
1764	gravity of its probable effect on facility residents. The agency
1765	shall indicate the classification on the written notice of the
1766	violation as follows:
1767	(a)  Class "I" violations are defined in s. 408.813 those
1768	conditions or occurrences related to the operation and
1769	maintenance of a facility or to the personal care of residents
1770	which the agency determines present an imminent danger to the
1771	residents or guests of the facility or a substantial probability
1772	that death or serious physical or emotional harm would result
1773	therefrom. The condition or practice constituting a class I
1774	violation shall be abated or eliminated within 24 hours, unless
1775	a fixed period, as determined by the agency, is required for
1776	correction. The agency shall impose an administrative fine for a
1777	cited class I violation in an amount not less than $5,000 and
1778	not exceeding $10,000 for each violation. A fine may be levied
1779	notwithstanding the correction of the violation.
1780	(b)  Class "II" violations are defined in s. 408.813 those
1781	conditions or occurrences related to the operation and
1782	maintenance of a facility or to the personal care of residents
1783	which the agency determines directly threaten the physical or
1784	emotional health, safety, or security of the facility residents,
1785	other than class I violations. The agency shall impose an
1786	administrative fine for a cited class II violation in an amount
1787	not less than $1,000 and not exceeding $5,000 for each
1788	violation. A fine shall be levied notwithstanding the correction
1789	of the violation.
1790	(c)  Class "III" violations are defined in s. 408.813 those
1791	conditions or occurrences related to the operation and
1792	maintenance of a facility or to the personal care of residents
1793	which the agency determines indirectly or potentially threaten
1794	the physical or emotional health, safety, or security of
1795	facility residents, other than class I or class II violations.
1796	The agency shall impose an administrative fine for a cited class
1797	III violation in an amount not less than $500 and not exceeding
1798	$1,000 for each violation. A citation for a class III violation
1799	must specify the time within which the violation is required to
1800	be corrected. If a class III violation is corrected within the
1801	time specified, no fine may be imposed, unless it is a repeated
1802	offense.
1803	(d)  Class "IV" violations are defined in s. 408.813 those
1804	conditions or occurrences related to the operation and
1805	maintenance of a building or to required reports, forms, or
1806	documents that do not have the potential of negatively affecting
1807	residents. These violations are of a type that the agency
1808	determines do not threaten the health, safety, or security of
1809	residents of the facility. The agency shall impose an
1810	administrative fine for a cited class IV violation in an amount
1811	not less than $100 and not exceeding $200 for each violation. A
1812	citation for a class IV violation must specify the time within
1813	which the violation is required to be corrected. If a class IV
1814	violation is corrected within the time specified, no fine shall
1815	be imposed. Any class IV violation that is corrected during the
1816	time an agency survey is being conducted will be identified as
1817	an agency finding and not as a violation.
1818	(8)  During an inspection, the agency, as an alternative to
1819	or in conjunction with an administrative action against a
1820	facility for violations of this part and adopted rules, shall
1821	make a reasonable attempt to discuss each violation and
1822	recommended corrective action with the owner or administrator of
1823	the facility, prior to written notification. The agency, instead
1824	of fixing a period within which the facility shall enter into
1825	compliance with standards, may request a plan of corrective
1826	action from the facility which demonstrates a good faith effort
1827	to remedy each violation by a specific date, subject to the
1828	approval of the agency.
1829	(9)  The agency shall develop and disseminate an annual
1830	list of all facilities sanctioned or fined $5,000 or more for
1831	violations of state standards, the number and class of
1832	violations involved, the penalties imposed, and the current
1833	status of cases. The list shall be disseminated, at no charge,
1834	to the Department of Elderly Affairs, the Department of Health,
1835	the Department of Children and Family Services, the Agency for
1836	Persons with Disabilities, the area agencies on aging, the
1837	Florida Statewide Advocacy Council, and the state and local
1838	ombudsman councils. The Department of Children and Family
1839	Services shall disseminate the list to service providers under
1840	contract to the department who are responsible for referring
1841	persons to a facility for residency. The agency may charge a fee
1842	commensurate with the cost of printing and postage to other
1843	interested parties requesting a copy of this list. This
1844	information may be provided electronically or on the agency's
1845	Internet website.
1846	Section 38.  Subsections (2) and (6) of section 429.23,
1847	Florida Statutes, are amended to read:
1848	429.23  Internal risk management and quality assurance
1849	program; adverse incidents and reporting requirements.--
1850	(2)  Every facility licensed under this part is required to
1851	maintain adverse incident reports. For purposes of this section,
1852	the term, "adverse incident" means:
1853	(a)  An event over which facility personnel could exercise
1854	control rather than as a result of the resident's condition and
1855	results in:
1856	1.  Death;
1857	2.  Brain or spinal damage;
1858	3.  Permanent disfigurement;
1859	4.  Fracture or dislocation of bones or joints;
1860	5.  Any condition that required medical attention to which
1861	the resident has not given his or her consent, including failure
1862	to honor advanced directives;
1863	6.  Any condition that requires the transfer of the
1864	resident from the facility to a unit providing more acute care
1865	due to the incident rather than the resident's condition before
1866	the incident; or.
1867	7.  An event that is reported to law enforcement or its
1868	personnel for investigation; or
1869	(b)  Abuse, neglect, or exploitation as defined in s.
1870	415.102;
1871	(c)  Events reported to law enforcement; or
1872	(b)(d)  Resident elopement, if the elopement places the
1873	resident at risk of harm or injury.
1874	(6)  Abuse, neglect, or exploitation must be reported to
1875	the Department of Children and Family Services as required under
1876	chapter 415. The agency shall annually submit to the Legislature
1877	a report on assisted living facility adverse incident reports.
1878	The report must include the following information arranged by
1879	county:
1880	(a)  A total number of adverse incidents;
1881	(b)  A listing, by category, of the type of adverse
1882	incidents occurring within each category and the type of staff
1883	involved;
1884	(c)  A listing, by category, of the types of injuries, if
1885	any, and the number of injuries occurring within each category;
1886	(d)  Types of liability claims filed based on an adverse
1887	incident report or reportable injury; and
1888	(e)  Disciplinary action taken against staff, categorized
1889	by the type of staff involved.
1890	Section 39.  Subsections (1) and (3) of section 430.80,
1891	Florida Statutes, are amended to read:
1892	430.80  Implementation of a teaching nursing home pilot
1893	project.--
1894	(1)  As used in this section, the term "teaching nursing
1895	home" means a nursing home facility licensed under chapter 400
1896	which contains a minimum of 275 400 licensed nursing home beds;
1897	has access to a resident senior population of sufficient size to
1898	support education, training, and research relating to geriatric
1899	care; and has a contractual relationship with a federally funded
1900	accredited geriatric research center in this state or operates
1901	in its own right a geriatric research center.
1902	(3)  To be designated as a teaching nursing home, a nursing
1903	home licensee must, at a minimum:
1904	(a)  Provide a comprehensive program of integrated senior
1905	services that include institutional services and community-based
1906	services;
1907	(b)  Participate in a nationally recognized accreditation
1908	program and hold a valid accreditation, such as the
1909	accreditation awarded by the Joint Commission on Accreditation
1910	of Healthcare Organizations, or possesses a Gold Seal Award as
1911	conferred by the state on the licensed nursing home;
1912	(c)  Have been in business in this state for a minimum of
1913	10 consecutive years;
1914	(d)  Demonstrate an active program in multidisciplinary
1915	education and research that relates to gerontology;
1916	(e)  Have a formalized contractual relationship with at
1917	least one accredited health profession education program located
1918	in this state;
1919	(f)  Have a formalized contractual relationship with an
1920	accredited hospital that is designated by law as a teaching
1921	hospital; and
1922	(f)(g)  Have senior staff members who hold formal faculty
1923	appointments at universities, which must include at least one
1924	accredited health profession education program; and.
1925	(g)(h)  Maintain insurance coverage pursuant to s.
1926	400.141(1)(s) s. 400.141(20) or proof of financial
1927	responsibility in a minimum amount of $750,000. Such proof of
1928	financial responsibility may include:
1929	1.  Maintaining an escrow account consisting of cash or
1930	assets eligible for deposit in accordance with s. 625.52; or
1931	2.  Obtaining and maintaining pursuant to chapter 675 an
1932	unexpired, irrevocable, nontransferable and nonassignable letter
1933	of credit issued by any bank or savings association organized
1934	and existing under the laws of this state or any bank or savings
1935	association organized under the laws of the United States that
1936	has its principal place of business in this state or has a
1937	branch office which is authorized to receive deposits in this
1938	state. The letter of credit shall be used to satisfy the
1939	obligation of the facility to the claimant upon presentment of a
1940	final judgment indicating liability and awarding damages to be
1941	paid by the facility or upon presentment of a settlement
1942	agreement signed by all parties to the agreement when such final
1943	judgment or settlement is a result of a liability claim against
1944	the facility.
1945	Section 40.  Subsection (5) of section 435.04, Florida
1946	Statutes, is amended to read:
1947	435.04  Level 2 screening standards.--
1948	(5)  Under penalty of perjury, all employees in such
1949	positions of trust or responsibility shall attest to meeting the
1950	requirements for qualifying for employment and agreeing to
1951	inform the employer immediately if convicted of any of the
1952	disqualifying offenses while employed by the employer. Each
1953	employer of employees in such positions of trust or
1954	responsibilities which is licensed or registered by a state
1955	agency shall submit to the licensing agency annually or at the
1956	time of license renewal, under penalty of perjury, an affidavit
1957	of compliance with the provisions of this section.
1958	Section 41.  Subsection (3) of section 435.05, Florida
1959	Statutes, is amended to read:
1960	435.05  Requirements for covered employees.--Except as
1961	otherwise provided by law, the following requirements shall
1962	apply to covered employees:
1963	(3)  Each employer required to conduct level 2 background
1964	screening must sign an affidavit annually or at the time of
1965	license renewal, under penalty of perjury, stating that all
1966	covered employees have been screened or are newly hired and are
1967	awaiting the results of the required screening checks.
1968	Section 42.  Subsection (2) of section 483.031, Florida
1969	Statutes, is amended to read:
1970	483.031  Application of part; exemptions.--This part
1971	applies to all clinical laboratories within this state, except:
1972	(2)  A clinical laboratory that performs only waived tests
1973	and has received a certificate of exemption from the agency
1974	under s. 483.106.
1975	Section 43.  Subsection (10) of section 483.041, Florida
1976	Statutes, is amended to read:
1977	483.041  Definitions.--As used in this part, the term:
1978	(10)  "Waived test" means a test that the federal Centers
1979	for Medicare and Medicaid Services Health Care Financing
1980	Administration has determined qualifies for a certificate of
1981	waiver under the federal Clinical Laboratory Improvement
1982	Amendments of 1988, and the federal rules adopted thereunder.
1983	Section 44.  Section 483.106, Florida Statutes, is
1984	repealed.
1985	Section 45.  Subsection (3) of section 483.172, Florida
1986	Statutes, is amended to read:
1987	483.172  License fees.--
1988	(3)  The agency shall assess a biennial fee of $100 for a
1989	certificate of exemption and a $100 biennial license fee under
1990	this section for facilities surveyed by an approved accrediting
1991	organization.
1992	Section 46.  Paragraph (b) of subsection (1) of section
1993	627.4239, Florida Statutes, is amended to read:
1994	627.4239  Coverage for use of drugs in treatment of
1995	cancer.--
1996	(1)  DEFINITIONS.--As used in this section, the term:
1997	(b)  "Standard reference compendium" means authoritative
1998	compendia identified by the Secretary of the United States
1999	Department of Health and Human Services and recognized by the
2000	federal Centers for Medicare and Medicaid Services:
2001	1.  The United States Pharmacopeia Drug Information;
2002	2.  The American Medical Association Drug Evaluations; or
2003	3.  The American Hospital Formulary Service Drug
2004	Information.
2005	Section 47.  Subsection (1) of section 651.105, Florida
2006	Statutes, is amended to read:
2007	651.105  Examination and inspections.--
2008	(1)  The office may at any time, and shall at least once
2009	every 5 3 years, examine the business of any applicant for a
2010	certificate of authority and any provider engaged in the
2011	execution of care contracts or engaged in the performance of
2012	obligations under such contracts, in the same manner as is
2013	provided for examination of insurance companies pursuant to s.
2014	624.316. Such examinations shall be made by a representative or
2015	examiner designated by the office, whose compensation will be
2016	fixed by the office pursuant to s. 624.320. Routine examinations
2017	may be made by having the necessary documents submitted to the
2018	office; and, for this purpose, financial documents and records
2019	conforming to commonly accepted accounting principles and
2020	practices, as required under s. 651.026, will be deemed
2021	adequate. The final written report of each such examination
2022	shall be filed with the office and, when so filed, will
2023	constitute a public record. Any provider being examined shall,
2024	upon request, give reasonable and timely access to all of its
2025	records. The representative or examiner designated by the office
2026	may at any time examine the records and affairs and inspect the
2027	physical property of any provider, whether in connection with a
2028	formal examination or not.
2029	Section 48.  Subsection (1) of section 641.407, Florida
2030	Statutes, is amended to read:
2031	641.407  Minimum surplus.--
2032	(1)  Each prepaid health clinic licensed on or before July
2033	1, 2009, shall have and maintain minimum surplus in accordance
2034	with the following schedule: On January 1, 2010, $225,000 1996,
2035	$150,000 or 10 percent of total liabilities, whichever is
2036	greater; and on January 1, 2011, $300,000 or 10 percent of total
2037	liabilities, whichever is greater. A prepaid health clinic
2038	licensed after July 1, 2009, shall have and maintain a surplus
2039	of $300,000 or 10 percent of total liabilities, whichever is
2040	greater. A prepaid health clinic licensed on or before January
2041	1, 2004, and that has an active membership on July 1, 2009,
2042	shall have and maintain a minimum surplus of $150,000 or 10
2043	percent of total liabilities, whichever is greater
2044	Section 49.  Subsection (13) of section 651.118, Florida
2045	Statutes, is amended to read:
2046	651.118  Agency for Health Care Administration;
2047	certificates of need; sheltered beds; community beds.--
2048	(13)  Residents, as defined in this chapter, are not
2049	considered new admissions for the purpose of s.
2050	400.141(1)(o)1.d.(15)(d).
2051	Section 50.  This act shall take effect upon becoming a
2052	law.

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