CS/HB 1143

1	A bill to be entitled
2	An act relating to the reduction and simplification of
3	health care provider regulation; amending s. 112.0455,
4	F.S., relating to the Drug-Free Workplace Act; deleting an
5	obsolete provision; amending s. 318.21, F.S.; revising
6	distribution of funds from civil penalties imposed for
7	traffic infractions by county courts; repealing s.
8	383.325, F.S., relating to confidentiality of inspection
9	reports of licensed birth center facilities; amending s.
10	395.002, F.S.; revising and deleting definitions
11	applicable to regulation of hospitals and other licensed
12	facilities; conforming a cross-reference; amending s.
13	395.003, F.S.; deleting an obsolete provision; conforming
14	a cross-reference; amending s. 395.0193, F.S.; requiring a
15	licensed facility to report certain peer review
16	information and final disciplinary actions to the Division
17	of Medical Quality Assurance of the Department of Health
18	rather than the Division of Health Quality Assurance of
19	the Agency for Health Care Administration; amending s.
20	395.1023, F.S.; providing for the Department of Children
21	and Family Services rather than the Department of Health
22	to perform certain functions with respect to child
23	protection cases; requiring certain hospitals to notify
24	the Department of Children and Family Services of
25	compliance; amending s. 395.1041, F.S., relating to
26	hospital emergency services and care; deleting obsolete
27	provisions; repealing s. 395.1046, F.S., relating to
28	complaint investigation procedures; amending s. 395.1055,
29	F.S.; requiring licensed facility beds to conform to
30	standards specified by the Agency for Health Care
31	Administration, the Florida Building Code, and the Florida
32	Fire Prevention Code; amending s. 395.10972, F.S.;
33	revising a reference to the Florida Society of Healthcare
34	Risk Management to conform to the current designation;
35	amending s. 395.2050, F.S.; revising a reference to the
36	federal Health Care Financing Administration to conform to
37	the current designation; amending s. 395.3036, F.S.;
38	correcting a reference; repealing s. 395.3037, F.S.,
39	relating to redundant definitions; amending ss. 154.11,
40	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
41	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
42	F.S.; revising references to the Joint Commission on
43	Accreditation of Healthcare Organizations, the Commission
44	on Accreditation of Rehabilitation Facilities, and the
45	Council on Accreditation to conform to their current
46	designations; amending s. 395.602, F.S.; revising the
47	definition of the term "rural hospital" to delete an
48	obsolete provision; amending s. 400.021, F.S.; revising
49	the definition of the term "geriatric outpatient clinic";
50	amending s. 400.063, F.S.; deleting an obsolete provision;
51	amending ss. 400.071 and 400.0712, F.S.; revising
52	applicability of general licensure requirements under pt.
53	II of ch. 408, F.S., to applications for nursing home
54	licensure; revising provisions governing inactive
55	licenses; amending s. 400.111, F.S.; providing for
56	disclosure of controlling interest of a nursing home
57	facility upon request by the Agency for Health Care
58	Administration; amending s. 400.1183, F.S.; revising
59	grievance record maintenance and reporting requirements
60	for nursing homes; amending s. 400.141, F.S.; providing
61	criteria for the provision of respite services by nursing
62	homes; requiring a written plan of care; requiring a
63	contract for services; requiring resident release to
64	caregivers to be designated in writing; providing an
65	exemption to the application of discharge planning rules;
66	providing for residents' rights; providing for use of
67	personal medications; providing terms of respite stay;
68	providing for communication of patient information;
69	requiring a physician order for care and proof of a
70	physical examination; providing for services for respite
71	patients and duties of facilities with respect to such
72	patients; conforming a cross-reference; requiring
73	facilities to maintain clinical records that meet
74	specified standards; providing a fine relating to an
75	admissions moratorium; deleting requirement for facilities
76	to submit certain information related to management
77	companies to the agency; deleting a requirement for
78	facilities to notify the agency of certain bankruptcy
79	filings to conform to changes made by the act; amending s.
80	400.142, F.S.; deleting language relating to agency
81	adoption of rules; amending 400.147, F.S.; revising
82	reporting requirements for licensed nursing home
83	facilities relating to adverse incidents; repealing s.
84	400.148, F.S., relating to the Medicaid "Up-or-Out"
85	Quality of Care Contract Management Program; amending s.
86	400.162, F.S., requiring nursing homes to provide a
87	resident property statement annually and upon request;
88	amending s. 400.179, F.S.; revising requirements for
89	nursing home lease bond alternative fees; deleting an
90	obsolete provision; amending s. 400.19, F.S.; revising
91	inspection requirements; repealing s. 400.195, F.S.,
92	relating to agency reporting requirements; amending s.
93	400.23, F.S.; deleting an obsolete provision; clarifying a
94	reference; amending s. 400.275, F.S.; revising agency
95	duties with regard to training nursing home surveyor
96	teams; revising requirements for team members; amending s.
97	400.484, F.S.; revising the schedule of home health agency
98	inspection violations; amending s. 400.606, F.S.; revising
99	the content requirements of the plan accompanying an
100	initial or change-of-ownership application for licensure
101	of a hospice; revising requirements relating to
102	certificates of need for certain hospice facilities;
103	amending s. 400.607, F.S.; revising grounds for agency
104	action against a hospice; amending s. 400.931, F.S.;
105	deleting a requirement that an applicant for a home
106	medical equipment provider license submit a surety bond to
107	the agency; amending s. 400.932, F.S.; revising grounds
108	for the imposition of administrative penalties for certain
109	violations by an employee of a home medical equipment
110	provider; amending s. 400.967, F.S.; revising the schedule
111	of inspection violations for intermediate care facilities
112	for the developmentally disabled; providing a penalty for
113	certain violations; amending s. 400.9905, F.S.; revising
114	definitions under the Health Care Clinic Act; amending s.
115	400.991, F.S.; conforming terminology; revising
116	application requirements relating to documentation of
117	financial ability to operate a mobile clinic; amending s.
118	408.034, F.S.; revising agency authority relating to
119	licensing of intermediate care facilities for the
120	developmentally disabled; amending s. 408.036, F.S.;
121	deleting an exemption from certain certificate-of-need
122	review requirements for a hospice or a hospice inpatient
123	facility; amending s. 408.043, F.S.; revising requirements
124	for certain freestanding inpatient hospice care facilities
125	to obtain a certificate of need; amending s. 408.061,
126	F.S.; revising health care facility data reporting
127	requirements; amending s. 408.10, F.S.; removing agency
128	authority to investigate certain consumer complaints;
129	amending s. 408.802, F.S.; removing applicability of pt.
130	II of ch. 408, F.S., relating to general licensure
131	requirements, to private review agents; amending s.
132	408.804, F.S.; providing penalties for altering, defacing,
133	or falsifying a license certificate issued by the agency
134	or displaying such an altered, defaced, or falsified
135	certificate; amending s. 408.806, F.S.; revising agency
136	responsibilities for notification of licensees of
137	impending expiration of a license; requiring payment of a
138	late fee for a license application to be considered
139	complete under certain circumstances; amending s. 408.810,
140	F.S.; revising provisions relating to information required
141	for licensure; requiring proof of submission of notice to
142	a mortgagor or landlord regarding provision of services
143	requiring licensure; requiring disclosure of information
144	by a controlling interest of certain court actions
145	relating to financial instability within a specified time
146	period; amending s. 408.813, F.S.; authorizing the agency
147	to impose fines for unclassified violations of pt. II of
148	ch. 408, F.S.; amending s. 408.815, F.S.; authorizing the
149	agency to extend a license expiration date under certain
150	circumstances; amending s. 409.221, F.S.; deleting a
151	reporting requirement relating to the consumer-directed
152	care program; amending s. 429.07, F.S.; deleting the
153	requirement for an assisted living facility to obtain an
154	additional license in order to provide limited nursing
155	services; deleting the requirement for the agency to
156	conduct quarterly monitoring visits of facilities that
157	hold a license to provide extended congregate care
158	services; deleting the requirement for the department to
159	report annually on the status of and recommendations
160	related to extended congregate care; deleting the
161	requirement for the agency to conduct monitoring visits at
162	least twice a year to facilities providing limited nursing
163	services; increasing the licensure fees and the maximum
164	fee required for the standard license; increasing the
165	licensure fees for the extended congregate care license;
166	eliminating the license fee for the limited nursing
167	services license; transferring from another provision of
168	law the requirement that a biennial survey of an assisted
169	living facility include specific actions to determine
170	whether the facility is adequately protecting residents'
171	rights; providing that an assisted living facility that
172	has a class I or class II violation is subject to
173	monitoring visits; requiring a registered nurse to
174	participate in certain monitoring visits; amending s.
175	429.11, F.S.; revising licensure application requirements
176	for assisted living facilities to eliminate provisional
177	licenses; amending s. 429.12, F.S.; revising notification
178	requirements for the sale or transfer of ownership of an
179	assisted living facility; amending s. 429.14, F.S.;
180	removing a ground for the imposition of an administrative
181	penalty; clarifying language relating to a facility's
182	request for a hearing under certain circumstances;
183	authorizing the agency to provide certain information
184	relating to the licensure status of assisted living
185	facilities electronically or through the agency's Internet
186	website; amending s. 429.17, F.S.; deleting provisions
187	relating to the limited nursing services license; revising
188	agency responsibilities regarding the issuance of
189	conditional licenses; amending s. 429.19, F.S.; clarifying
190	that a monitoring fee may be assessed in addition to an
191	administrative fine; amending s. 429.23, F.S.; deleting
192	reporting requirements for assisted living facilities
193	relating to liability claims; amending s. 429.255, F.S.;
194	eliminating provisions authorizing the use of volunteers
195	to provide certain health-care-related services in
196	assisted living facilities; authorizing assisted living
197	facilities to provide limited nursing services; requiring
198	an assisted living facility to be responsible for certain
199	recordkeeping and staff to be trained to monitor residents
200	receiving certain health-care-related services; amending
201	s. 429.28, F.S.; deleting a requirement for a biennial
202	survey of an assisted living facility, to conform to
203	changes made by the act; amending s. 429.35, F.S.;
204	authorizing the agency to provide certain information
205	relating to the inspections of assisted living facilities
206	electronically or through the agency's Internet website;
207	amending s. 429.41, F.S., relating to rulemaking;
208	conforming provisions to changes made by the act; amending
209	s. 429.53, F.S.; revising provisions relating to
210	consultation by the agency; revising a definition;
211	amending s. 429.54, F.S.; requiring licensed assisted
212	living facilities to electronically report certain data
213	semiannually to the agency in accordance with rules
214	adopted by the department; amending s. 429.71, F.S.;
215	revising schedule of inspection violations for adult
216	family-care homes; amending s. 429.911, F.S.; deleting a
217	ground for agency action against an adult day care center;
218	amending s. 429.915, F.S.; revising agency
219	responsibilities regarding the issuance of conditional
220	licenses; amending s. 483.294, F.S.; revising frequency of
221	agency inspections of multiphasic health testing centers;
222	amending ss. 394.4787, 400.0239, 408.07, 430.80, and
223	651.118, F.S.; conforming terminology and cross-
224	references; revising a reference; providing an effective
225	date.
226
227	Be It Enacted by the Legislature of the State of Florida:
228
229	Section 1.  Present paragraph (e) of subsection (10) and
230	paragraph (e) of subsection (14) of section 112.0455, Florida
231	Statutes, are amended, and paragraphs (f) through (k) of
232	subsection (10) of that section are redesignated as paragraphs
233	(e) through (j), respectively, to read:
234	112.0455  Drug-Free Workplace Act.-
235	(10)  EMPLOYER PROTECTION.-
236	(e)  Nothing in this section shall be construed to operate
237	retroactively, and nothing in this section shall abrogate the
238	right of an employer under state law to conduct drug tests prior
239	to January 1, 1990. A drug test conducted by an employer prior
240	to January 1, 1990, is not subject to this section.
241	(14)  DISCIPLINE REMEDIES.-
242	(e)  Upon resolving an appeal filed pursuant to paragraph
243	(c), and finding a violation of this section, the commission may
244	order the following relief:
245	1.  Rescind the disciplinary action, expunge related
246	records from the personnel file of the employee or job applicant
247	and reinstate the employee.
248	2.  Order compliance with paragraph (10)(f)(g).
249	3.  Award back pay and benefits.
250	4.  Award the prevailing employee or job applicant the
251	necessary costs of the appeal, reasonable attorney's fees, and
252	expert witness fees.
253	Section 2.  Paragraph (n) of subsection (1) of section
254	154.11, Florida Statutes, is amended to read:
255	154.11  Powers of board of trustees.-
256	(1)  The board of trustees of each public health trust
257	shall be deemed to exercise a public and essential governmental
258	function of both the state and the county and in furtherance
259	thereof it shall, subject to limitation by the governing body of
260	the county in which such board is located, have all of the
261	powers necessary or convenient to carry out the operation and
262	governance of designated health care facilities, including, but
263	without limiting the generality of, the foregoing:
264	(n)  To appoint originally the staff of physicians to
265	practice in any designated facility owned or operated by the
266	board and to approve the bylaws and rules to be adopted by the
267	medical staff of any designated facility owned and operated by
268	the board, such governing regulations to be in accordance with
269	the standards of The Joint Commission on the Accreditation of
270	Hospitals which provide, among other things, for the method of
271	appointing additional staff members and for the removal of staff
272	members.
273	Section 3.  Subsection (15) of section 318.21, Florida
274	Statutes, is amended to read:
275	318.21  Disposition of civil penalties by county courts.-
276	All civil penalties received by a county court pursuant to the
277	provisions of this chapter shall be distributed and paid monthly
278	as follows:
279	(15)  Of the additional fine assessed under s. 318.18(3)(e)
280	for a violation of s. 316.1893, 50 percent of the moneys
281	received from the fines shall be remitted to the Department of
282	Revenue and deposited into the Brain and Spinal Cord Injury
283	Trust Fund of Department of Health and shall be appropriated to
284	the Department of Health Agency for Health Care Administration
285	as general revenue to provide an enhanced Medicaid payment to
286	nursing homes that serve Medicaid recipients with spinal cord
287	injuries that are medically complex and who are technologically
288	and respiratory dependent with brain and spinal cord injuries.
289	The remaining 50 percent of the moneys received from the
290	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
291	the Department of Revenue and deposited into the Department of
292	Health Administrative Trust Fund to provide financial support to
293	certified trauma centers in the counties where enhanced penalty
294	zones are established to ensure the availability and
295	accessibility of trauma services. Funds deposited into the
296	Administrative Trust Fund under this subsection shall be
297	allocated as follows:
298	(a)  Fifty percent shall be allocated equally among all
299	Level I, Level II, and pediatric trauma centers in recognition
300	of readiness costs for maintaining trauma services.
301	(b)  Fifty percent shall be allocated among Level I, Level
302	II, and pediatric trauma centers based on each center's relative
303	volume of trauma cases as reported in the Department of Health
304	Trauma Registry.
305	Section 4.  Section 383.325, Florida Statutes, is repealed.
306	Section 5.  Subsection (2) of section 394.741, Florida
307	Statutes, is amended to read:
308	394.741  Accreditation requirements for providers of
309	behavioral health care services.-
310	(2)  Notwithstanding any provision of law to the contrary,
311	accreditation shall be accepted by the agency and department in
312	lieu of the agency's and department's facility licensure onsite
313	review requirements and shall be accepted as a substitute for
314	the department's administrative and program monitoring
315	requirements, except as required by subsections (3) and (4),
316	for:
317	(a)  Any organization from which the department purchases
318	behavioral health care services that is accredited by The Joint
319	Commission on Accreditation of Healthcare Organizations or the
320	Council on Accreditation for Children and Family Services, or
321	has those services that are being purchased by the department
322	accredited by the Commission on Accreditation of Rehabilitation
323	Facilities CARF-the Rehabilitation Accreditation Commission.
324	(b)  Any mental health facility licensed by the agency or
325	any substance abuse component licensed by the department that is
326	accredited by The Joint Commission on Accreditation of
327	Healthcare Organizations, the Commission on Accreditation of
328	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
329	Commission, or the Council on Accreditation of Children and
330	Family Services.
331	(c)  Any network of providers from which the department or
332	the agency purchases behavioral health care services accredited
333	by The Joint Commission on Accreditation of Healthcare
334	Organizations, the Commission on Accreditation of Rehabilitation
335	Facilities CARF-the Rehabilitation Accreditation Commission, the
336	Council on Accreditation of Children and Family
337	National Committee for Quality Assurance. A provider
338	organization, which is part of an accredited network, is
339	afforded the same rights under this part.
340	Section 6.  Present subsections (15) through (32) of
341	section 395.002, Florida Statutes, are renumbered as subsections
342	(14) through (28), respectively, and present subsections (1),
343	(14), (24), (30), and (31), and paragraph (c) of present
344	subsection (28) of that section are amended to read:
345	395.002  Definitions.-As used in this chapter:
346	(1)  "Accrediting organizations" means nationally
347	recognized or approved accrediting organizations whose standards
348	incorporate comparable licensure requirements as determined by
349	the agency the Joint Commission on Accreditation of Healthcare
350	Organizations, the American Osteopathic Association, the
351	Commission on Accreditation of Rehabilitation Facilities, and
352	the Accreditation Association for Ambulatory Health Care, Inc.
353	(14)  "Initial denial determination" means a determination
354	by a private review agent that the health care services
355	furnished or proposed to be furnished to a patient are
356	inappropriate, not medically necessary, or not reasonable.
357	(24)  "Private review agent" means any person or entity
358	which performs utilization review services for third-party
359	payors on a contractual basis for outpatient or inpatient
360	services. However, the term shall not include full-time
361	employees, personnel, or staff of health insurers, health
362	maintenance organizations, or hospitals, or wholly owned
363	subsidiaries thereof or affiliates under common ownership, when
364	performing utilization review for their respective hospitals,
365	health maintenance organizations, or insureds of the same
366	insurance group. For this purpose, health insurers, health
367	maintenance organizations, and hospitals, or wholly owned
368	subsidiaries thereof or affiliates under common ownership,
369	include such entities engaged as administrators of self-
370	insurance as defined in s. 624.031.
371	(26)(28)  "Specialty hospital" means any facility which
372	meets the provisions of subsection (12), and which regularly
373	makes available either:
374	(c)  Intensive residential treatment programs for children
375	and adolescents as defined in subsection (14) (15).
376	(30)  "Utilization review" means a system for reviewing the
377	medical necessity or appropriateness in the allocation of health
378	care resources of hospital services given or proposed to be
379	given to a patient or group of patients.
380	(31)  "Utilization review plan" means a description of the
381	policies and procedures governing utilization review activities
382	performed by a private review agent.
383	Section 7.  Paragraph (c) of subsection (1) and paragraph
384	(b) of subsection (2) of section 395.003, Florida Statutes, are
385	amended to read:
386	395.003  Licensure; denial, suspension, and revocation.-
387	(1)
388	(c)  Until July 1, 2006, additional emergency departments
389	located off the premises of licensed hospitals may not be
390	authorized by the agency.
391	(2)
392	(b)  The agency shall, at the request of a licensee that is
393	a teaching hospital as defined in s. 408.07(45), issue a single
394	license to a licensee for facilities that have been previously
395	licensed as separate premises, provided such separately licensed
396	facilities, taken together, constitute the same premises as
397	defined in s. 395.002(22)(23). Such license for the single
398	premises shall include all of the beds, services, and programs
399	that were previously included on the licenses for the separate
400	premises. The granting of a single license under this paragraph
401	shall not in any manner reduce the number of beds, services, or
402	programs operated by the licensee.
403	Section 8.  Paragraph (e) of subsection (2) and subsection
404	(4) of section 395.0193, Florida Statutes, are amended to read:
405	395.0193  Licensed facilities; peer review; disciplinary
406	powers; agency or partnership with physicians.-
407	(2)  Each licensed facility, as a condition of licensure,
408	shall provide for peer review of physicians who deliver health
409	care services at the facility. Each licensed facility shall
410	develop written, binding procedures by which such peer review
411	shall be conducted. Such procedures shall include:
412	(e)  Recording of agendas and minutes which do not contain
413	confidential material, for review by the Division of Medical
414	Quality Assurance of the department Health Quality Assurance of
415	the agency.
416	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
417	actions taken under subsection (3) shall be reported in writing
418	to the Division of Medical Quality Assurance of the department
419	Health Quality Assurance of the agency within 30 working days
420	after its initial occurrence, regardless of the pendency of
421	appeals to the governing board of the hospital. The notification
422	shall identify the disciplined practitioner, the action taken,
423	and the reason for such action. All final disciplinary actions
424	taken under subsection (3), if different from those which were
425	reported to the department agency within 30 days after the
426	initial occurrence, shall be reported within 10 working days to
427	the Division of Medical Quality Assurance of the department
428	Health Quality Assurance of the agency in writing and shall
429	specify the disciplinary action taken and the specific grounds
430	therefor. The division shall review each report and determine
431	whether it potentially involved conduct by the licensee that is
432	subject to disciplinary action, in which case s. 456.073 shall
433	apply. The reports are not subject to inspection under s.
434	119.07(1) even if the division's investigation results in a
435	finding of probable cause.
436	Section 9.  Section 395.1023, Florida Statutes, is amended
437	to read:
438	395.1023  Child abuse and neglect cases; duties.-Each
439	licensed facility shall adopt a protocol that, at a minimum,
440	requires the facility to:
441	(1)  Incorporate a facility policy that every staff member
442	has an affirmative duty to report, pursuant to chapter 39, any
443	actual or suspected case of child abuse, abandonment, or
444	neglect; and
445	(2)  In any case involving suspected child abuse,
446	abandonment, or neglect, designate, at the request of the
447	Department of Children and Family Services, a staff physician to
448	act as a liaison between the hospital and the Department of
449	Children and Family Services office which is investigating the
450	suspected abuse, abandonment, or neglect, and the child
451	protection team, as defined in s. 39.01, when the case is
452	referred to such a team.
453
454	Each general hospital and appropriate specialty hospital shall
455	comply with the provisions of this section and shall notify the
456	agency and the Department of Children and Family Services of its
457	compliance by sending a copy of its policy to the agency and the
458	Department of Children and Family Services as required by rule.
459	The failure by a general hospital or appropriate specialty
460	hospital to comply shall be punished by a fine not exceeding
461	$1,000, to be fixed, imposed, and collected by the agency. Each
462	day in violation is considered a separate offense.
463	Section 10.  Subsection (2) and paragraph (d) of subsection
464	(3) of section 395.1041, Florida Statutes, are amended to read:
465	395.1041  Access to emergency services and care.-
466	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
467	shall establish and maintain an inventory of hospitals with
468	emergency services. The inventory shall list all services within
469	the service capability of the hospital, and such services shall
470	appear on the face of the hospital license. Each hospital having
471	emergency services shall notify the agency of its service
472	capability in the manner and form prescribed by the agency. The
473	agency shall use the inventory to assist emergency medical
474	services providers and others in locating appropriate emergency
475	medical care. The inventory shall also be made available to the
476	general public. On or before August 1, 1992, the agency shall
477	request that each hospital identify the services which are
478	within its service capability. On or before November 1, 1992,
479	the agency shall notify each hospital of the service capability
480	to be included in the inventory. The hospital has 15 days from
481	the date of receipt to respond to the notice. By December 1,
482	1992, the agency shall publish a final inventory. Each hospital
483	shall reaffirm its service capability when its license is
484	renewed and shall notify the agency of the addition of a new
485	service or the termination of a service prior to a change in its
486	service capability.
487	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
488	FACILITY OR HEALTH CARE PERSONNEL.-
489	(d)1.  Every hospital shall ensure the provision of
490	services within the service capability of the hospital, at all
491	times, either directly or indirectly through an arrangement with
492	another hospital, through an arrangement with one or more
493	physicians, or as otherwise made through prior arrangements. A
494	hospital may enter into an agreement with another hospital for
495	purposes of meeting its service capability requirement, and
496	appropriate compensation or other reasonable conditions may be
497	negotiated for these backup services.
498	2.  If any arrangement requires the provision of emergency
499	medical transportation, such arrangement must be made in
500	consultation with the applicable provider and may not require
501	the emergency medical service provider to provide transportation
502	that is outside the routine service area of that provider or in
503	a manner that impairs the ability of the emergency medical
504	service provider to timely respond to prehospital emergency
505	calls.
506	3.  A hospital shall not be required to ensure service
507	capability at all times as required in subparagraph 1. if, prior
508	to the receiving of any patient needing such service capability,
509	such hospital has demonstrated to the agency that it lacks the
510	ability to ensure such capability and it has exhausted all
511	reasonable efforts to ensure such capability through backup
512	arrangements. In reviewing a hospital's demonstration of lack of
513	ability to ensure service capability, the agency shall consider
514	factors relevant to the particular case, including the
515	following:
516	a.  Number and proximity of hospitals with the same service
517	capability.
518	b.  Number, type, credentials, and privileges of
519	specialists.
520	c.  Frequency of procedures.
521	d.  Size of hospital.
522	4.  The agency shall publish proposed rules implementing a
523	reasonable exemption procedure by November 1, 1992. Subparagraph
524	1. shall become effective upon the effective date of said rules
525	or January 31, 1993, whichever is earlier. For a period not to
526	exceed 1 year from the effective date of subparagraph 1., a
527	hospital requesting an exemption shall be deemed to be exempt
528	from offering the service until the agency initially acts to
529	deny or grant the original request. The agency has 45 days from
530	the date of receipt of the request to approve or deny the
531	request. After the first year from the effective date of
532	subparagraph 1., If the agency fails to initially act within the
533	time period, the hospital is deemed to be exempt from offering
534	the service until the agency initially acts to deny the request.
535	Section 11.  Section 395.1046, Florida Statutes, is
536	repealed.
537	Section 12.  Paragraph (e) of subsection (1) of section
538	395.1055, Florida Statutes, is amended to read:
539	395.1055  Rules and enforcement.-
540	(1)  The agency shall adopt rules pursuant to ss.
541	120.536(1) and 120.54 to implement the provisions of this part,
542	which shall include reasonable and fair minimum standards for
543	ensuring that:
544	(e)  Licensed facility beds conform to minimum space,
545	equipment, and furnishings standards as specified by the agency,
546	the Florida Building Code, and the Florida Fire Prevention Code
547	department.
548	Section 13.  Subsection (1) of section 395.10972, Florida
549	Statutes, is amended to read:
550	395.10972  Health Care Risk Manager Advisory Council.-The
551	Secretary of Health Care Administration may appoint a seven-
552	member advisory council to advise the agency on matters
553	pertaining to health care risk managers. The members of the
554	council shall serve at the pleasure of the secretary. The
555	council shall designate a chair. The council shall meet at the
556	call of the secretary or at those times as may be required by
557	rule of the agency. The members of the advisory council shall
558	receive no compensation for their services, but shall be
559	reimbursed for travel expenses as provided in s. 112.061. The
560	council shall consist of individuals representing the following
561	areas:
562	(1)  Two shall be active health care risk managers,
563	including one risk manager who is recommended by and a member of
564	the Florida Society for of Healthcare Risk Management and
565	Patient Safety.
566	Section 14.  Subsection (3) of section 395.2050, Florida
567	Statutes, is amended to read:
568	395.2050  Routine inquiry for organ and tissue donation;
569	certification for procurement activities; death records review.-
570	(3)  Each organ procurement organization designated by the
571	federal Centers for Medicare and Medicaid Services Health Care
572	Financing Administration and licensed by the state shall conduct
573	an annual death records review in the organ procurement
574	organization's affiliated donor hospitals. The organ procurement
575	organization shall enlist the services of every Florida licensed
576	tissue bank and eye bank affiliated with or providing service to
577	the donor hospital and operating in the same service area to
578	participate in the death records review.
579	Section 15.  Subsection (2) of section 395.3036, Florida
580	Statutes, is amended to read:
581	395.3036  Confidentiality of records and meetings of
582	corporations that lease public hospitals or other public health
583	care facilities.-The records of a private corporation that
584	leases a public hospital or other public health care facility
585	are confidential and exempt from the provisions of s. 119.07(1)
586	and s. 24(a), Art. I of the State Constitution, and the meetings
587	of the governing board of a private corporation are exempt from
588	s. 286.011 and s. 24(b), Art. I of the State Constitution when
589	the public lessor complies with the public finance
590	accountability provisions of s. 155.40(5) with respect to the
591	transfer of any public funds to the private lessee and when the
592	private lessee meets at least three of the five following
593	criteria:
594	(2)  The public lessor and the private lessee do not
595	commingle any of their funds in any account maintained by either
596	of them, other than the payment of the rent and administrative
597	fees or the transfer of funds pursuant to s. 155.40(2)
598	subsection (2).
599	Section 16.  Section 395.3037, Florida Statutes, is
600	repealed.
601	Section 17.  Subsections (1), (4), and (5) of section
602	395.3038, Florida Statutes, are amended to read:
603	395.3038  State-listed primary stroke centers and
604	comprehensive stroke centers; notification of hospitals.-
605	(1)  The agency shall make available on its website and to
606	the department a list of the name and address of each hospital
607	that meets the criteria for a primary stroke center and the name
608	and address of each hospital that meets the criteria for a
609	comprehensive stroke center. The list of primary and
610	comprehensive stroke centers shall include only those hospitals
611	that attest in an affidavit submitted to the agency that the
612	hospital meets the named criteria, or those hospitals that
613	attest in an affidavit submitted to the agency that the hospital
614	is certified as a primary or a comprehensive stroke center by
615	The Joint Commission on Accreditation of Healthcare
616	Organizations.
617	(4)  The agency shall adopt by rule criteria for a primary
618	stroke center which are substantially similar to the
619	certification standards for primary stroke centers of The Joint
620	Commission on Accreditation of Healthcare Organizations.
621	(5)  The agency shall adopt by rule criteria for a
622	comprehensive stroke center. However, if The Joint Commission on
623	Accreditation of Healthcare Organizations establishes criteria
624	for a comprehensive stroke center, the agency shall establish
625	criteria for a comprehensive stroke center which are
626	substantially similar to those criteria established by The Joint
627	Commission on Accreditation of Healthcare Organizations.
628	Section 18.  Paragraph (e) of subsection (2) of section
629	395.602, Florida Statutes, is amended to read:
630	395.602  Rural hospitals.-
631	(2)  DEFINITIONS.-As used in this part:
632	(e)  "Rural hospital" means an acute care hospital licensed
633	under this chapter, having 100 or fewer licensed beds and an
634	emergency room, which is:
635	1.  The sole provider within a county with a population
636	density of no greater than 100 persons per square mile;
637	2.  An acute care hospital, in a county with a population
638	density of no greater than 100 persons per square mile, which is
639	at least 30 minutes of travel time, on normally traveled roads
640	under normal traffic conditions, from any other acute care
641	hospital within the same county;
642	3.  A hospital supported by a tax district or subdistrict
643	whose boundaries encompass a population of 100 persons or fewer
644	per square mile;
645	4.  A hospital in a constitutional charter county with a
646	population of over 1 million persons that has imposed a local
647	option health service tax pursuant to law and in an area that
648	was directly impacted by a catastrophic event on August 24,
649	1992, for which the Governor of Florida declared a state of
650	emergency pursuant to chapter 125, and has 120 beds or less that
651	serves an agricultural community with an emergency room
652	utilization of no less than 20,000 visits and a Medicaid
653	inpatient utilization rate greater than 15 percent;
654	4.5.  A hospital with a service area that has a population
655	of 100 persons or fewer per square mile. As used in this
656	subparagraph, the term "service area" means the fewest number of
657	zip codes that account for 75 percent of the hospital's
658	discharges for the most recent 5-year period, based on
659	information available from the hospital inpatient discharge
660	database in the Florida Center for Health Information and Policy
661	Analysis at the Agency for Health Care Administration; or
662	5.6.  A hospital designated as a critical access hospital,
663	as defined in s. 408.07(15).
664
665	Population densities used in this paragraph must be based upon
666	the most recently completed United States census. A hospital
667	that received funds under s. 409.9116 for a quarter beginning no
668	later than July 1, 2002, is deemed to have been and shall
669	continue to be a rural hospital from that date through June 30,
670	2015, if the hospital continues to have 100 or fewer licensed
671	beds and an emergency room, or meets the criteria of
672	subparagraph 4. An acute care hospital that has not previously
673	been designated as a rural hospital and that meets the criteria
674	of this paragraph shall be granted such designation upon
675	application, including supporting documentation to the Agency
676	for Health Care Administration.
677	Section 19.  Subsection (8) of section 400.021, Florida
678	Statutes, is amended to read:
679	400.021  Definitions.-When used in this part, unless the
680	context otherwise requires, the term:
681	(8)  "Geriatric outpatient clinic" means a site for
682	providing outpatient health care to persons 60 years of age or
683	older, which is staffed by a registered nurse or a physician
684	assistant, or a licensed practical nurse under the direct
685	supervision of a registered nurse, advanced registered nurse
686	practitioner, or physician assistant.
687	Section 20.  Subsection (2) of section 400.063, Florida
688	Statutes, is amended to read:
689	400.063  Resident protection.-
690	(2)  The agency is authorized to establish for each
691	facility, subject to intervention by the agency, a separate bank
692	account for the deposit to the credit of the agency of any
693	moneys received from the Health Care Trust Fund or any other
694	moneys received for the maintenance and care of residents in the
695	facility, and the agency is authorized to disburse moneys from
696	such account to pay obligations incurred for the purposes of
697	this section. The agency is authorized to requisition moneys
698	from the Health Care Trust Fund in advance of an actual need for
699	cash on the basis of an estimate by the agency of moneys to be
700	spent under the authority of this section. Any bank account
701	established under this section need not be approved in advance
702	of its creation as required by s. 17.58, but shall be secured by
703	depository insurance equal to or greater than the balance of
704	such account or by the pledge of collateral security in
705	conformance with criteria established in s. 18.11. The agency
706	shall notify the Chief Financial Officer of any such account so
707	established and shall make a quarterly accounting to the Chief
708	Financial Officer for all moneys deposited in such account.
709	Section 21.  Subsections (1) and (5) of section 400.071,
710	Florida Statutes, are amended to read:
711	400.071  Application for license.-
712	(1)  In addition to the requirements of part II of chapter
713	408, the application for a license shall be under oath and must
714	contain the following:
715	(a)  The location of the facility for which a license is
716	sought and an indication, as in the original application, that
717	such location conforms to the local zoning ordinances.
718	(b)  A signed affidavit disclosing any financial or
719	ownership interest that a controlling interest as defined in
720	part II of chapter 408 has held in the last 5 years in any
721	entity licensed by this state or any other state to provide
722	health or residential care which has closed voluntarily or
723	involuntarily; has filed for bankruptcy; has had a receiver
724	appointed; has had a license denied, suspended, or revoked; or
725	has had an injunction issued against it which was initiated by a
726	regulatory agency. The affidavit must disclose the reason any
727	such entity was closed, whether voluntarily or involuntarily.
728	(c)  The total number of beds and the total number of
729	Medicare and Medicaid certified beds.
730	(b)(d)  Information relating to the applicant and employees
731	which the agency requires by rule. The applicant must
732	demonstrate that sufficient numbers of qualified staff, by
733	training or experience, will be employed to properly care for
734	the type and number of residents who will reside in the
735	facility.
736	(c)(e)  Copies of any civil verdict or judgment involving
737	the applicant rendered within the 10 years preceding the
738	application, relating to medical negligence, violation of
739	residents' rights, or wrongful death. As a condition of
740	licensure, the licensee agrees to provide to the agency copies
741	of any new verdict or judgment involving the applicant, relating
742	to such matters, within 30 days after filing with the clerk of
743	the court. The information required in this paragraph shall be
744	maintained in the facility's licensure file and in an agency
745	database which is available as a public record.
746	(5)  As a condition of licensure, each facility must
747	establish and submit with its application a plan for quality
748	assurance and for conducting risk management.
749	Section 22.  Section 400.0712, Florida Statutes, is amended
750	to read:
751	400.0712  Application for inactive license.-
752	(1)  As specified in this section, the agency may issue an
753	inactive license to a nursing home facility for all or a portion
754	of its beds. Any request by a licensee that a nursing home or
755	portion of a nursing home become inactive must be submitted to
756	the agency in the approved format. The facility may not initiate
757	any suspension of services, notify residents, or initiate
758	inactivity before receiving approval from the agency; and a
759	licensee that violates this provision may not be issued an
760	inactive license.
761	(1)(2)  In addition to the powers granted under part II of
762	chapter 408, the agency may issue an inactive license to a
763	nursing home that chooses to use an unoccupied contiguous
764	portion of the facility for an alternative use to meet the needs
765	of elderly persons through the use of less restrictive, less
766	institutional services.
767	(a)  An inactive license issued under this subsection may
768	be granted for a period not to exceed the current licensure
769	expiration date but may be renewed by the agency at the time of
770	licensure renewal.
771	(b)  A request to extend the inactive license must be
772	submitted to the agency in the approved format and approved by
773	the agency in writing.
774	(c)  Nursing homes that receive an inactive license to
775	provide alternative services shall not receive preference for
776	participation in the Assisted Living for the Elderly Medicaid
777	waiver.
778	(2)(3)  The agency shall adopt rules pursuant to ss.
779	120.536(1) and 120.54 necessary to implement this section.
780	Section 23.  Section 400.111, Florida Statutes, is amended
781	to read:
782	400.111  Disclosure of controlling interest.-In addition to
783	the requirements of part II of chapter 408, when requested by
784	the agency, the licensee shall submit a signed affidavit
785	disclosing any financial or ownership interest that a
786	controlling interest has held within the last 5 years in any
787	entity licensed by the state or any other state to provide
788	health or residential care which entity has closed voluntarily
789	or involuntarily; has filed for bankruptcy; has had a receiver
790	appointed; has had a license denied, suspended, or revoked; or
791	has had an injunction issued against it which was initiated by a
792	regulatory agency. The affidavit must disclose the reason such
793	entity was closed, whether voluntarily or involuntarily.
794	Section 24.  Subsection (2) of section 400.1183, Florida
795	Statutes, is amended to read:
796	400.1183  Resident grievance procedures.-
797	(2)  Each facility shall maintain records of all grievances
798	for agency inspection and shall report to the agency at the time
799	of relicensure the total number of grievances handled during the
800	prior licensure period, a categorization of the cases underlying
801	the grievances, and the final disposition of the grievances.
802	Section 25.  Paragraphs (o) through (w) of subsection (1)
803	of section 400.141, Florida Statutes, are redesignated as
804	paragraphs (n) through (u), respectively, and present paragraphs
805	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
806	to read:
807	400.141  Administration and management of nursing home
808	facilities.-
809	(1)  Every licensed facility shall comply with all
810	applicable standards and rules of the agency and shall:
811	(f)  Be allowed and encouraged by the agency to provide
812	other needed services under certain conditions. If the facility
813	has a standard licensure status, and has had no class I or class
814	II deficiencies during the past 2 years or has been awarded a
815	Gold Seal under the program established in s. 400.235, it may be
816	encouraged by the agency to provide services, including, but not
817	limited to, respite and adult day services, which enable
818	individuals to move in and out of the facility. A facility is
819	not subject to any additional licensure requirements for
820	providing these services.
821	1.  Respite care may be offered to persons in need of
822	short-term or temporary nursing home services. For each person
823	admitted under the respite care program, the facility licensee
824	must:
825	a.  Have a written abbreviated plan of care that, at a
826	minimum, includes nutritional requirements, medication orders,
827	physician orders, nursing assessments, and dietary preferences.
828	The nursing or physician assessments may take the place of all
829	other assessments required for full-time residents.
830	b.  Have a contract that, at a minimum, specifies the
831	services to be provided to the respite resident, including
832	charges for services, activities, equipment, emergency medical
833	services, and the administration of medications. If multiple
834	respite admissions for a single person are anticipated, the
835	original contract is valid for 1 year after the date of
836	execution.
837	c.  Ensure that each resident is released to his or her
838	caregiver or an individual designated in writing by the
839	caregiver.
840	2.  A person admitted under the respite care program is:
841	a.  Exempt from requirements in rule related to discharge
842	planning.
843	b.  Covered by the resident's rights set forth in s.
844	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
845	shall not be considered trust funds subject to the requirements
846	of s. 400.022(1)(h) until the resident has been in the facility
847	for more than 14 consecutive days.
848	c.  Allowed to use his or her personal medications for the
849	respite stay if permitted by facility policy. The facility must
850	obtain a physician's orders for the medications. The caregiver
851	may provide information regarding the medications as part of the
852	nursing assessment, which must agree with the physician's
853	orders. Medications shall be released with the resident upon
854	discharge in accordance with current orders.
855	3.  A person receiving respite care is entitled to a total
856	of 60 days in the facility within a contract year or a calendar
857	year if the contract is for less than 12 months. However, each
858	single stay may not exceed 14 days. If a stay exceeds 14
859	consecutive days, the facility must comply with all assessment
860	and care planning requirements applicable to nursing home
861	residents.
862	4.  A person receiving respite care must reside in a
863	licensed nursing home bed.
864	5.  A prospective respite resident must provide medical
865	information from a physician, a physician assistant, or a nurse
866	practitioner and other information from the primary caregiver as
867	may be required by the facility prior to or at the time of
868	admission to receive respite care. The medical information must
869	include a physician's order for respite care and proof of a
870	physical examination by a licensed physician, physician
871	assistant, or nurse practitioner. The physician's order and
872	physical examination may be used to provide intermittent respite
873	care for up to 12 months after the date the order is written.
874	6.  The facility must assume the duties of the primary
875	caregiver. To ensure continuity of care and services, the
876	resident is entitled to retain his or her personal physician and
877	must have access to medically necessary services such as
878	physical therapy, occupational therapy, or speech therapy, as
879	needed. The facility must arrange for transportation to these
880	services if necessary. Respite care must be provided in
881	accordance with this part and rules adopted by the agency.
882	However, the agency shall, by rule, adopt modified requirements
883	for resident assessment, resident care plans, resident
884	contracts, physician orders, and other provisions, as
885	appropriate, for short-term or temporary nursing home services.
886	7.  The agency shall allow for shared programming and staff
887	in a facility which meets minimum standards and offers services
888	pursuant to this paragraph, but, if the facility is cited for
889	deficiencies in patient care, may require additional staff and
890	programs appropriate to the needs of service recipients. A
891	person who receives respite care may not be counted as a
892	resident of the facility for purposes of the facility's licensed
893	capacity unless that person receives 24-hour respite care. A
894	person receiving either respite care for 24 hours or longer or
895	adult day services must be included when calculating minimum
896	staffing for the facility. Any costs and revenues generated by a
897	nursing home facility from nonresidential programs or services
898	shall be excluded from the calculations of Medicaid per diems
899	for nursing home institutional care reimbursement.
900	(g)  If the facility has a standard license or is a Gold
901	Seal facility, exceeds the minimum required hours of licensed
902	nursing and certified nursing assistant direct care per resident
903	per day, and is part of a continuing care facility licensed
904	under chapter 651 or a retirement community that offers other
905	services pursuant to part III of this chapter or part I or part
906	III of chapter 429 on a single campus, be allowed to share
907	programming and staff. At the time of inspection and in the
908	semiannual report required pursuant to paragraph (n) (o), a
909	continuing care facility or retirement community that uses this
910	option must demonstrate through staffing records that minimum
911	staffing requirements for the facility were met. Licensed nurses
912	and certified nursing assistants who work in the nursing home
913	facility may be used to provide services elsewhere on campus if
914	the facility exceeds the minimum number of direct care hours
915	required per resident per day and the total number of residents
916	receiving direct care services from a licensed nurse or a
917	certified nursing assistant does not cause the facility to
918	violate the staffing ratios required under s. 400.23(3)(a).
919	Compliance with the minimum staffing ratios shall be based on
920	total number of residents receiving direct care services,
921	regardless of where they reside on campus. If the facility
922	receives a conditional license, it may not share staff until the
923	conditional license status ends. This paragraph does not
924	restrict the agency's authority under federal or state law to
925	require additional staff if a facility is cited for deficiencies
926	in care which are caused by an insufficient number of certified
927	nursing assistants or licensed nurses. The agency may adopt
928	rules for the documentation necessary to determine compliance
929	with this provision.
930	(j)  Keep full records of resident admissions and
931	discharges; medical and general health status, including medical
932	records, personal and social history, and identity and address
933	of next of kin or other persons who may have responsibility for
934	the affairs of the residents; and individual resident care plans
935	including, but not limited to, prescribed services, service
936	frequency and duration, and service goals. The records shall be
937	open to inspection by the agency. The facility must maintain
938	clinical records on each resident in accordance with accepted
939	professional standards and practices that are complete,
940	accurately documented, readily accessible, and systematically
941	organized.
942	(n)  Submit to the agency the information specified in s.
943	400.071(1)(b) for a management company within 30 days after the
944	effective date of the management agreement.
945	(n)(o)1.  Submit semiannually to the agency, or more
946	frequently if requested by the agency, information regarding
947	facility staff-to-resident ratios, staff turnover, and staff
948	stability, including information regarding certified nursing
949	assistants, licensed nurses, the director of nursing, and the
950	facility administrator. For purposes of this reporting:
951	a.  Staff-to-resident ratios must be reported in the
952	categories specified in s. 400.23(3)(a) and applicable rules.
953	The ratio must be reported as an average for the most recent
954	calendar quarter.
955	b.  Staff turnover must be reported for the most recent 12-
956	month period ending on the last workday of the most recent
957	calendar quarter prior to the date the information is submitted.
958	The turnover rate must be computed quarterly, with the annual
959	rate being the cumulative sum of the quarterly rates. The
960	turnover rate is the total number of terminations or separations
961	experienced during the quarter, excluding any employee
962	terminated during a probationary period of 3 months or less,
963	divided by the total number of staff employed at the end of the
964	period for which the rate is computed, and expressed as a
965	percentage.
966	c.  The formula for determining staff stability is the
967	total number of employees that have been employed for more than
968	12 months, divided by the total number of employees employed at
969	the end of the most recent calendar quarter, and expressed as a
970	percentage.
971	d.  A nursing facility that has failed to comply with state
972	minimum-staffing requirements for 2 consecutive days is
973	prohibited from accepting new admissions until the facility has
974	achieved the minimum-staffing requirements for a period of 6
975	consecutive days. For the purposes of this sub-subparagraph, any
976	person who was a resident of the facility and was absent from
977	the facility for the purpose of receiving medical care at a
978	separate location or was on a leave of absence is not considered
979	a new admission. Failure to impose such an admissions moratorium
980	is subject to a $1,000 fine constitutes a class II deficiency.
981	e.  A nursing facility which does not have a conditional
982	license may be cited for failure to comply with the standards in
983	s. 400.23(3)(a)1.a. only if it has failed to meet those
984	standards on 2 consecutive days or if it has failed to meet at
985	least 97 percent of those standards on any one day.
986	f.  A facility which has a conditional license must be in
987	compliance with the standards in s. 400.23(3)(a) at all times.
988	2.  This paragraph does not limit the agency's ability to
989	impose a deficiency or take other actions if a facility does not
990	have enough staff to meet the residents' needs.
991	(r)  Report to the agency any filing for bankruptcy
992	protection by the facility or its parent corporation,
993	divestiture or spin-off of its assets, or corporate
994	reorganization within 30 days after the completion of such
995	activity.
996	Section 26.  Subsection (3) of section 400.142, Florida
997	Statutes, is amended to read:
998	400.142  Emergency medication kits; orders not to
999	resuscitate.-
1000	(3)  Facility staff may withhold or withdraw
1001	cardiopulmonary resuscitation if presented with an order not to
1002	resuscitate executed pursuant to s. 401.45. The agency shall
1003	adopt rules providing for the implementation of such orders.
1004	Facility staff and facilities shall not be subject to criminal
1005	prosecution or civil liability, nor be considered to have
1006	engaged in negligent or unprofessional conduct, for withholding
1007	or withdrawing cardiopulmonary resuscitation pursuant to such an
1008	order and rules adopted by the agency. The absence of an order
1009	not to resuscitate executed pursuant to s. 401.45 does not
1010	preclude a physician from withholding or withdrawing
1011	cardiopulmonary resuscitation as otherwise permitted by law.
1012	Section 27.  Subsections (11) through (15) of section
1013	400.147, Florida Statutes, are renumbered as subsections (10)
1014	through (14), respectively, and present subsection (10) is
1015	amended to read:
1016	400.147  Internal risk management and quality assurance
1017	program.-
1018	(10)  By the 10th of each month, each facility subject to
1019	this section shall report any notice received pursuant to s.
1020	400.0233(2) and each initial complaint that was filed with the
1021	clerk of the court and served on the facility during the
1022	previous month by a resident or a resident's family member,
1023	guardian, conservator, or personal legal representative. The
1024	report must include the name of the resident, the resident's
1025	date of birth and social security number, the Medicaid
1026	identification number for Medicaid-eligible persons, the date or
1027	dates of the incident leading to the claim or dates of
1028	residency, if applicable, and the type of injury or violation of
1029	rights alleged to have occurred. Each facility shall also submit
1030	a copy of the notices received pursuant to s. 400.0233(2) and
1031	complaints filed with the clerk of the court. This report is
1032	confidential as provided by law and is not discoverable or
1033	admissible in any civil or administrative action, except in such
1034	actions brought by the agency to enforce the provisions of this
1035	part.
1036	Section 28.  Section 400.148, Florida Statutes, is
1037	repealed.
1038	Section 29.  Paragraph (f) of subsection (5) of section
1039	400.162, Florida Statutes, is amended to read:
1040	400.162  Property and personal affairs of residents.-
1041	(5)
1042	(f)  At least every 3 months, the licensee shall furnish
1043	the resident and the guardian, trustee, or conservator, if any,
1044	for the resident a complete and verified statement of all funds
1045	and other property to which this subsection applies, detailing
1046	the amounts and items received, together with their sources and
1047	disposition. For resident property, the licensee shall furnish
1048	such a statement annually and within 7 calendar days after a
1049	request for a statement. In any event, the licensee shall
1050	furnish such statements a statement annually and upon the
1051	discharge or transfer of a resident. Any governmental agency or
1052	private charitable agency contributing funds or other property
1053	on account of a resident also shall be entitled to receive such
1054	statements statement annually and upon discharge or transfer and
1055	such other report as it may require pursuant to law.
1056	Section 30.  Paragraphs (d) and (e) of subsection (2) of
1057	section 400.179, Florida Statutes, are amended to read:
1058	400.179  Liability for Medicaid underpayments and
1059	overpayments.-
1060	(2)  Because any transfer of a nursing facility may expose
1061	the fact that Medicaid may have underpaid or overpaid the
1062	transferor, and because in most instances, any such underpayment
1063	or overpayment can only be determined following a formal field
1064	audit, the liabilities for any such underpayments or
1065	overpayments shall be as follows:
1066	(d)  Where the transfer involves a facility that has been
1067	leased by the transferor:
1068	1.  The transferee shall, as a condition to being issued a
1069	license by the agency, acquire, maintain, and provide proof to
1070	the agency of a bond with a term of 30 months, renewable
1071	annually, in an amount not less than the total of 3 months'
1072	Medicaid payments to the facility computed on the basis of the
1073	preceding 12-month average Medicaid payments to the facility.
1074	2.  A leasehold licensee may meet the requirements of
1075	subparagraph 1. by payment of a nonrefundable fee, paid at
1076	initial licensure, paid at the time of any subsequent change of
1077	ownership, and paid annually thereafter, in the amount of 1
1078	percent of the total of 3 months' Medicaid payments to the
1079	facility computed on the basis of the preceding 12-month average
1080	Medicaid payments to the facility. If a preceding 12-month
1081	average is not available, projected Medicaid payments may be
1082	used. The fee shall be deposited into the Grants and Donations
1083	Trust Fund and shall be accounted for separately as a Medicaid
1084	nursing home overpayment account. These fees shall be used at
1085	the sole discretion of the agency to repay nursing home Medicaid
1086	overpayments. Payment of this fee shall not release the licensee
1087	from any liability for any Medicaid overpayments, nor shall
1088	payment bar the agency from seeking to recoup overpayments from
1089	the licensee and any other liable party. As a condition of
1090	exercising this lease bond alternative, licensees paying this
1091	fee must maintain an existing lease bond through the end of the
1092	30-month term period of that bond. The agency is herein granted
1093	specific authority to promulgate all rules pertaining to the
1094	administration and management of this account, including
1095	withdrawals from the account, subject to federal review and
1096	approval. This provision shall take effect upon becoming law and
1097	shall apply to any leasehold license application. The financial
1098	viability of the Medicaid nursing home overpayment account shall
1099	be determined by the agency through annual review of the account
1100	balance and the amount of total outstanding, unpaid Medicaid
1101	overpayments owing from leasehold licensees to the agency as
1102	determined by final agency audits. By March 31 of each year, the
1103	agency shall assess the cumulative fees collected under this
1104	subparagraph, minus any amounts used to repay nursing home
1105	Medicaid overpayments. If the net cumulative collections, minus
1106	amounts utilized to repay nursing home Medicaid overpayments,
1107	exceed $25 million, the provisions of this paragraph shall not
1108	apply for the subsequent fiscal year.
1109	3.  The leasehold licensee may meet the bond requirement
1110	through other arrangements acceptable to the agency. The agency
1111	is herein granted specific authority to promulgate rules
1112	pertaining to lease bond arrangements.
1113	4.  All existing nursing facility licensees, operating the
1114	facility as a leasehold, shall acquire, maintain, and provide
1115	proof to the agency of the 30-month bond required in
1116	subparagraph 1., above, on and after July 1, 1993, for each
1117	license renewal.
1118	5.  It shall be the responsibility of all nursing facility
1119	operators, operating the facility as a leasehold, to renew the
1120	30-month bond and to provide proof of such renewal to the agency
1121	annually.
1122	6.  Any failure of the nursing facility operator to
1123	acquire, maintain, renew annually, or provide proof to the
1124	agency shall be grounds for the agency to deny, revoke, and
1125	suspend the facility license to operate such facility and to
1126	take any further action, including, but not limited to,
1127	enjoining the facility, asserting a moratorium pursuant to part
1128	II of chapter 408, or applying for a receiver, deemed necessary
1129	to ensure compliance with this section and to safeguard and
1130	protect the health, safety, and welfare of the facility's
1131	residents. A lease agreement required as a condition of bond
1132	financing or refinancing under s. 154.213 by a health facilities
1133	authority or required under s. 159.30 by a county or
1134	municipality is not a leasehold for purposes of this paragraph
1135	and is not subject to the bond requirement of this paragraph.
1136	(e)  For the 2009-2010 fiscal year only, the provisions of
1137	paragraph (d) shall not apply. This paragraph expires July 1,
1138	2010.
1139	Section 31.  Subsection (3) of section 400.19, Florida
1140	Statutes, is amended to read:
1141	400.19  Right of entry and inspection.-
1142	(3)  The agency shall every 15 months conduct at least one
1143	unannounced inspection to determine compliance by the licensee
1144	with statutes, and with rules promulgated under the provisions
1145	of those statutes, governing minimum standards of construction,
1146	quality and adequacy of care, and rights of residents. The
1147	survey shall be conducted every 6 months for the next 2-year
1148	period if the facility has been cited for a class I deficiency,
1149	has been cited for two or more class II deficiencies arising
1150	from separate surveys or investigations within a 60-day period,
1151	or has had three or more substantiated complaints within a 6-
1152	month period, each resulting in at least one class I or class II
1153	deficiency. In addition to any other fees or fines in this part,
1154	the agency shall assess a fine for each facility that is subject
1155	to the 6-month survey cycle. The fine for the 2-year period
1156	shall be $6,000, one-half to be paid at the completion of each
1157	survey. The agency may adjust this fine by the change in the
1158	Consumer Price Index, based on the 12 months immediately
1159	preceding the increase, to cover the cost of the additional
1160	surveys. The agency shall verify through subsequent inspection
1161	that any deficiency identified during inspection is corrected.
1162	However, the agency may verify the correction of a class III or
1163	class IV deficiency unrelated to resident rights or resident
1164	care without reinspecting the facility if adequate written
1165	documentation has been received from the facility, which
1166	provides assurance that the deficiency has been corrected. The
1167	giving or causing to be given of advance notice of such
1168	unannounced inspections by an employee of the agency to any
1169	unauthorized person shall constitute cause for suspension of not
1170	fewer than 5 working days according to the provisions of chapter
1171	110.
1172	Section 32.  Section 400.195, Florida Statutes, is
1173	repealed.
1174	Section 33.  Subsection (5) of section 400.23, Florida
1175	Statutes, is amended to read:
1176	400.23  Rules; evaluation and deficiencies; licensure
1177	status.-
1178	(5)  The agency, in collaboration with the Division of
1179	Children's Medical Services Network of the Department of Health,
1180	must, no later than December 31, 1993, adopt rules for minimum
1181	standards of care for persons under 21 years of age who reside
1182	in nursing home facilities. The rules must include a methodology
1183	for reviewing a nursing home facility under ss. 408.031-408.045
1184	which serves only persons under 21 years of age. A facility may
1185	be exempt from these standards for specific persons between 18
1186	and 21 years of age, if the person's physician agrees that
1187	minimum standards of care based on age are not necessary.
1188	Section 34.  Subsection (1) of section 400.275, Florida
1189	Statutes, is amended to read:
1190	400.275  Agency duties.-
1191	(1)  The agency shall ensure that each newly hired nursing
1192	home surveyor, as a part of basic training, is assigned full-
1193	time to a licensed nursing home for at least 2 days within a 7-
1194	day period to observe facility operations outside of the survey
1195	process before the surveyor begins survey responsibilities. Such
1196	observations may not be the sole basis of a deficiency citation
1197	against the facility. The agency may not assign an individual to
1198	be a member of a survey team for purposes of a survey,
1199	evaluation, or consultation visit at a nursing home facility in
1200	which the surveyor was an employee within the preceding 2 5
1201	years.
1202	Section 35.  Subsection (2) of section 400.484, Florida
1203	Statutes, is amended to read:
1204	400.484  Right of inspection; violations deficiencies;
1205	fines.-
1206	(2)  The agency shall impose fines for various classes of
1207	violations deficiencies in accordance with the following
1208	schedule:
1209	(a)  Class I violations are defined in s. 408.813. A class
1210	I deficiency is any act, omission, or practice that results in a
1211	patient's death, disablement, or permanent injury, or places a
1212	patient at imminent risk of death, disablement, or permanent
1213	injury. Upon finding a class I violation deficiency, the agency
1214	shall impose an administrative fine in the amount of $15,000 for
1215	each occurrence and each day that the violation deficiency
1216	exists.
1217	(b)  Class II violations are defined in s. 408.813. A class
1218	II deficiency is any act, omission, or practice that has a
1219	direct adverse effect on the health, safety, or security of a
1220	patient. Upon finding a class II violation deficiency, the
1221	agency shall impose an administrative fine in the amount of
1222	$5,000 for each occurrence and each day that the violation
1223	deficiency exists.
1224	(c)  Class III violations are defined in s. 408.813. A
1225	class III deficiency is any act, omission, or practice that has
1226	an indirect, adverse effect on the health, safety, or security
1227	of a patient. Upon finding an uncorrected or repeated class III
1228	violation deficiency, the agency shall impose an administrative
1229	fine not to exceed $1,000 for each occurrence and each day that
1230	the uncorrected or repeated violation deficiency exists.
1231	(d)  Class IV violations are defined in s. 408.813. A class
1232	IV deficiency is any act, omission, or practice related to
1233	required reports, forms, or documents which does not have the
1234	potential of negatively affecting patients. These violations are
1235	of a type that the agency determines do not threaten the health,
1236	safety, or security of patients. Upon finding an uncorrected or
1237	repeated class IV violation deficiency, the agency shall impose
1238	an administrative fine not to exceed $500 for each occurrence
1239	and each day that the uncorrected or repeated violation
1240	deficiency exists.
1241	Section 36.  Paragraph (i) of subsection (1) and subsection
1242	(4) of section 400.606, Florida Statutes, are amended to read:
1243	400.606  License; application; renewal; conditional license
1244	or permit; certificate of need.-
1245	(1)  In addition to the requirements of part II of chapter
1246	408, the initial application and change of ownership application
1247	must be accompanied by a plan for the delivery of home,
1248	residential, and homelike inpatient hospice services to
1249	terminally ill persons and their families. Such plan must
1250	contain, but need not be limited to:
1251	(i)  The projected annual operating cost of the hospice.
1252
1253	If the applicant is an existing licensed health care provider,
1254	the application must be accompanied by a copy of the most recent
1255	profit-loss statement and, if applicable, the most recent
1256	licensure inspection report.
1257	(4)  A freestanding hospice facility that is primarily
1258	engaged in providing inpatient and related services and that is
1259	not otherwise licensed as a health care facility shall be
1260	required to obtain a certificate of need. However, a
1261	freestanding hospice facility with six or fewer beds shall not
1262	be required to comply with institutional standards such as, but
1263	not limited to, standards requiring sprinkler systems, emergency
1264	electrical systems, or special lavatory devices.
1265	Section 37.  Subsection (2) of section 400.607, Florida
1266	Statutes, is amended to read:
1267	400.607  Denial, suspension, revocation of license;
1268	emergency actions; imposition of administrative fine; grounds.-
1269	(2)  A violation of this part, part II of chapter 408, or
1270	applicable rules Any of the following actions by a licensed
1271	hospice or any of its employees shall be grounds for
1272	administrative action by the agency against a hospice.:
1273	(a)  A violation of the provisions of this part, part II of
1274	chapter 408, or applicable rules.
1275	(b)  An intentional or negligent act materially affecting
1276	the health or safety of a patient.
1277	Section 38.  Subsection (1) of section 400.925, Florida
1278	Statutes, is amended to read:
1279	400.925  Definitions.-As used in this part, the term:
1280	(1)  "Accrediting organizations" means The Joint Commission
1281	on Accreditation of Healthcare Organizations or other national
1282	accreditation agencies whose standards for accreditation are
1283	comparable to those required by this part for licensure.
1284	Section 39.  Subsections (3) through (6) of section
1285	400.931, Florida Statutes, are renumbered as subsections (2)
1286	through (5), respectively, and present subsection (2) of that
1287	section is amended to read:
1288	400.931  Application for license; fee; provisional license;
1289	temporary permit.-
1290	(2)  As an alternative to submitting proof of financial
1291	ability to operate as required in s. 408.810(8), the applicant
1292	may submit a $50,000 surety bond to the agency.
1293	Section 40.  Subsection (2) of section 400.932, Florida
1294	Statutes, is amended to read:
1295	400.932  Administrative penalties.-
1296	(2)  A violation of this part, part II of chapter 408, or
1297	applicable rules Any of the following actions by an employee of
1298	a home medical equipment provider shall be are grounds for
1299	administrative action or penalties by the agency.:
1300	(a)  Violation of this part, part II of chapter 408, or
1301	applicable rules.
1302	(b)  An intentional, reckless, or negligent act that
1303	materially affects the health or safety of a patient.
1304	Section 41.  Subsection (3) of section 400.967, Florida
1305	Statutes, is amended to read:
1306	400.967  Rules and classification of violations
1307	deficiencies.-
1308	(3)  The agency shall adopt rules to provide that, when the
1309	criteria established under this part and part II of chapter 408
1310	are not met, such violations deficiencies shall be classified
1311	according to the nature of the violation deficiency. The agency
1312	shall indicate the classification on the face of the notice of
1313	deficiencies as follows:
1314	(a)  Class I violations deficiencies are defined in s.
1315	408.813 those which the agency determines present an imminent
1316	danger to the residents or guests of the facility or a
1317	substantial probability that death or serious physical harm
1318	would result therefrom. The condition or practice constituting a
1319	class I violation must be abated or eliminated immediately,
1320	unless a fixed period of time, as determined by the agency, is
1321	required for correction. A class I violation deficiency is
1322	subject to a civil penalty in an amount not less than $5,000 and
1323	not exceeding $10,000 for each violation deficiency. A fine may
1324	be levied notwithstanding the correction of the violation
1325	deficiency.
1326	(b)  Class II violations deficiencies are defined in s.
1327	408.813 those which the agency determines have a direct or
1328	immediate relationship to the health, safety, or security of the
1329	facility residents, other than class I deficiencies. A class II
1330	violation deficiency is subject to a civil penalty in an amount
1331	not less than $1,000 and not exceeding $5,000 for each violation
1332	deficiency. A citation for a class II violation deficiency shall
1333	specify the time within which the violation deficiency must be
1334	corrected. If a class II violation deficiency is corrected
1335	within the time specified, no civil penalty shall be imposed,
1336	unless it is a repeated offense.
1337	(c)  Class III violations deficiencies are defined in s.
1338	408.813 those which the agency determines to have an indirect or
1339	potential relationship to the health, safety, or security of the
1340	facility residents, other than class I or class II deficiencies.
1341	A class III violation deficiency is subject to a civil penalty
1342	of not less than $500 and not exceeding $1,000 for each
1343	deficiency. A citation for a class III violation deficiency
1344	shall specify the time within which the violation deficiency
1345	must be corrected. If a class III violation deficiency is
1346	corrected within the time specified, no civil penalty shall be
1347	imposed, unless it is a repeated offense.
1348	(d)  Class IV violations are defined in s. 408.813. Upon
1349	finding an uncorrected or repeated class IV violation, the
1350	agency shall impose an administrative fine not to exceed $500
1351	for each occurrence and each day that the uncorrected or
1352	repeated violation exists.
1353	Section 42.  Subsections (4) and (7) of section 400.9905,
1354	Florida Statutes, are amended to read:
1355	400.9905  Definitions.-
1356	(4)  "Clinic" means an entity at which health care services
1357	are provided to individuals and which tenders charges for
1358	reimbursement for such services, including a mobile clinic and a
1359	portable health service or equipment provider. For purposes of
1360	this part, the term does not include and the licensure
1361	requirements of this part do not apply to:
1362	(a)  Entities licensed or registered by the state under
1363	chapter 395; or entities licensed or registered by the state and
1364	providing only health care services within the scope of services
1365	authorized under their respective licenses granted under ss.
1366	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1367	chapter except part X, chapter 429, chapter 463, chapter 465,
1368	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1369	chapter 651; end-stage renal disease providers authorized under
1370	42 C.F.R. part 405, subpart U; or providers certified under 42
1371	C.F.R. part 485, subpart B or subpart H; or any entity that
1372	provides neonatal or pediatric hospital-based health care
1373	services or other health care services by licensed practitioners
1374	solely within a hospital licensed under chapter 395.
1375	(b)  Entities that own, directly or indirectly, entities
1376	licensed or registered by the state pursuant to chapter 395; or
1377	entities that own, directly or indirectly, entities licensed or
1378	registered by the state and providing only health care services
1379	within the scope of services authorized pursuant to their
1380	respective licenses granted under ss. 383.30-383.335, chapter
1381	390, chapter 394, chapter 397, this chapter except part X,
1382	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1383	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1384	disease providers authorized under 42 C.F.R. part 405, subpart
1385	U; or providers certified under 42 C.F.R. part 485, subpart B or
1386	subpart H; or any entity that provides neonatal or pediatric
1387	hospital-based health care services by licensed practitioners
1388	solely within a hospital licensed under chapter 395.
1389	(c)  Entities that are owned, directly or indirectly, by an
1390	entity licensed or registered by the state pursuant to chapter
1391	395; or entities that are owned, directly or indirectly, by an
1392	entity licensed or registered by the state and providing only
1393	health care services within the scope of services authorized
1394	pursuant to their respective licenses granted under ss. 383.30-
1395	383.335, chapter 390, chapter 394, chapter 397, this chapter
1396	except part X, chapter 429, chapter 463, chapter 465, chapter
1397	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1398	651; end-stage renal disease providers authorized under 42
1399	C.F.R. part 405, subpart U; or providers certified under 42
1400	C.F.R. part 485, subpart B or subpart H; or any entity that
1401	provides neonatal or pediatric hospital-based health care
1402	services by licensed practitioners solely within a hospital
1403	under chapter 395.
1404	(d)  Entities that are under common ownership, directly or
1405	indirectly, with an entity licensed or registered by the state
1406	pursuant to chapter 395; or entities that are under common
1407	ownership, directly or indirectly, with an entity licensed or
1408	registered by the state and providing only health care services
1409	within the scope of services authorized pursuant to their
1410	respective licenses granted under ss. 383.30-383.335, chapter
1411	390, chapter 394, chapter 397, this chapter except part X,
1412	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1413	part I of chapter 483, chapter 484, or chapter 651; end-stage
1414	renal disease providers authorized under 42 C.F.R. part 405,
1415	subpart U; or providers certified under 42 C.F.R. part 485,
1416	subpart B or subpart H; or any entity that provides neonatal or
1417	pediatric hospital-based health care services by licensed
1418	practitioners solely within a hospital licensed under chapter
1419	395.
1420	(e)  An entity that is exempt from federal taxation under
1421	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1422	under 26 U.S.C. s. 409 that has a board of trustees not less
1423	than two-thirds of which are Florida-licensed health care
1424	practitioners and provides only physical therapy services under
1425	physician orders, any community college or university clinic,
1426	and any entity owned or operated by the federal or state
1427	government, including agencies, subdivisions, or municipalities
1428	thereof.
1429	(f)  A sole proprietorship, group practice, partnership, or
1430	corporation that provides health care services by physicians
1431	covered by s. 627.419, that is directly supervised by one or
1432	more of such physicians, and that is wholly owned by one or more
1433	of those physicians or by a physician and the spouse, parent,
1434	child, or sibling of that physician.
1435	(g)  A sole proprietorship, group practice, partnership, or
1436	corporation that provides health care services by licensed
1437	health care practitioners under chapter 457, chapter 458,
1438	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1439	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1440	chapter 490, chapter 491, or part I, part III, part X, part
1441	XIII, or part XIV of chapter 468, or s. 464.012, which are
1442	wholly owned by one or more licensed health care practitioners,
1443	or the licensed health care practitioners set forth in this
1444	paragraph and the spouse, parent, child, or sibling of a
1445	licensed health care practitioner, so long as one of the owners
1446	who is a licensed health care practitioner is supervising the
1447	business activities and is legally responsible for the entity's
1448	compliance with all federal and state laws. However, a health
1449	care practitioner may not supervise services beyond the scope of
1450	the practitioner's license, except that, for the purposes of
1451	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1452	provides only services authorized pursuant to s. 456.053(3)(b)
1453	may be supervised by a licensee specified in s. 456.053(3)(b).
1454	(h)  Clinical facilities affiliated with an accredited
1455	medical school at which training is provided for medical
1456	students, residents, or fellows.
1457	(i)  Entities that provide only oncology or radiation
1458	therapy services by physicians licensed under chapter 458 or
1459	chapter 459 or entities that provide oncology or radiation
1460	therapy services by physicians licensed under chapter 458 or
1461	chapter 459 which are owned by a corporation whose shares are
1462	publicly traded on a recognized stock exchange.
1463	(j)  Clinical facilities affiliated with a college of
1464	chiropractic accredited by the Council on Chiropractic Education
1465	at which training is provided for chiropractic students.
1466	(k)  Entities that provide licensed practitioners to staff
1467	emergency departments or to deliver anesthesia services in
1468	facilities licensed under chapter 395 and that derive at least
1469	90 percent of their gross annual revenues from the provision of
1470	such services. Entities claiming an exemption from licensure
1471	under this paragraph must provide documentation demonstrating
1472	compliance.
1473	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1474	perinatology clinical facilities that are a publicly traded
1475	corporation or that are wholly owned, directly or indirectly, by
1476	a publicly traded corporation. As used in this paragraph, a
1477	publicly traded corporation is a corporation that issues
1478	securities traded on an exchange registered with the United
1479	States Securities and Exchange Commission as a national
1480	securities exchange.
1481	(7)  "Portable health service or equipment provider" means
1482	an entity that contracts with or employs persons to provide
1483	portable health care services or equipment to multiple locations
1484	performing treatment or diagnostic testing of individuals, that
1485	bills third-party payors for those services, and that otherwise
1486	meets the definition of a clinic in subsection (4).
1487	Section 43.  Paragraph (b) of subsection (1) and paragraph
1488	(c) of subsection (4) of section 400.991, Florida Statutes, are
1489	amended to read:
1490	400.991  License requirements; background screenings;
1491	prohibitions.-
1492	(1)
1493	(b)  Each mobile clinic must obtain a separate health care
1494	clinic license and must provide to the agency, at least
1495	quarterly, its projected street location to enable the agency to
1496	locate and inspect such clinic. A portable health service or
1497	equipment provider must obtain a health care clinic license for
1498	a single administrative office and is not required to submit
1499	quarterly projected street locations.
1500	(4)  In addition to the requirements of part II of chapter
1501	408, the applicant must file with the application satisfactory
1502	proof that the clinic is in compliance with this part and
1503	applicable rules, including:
1504	(c)  Proof of financial ability to operate as required
1505	under ss. s. 408.810(8) and 408.8065. As an alternative to
1506	submitting proof of financial ability to operate as required
1507	under s. 408.810(8), the applicant may file a surety bond of at
1508	least $500,000 which guarantees that the clinic will act in full
1509	conformity with all legal requirements for operating a clinic,
1510	payable to the agency. The agency may adopt rules to specify
1511	related requirements for such surety bond.
1512	Section 44.  Paragraph (g) of subsection (1) and paragraph
1513	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1514	amended to read:
1515	400.9935  Clinic responsibilities.-
1516	(1)  Each clinic shall appoint a medical director or clinic
1517	director who shall agree in writing to accept legal
1518	responsibility for the following activities on behalf of the
1519	clinic. The medical director or the clinic director shall:
1520	(g)  Conduct systematic reviews of clinic billings to
1521	ensure that the billings are not fraudulent or unlawful. Upon
1522	discovery of an unlawful charge, the medical director or clinic
1523	director shall take immediate corrective action. If the clinic
1524	performs only the technical component of magnetic resonance
1525	imaging, static radiographs, computed tomography, or positron
1526	emission tomography, and provides the professional
1527	interpretation of such services, in a fixed facility that is
1528	accredited by The Joint Commission on Accreditation of
1529	Healthcare Organizations or the Accreditation Association for
1530	Ambulatory Health Care, and the American College of Radiology;
1531	and if, in the preceding quarter, the percentage of scans
1532	performed by that clinic which was billed to all personal injury
1533	protection insurance carriers was less than 15 percent, the
1534	chief financial officer of the clinic may, in a written
1535	acknowledgment provided to the agency, assume the responsibility
1536	for the conduct of the systematic reviews of clinic billings to
1537	ensure that the billings are not fraudulent or unlawful.
1538	(7)(a)  Each clinic engaged in magnetic resonance imaging
1539	services must be accredited by The Joint Commission on
1540	Accreditation of Healthcare Organizations, the American College
1541	of Radiology, or the Accreditation Association for Ambulatory
1542	Health Care, within 1 year after licensure. A clinic that is
1543	accredited by the American College of Radiology or is within the
1544	original 1-year period after licensure and replaces its core
1545	magnetic resonance imaging equipment shall be given 1 year after
1546	the date on which the equipment is replaced to attain
1547	accreditation. However, a clinic may request a single, 6-month
1548	extension if it provides evidence to the agency establishing
1549	that, for good cause shown, such clinic cannot be accredited
1550	within 1 year after licensure, and that such accreditation will
1551	be completed within the 6-month extension. After obtaining
1552	accreditation as required by this subsection, each such clinic
1553	must maintain accreditation as a condition of renewal of its
1554	license. A clinic that files a change of ownership application
1555	must comply with the original accreditation timeframe
1556	requirements of the transferor. The agency shall deny a change
1557	of ownership application if the clinic is not in compliance with
1558	the accreditation requirements. When a clinic adds, replaces, or
1559	modifies magnetic resonance imaging equipment and the
1560	accreditation agency requires new accreditation, the clinic must
1561	be accredited within 1 year after the date of the addition,
1562	replacement, or modification but may request a single, 6-month
1563	extension if the clinic provides evidence of good cause to the
1564	agency.
1565	Section 45.  Subsection (2) of section 408.034, Florida
1566	Statutes, is amended to read:
1567	408.034  Duties and responsibilities of agency; rules.-
1568	(2)  In the exercise of its authority to issue licenses to
1569	health care facilities and health service providers, as provided
1570	under chapters 393 and 395 and parts II, and IV, and VIII of
1571	chapter 400, the agency may not issue a license to any health
1572	care facility or health service provider that fails to receive a
1573	certificate of need or an exemption for the licensed facility or
1574	service.
1575	Section 46.  Paragraph (d) of subsection (1) of section
1576	408.036, Florida Statutes, is amended to read:
1577	408.036  Projects subject to review; exemptions.-
1578	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1579	health-care-related projects, as described in paragraphs (a)-
1580	(g), are subject to review and must file an application for a
1581	certificate of need with the agency. The agency is exclusively
1582	responsible for determining whether a health-care-related
1583	project is subject to review under ss. 408.031-408.045.
1584	(d)  The establishment of a hospice or hospice inpatient
1585	facility, except as provided in s. 408.043.
1586	Section 47.  Subsection (2) of section 408.043, Florida
1587	Statutes, is amended to read:
1588	408.043  Special provisions.-
1589	(2)  HOSPICES.-When an application is made for a
1590	certificate of need to establish or to expand a hospice, the
1591	need for such hospice shall be determined on the basis of the
1592	need for and availability of hospice services in the community.
1593	The formula on which the certificate of need is based shall
1594	discourage regional monopolies and promote competition. The
1595	inpatient hospice care component of a hospice which is a
1596	freestanding facility, or a part of a facility, which is
1597	primarily engaged in providing inpatient care and related
1598	services and is not licensed as a health care facility shall
1599	also be required to obtain a certificate of need. Provision of
1600	hospice care by any current provider of health care is a
1601	significant change in service and therefore requires a
1602	certificate of need for such services.
1603	Section 48.  Paragraph (k) of subsection (3) of section
1604	408.05, Florida Statutes, is amended to read:
1605	408.05  Florida Center for Health Information and Policy
1606	Analysis.-
1607	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1608	produce comparable and uniform health information and statistics
1609	for the development of policy recommendations, the agency shall
1610	perform the following functions:
1611	(k)  Develop, in conjunction with the State Consumer Health
1612	Information and Policy Advisory Council, and implement a long-
1613	range plan for making available health care quality measures and
1614	financial data that will allow consumers to compare health care
1615	services. The health care quality measures and financial data
1616	the agency must make available shall include, but is not limited
1617	to, pharmaceuticals, physicians, health care facilities, and
1618	health plans and managed care entities. The agency shall submit
1619	the initial plan to the Governor, the President of the Senate,
1620	and the Speaker of the House of Representatives by January 1,
1621	2006, and shall update the plan and report on the status of its
1622	implementation annually thereafter. The agency shall also make
1623	the plan and status report available to the public on its
1624	Internet website. As part of the plan, the agency shall identify
1625	the process and timeframes for implementation, any barriers to
1626	implementation, and recommendations of changes in the law that
1627	may be enacted by the Legislature to eliminate the barriers. As
1628	preliminary elements of the plan, the agency shall:
1629	1.  Make available patient-safety indicators, inpatient
1630	quality indicators, and performance outcome and patient charge
1631	data collected from health care facilities pursuant to s.
1632	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1633	"inpatient quality indicators" shall be as defined by the
1634	Centers for Medicare and Medicaid Services, the National Quality
1635	Forum, The Joint Commission on Accreditation of Healthcare
1636	Organizations, the Agency for Healthcare Research and Quality,
1637	the Centers for Disease Control and Prevention, or a similar
1638	national entity that establishes standards to measure the
1639	performance of health care providers, or by other states. The
1640	agency shall determine which conditions, procedures, health care
1641	quality measures, and patient charge data to disclose based upon
1642	input from the council. When determining which conditions and
1643	procedures are to be disclosed, the council and the agency shall
1644	consider variation in costs, variation in outcomes, and
1645	magnitude of variations and other relevant information. When
1646	determining which health care quality measures to disclose, the
1647	agency:
1648	a.  Shall consider such factors as volume of cases; average
1649	patient charges; average length of stay; complication rates;
1650	mortality rates; and infection rates, among others, which shall
1651	be adjusted for case mix and severity, if applicable.
1652	b.  May consider such additional measures that are adopted
1653	by the Centers for Medicare and Medicaid Studies, National
1654	Quality Forum, The Joint Commission on Accreditation of
1655	Healthcare Organizations, the Agency for Healthcare Research and
1656	Quality, Centers for Disease Control and Prevention, or a
1657	similar national entity that establishes standards to measure
1658	the performance of health care providers, or by other states.
1659
1660	When determining which patient charge data to disclose, the
1661	agency shall include such measures as the average of
1662	undiscounted charges on frequently performed procedures and
1663	preventive diagnostic procedures, the range of procedure charges
1664	from highest to lowest, average net revenue per adjusted patient
1665	day, average cost per adjusted patient day, and average cost per
1666	admission, among others.
1667	2.  Make available performance measures, benefit design,
1668	and premium cost data from health plans licensed pursuant to
1669	chapter 627 or chapter 641. The agency shall determine which
1670	health care quality measures and member and subscriber cost data
1671	to disclose, based upon input from the council. When determining
1672	which data to disclose, the agency shall consider information
1673	that may be required by either individual or group purchasers to
1674	assess the value of the product, which may include membership
1675	satisfaction, quality of care, current enrollment or membership,
1676	coverage areas, accreditation status, premium costs, plan costs,
1677	premium increases, range of benefits, copayments and
1678	deductibles, accuracy and speed of claims payment, credentials
1679	of physicians, number of providers, names of network providers,
1680	and hospitals in the network. Health plans shall make available
1681	to the agency any such data or information that is not currently
1682	reported to the agency or the office.
1683	3.  Determine the method and format for public disclosure
1684	of data reported pursuant to this paragraph. The agency shall
1685	make its determination based upon input from the State Consumer
1686	Health Information and Policy Advisory Council. At a minimum,
1687	the data shall be made available on the agency's Internet
1688	website in a manner that allows consumers to conduct an
1689	interactive search that allows them to view and compare the
1690	information for specific providers. The website must include
1691	such additional information as is determined necessary to ensure
1692	that the website enhances informed decisionmaking among
1693	consumers and health care purchasers, which shall include, at a
1694	minimum, appropriate guidance on how to use the data and an
1695	explanation of why the data may vary from provider to provider.
1696	The data specified in subparagraph 1. shall be released no later
1697	than January 1, 2006, for the reporting of infection rates, and
1698	no later than October 1, 2005, for mortality rates and
1699	complication rates. The data specified in subparagraph 2. shall
1700	be released no later than October 1, 2006.
1701	4.  Publish on its website undiscounted charges for no
1702	fewer than 150 of the most commonly performed adult and
1703	pediatric procedures, including outpatient, inpatient,
1704	diagnostic, and preventative procedures.
1705	Section 49.  Paragraph (a) of subsection (1) of section
1706	408.061, Florida Statutes, is amended to read:
1707	408.061  Data collection; uniform systems of financial
1708	reporting; information relating to physician charges;
1709	confidential information; immunity.-
1710	(1)  The agency shall require the submission by health care
1711	facilities, health care providers, and health insurers of data
1712	necessary to carry out the agency's duties. Specifications for
1713	data to be collected under this section shall be developed by
1714	the agency with the assistance of technical advisory panels
1715	including representatives of affected entities, consumers,
1716	purchasers, and such other interested parties as may be
1717	determined by the agency.
1718	(a)  Data submitted by health care facilities, including
1719	the facilities as defined in chapter 395, shall include, but are
1720	not limited to: case-mix data, patient admission and discharge
1721	data, hospital emergency department data which shall include the
1722	number of patients treated in the emergency department of a
1723	licensed hospital reported by patient acuity level, data on
1724	hospital-acquired infections as specified by rule, data on
1725	complications as specified by rule, data on readmissions as
1726	specified by rule, with patient and provider-specific
1727	identifiers included, actual charge data by diagnostic groups,
1728	financial data, accounting data, operating expenses, expenses
1729	incurred for rendering services to patients who cannot or do not
1730	pay, interest charges, depreciation expenses based on the
1731	expected useful life of the property and equipment involved, and
1732	demographic data. The agency shall adopt nationally recognized
1733	risk adjustment methodologies or software consistent with the
1734	standards of the Agency for Healthcare Research and Quality and
1735	as selected by the agency for all data submitted as required by
1736	this section. Data may be obtained from documents such as, but
1737	not limited to: leases, contracts, debt instruments, itemized
1738	patient bills, medical record abstracts, and related diagnostic
1739	information. Reported data elements shall be reported
1740	electronically and in accordance with rule 59E-7.012, Florida
1741	Administrative Code. Data submitted shall be certified by the
1742	chief executive officer or an appropriate and duly authorized
1743	representative or employee of the licensed facility that the
1744	information submitted is true and accurate.
1745	Section 50.  Section 408.10, Florida Statutes, is amended
1746	to read:
1747	408.10  Consumer complaints.-The agency shall:
1748	(1)  publish and make available to the public a toll-free
1749	telephone number for the purpose of handling consumer complaints
1750	and shall serve as a liaison between consumer entities and other
1751	private entities and governmental entities for the disposition
1752	of problems identified by consumers of health care.
1753	(2)  Be empowered to investigate consumer complaints
1754	relating to problems with health care facilities' billing
1755	practices and issue reports to be made public in any cases where
1756	the agency determines the health care facility has engaged in
1757	billing practices which are unreasonable and unfair to the
1758	consumer.
1759	Section 51.  Subsections (12) through (30) of section
1760	408.802, Florida Statutes, are renumbered as subsections (11)
1761	through (29), respectively, and present subsection (11) of that
1762	section is amended to read:
1763	408.802  Applicability.-The provisions of this part apply
1764	to the provision of services that require licensure as defined
1765	in this part and to the following entities licensed, registered,
1766	or certified by the agency, as described in chapters 112, 383,
1767	390, 394, 395, 400, 429, 440, 483, and 765:
1768	(11)  Private review agents, as provided under part I of
1769	chapter 395.
1770	Section 52.  Subsection (3) is added to section 408.804,
1771	Florida Statutes, to read:
1772	408.804  License required; display.-
1773	(3)  Any person who knowingly alters, defaces, or falsifies
1774	a license certificate issued by the agency, or causes or
1775	procures any person to commit such an offense, commits a
1776	misdemeanor of the second degree, punishable as provided in s.
1777	775.082 or s 775.083. Any licensee or provider who displays an
1778	altered, defaced, or falsified license certificate is subject to
1779	the penalties set forth in s. 408.815 and an administrative fine
1780	of $1,000 for each day of illegal display.
1781	Section 53.  Paragraph (d) of subsection (2) of section
1782	408.806, Florida Statutes, is amended, present subsections (3)
1783	through (8) are renumbered as subsections (4) through (9),
1784	respectively, and a new subsection (3) is added to that section,
1785	to read:
1786	408.806  License application process.-
1787	(2)
1788	(d)  The agency shall notify the licensee by mail or
1789	electronically at least 90 days before the expiration of a
1790	license that a renewal license is necessary to continue
1791	operation. The licensee's failure to timely file submit a
1792	renewal application and license application fee with the agency
1793	shall result in a $50 per day late fee charged to the licensee
1794	by the agency; however, the aggregate amount of the late fee may
1795	not exceed 50 percent of the licensure fee or $500, whichever is
1796	less. The agency shall provide a courtesy notice to the licensee
1797	by United States mail, electronically, or by any other manner at
1798	its address of record or mailing address, if provided, at least
1799	90 days prior to the expiration of a license informing the
1800	licensee of the expiration of the license. If the agency does
1801	not provide the courtesy notice or the licensee does not receive
1802	the courtesy notice, the licensee continues to be legally
1803	obligated to timely file the renewal application and license
1804	application fee with the agency and is not excused from the
1805	payment of a late fee. If an application is received after the
1806	required filing date and exhibits a hand-canceled postmark
1807	obtained from a United States post office dated on or before the
1808	required filing date, no fine will be levied.
1809	(3)  Payment of the late fee is required to consider any
1810	late application complete, and failure to pay the late fee is
1811	considered an omission from the application.
1812	Section 54.  Subsections (6) and (9) of section 408.810,
1813	Florida Statutes, are amended to read:
1814	408.810  Minimum licensure requirements.-In addition to the
1815	licensure requirements specified in this part, authorizing
1816	statutes, and applicable rules, each applicant and licensee must
1817	comply with the requirements of this section in order to obtain
1818	and maintain a license.
1819	(6)(a)  An applicant must provide the agency with proof of
1820	the applicant's legal right to occupy the property before a
1821	license may be issued. Proof may include, but need not be
1822	limited to, copies of warranty deeds, lease or rental
1823	agreements, contracts for deeds, quitclaim deeds, or other such
1824	documentation.
1825	(b)  In the event the property is encumbered by a mortgage
1826	or is leased, an applicant must provide the agency with proof
1827	that the mortgagor or landlord has been provided written notice
1828	of the applicant's intent as mortgagee or tenant to provide
1829	services that require licensure and instruct the mortgagor or
1830	landlord to serve the agency by certified mail with copies of
1831	any foreclosure or eviction actions initiated by the mortgagor
1832	or landlord against the applicant.
1833	(9)  A controlling interest may not withhold from the
1834	agency any evidence of financial instability, including, but not
1835	limited to, checks returned due to insufficient funds,
1836	delinquent accounts, nonpayment of withholding taxes, unpaid
1837	utility expenses, nonpayment for essential services, or adverse
1838	court action concerning the financial viability of the provider
1839	or any other provider licensed under this part that is under the
1840	control of the controlling interest. A controlling interest
1841	shall notify the agency within 10 days after a court action to
1842	initiate bankruptcy, foreclosure, or eviction proceedings
1843	concerning the provider, in which the controlling interest is a
1844	petitioner or defendant. Any person who violates this subsection
1845	commits a misdemeanor of the second degree, punishable as
1846	provided in s. 775.082 or s. 775.083. Each day of continuing
1847	violation is a separate offense.
1848	Section 55.  Subsection (3) is added to section 408.813,
1849	Florida Statutes, to read:
1850	408.813  Administrative fines; violations.-As a penalty for
1851	any violation of this part, authorizing statutes, or applicable
1852	rules, the agency may impose an administrative fine.
1853	(3)  The agency may impose an administrative fine for a
1854	violation that does not qualify as a class I, class II, class
1855	III, or class IV violation. Unless otherwise specified by law,
1856	the amount of the fine shall not exceed $500 for each violation.
1857	Unclassified violations may include:
1858	(a)  Violating any term or condition of a license.
1859	(b)  Violating any provision of this part, authorizing
1860	statutes, or applicable rules.
1861	(c)  Exceeding licensed capacity.
1862	(d)  Providing services beyond the scope of the license.
1863	(e)  Violating a moratorium imposed pursuant to s. 408.814.
1864	Section 56.  Subsection (5) is added to section 408.815,
1865	Florida Statutes, to read:
1866	408.815  License or application denial; revocation.-
1867	(5)  In order to ensure the health, safety, and welfare of
1868	clients when a license has been denied, revoked, or is set to
1869	terminate, the agency may extend the license expiration date for
1870	a period of up to 30 days for the sole purpose of allowing the
1871	safe and orderly discharge of clients. The agency may impose
1872	conditions on the extension, including, but not limited to,
1873	prohibiting or limiting admissions, expedited discharge
1874	planning, required status reports, and mandatory monitoring by
1875	the agency or third parties. In imposing these conditions, the
1876	agency shall take into consideration the nature and number of
1877	clients, the availability and location of acceptable alternative
1878	placements, and the ability of the licensee to continue
1879	providing care to the clients. The agency may terminate the
1880	extension or modify the conditions at any time. This authority
1881	is in addition to any other authority granted to the agency
1882	under chapter 120, this part, and authorizing statutes but
1883	creates no right or entitlement to an extension of a license
1884	expiration date.
1885	Section 57.  Paragraph (k) of subsection (4) of section
1886	409.221, Florida Statutes, is amended to read:
1887	409.221  Consumer-directed care program.-
1888	(4)  CONSUMER-DIRECTED CARE.-
1889	(k)  Reviews and reports.-The agency and the Departments of
1890	Elderly Affairs, Health, and Children and Family Services and
1891	the Agency for Persons with Disabilities shall each, on an
1892	ongoing basis, review and assess the implementation of the
1893	consumer-directed care program. By January 15 of each year, the
1894	agency shall submit a written report to the Legislature that
1895	includes each department's review of the program and contains
1896	recommendations for improvements to the program.
1897	Section 58.  Subsections (3) and (4) of section 429.07,
1898	Florida Statutes, are amended, and subsections (6) and (7) are
1899	added to that section, to read:
1900	429.07  License required; fee; inspections.-
1901	(3)  In addition to the requirements of s. 408.806, each
1902	license granted by the agency must state the type of care for
1903	which the license is granted. Licenses shall be issued for one
1904	or more of the following categories of care: standard, extended
1905	congregate care, limited nursing services, or limited mental
1906	health.
1907	(a)  A standard license shall be issued to a facility
1908	facilities providing one or more of the personal services
1909	identified in s. 429.02. Such licensee facilities may also
1910	employ or contract with a person licensed under part I of
1911	chapter 464 to administer medications and perform other tasks as
1912	specified in s. 429.255.
1913	(b)  An extended congregate care license shall be issued to
1914	a licensee facilities providing, directly or through contract,
1915	services beyond those authorized in paragraph (a), including
1916	acts performed pursuant to part I of chapter 464 by persons
1917	licensed thereunder, and supportive services defined by rule to
1918	persons who otherwise would be disqualified from continued
1919	residence in a facility licensed under this part.
1920	1.  In order for extended congregate care services to be
1921	provided in a facility licensed under this part, the agency must
1922	first determine that all requirements established in law and
1923	rule are met and must specifically designate, on the facility's
1924	license, that such services may be provided and whether the
1925	designation applies to all or part of a facility. Such
1926	designation may be made at the time of initial licensure or
1927	relicensure, or upon request in writing by a licensee under this
1928	part and part II of chapter 408. Notification of approval or
1929	denial of such request shall be made in accordance with part II
1930	of chapter 408. An existing licensee facilities qualifying to
1931	provide extended congregate care services must have maintained a
1932	standard license and may not have been subject to administrative
1933	sanctions during the previous 2 years, or since initial
1934	licensure if the facility has been licensed for less than 2
1935	years, for any of the following reasons:
1936	a.  A class I or class II violation;
1937	b.  Three or more repeat or recurring class III violations
1938	of identical or similar resident care standards as specified in
1939	rule from which a pattern of noncompliance is found by the
1940	agency;
1941	c.  Three or more class III violations that were not
1942	corrected in accordance with the corrective action plan approved
1943	by the agency;
1944	d.  Violation of resident care standards resulting in a
1945	requirement to employ the services of a consultant pharmacist or
1946	consultant dietitian;
1947	e.  Denial, suspension, or revocation of a license for
1948	another facility under this part in which the applicant for an
1949	extended congregate care license has at least 25 percent
1950	ownership interest; or
1951	f.  Imposition of a moratorium pursuant to this part or
1952	part II of chapter 408 or initiation of injunctive proceedings.
1953	2.  A licensee Facilities that is are licensed to provide
1954	extended congregate care services shall maintain a written
1955	progress report for on each person who receives such services,
1956	and the which report must describe describes the type, amount,
1957	duration, scope, and outcome of services that are rendered and
1958	the general status of the resident's health. A registered nurse,
1959	or appropriate designee, representing the agency shall visit
1960	such facilities at least quarterly to monitor residents who are
1961	receiving extended congregate care services and to determine if
1962	the facility is in compliance with this part, part II of chapter
1963	408, and rules that relate to extended congregate care. One of
1964	these visits may be in conjunction with the regular survey. The
1965	monitoring visits may be provided through contractual
1966	arrangements with appropriate community agencies. A registered
1967	nurse shall serve as part of the team that inspects such
1968	facility. The agency may waive one of the required yearly
1969	monitoring visits for a facility that has been licensed for at
1970	least 24 months to provide extended congregate care services,
1971	if, during the inspection, the registered nurse determines that
1972	extended congregate care services are being provided
1973	appropriately, and if the facility has no class I or class II
1974	violations and no uncorrected class III violations. Before such
1975	decision is made, the agency shall consult with the long-term
1976	care ombudsman council for the area in which the facility is
1977	located to determine if any complaints have been made and
1978	substantiated about the quality of services or care. The agency
1979	may not waive one of the required yearly monitoring visits if
1980	complaints have been made and substantiated.
1981	3.  Licensees Facilities that are licensed to provide
1982	extended congregate care services shall:
1983	a.  Demonstrate the capability to meet unanticipated
1984	resident service needs.
1985	b.  Offer a physical environment that promotes a homelike
1986	setting, provides for resident privacy, promotes resident
1987	independence, and allows sufficient congregate space as defined
1988	by rule.
1989	c.  Have sufficient staff available, taking into account
1990	the physical plant and firesafety features of the building, to
1991	assist with the evacuation of residents in an emergency, as
1992	necessary.
1993	d.  Adopt and follow policies and procedures that maximize
1994	resident independence, dignity, choice, and decisionmaking to
1995	permit residents to age in place to the extent possible, so that
1996	moves due to changes in functional status are minimized or
1997	avoided.
1998	e.  Allow residents or, if applicable, a resident's
1999	representative, designee, surrogate, guardian, or attorney in
2000	fact to make a variety of personal choices, participate in
2001	developing service plans, and share responsibility in
2002	decisionmaking.
2003	f.  Implement the concept of managed risk.
2004	g.  Provide, either directly or through contract, the
2005	services of a person licensed pursuant to part I of chapter 464.
2006	h.  In addition to the training mandated in s. 429.52,
2007	provide specialized training as defined by rule for facility
2008	staff.
2009	4.  Licensees Facilities licensed to provide extended
2010	congregate care services are exempt from the criteria for
2011	continued residency as set forth in rules adopted under s.
2012	429.41. Licensees Facilities so licensed shall adopt their own
2013	requirements within guidelines for continued residency set forth
2014	by rule. However, such licensees facilities may not serve
2015	residents who require 24-hour nursing supervision. Licensees
2016	Facilities licensed to provide extended congregate care services
2017	shall provide each resident with a written copy of facility
2018	policies governing admission and retention.
2019	5.  The primary purpose of extended congregate care
2020	services is to allow residents, as they become more impaired,
2021	the option of remaining in a familiar setting from which they
2022	would otherwise be disqualified for continued residency. A
2023	facility licensed to provide extended congregate care services
2024	may also admit an individual who exceeds the admission criteria
2025	for a facility with a standard license, if the individual is
2026	determined appropriate for admission to the extended congregate
2027	care facility.
2028	6.  Before admission of an individual to a facility
2029	licensed to provide extended congregate care services, the
2030	individual must undergo a medical examination as provided in s.
2031	429.26(4) and the facility must develop a preliminary service
2032	plan for the individual.
2033	7.  When a licensee facility can no longer provide or
2034	arrange for services in accordance with the resident's service
2035	plan and needs and the licensee's facility's policy, the
2036	licensee facility shall make arrangements for relocating the
2037	person in accordance with s. 429.28(1)(k).
2038	8.  Failure to provide extended congregate care services
2039	may result in denial of extended congregate care license
2040	renewal.
2041	9.  No later than January 1 of each year, the department,
2042	in consultation with the agency, shall prepare and submit to the
2043	Governor, the President of the Senate, the Speaker of the House
2044	of Representatives, and the chairs of appropriate legislative
2045	committees, a report on the status of, and recommendations
2046	related to, extended congregate care services. The status report
2047	must include, but need not be limited to, the following
2048	information:
2049	a.  A description of the facilities licensed to provide
2050	such services, including total number of beds licensed under
2051	this part.
2052	b.  The number and characteristics of residents receiving
2053	such services.
2054	c.  The types of services rendered that could not be
2055	provided through a standard license.
2056	d.  An analysis of deficiencies cited during licensure
2057	inspections.
2058	e.  The number of residents who required extended
2059	congregate care services at admission and the source of
2060	admission.
2061	f.  Recommendations for statutory or regulatory changes.
2062	g.  The availability of extended congregate care to state
2063	clients residing in facilities licensed under this part and in
2064	need of additional services, and recommendations for
2065	appropriations to subsidize extended congregate care services
2066	for such persons.
2067	h.  Such other information as the department considers
2068	appropriate.
2069	(c)  A limited nursing services license shall be issued to
2070	a facility that provides services beyond those authorized in
2071	paragraph (a) and as specified in this paragraph.
2072	1.  In order for limited nursing services to be provided in
2073	a facility licensed under this part, the agency must first
2074	determine that all requirements established in law and rule are
2075	met and must specifically designate, on the facility's license,
2076	that such services may be provided. Such designation may be made
2077	at the time of initial licensure or relicensure, or upon request
2078	in writing by a licensee under this part and part II of chapter
2079	408. Notification of approval or denial of such request shall be
2080	made in accordance with part II of chapter 408. Existing
2081	facilities qualifying to provide limited nursing services shall
2082	have maintained a standard license and may not have been subject
2083	to administrative sanctions that affect the health, safety, and
2084	welfare of residents for the previous 2 years or since initial
2085	licensure if the facility has been licensed for less than 2
2086	years.
2087	2.  Facilities that are licensed to provide limited nursing
2088	services shall maintain a written progress report on each person
2089	who receives such nursing services, which report describes the
2090	type, amount, duration, scope, and outcome of services that are
2091	rendered and the general status of the resident's health. A
2092	registered nurse representing the agency shall visit such
2093	facilities at least twice a year to monitor residents who are
2094	receiving limited nursing services and to determine if the
2095	facility is in compliance with applicable provisions of this
2096	part, part II of chapter 408, and related rules. The monitoring
2097	visits may be provided through contractual arrangements with
2098	appropriate community agencies. A registered nurse shall also
2099	serve as part of the team that inspects such facility.
2100	3.  A person who receives limited nursing services under
2101	this part must meet the admission criteria established by the
2102	agency for assisted living facilities. When a resident no longer
2103	meets the admission criteria for a facility licensed under this
2104	part, arrangements for relocating the person shall be made in
2105	accordance with s. 429.28(1)(k), unless the facility is licensed
2106	to provide extended congregate care services.
2107	(4)  In accordance with s. 408.805, an applicant or
2108	licensee shall pay a fee for each license application submitted
2109	under this part, part II of chapter 408, and applicable rules.
2110	The amount of the fee shall be established by rule.
2111	(a)  The biennial license fee required of a facility is
2112	$356 $300 per license, with an additional fee of $67.50 $50 per
2113	resident based on the total licensed resident capacity of the
2114	facility, except that no additional fee will be assessed for
2115	beds designated for recipients of optional state supplementation
2116	payments provided for in s. 409.212. The total fee may not
2117	exceed $18,000 $10,000.
2118	(b)  In addition to the total fee assessed under paragraph
2119	(a), the agency shall require facilities that are licensed to
2120	provide extended congregate care services under this part to pay
2121	an additional fee per licensed facility. The amount of the
2122	biennial fee shall be $501 $400 per license, with an additional
2123	fee of $10 per resident based on the total licensed resident
2124	capacity of the facility.
2125	(c)  In addition to the total fee assessed under paragraph
2126	(a), the agency shall require facilities that are licensed to
2127	provide limited nursing services under this part to pay an
2128	additional fee per licensed facility. The amount of the biennial
2129	fee shall be $250 per license, with an additional fee of $10 per
2130	resident based on the total licensed resident capacity of the
2131	facility.
2132	(6)  In order to determine whether the facility is
2133	adequately protecting residents' rights as provided in s.
2134	429.28, the biennial survey shall include private informal
2135	conversations with a sample of residents and consultation with
2136	the ombudsman council in the planning and service area in which
2137	the facility is located to discuss residents' experiences within
2138	the facility.
2139	(7)  An assisted living facility that has been cited within
2140	the previous 24-month period for a class I or class II
2141	violation, regardless of the status of any enforcement or
2142	disciplinary action, is subject to periodic unannounced
2143	monitoring to determine if the facility is in compliance with
2144	this part, part II of chapter 408, and applicable rules.
2145	Monitoring may occur through a desk review or an onsite
2146	assessment. If the class I or class II violation relates to
2147	providing or failing to provide nursing care, a registered nurse
2148	must participate in at least two onsite monitoring visits within
2149	a 12-month period.
2150	Section 59.  Subsection (7) of section 429.11, Florida
2151	Statutes, is renumbered as subsection (6), and present
2152	subsection (6) of that section is amended to read:
2153	429.11  Initial application for license; provisional
2154	license.-
2155	(6)  In addition to the license categories available in s.
2156	408.808, a provisional license may be issued to an applicant
2157	making initial application for licensure or making application
2158	for a change of ownership. A provisional license shall be
2159	limited in duration to a specific period of time not to exceed 6
2160	months, as determined by the agency.
2161	Section 60.  Section 429.12, Florida Statutes, is amended
2162	to read:
2163	429.12  Sale or transfer of ownership of a facility.-It is
2164	the intent of the Legislature to protect the rights of the
2165	residents of an assisted living facility when the facility is
2166	sold or the ownership thereof is transferred. Therefore, in
2167	addition to the requirements of part II of chapter 408, whenever
2168	a facility is sold or the ownership thereof is transferred,
2169	including leasing:.
2170	(1)  The transferee shall notify the residents, in writing,
2171	of the change of ownership within 7 days after receipt of the
2172	new license.
2173	(2)  The transferor of a facility the license of which is
2174	denied pending an administrative hearing shall, as a part of the
2175	written change-of-ownership contract, advise the transferee that
2176	a plan of correction must be submitted by the transferee and
2177	approved by the agency at least 7 days before the change of
2178	ownership and that failure to correct the condition which
2179	resulted in the moratorium pursuant to part II of chapter 408 or
2180	denial of licensure is grounds for denial of the transferee's
2181	license.
2182	Section 61.  Paragraphs (b) through (l) of subsection (1)
2183	of section 429.14, Florida Statutes, are redesignated as
2184	paragraphs (a) through (k), respectively, and present paragraph
2185	(a) of subsection (1) and subsections (5) and (6) of that
2186	section are amended to read:
2187	429.14  Administrative penalties.-
2188	(1)  In addition to the requirements of part II of chapter
2189	408, the agency may deny, revoke, and suspend any license issued
2190	under this part and impose an administrative fine in the manner
2191	provided in chapter 120 against a licensee of an assisted living
2192	facility for a violation of any provision of this part, part II
2193	of chapter 408, or applicable rules, or for any of the following
2194	actions by a licensee of an assisted living facility, for the
2195	actions of any person subject to level 2 background screening
2196	under s. 408.809, or for the actions of any facility employee:
2197	(a)  An intentional or negligent act seriously affecting
2198	the health, safety, or welfare of a resident of the facility.
2199	(5)  An action taken by the agency to suspend, deny, or
2200	revoke a facility's license under this part or part II of
2201	chapter 408, in which the agency claims that the facility owner
2202	or an employee of the facility has threatened the health,
2203	safety, or welfare of a resident of the facility shall be heard
2204	by the Division of Administrative Hearings of the Department of
2205	Management Services within 120 days after receipt of the
2206	facility's request for a hearing, unless that time limitation is
2207	waived by both parties. The administrative law judge must render
2208	a decision within 30 days after receipt of a proposed
2209	recommended order.
2210	(6)  The agency shall provide to the Division of Hotels and
2211	Restaurants of the Department of Business and Professional
2212	Regulation, on a monthly basis, a list of those assisted living
2213	facilities that have had their licenses denied, suspended, or
2214	revoked or that are involved in an appellate proceeding pursuant
2215	to s. 120.60 related to the denial, suspension, or revocation of
2216	a license. This information may be provided electronically or
2217	through the agency's Internet website.
2218	Section 62.  Subsections (1), (4), and (5) of section
2219	429.17, Florida Statutes, are amended to read:
2220	429.17  Expiration of license; renewal; conditional
2221	license.-
2222	(1)  Limited nursing, Extended congregate care, and limited
2223	mental health licenses shall expire at the same time as the
2224	facility's standard license, regardless of when issued.
2225	(4)  In addition to the license categories available in s.
2226	408.808, a conditional license may be issued to an applicant for
2227	license renewal if the applicant fails to meet all standards and
2228	requirements for licensure. A conditional license issued under
2229	this subsection shall be limited in duration to a specific
2230	period of time not to exceed 6 months, as determined by the
2231	agency, and shall be accompanied by an agency-approved plan of
2232	correction.
2233	(5)  When an extended congregate care or limited nursing
2234	license is requested during a facility's biennial license
2235	period, the fee shall be prorated in order to permit the
2236	additional license to expire at the end of the biennial license
2237	period. The fee shall be calculated as of the date the
2238	additional license application is received by the agency.
2239	Section 63.  Subsection (7) of section 429.19, Florida
2240	Statutes, is amended to read:
2241	429.19  Violations; imposition of administrative fines;
2242	grounds.-
2243	(7)  In addition to any administrative fines imposed, the
2244	agency may assess a survey or monitoring fee, equal to the
2245	lesser of one half of the facility's biennial license and bed
2246	fee or $500, to cover the cost of conducting initial complaint
2247	investigations that result in the finding of a violation that
2248	was the subject of the complaint or to monitor the health,
2249	safety, or security of residents under s. 429.07(7) monitoring
2250	visits conducted under s. 429.28(3)(c) to verify the correction
2251	of the violations.
2252	Section 64.  Subsections (6) through (10) of section
2253	429.23, Florida Statutes, are renumbered as subsections (5)
2254	through (9), respectively, and present subsection (5) of that
2255	section is amended to read:
2256	429.23  Internal risk management and quality assurance
2257	program; adverse incidents and reporting requirements.-
2258	(5)  Each facility shall report monthly to the agency any
2259	liability claim filed against it. The report must include the
2260	name of the resident, the dates of the incident leading to the
2261	claim, if applicable, and the type of injury or violation of
2262	rights alleged to have occurred. This report is not discoverable
2263	in any civil or administrative action, except in such actions
2264	brought by the agency to enforce the provisions of this part.
2265	Section 65.  Paragraph (a) of subsection (1) and subsection
2266	(2) of section 429.255, Florida Statutes, are amended to read:
2267	429.255  Use of personnel; emergency care.-
2268	(1)(a)  Persons under contract to the facility or, facility
2269	staff, or volunteers, who are licensed according to part I of
2270	chapter 464, or those persons exempt under s. 464.022(1), and
2271	others as defined by rule, may administer medications to
2272	residents, take residents' vital signs, manage individual weekly
2273	pill organizers for residents who self-administer medication,
2274	give prepackaged enemas ordered by a physician, observe
2275	residents, document observations on the appropriate resident's
2276	record, report observations to the resident's physician, and
2277	contract or allow residents or a resident's representative,
2278	designee, surrogate, guardian, or attorney in fact to contract
2279	with a third party, provided residents meet the criteria for
2280	appropriate placement as defined in s. 429.26. Persons under
2281	contract to the facility or facility staff who are licensed
2282	according to part I of chapter 464 may provide limited nursing
2283	services. Nursing assistants certified pursuant to part II of
2284	chapter 464 may take residents' vital signs as directed by a
2285	licensed nurse or physician. The facility is responsible for
2286	maintaining documentation of services provided under this
2287	paragraph as required by rule and ensuring that staff are
2288	adequately trained to monitor residents receiving these
2289	services.
2290	(2)  In facilities licensed to provide extended congregate
2291	care, persons under contract to the facility or, facility staff,
2292	or volunteers, who are licensed according to part I of chapter
2293	464, or those persons exempt under s. 464.022(1), or those
2294	persons certified as nursing assistants pursuant to part II of
2295	chapter 464, may also perform all duties within the scope of
2296	their license or certification, as approved by the facility
2297	administrator and pursuant to this part.
2298	Section 66.  Subsection (3) of section 429.28, Florida
2299	Statutes, is amended to read:
2300	429.28  Resident bill of rights.-
2301	(3)(a)  The agency shall conduct a survey to determine
2302	general compliance with facility standards and compliance with
2303	residents' rights as a prerequisite to initial licensure or
2304	licensure renewal.
2305	(b)  In order to determine whether the facility is
2306	adequately protecting residents' rights, the biennial survey
2307	shall include private informal conversations with a sample of
2308	residents and consultation with the ombudsman council in the
2309	planning and service area in which the facility is located to
2310	discuss residents' experiences within the facility.
2311	(c)  During any calendar year in which no survey is
2312	conducted, the agency shall conduct at least one monitoring
2313	visit of each facility cited in the previous year for a class I
2314	or class II violation, or more than three uncorrected class III
2315	violations.
2316	(d)  The agency may conduct periodic followup inspections
2317	as necessary to monitor the compliance of facilities with a
2318	history of any class I, class II, or class III violations that
2319	threaten the health, safety, or security of residents.
2320	(e)  The agency may conduct complaint investigations as
2321	warranted to investigate any allegations of noncompliance with
2322	requirements required under this part or rules adopted under
2323	this part.
2324	Section 67.  Subsection (2) of section 429.35, Florida
2325	Statutes, is amended to read:
2326	429.35  Maintenance of records; reports.-
2327	(2)  Within 60 days after the date of the biennial
2328	inspection visit required under s. 408.811 or within 30 days
2329	after the date of any interim visit, the agency shall forward
2330	the results of the inspection to the local ombudsman council in
2331	whose planning and service area, as defined in part II of
2332	chapter 400, the facility is located; to at least one public
2333	library or, in the absence of a public library, the county seat
2334	in the county in which the inspected assisted living facility is
2335	located; and, when appropriate, to the district Adult Services
2336	and Mental Health Program Offices. This information may be
2337	provided electronically or through the agency's Internet
2338	website.
2339	Section 68.  Paragraphs (i) and (j) of subsection (1) of
2340	section 429.41, Florida Statutes, are amended to read:
2341	429.41  Rules establishing standards.-
2342	(1)  It is the intent of the Legislature that rules
2343	published and enforced pursuant to this section shall include
2344	criteria by which a reasonable and consistent quality of
2345	resident care and quality of life may be ensured and the results
2346	of such resident care may be demonstrated. Such rules shall also
2347	ensure a safe and sanitary environment that is residential and
2348	noninstitutional in design or nature. It is further intended
2349	that reasonable efforts be made to accommodate the needs and
2350	preferences of residents to enhance the quality of life in a
2351	facility. The agency, in consultation with the department, may
2352	adopt rules to administer the requirements of part II of chapter
2353	408. In order to provide safe and sanitary facilities and the
2354	highest quality of resident care accommodating the needs and
2355	preferences of residents, the department, in consultation with
2356	the agency, the Department of Children and Family Services, and
2357	the Department of Health, shall adopt rules, policies, and
2358	procedures to administer this part, which must include
2359	reasonable and fair minimum standards in relation to:
2360	(i)  Facilities holding an a limited nursing, extended
2361	congregate care, or limited mental health license.
2362	(j)  The establishment of specific criteria to define
2363	appropriateness of resident admission and continued residency in
2364	a facility holding a standard, limited nursing, extended
2365	congregate care, and limited mental health license.
2366	Section 69.  Subsections (1) and (2) of section 429.53,
2367	Florida Statutes, are amended to read:
2368	429.53  Consultation by the agency.-
2369	(1)  The area offices of licensure and certification of the
2370	agency shall provide consultation to the following upon request:
2371	(a)  A licensee of a facility.
2372	(b)  A person interested in obtaining a license to operate
2373	a facility under this part.
2374	(2)  As used in this section, "consultation" includes:
2375	(a)  An explanation of the requirements of this part and
2376	rules adopted pursuant thereto;
2377	(b)  An explanation of the license application and renewal
2378	procedures;
2379	(c)  The provision of a checklist of general local and
2380	state approvals required prior to constructing or developing a
2381	facility and a listing of the types of agencies responsible for
2382	such approvals;
2383	(d)  An explanation of benefits and financial assistance
2384	available to a recipient of supplemental security income
2385	residing in a facility;
2386	(c)(e)  Any other information which the agency deems
2387	necessary to promote compliance with the requirements of this
2388	part; and
2389	(f)  A preconstruction review of a facility to ensure
2390	compliance with agency rules and this part.
2391	Section 70.  Subsections (1) and (2) of section 429.54,
2392	Florida Statutes, are renumbered as subsections (2) and (3),
2393	respectively, and a new subsection (1) is added to that section
2394	to read:
2395	429.54  Collection of information; local subsidy.-
2396	(1)  A facility that is licensed under this part must
2397	report electronically to the agency semiannually, or more
2398	frequently as determined by rule, data related to the facility,
2399	including, but not limited to, the total number of residents,
2400	the number of residents who are receiving limited mental health
2401	services, the number of residents who are receiving extended
2402	congregate care services, the number of residents who are
2403	receiving limited nursing services, funding sources of the
2404	residents, and professional staffing employed by or under
2405	contract with the licensee to provide resident services. The
2406	department, in consultation with the agency, shall adopt rules
2407	to administer this subsection.
2408	Section 71.  Subsections (1) and (5) of section 429.71,
2409	Florida Statutes, are amended to read:
2410	429.71  Classification of violations deficiencies;
2411	administrative fines.-
2412	(1)  In addition to the requirements of part II of chapter
2413	408 and in addition to any other liability or penalty provided
2414	by law, the agency may impose an administrative fine on a
2415	provider according to the following classification:
2416	(a)  Class I violations are defined in s. 408.813 those
2417	conditions or practices related to the operation and maintenance
2418	of an adult family-care home or to the care of residents which
2419	the agency determines present an imminent danger to the
2420	residents or guests of the facility or a substantial probability
2421	that death or serious physical or emotional harm would result
2422	therefrom. The condition or practice that constitutes a class I
2423	violation must be abated or eliminated within 24 hours, unless a
2424	fixed period, as determined by the agency, is required for
2425	correction. A class I violation deficiency is subject to an
2426	administrative fine in an amount not less than $500 and not
2427	exceeding $1,000 for each violation. A fine may be levied
2428	notwithstanding the correction of the deficiency.
2429	(b)  Class II violations are defined in s. 408.813 those
2430	conditions or practices related to the operation and maintenance
2431	of an adult family-care home or to the care of residents which
2432	the agency determines directly threaten the physical or
2433	emotional health, safety, or security of the residents, other
2434	than class I violations. A class II violation is subject to an
2435	administrative fine in an amount not less than $250 and not
2436	exceeding $500 for each violation. A citation for a class II
2437	violation must specify the time within which the violation is
2438	required to be corrected. If a class II violation is corrected
2439	within the time specified, no civil penalty shall be imposed,
2440	unless it is a repeated offense.
2441	(c)  Class III violations are defined in s. 408.813 those
2442	conditions or practices related to the operation and maintenance
2443	of an adult family-care home or to the care of residents which
2444	the agency determines indirectly or potentially threaten the
2445	physical or emotional health, safety, or security of residents,
2446	other than class I or class II violations. A class III violation
2447	is subject to an administrative fine in an amount not less than
2448	$100 and not exceeding $250 for each violation. A citation for a
2449	class III violation shall specify the time within which the
2450	violation is required to be corrected. If a class III violation
2451	is corrected within the time specified, no civil penalty shall
2452	be imposed, unless it is a repeated violation offense.
2453	(d)  Class IV violations are defined in s. 408.813 those
2454	conditions or occurrences related to the operation and
2455	maintenance of an adult family-care home, or related to the
2456	required reports, forms, or documents, which do not have the
2457	potential of negatively affecting the residents. A provider that
2458	does not correct A class IV violation within the time limit
2459	specified by the agency is subject to an administrative fine in
2460	an amount not less than $50 and not exceeding $100 for each
2461	violation. Any class IV violation that is corrected during the
2462	time the agency survey is conducted will be identified as an
2463	agency finding and not as a violation, unless it is a repeat
2464	violation.
2465	(5)  As an alternative to or in conjunction with an
2466	administrative action against a provider, the agency may request
2467	a plan of corrective action that demonstrates a good faith
2468	effort to remedy each violation by a specific date, subject to
2469	the approval of the agency.
2470	Section 72.  Paragraphs (b) through (e) of subsection (2)
2471	of section 429.911, Florida Statutes, are redesignated as
2472	paragraphs (a) through (d), respectively, and present paragraph
2473	(a) of that subsection is amended to read:
2474	429.911  Denial, suspension, revocation of license;
2475	emergency action; administrative fines; investigations and
2476	inspections.-
2477	(2)  Each of the following actions by the owner of an adult
2478	day care center or by its operator or employee is a ground for
2479	action by the agency against the owner of the center or its
2480	operator or employee:
2481	(a)  An intentional or negligent act materially affecting
2482	the health or safety of center participants.
2483	Section 73.  Section 429.915, Florida Statutes, is amended
2484	to read:
2485	429.915  Conditional license.-In addition to the license
2486	categories available in part II of chapter 408, the agency may
2487	issue a conditional license to an applicant for license renewal
2488	or change of ownership if the applicant fails to meet all
2489	standards and requirements for licensure. A conditional license
2490	issued under this subsection must be limited to a specific
2491	period not exceeding 6 months, as determined by the agency, and
2492	must be accompanied by an approved plan of correction.
2493	Section 74.  Subsection (7) of section 394.4787, Florida
2494	Statutes, is amended to read:
2495	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
2496	and 394.4789.-As used in this section and ss. 394.4786,
2497	394.4788, and 394.4789:
2498	(7)  "Specialty psychiatric hospital" means a hospital
2499	licensed by the agency pursuant to s. 395.002(26)(28) and part
2500	II of chapter 408 as a specialty psychiatric hospital.
2501	Section 75.  Paragraph (g) of subsection (2) of section
2502	400.0239, Florida Statutes, is amended to read:
2503	400.0239  Quality of Long-Term Care Facility Improvement
2504	Trust Fund.-
2505	(2)  Expenditures from the trust fund shall be allowable
2506	for direct support of the following:
2507	(g)  Other initiatives authorized by the Centers for
2508	Medicare and Medicaid Services for the use of federal civil
2509	monetary penalties, including projects recommended through the
2510	Medicaid "Up-or-Out" Quality of Care Contract Management Program
2511	pursuant to s. 400.148.
2512	Section 76.  Subsection (43) of section 408.07, Florida
2513	Statutes, is amended to read:
2514	408.07  Definitions.-As used in this chapter, with the
2515	exception of ss. 408.031-408.045, the term:
2516	(43)  "Rural hospital" means an acute care hospital
2517	licensed under chapter 395, having 100 or fewer licensed beds
2518	and an emergency room, and which is:
2519	(a)  The sole provider within a county with a population
2520	density of no greater than 100 persons per square mile;
2521	(b)  An acute care hospital, in a county with a population
2522	density of no greater than 100 persons per square mile, which is
2523	at least 30 minutes of travel time, on normally traveled roads
2524	under normal traffic conditions, from another acute care
2525	hospital within the same county;
2526	(c)  A hospital supported by a tax district or subdistrict
2527	whose boundaries encompass a population of 100 persons or fewer
2528	per square mile;
2529	(d)  A hospital with a service area that has a population
2530	of 100 persons or fewer per square mile. As used in this
2531	paragraph, the term "service area" means the fewest number of
2532	zip codes that account for 75 percent of the hospital's
2533	discharges for the most recent 5-year period, based on
2534	information available from the hospital inpatient discharge
2535	database in the Florida Center for Health Information and Policy
2536	Analysis at the Agency for Health Care Administration; or
2537	(e)  A critical access hospital.
2538
2539	Population densities used in this subsection must be based upon
2540	the most recently completed United States census. A hospital
2541	that received funds under s. 409.9116 for a quarter beginning no
2542	later than July 1, 2002, is deemed to have been and shall
2543	continue to be a rural hospital from that date through June 30,
2544	2015, if the hospital continues to have 100 or fewer licensed
2545	beds and an emergency room, or meets the criteria of s.
2546	395.602(2)(e)4. An acute care hospital that has not previously
2547	been designated as a rural hospital and that meets the criteria
2548	of this subsection shall be granted such designation upon
2549	application, including supporting documentation, to the Agency
2550	for Health Care Administration.
2551	Section 77.  Paragraphs (b) and (h) of subsection (3) of
2552	section 430.80, Florida Statutes, are amended to read:
2553	430.80  Implementation of a teaching nursing home pilot
2554	project.-
2555	(3)  To be designated as a teaching nursing home, a nursing
2556	home licensee must, at a minimum:
2557	(b)  Participate in a nationally recognized accreditation
2558	program and hold a valid accreditation, such as the
2559	accreditation awarded by The Joint Commission on Accreditation
2560	of Healthcare Organizations;
2561	(h)  Maintain insurance coverage pursuant to s.
2562	400.141(1)(q)(s) or proof of financial responsibility in a
2563	minimum amount of $750,000. Such proof of financial
2564	responsibility may include:
2565	1.  Maintaining an escrow account consisting of cash or
2566	assets eligible for deposit in accordance with s. 625.52; or
2567	2.  Obtaining and maintaining pursuant to chapter 675 an
2568	unexpired, irrevocable, nontransferable and nonassignable letter
2569	of credit issued by any bank or savings association organized
2570	and existing under the laws of this state or any bank or savings
2571	association organized under the laws of the United States that
2572	has its principal place of business in this state or has a
2573	branch office which is authorized to receive deposits in this
2574	state. The letter of credit shall be used to satisfy the
2575	obligation of the facility to the claimant upon presentment of a
2576	final judgment indicating liability and awarding damages to be
2577	paid by the facility or upon presentment of a settlement
2578	agreement signed by all parties to the agreement when such final
2579	judgment or settlement is a result of a liability claim against
2580	the facility.
2581	Section 78.  Paragraph (a) of subsection (2) of section
2582	440.13, Florida Statutes, is amended to read:
2583	440.13  Medical services and supplies; penalty for
2584	violations; limitations.-
2585	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2586	(a)  Subject to the limitations specified elsewhere in this
2587	chapter, the employer shall furnish to the employee such
2588	medically necessary remedial treatment, care, and attendance for
2589	such period as the nature of the injury or the process of
2590	recovery may require, which is in accordance with established
2591	practice parameters and protocols of treatment as provided for
2592	in this chapter, including medicines, medical supplies, durable
2593	medical equipment, orthoses, prostheses, and other medically
2594	necessary apparatus. Remedial treatment, care, and attendance,
2595	including work-hardening programs or pain-management programs
2596	accredited by the Commission on Accreditation of Rehabilitation
2597	Facilities or The Joint Commission on the Accreditation of
2598	Health Organizations or pain-management programs affiliated with
2599	medical schools, shall be considered as covered treatment only
2600	when such care is given based on a referral by a physician as
2601	defined in this chapter. Medically necessary treatment, care,
2602	and attendance does not include chiropractic services in excess
2603	of 24 treatments or rendered 12 weeks beyond the date of the
2604	initial chiropractic treatment, whichever comes first, unless
2605	the carrier authorizes additional treatment or the employee is
2606	catastrophically injured.
2607
2608	Failure of the carrier to timely comply with this subsection
2609	shall be a violation of this chapter and the carrier shall be
2610	subject to penalties as provided for in s. 440.525.
2611	Section 79.  Section 483.294, Florida Statutes, is amended
2612	to read:
2613	483.294  Inspection of centers.-In accordance with s.
2614	408.811, the agency shall biennially, at least once annually,
2615	inspect the premises and operations of all centers subject to
2616	licensure under this part.
2617	Section 80.  Subsection (1) of section 627.645, Florida
2618	Statutes, is amended to read:
2619	627.645  Denial of health insurance claims restricted.-
2620	(1)  No claim for payment under a health insurance policy
2621	or self-insured program of health benefits for treatment, care,
2622	or services in a licensed hospital which is accredited by The
2623	Joint Commission on the Accreditation of Hospitals, the American
2624	Osteopathic Association, or the Commission on the Accreditation
2625	of Rehabilitative Facilities shall be denied because such
2626	hospital lacks major surgical facilities and is primarily of a
2627	rehabilitative nature, if such rehabilitation is specifically
2628	for treatment of physical disability.
2629	Section 81.  Paragraph (c) of subsection (2) of section
2630	627.668, Florida Statutes, is amended to read:
2631	627.668  Optional coverage for mental and nervous disorders
2632	required; exception.-
2633	(2)  Under group policies or contracts, inpatient hospital
2634	benefits, partial hospitalization benefits, and outpatient
2635	benefits consisting of durational limits, dollar amounts,
2636	deductibles, and coinsurance factors shall not be less favorable
2637	than for physical illness generally, except that:
2638	(c)  Partial hospitalization benefits shall be provided
2639	under the direction of a licensed physician. For purposes of
2640	this part, the term "partial hospitalization services" is
2641	defined as those services offered by a program accredited by The
2642	Joint Commission on Accreditation of Hospitals (JCAH) or in
2643	compliance with equivalent standards. Alcohol rehabilitation
2644	programs accredited by The Joint Commission on Accreditation of
2645	Hospitals or approved by the state and licensed drug abuse
2646	rehabilitation programs shall also be qualified providers under
2647	this section. In any benefit year, if partial hospitalization
2648	services or a combination of inpatient and partial
2649	hospitalization are utilized, the total benefits paid for all
2650	such services shall not exceed the cost of 30 days of inpatient
2651	hospitalization for psychiatric services, including physician
2652	fees, which prevail in the community in which the partial
2653	hospitalization services are rendered. If partial
2654	hospitalization services benefits are provided beyond the limits
2655	set forth in this paragraph, the durational limits, dollar
2656	amounts, and coinsurance factors thereof need not be the same as
2657	those applicable to physical illness generally.
2658	Section 82.  Subsection (3) of section 627.669, Florida
2659	Statutes, is amended to read:
2660	627.669  Optional coverage required for substance abuse
2661	impaired persons; exception.-
2662	(3)  The benefits provided under this section shall be
2663	applicable only if treatment is provided by, or under the
2664	supervision of, or is prescribed by, a licensed physician or
2665	licensed psychologist and if services are provided in a program
2666	accredited by The Joint Commission on Accreditation of Hospitals
2667	or approved by the state.
2668	Section 83.  Paragraph (a) of subsection (1) of section
2669	627.736, Florida Statutes, is amended to read:
2670	627.736  Required personal injury protection benefits;
2671	exclusions; priority; claims.-
2672	(1)  REQUIRED BENEFITS.-Every insurance policy complying
2673	with the security requirements of s. 627.733 shall provide
2674	personal injury protection to the named insured, relatives
2675	residing in the same household, persons operating the insured
2676	motor vehicle, passengers in such motor vehicle, and other
2677	persons struck by such motor vehicle and suffering bodily injury
2678	while not an occupant of a self-propelled vehicle, subject to
2679	the provisions of subsection (2) and paragraph (4)(e), to a
2680	limit of $10,000 for loss sustained by any such person as a
2681	result of bodily injury, sickness, disease, or death arising out
2682	of the ownership, maintenance, or use of a motor vehicle as
2683	follows:
2684	(a)  Medical benefits.-Eighty percent of all reasonable
2685	expenses for medically necessary medical, surgical, X-ray,
2686	dental, and rehabilitative services, including prosthetic
2687	devices, and medically necessary ambulance, hospital, and
2688	nursing services. However, the medical benefits shall provide
2689	reimbursement only for such services and care that are lawfully
2690	provided, supervised, ordered, or prescribed by a physician
2691	licensed under chapter 458 or chapter 459, a dentist licensed
2692	under chapter 466, or a chiropractic physician licensed under
2693	chapter 460 or that are provided by any of the following persons
2694	or entities:
2695	1.  A hospital or ambulatory surgical center licensed under
2696	chapter 395.
2697	2.  A person or entity licensed under ss. 401.2101-401.45
2698	that provides emergency transportation and treatment.
2699	3.  An entity wholly owned by one or more physicians
2700	licensed under chapter 458 or chapter 459, chiropractic
2701	physicians licensed under chapter 460, or dentists licensed
2702	under chapter 466 or by such practitioner or practitioners and
2703	the spouse, parent, child, or sibling of that practitioner or
2704	those practitioners.
2705	4.  An entity wholly owned, directly or indirectly, by a
2706	hospital or hospitals.
2707	5.  A health care clinic licensed under ss. 400.990-400.995
2708	that is:
2709	a.  Accredited by The Joint Commission on Accreditation of
2710	Healthcare Organizations, the American Osteopathic Association,
2711	the Commission on Accreditation of Rehabilitation Facilities, or
2712	the Accreditation Association for Ambulatory Health Care, Inc.;
2713	or
2714	b.  A health care clinic that:
2715	(I)  Has a medical director licensed under chapter 458,
2716	chapter 459, or chapter 460;
2717	(II)  Has been continuously licensed for more than 3 years
2718	or is a publicly traded corporation that issues securities
2719	traded on an exchange registered with the United States
2720	Securities and Exchange Commission as a national securities
2721	exchange; and
2722	(III)  Provides at least four of the following medical
2723	specialties:
2724	(A)  General medicine.
2725	(B)  Radiography.
2726	(C)  Orthopedic medicine.
2727	(D)  Physical medicine.
2728	(E)  Physical therapy.
2729	(F)  Physical rehabilitation.
2730	(G)  Prescribing or dispensing outpatient prescription
2731	medication.
2732	(H)  Laboratory services.
2733
2734	The Financial Services Commission shall adopt by rule the form
2735	that must be used by an insurer and a health care provider
2736	specified in subparagraph 3., subparagraph 4., or subparagraph
2737	5. to document that the health care provider meets the criteria
2738	of this paragraph, which rule must include a requirement for a
2739	sworn statement or affidavit.
2740
2741	Only insurers writing motor vehicle liability insurance in this
2742	state may provide the required benefits of this section, and no
2743	such insurer shall require the purchase of any other motor
2744	vehicle coverage other than the purchase of property damage
2745	liability coverage as required by s. 627.7275 as a condition for
2746	providing such required benefits. Insurers may not require that
2747	property damage liability insurance in an amount greater than
2748	$10,000 be purchased in conjunction with personal injury
2749	protection. Such insurers shall make benefits and required
2750	property damage liability insurance coverage available through
2751	normal marketing channels. Any insurer writing motor vehicle
2752	liability insurance in this state who fails to comply with such
2753	availability requirement as a general business practice shall be
2754	deemed to have violated part IX of chapter 626, and such
2755	violation shall constitute an unfair method of competition or an
2756	unfair or deceptive act or practice involving the business of
2757	insurance; and any such insurer committing such violation shall
2758	be subject to the penalties afforded in such part, as well as
2759	those which may be afforded elsewhere in the insurance code.
2760	Section 84.  Subsection (12) of section 641.495, Florida
2761	Statutes, is amended to read:
2762	641.495  Requirements for issuance and maintenance of
2763	certificate.-
2764	(12)  The provisions of part I of chapter 395 do not apply
2765	to a health maintenance organization that, on or before January
2766	1, 1991, provides not more than 10 outpatient holding beds for
2767	short-term and hospice-type patients in an ambulatory care
2768	facility for its members, provided that such health maintenance
2769	organization maintains current accreditation by The Joint
2770	Commission on Accreditation of Health Care Organizations, the
2771	Accreditation Association for Ambulatory Health Care, or the
2772	National Committee for Quality Assurance.
2773	Section 85.  Subsection (13) of section 651.118, Florida
2774	Statutes, is amended to read:
2775	651.118  Agency for Health Care Administration;
2776	certificates of need; sheltered beds; community beds.-
2777	(13)  Residents, as defined in this chapter, are not
2778	considered new admissions for the purpose of s.
2779	400.141(1)(n)(o)1.d.
2780	Section 86.  Subsection (2) of section 766.1015, Florida
2781	Statutes, is amended to read:
2782	766.1015  Civil immunity for members of or consultants to
2783	certain boards, committees, or other entities.-
2784	(2)  Such committee, board, group, commission, or other
2785	entity must be established in accordance with state law or in
2786	accordance with requirements of The Joint Commission on
2787	Accreditation of Healthcare Organizations, established and duly
2788	constituted by one or more public or licensed private hospitals
2789	or behavioral health agencies, or established by a governmental
2790	agency. To be protected by this section, the act, decision,
2791	omission, or utterance may not be made or done in bad faith or
2792	with malicious intent.
2793	Section 87.  This act shall take effect July 1, 2010.

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