CS/CS/CS/HB 1143

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., relating to the Drug-Free Workplace Act; deleting an
4	obsolete provision; amending s. 318.21, F.S.; revising
5	distribution of funds from civil penalties imposed for
6	traffic infractions by county courts; amending s.
7	381.00315, F.S.; directing the Department of Health to
8	accept funds from counties, municipalities, and certain
9	other entities for the purchase of certain products made
10	available under a contract of the United States Department
11	of Health and Human Services for the manufacture and
12	delivery of such products in response to a public health
13	emergency; amending s. 381.0072, F.S.; limiting Department
14	of Health food service inspections in nursing homes;
15	requiring the department to coordinate inspections with
16	the Agency for Health Care Administration; repealing s.
17	383.325, F.S., relating to confidentiality of inspection
18	reports of licensed birth center facilities; amending s.
19	390.0111, F.S.; requiring that an ultrasound be performed
20	on any woman obtaining an abortion; specifying who must
21	perform an ultrasound; requiring that the ultrasound be
22	reviewed with the patient prior to the woman giving
23	informed consent; specifying who must review the
24	ultrasound with the patient; requiring that the woman
25	certify in writing that she declined to review the
26	ultrasound and did so of her own free will and without
27	undue influence; providing an exemption from the
28	requirement to view the ultrasound for women who are the
29	victims of rape, incest, domestic violence, or human
30	trafficking or for women who have a serious medical
31	condition necessitating the abortion; revising
32	requirements for written materials; amending s. 390.012,
33	F.S.; requiring ultrasounds for all patients; requiring
34	that live ultrasound images be reviewed and explained to
35	the patient; requiring that all other provisions in s.
36	390.0111, F.S., be complied with if the patient declines
37	to view her live ultrasound images; amending s. 395.002,
38	F.S.; revising and deleting definitions applicable to
39	regulation of hospitals and other licensed facilities;
40	conforming a cross-reference; amending s. 395.003, F.S.;
41	deleting an obsolete provision; conforming a cross-
42	reference; amending s. 395.0193, F.S.; requiring a
43	licensed facility to report certain peer review
44	information and final disciplinary actions to the Division
45	of Medical Quality Assurance of the Department of Health
46	rather than the Division of Health Quality Assurance of
47	the Agency for Health Care Administration; amending s.
48	395.1023, F.S.; providing for the Department of Children
49	and Family Services rather than the Department of Health
50	to perform certain functions with respect to child
51	protection cases; requiring certain hospitals to notify
52	the Department of Children and Family Services of
53	compliance; amending s. 395.1041, F.S., relating to
54	hospital emergency services and care; deleting obsolete
55	provisions; repealing s. 395.1046, F.S., relating to
56	complaint investigation procedures; amending s. 395.1055,
57	F.S.; requiring licensed facility beds to conform to
58	standards specified by the Agency for Health Care
59	Administration, the Florida Building Code, and the Florida
60	Fire Prevention Code; amending s. 395.10972, F.S.;
61	revising a reference to the Florida Society of Healthcare
62	Risk Management to conform to the current designation;
63	amending s. 395.2050, F.S.; revising a reference to the
64	federal Health Care Financing Administration to conform to
65	the current designation; amending s. 395.3036, F.S.;
66	correcting a reference; repealing s. 395.3037, F.S.,
67	relating to redundant definitions; amending ss. 154.11,
68	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
69	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
70	F.S.; revising references to the Joint Commission on
71	Accreditation of Healthcare Organizations, the Commission
72	on Accreditation of Rehabilitation Facilities, and the
73	Council on Accreditation to conform to their current
74	designations; amending s. 395.602, F.S.; revising the
75	definition of the term "rural hospital" to delete an
76	obsolete provision; amending s. 400.021, F.S.; revising
77	the definition of the term "geriatric outpatient clinic";
78	amending s. 400.0255, F.S.; correcting an obsolete cross-
79	reference to administrative rules; amending s. 400.063,
80	F.S.; deleting an obsolete provision; amending ss. 400.071
81	and 400.0712, F.S.; revising applicability of general
82	licensure requirements under part II of ch. 408, F.S., to
83	applications for nursing home licensure; revising
84	provisions governing inactive licenses; amending s.
85	400.111, F.S.; providing for disclosure of controlling
86	interest of a nursing home facility upon request by the
87	Agency for Health Care Administration; amending s.
88	400.1183, F.S.; revising grievance record maintenance and
89	reporting requirements for nursing homes; amending s.
90	400.141, F.S.; providing criteria for the provision of
91	respite services by nursing homes; requiring a written
92	plan of care; requiring a contract for services; requiring
93	resident release to caregivers to be designated in
94	writing; providing an exemption to the application of
95	discharge planning rules; providing for residents' rights;
96	providing for use of personal medications; providing terms
97	of respite stay; providing for communication of patient
98	information; requiring a physician order for care and
99	proof of a physical examination; providing for services
100	for respite patients and duties of facilities with respect
101	to such patients; conforming a cross-reference; requiring
102	facilities to maintain clinical records that meet
103	specified standards; providing a fine relating to an
104	admissions moratorium; deleting requirement for facilities
105	to submit certain information related to management
106	companies to the agency; deleting a requirement for
107	facilities to notify the agency of certain bankruptcy
108	filings to conform to changes made by the act; amending s.
109	400.142, F.S.; deleting language relating to agency
110	adoption of rules; amending 400.147, F.S.; revising
111	reporting requirements for licensed nursing home
112	facilities relating to adverse incidents; repealing s.
113	400.148, F.S., relating to the Medicaid "Up-or-Out"
114	Quality of Care Contract Management Program; amending s.
115	400.162, F.S., requiring nursing homes to provide a
116	resident property statement annually and upon request;
117	amending s. 400.179, F.S.; revising requirements for
118	nursing home lease bond alternative fees; deleting an
119	obsolete provision; amending s. 400.19, F.S.; revising
120	inspection requirements; repealing s. 400.195, F.S.,
121	relating to agency reporting requirements; amending s.
122	400.23, F.S.; deleting an obsolete provision; correcting a
123	reference; directing the agency to adopt rules for minimum
124	staffing standards in nursing homes that serve persons
125	under 21 years of age; providing minimum staffing
126	standards; amending s. 400.275, F.S.; revising agency
127	duties with regard to training nursing home surveyor
128	teams; revising requirements for team members; amending s.
129	400.484, F.S.; revising the schedule of home health agency
130	inspection violations; amending s. 400.606, F.S.; revising
131	the content requirements of the plan accompanying an
132	initial or change-of-ownership application for licensure
133	of a hospice; revising requirements relating to
134	certificates of need for certain hospice facilities;
135	amending s. 400.607, F.S.; revising grounds for agency
136	action against a hospice; amending s. 400.915, F.S.;
137	correcting an obsolete cross-reference to administrative
138	rules; amending s. 400.931, F.S.; deleting a requirement
139	that an applicant for a home medical equipment provider
140	license submit a surety bond to the agency; amending s.
141	400.932, F.S.; revising grounds for the imposition of
142	administrative penalties for certain violations by an
143	employee of a home medical equipment provider; amending s.
144	400.967, F.S.; revising the schedule of inspection
145	violations for intermediate care facilities for the
146	developmentally disabled; providing a penalty for certain
147	violations; amending s. 400.9905, F.S.; providing that
148	part X of ch, 400, F.S., the Health Care Clinic Act, does
149	not apply to an entity owned by a corporation with a
150	specified amount of annual sales of health care services
151	under certain circumstances or to an entity owned or
152	controlled by a publicly traded entity with a specified
153	amount of annual revenues; amending s. 400.991, F.S.;
154	conforming terminology; revising application requirements
155	relating to documentation of financial ability to operate
156	a mobile clinic; amending s. 408.034, F.S.; revising
157	agency authority relating to licensing of intermediate
158	care facilities for the developmentally disabled; amending
159	s. 408.036, F.S.; deleting an exemption from certain
160	certificate-of-need review requirements for a hospice or a
161	hospice inpatient facility; amending s. 408.043, F.S.;
162	revising requirements for certain freestanding inpatient
163	hospice care facilities to obtain a certificate of need;
164	amending s. 408.061, F.S.; revising health care facility
165	data reporting requirements; amending s. 408.10, F.S.;
166	removing agency authority to investigate certain consumer
167	complaints; amending s. 408.802, F.S.; removing
168	applicability of part II of ch. 408, F.S., relating to
169	general licensure requirements, to private review agents;
170	amending s. 408.804, F.S.; providing penalties for
171	altering, defacing, or falsifying a license certificate
172	issued by the agency or displaying such an altered,
173	defaced, or falsified certificate; amending s. 408.806,
174	F.S.; revising agency responsibilities for notification of
175	licensees of impending expiration of a license; requiring
176	payment of a late fee for a license application to be
177	considered complete under certain circumstances; amending
178	s. 408.810, F.S.; revising provisions relating to
179	information required for licensure; requiring proof of
180	submission of notice to a mortgagor or landlord regarding
181	provision of services requiring licensure; requiring
182	disclosure of information by a controlling interest of
183	certain court actions relating to financial instability
184	within a specified time period; amending s. 408.813, F.S.;
185	authorizing the agency to impose fines for unclassified
186	violations of part II of ch. 408, F.S.; amending s.
187	408.815, F.S.; authorizing the agency to extend a license
188	expiration date under certain circumstances; amending s.
189	409.221, F.S.; deleting a reporting requirement relating
190	to the consumer-directed care program; amending s.
191	409.91196, F.S.; conforming a cross-reference; amending s.
192	409.912, F.S.; revising procedures for implementation of a
193	Medicaid prescribed-drug spending-control program;
194	amending s. 429.07, F.S.; deleting the requirement for an
195	assisted living facility to obtain an additional license
196	in order to provide limited nursing services; deleting the
197	requirement for the agency to conduct quarterly monitoring
198	visits of facilities that hold a license to provide
199	extended congregate care services; deleting the
200	requirement for the department to report annually on the
201	status of and recommendations related to extended
202	congregate care; deleting the requirement for the agency
203	to conduct monitoring visits at least twice a year to
204	facilities providing limited nursing services; increasing
205	the licensure fees and the maximum fee required for the
206	standard license; increasing the licensure fees for the
207	extended congregate care license; eliminating the license
208	fee for the limited nursing services license; transferring
209	from another provision of law the requirement that a
210	biennial survey of an assisted living facility include
211	specific actions to determine whether the facility is
212	adequately protecting residents' rights; providing that an
213	assisted living facility that has a class I or class II
214	violation is subject to monitoring visits; requiring a
215	registered nurse to participate in certain monitoring
216	visits; amending s. 429.11, F.S.; revising licensure
217	application requirements for assisted living facilities to
218	eliminate provisional licenses; amending s. 429.12, F.S.;
219	revising notification requirements for the sale or
220	transfer of ownership of an assisted living facility;
221	amending s. 429.14, F.S.; removing a ground for the
222	imposition of an administrative penalty; clarifying
223	provisions relating to a facility's request for a hearing
224	under certain circumstances; authorizing the agency to
225	provide certain information relating to the licensure
226	status of assisted living facilities electronically or
227	through the agency's Internet website; amending s. 429.17,
228	F.S.; deleting provisions relating to the limited nursing
229	services license; revising agency responsibilities
230	regarding the issuance of conditional licenses; amending
231	s. 429.19, F.S.; clarifying that a monitoring fee may be
232	assessed in addition to an administrative fine; amending
233	s. 429.23, F.S.; deleting reporting requirements for
234	assisted living facilities relating to liability claims;
235	amending s. 429.255, F.S.; eliminating provisions
236	authorizing the use of volunteers to provide certain
237	health-care-related services in assisted living
238	facilities; authorizing assisted living facilities to
239	provide limited nursing services; requiring an assisted
240	living facility to be responsible for certain
241	recordkeeping and staff to be trained to monitor residents
242	receiving certain health-care-related services; amending
243	s. 429.28, F.S.; deleting a requirement for a biennial
244	survey of an assisted living facility, to conform to
245	changes made by the act; amending s. 429.35, F.S.;
246	authorizing the agency to provide certain information
247	relating to the inspections of assisted living facilities
248	electronically or through the agency's Internet website;
249	amending s. 429.41, F.S., relating to rulemaking;
250	conforming provisions to changes made by the act; amending
251	s. 429.53, F.S.; revising provisions relating to
252	consultation by the agency; revising a definition;
253	amending s. 429.54, F.S.; requiring licensed assisted
254	living facilities to electronically report certain data
255	semiannually to the agency in accordance with rules
256	adopted by the department; amending s. 429.71, F.S.;
257	revising schedule of inspection violations for adult
258	family-care homes; amending s. 429.911, F.S.; deleting a
259	ground for agency action against an adult day care center;
260	amending s. 429.915, F.S.; revising agency
261	responsibilities regarding the issuance of conditional
262	licenses; amending s. 483.294, F.S.; revising frequency of
263	agency inspections of multiphasic health testing centers;
264	amending s. 499.003, F.S.; defining the term "medical
265	convenience kit" for purposes of pt. I of ch. 499, F.S.;
266	providing an exception to applicability of the term;
267	amending s. 499.0121, F.S.; providing an exception to the
268	requirement that a wholesale distributor of prescription
269	drugs provide a pedigree paper to the person who receives
270	the drug for wholesale distribution of prescription drugs
271	contained within a medical convenience kit under specified
272	conditions; providing that the exception does not apply to
273	any kit that contains certain controlled substances;
274	amending s. 626.9541, F.S.; authorizing an insurer
275	offering a group or individual health benefit plan to
276	offer a wellness program; authorizing rewards or
277	incentives; providing that such rewards or incentives are
278	not insurance benefits; providing for verification of a
279	member's inability to participate for medical reasons;
280	amending s. 633.081, F.S.; limiting Fire Marshal
281	inspections of nursing homes to once a year; providing for
282	additional inspections based on complaints and violations
283	identified in the course of orientation or training
284	activities; amending s. 766.202, F.S.; adding persons
285	licensed under part XIV of ch. 468, F.S., to the
286	definition of "health care provider"; amending ss.
287	394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
288	conforming terminology and cross-references; revising a
289	reference; providing a statement of public policy
290	protecting persons from government compulsion relating to
291	purchasing health insurance coverage; preserving the right
292	to collect certain debts incurred for health insurance or
293	health services; authorizing the Attorney General to
294	implement or advocate such public policy in federal or
295	state court or administrative forums on behalf of certain
296	persons; creating s. 627.64995, F.S.; prohibiting the use
297	of state or federal funds to provide coverage for
298	abortions in an exchange created pursuant to federal law;
299	specifying conditions under which a health insurance
300	policy or group health insurance policy is deemed to be
301	purchased with state or federal funds; providing
302	exceptions; creating s. 641.31099, F.S.; prohibiting the
303	use of state or federal funds to provide coverage for
304	abortions in an exchange created pursuant to federal law;
305	specifying conditions under which a health maintenance
306	contract is deemed to provide coverage purchased with
307	state or federal funds; providing exceptions; providing an
308	effective date.
309
310	Be It Enacted by the Legislature of the State of Florida:
311
312	Section 1.  Present paragraph (e) of subsection (10) and
313	paragraph (e) of subsection (14) of section 112.0455, Florida
314	Statutes, are amended, and paragraphs (f) through (k) of
315	subsection (10) of that section are redesignated as paragraphs
316	(e) through (j), respectively, to read:
317	112.0455  Drug-Free Workplace Act.-
318	(10)  EMPLOYER PROTECTION.-
319	(e)  Nothing in this section shall be construed to operate
320	retroactively, and nothing in this section shall abrogate the
321	right of an employer under state law to conduct drug tests prior
322	to January 1, 1990. A drug test conducted by an employer prior
323	to January 1, 1990, is not subject to this section.
324	(14)  DISCIPLINE REMEDIES.-
325	(e)  Upon resolving an appeal filed pursuant to paragraph
326	(c), and finding a violation of this section, the commission may
327	order the following relief:
328	1.  Rescind the disciplinary action, expunge related
329	records from the personnel file of the employee or job applicant
330	and reinstate the employee.
331	2.  Order compliance with paragraph (10)(f)(g).
332	3.  Award back pay and benefits.
333	4.  Award the prevailing employee or job applicant the
334	necessary costs of the appeal, reasonable attorney's fees, and
335	expert witness fees.
336	Section 2.  Paragraph (n) of subsection (1) of section
337	154.11, Florida Statutes, is amended to read:
338	154.11  Powers of board of trustees.-
339	(1)  The board of trustees of each public health trust
340	shall be deemed to exercise a public and essential governmental
341	function of both the state and the county and in furtherance
342	thereof it shall, subject to limitation by the governing body of
343	the county in which such board is located, have all of the
344	powers necessary or convenient to carry out the operation and
345	governance of designated health care facilities, including, but
346	without limiting the generality of, the foregoing:
347	(n)  To appoint originally the staff of physicians to
348	practice in any designated facility owned or operated by the
349	board and to approve the bylaws and rules to be adopted by the
350	medical staff of any designated facility owned and operated by
351	the board, such governing regulations to be in accordance with
352	the standards of The Joint Commission on the Accreditation of
353	Hospitals which provide, among other things, for the method of
354	appointing additional staff members and for the removal of staff
355	members.
356	Section 3.  Subsection (15) of section 318.21, Florida
357	Statutes, is amended to read:
358	318.21  Disposition of civil penalties by county courts.-
359	All civil penalties received by a county court pursuant to the
360	provisions of this chapter shall be distributed and paid monthly
361	as follows:
362	(15)  Of the additional fine assessed under s. 318.18(3)(e)
363	for a violation of s. 316.1893, 50 percent of the moneys
364	received from the fines shall be remitted to the Department of
365	Revenue and deposited into the Brain and Spinal Cord Injury
366	Trust Fund of Department of Health and shall be appropriated to
367	the Department of Health Agency for Health Care Administration
368	as general revenue to provide an enhanced Medicaid payment to
369	nursing homes that serve Medicaid recipients with spinal cord
370	injuries that are medically complex and who are technologically
371	and respiratory dependent with brain and spinal cord injuries.
372	The remaining 50 percent of the moneys received from the
373	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
374	the Department of Revenue and deposited into the Department of
375	Health Administrative Trust Fund to provide financial support to
376	certified trauma centers in the counties where enhanced penalty
377	zones are established to ensure the availability and
378	accessibility of trauma services. Funds deposited into the
379	Administrative Trust Fund under this subsection shall be
380	allocated as follows:
381	(a)  Fifty percent shall be allocated equally among all
382	Level I, Level II, and pediatric trauma centers in recognition
383	of readiness costs for maintaining trauma services.
384	(b)  Fifty percent shall be allocated among Level I, Level
385	II, and pediatric trauma centers based on each center's relative
386	volume of trauma cases as reported in the Department of Health
387	Trauma Registry.
388	Section 4.  Subsection (3) is added to section 381.00315,
389	Florida Statutes, to read:
390	381.00315  Public health advisories; public health
391	emergencies.-The State Health Officer is responsible for
392	declaring public health emergencies and issuing public health
393	advisories.
394	(3)  To facilitate effective emergency management, when the
395	United States Department of Health and Human Services contracts
396	for the manufacture and delivery of licensable products in
397	response to a public health emergency and the terms of those
398	contracts are made available to the states, the department shall
399	accept funds provided by counties, municipalities, and other
400	entities designated in the state emergency management plan
401	required under s. 252.35(2)(a) for the purpose of participation
402	in such contracts. The department shall deposit the funds into
403	the Grants and Donations Trust Fund and expend the funds on
404	behalf of the donor county, municipality, or other entity for
405	the purchase the licensable products made available under the
406	contract.
407	Section 5.  Paragraph (e) is added to subsection (2) of
408	section 381.0072, Florida Statutes, to read:
409	381.0072  Food service protection.-It shall be the duty of
410	the Department of Health to adopt and enforce sanitation rules
411	consistent with law to ensure the protection of the public from
412	food-borne illness. These rules shall provide the standards and
413	requirements for the storage, preparation, serving, or display
414	of food in food service establishments as defined in this
415	section and which are not permitted or licensed under chapter
416	500 or chapter 509.
417	(2)  DUTIES.-
418	(e)  The department shall inspect food service
419	establishments in nursing homes licensed under part II of
420	chapter 400 twice each year. The department may make additional
421	inspections only in response to complaints. The department shall
422	coordinate inspections with the Agency for Health Care
423	Administration, such that the department's inspection is at
424	least 60 days after a recertification visit by the Agency for
425	Health Care Administration.
426	Section 6.  Section 383.325, Florida Statutes, is repealed.
427	Section 7.  Subsection (7) of section 394.4787, Florida
428	Statutes, is amended to read:
429	394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
430	and 394.4789.-As used in this section and ss. 394.4786,
431	394.4788, and 394.4789:
432	(7)  "Specialty psychiatric hospital" means a hospital
433	licensed by the agency pursuant to s. 395.002(26)(28) and part
434	II of chapter 408 as a specialty psychiatric hospital.
435	Section 8.  Subsection (2) of section 394.741, Florida
436	Statutes, is amended to read:
437	394.741  Accreditation requirements for providers of
438	behavioral health care services.-
439	(2)  Notwithstanding any provision of law to the contrary,
440	accreditation shall be accepted by the agency and department in
441	lieu of the agency's and department's facility licensure onsite
442	review requirements and shall be accepted as a substitute for
443	the department's administrative and program monitoring
444	requirements, except as required by subsections (3) and (4),
445	for:
446	(a)  Any organization from which the department purchases
447	behavioral health care services that is accredited by The Joint
448	Commission on Accreditation of Healthcare Organizations or the
449	Council on Accreditation for Children and Family Services, or
450	has those services that are being purchased by the department
451	accredited by the Commission on Accreditation of Rehabilitation
452	Facilities CARF-the Rehabilitation Accreditation Commission.
453	(b)  Any mental health facility licensed by the agency or
454	any substance abuse component licensed by the department that is
455	accredited by The Joint Commission on Accreditation of
456	Healthcare Organizations, the Commission on Accreditation of
457	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
458	Commission, or the Council on Accreditation of Children and
459	Family Services.
460	(c)  Any network of providers from which the department or
461	the agency purchases behavioral health care services accredited
462	by The Joint Commission on Accreditation of Healthcare
463	Organizations, the Commission on Accreditation of Rehabilitation
464	Facilities CARF-the Rehabilitation Accreditation Commission, the
465	Council on Accreditation of Children and Family Services, or the
466	National Committee for Quality Assurance. A provider
467	organization, which is part of an accredited network, is
468	afforded the same rights under this part.
469	Section 9.  Subsection (3) of section 390.0111, Florida
470	Statutes, is amended to read:
471	390.0111  Termination of pregnancies.-
472	(3)  CONSENTS REQUIRED.-A termination of pregnancy may not
473	be performed or induced except with the voluntary and informed
474	written consent of the pregnant woman or, in the case of a
475	mental incompetent, the voluntary and informed written consent
476	of her court-appointed guardian.
477	(a)  Except in the case of a medical emergency, consent to
478	a termination of pregnancy is voluntary and informed only if:
479	1.  The physician who is to perform the procedure, or the
480	referring physician, has, at a minimum, orally, in person,
481	informed the woman of:
482	a.  The nature and risks of undergoing or not undergoing
483	the proposed procedure that a reasonable patient would consider
484	material to making a knowing and willful decision of whether to
485	terminate a pregnancy.
486	b.  The probable gestational age of the fetus, verified by
487	an ultrasound, at the time the termination of pregnancy is to be
488	performed.
489	(I)  The ultrasound must be performed by the physician who
490	is to perform the abortion or by a person having documented
491	evidence that he or she has completed a course in the operation
492	of ultrasound equipment, as prescribed by rule by the Department
493	of Health, and who is working in conjunction with the physician.
494	(II)  The person performing the ultrasound must allow the
495	woman to view the live ultrasound images, and a physician or a
496	registered nurse, licensed practical nurse, advanced registered
497	nurse practitioner, or physician assistant working in
498	conjunction with the physician must contemporaneously review and
499	explain the live ultrasound images to the woman prior to the
500	woman giving informed consent to having an abortion procedure
501	performed. However, this sub-sub-subparagraph does not apply if,
502	at the time the woman schedules or arrives for her appointment
503	to obtain an abortion, a copy of a restraining order, police
504	report, medical record, or other court order or documentation is
505	presented that evidences that the woman is obtaining the
506	abortion because the woman is a victim of rape, incest, domestic
507	violence, or human trafficking or that the woman has been
508	diagnosed as having a condition that, on the basis of a
509	physician's good faith clinical judgment, would create a serious
510	risk of substantial and irreversible impairment of a major
511	bodily function if the woman delayed terminating her pregnancy.
512	(III)  The woman has a right to decline to view the
513	ultrasound images after she is informed of her right and offered
514	an opportunity to view them. If the woman declines to view the
515	ultrasound images, the woman shall complete a form, as
516	determined by department rule, acknowledging that she was
517	offered an opportunity to view her ultrasound but that she
518	rejected that opportunity. The form must also indicate that the
519	woman's decision not to view the ultrasound was not based on any
520	undue influence from any third party to discourage her from
521	viewing the images and that she declined to view the images of
522	her own free will.
523	c.  The medical risks to the woman and fetus of carrying
524	the pregnancy to term.
525	2.  Printed materials prepared and provided by the
526	department have been provided to the pregnant woman, if she
527	chooses to view these materials, including:
528	a.  A description of the fetus, including a description of
529	the various stages of development.
530	b.  A list of entities agencies that offer alternatives to
531	terminating the pregnancy.
532	c.  Detailed information on the availability of medical
533	assistance benefits for prenatal care, childbirth, and neonatal
534	care.
535	3.  The woman acknowledges in writing, before the
536	termination of pregnancy, that the information required to be
537	provided under this subsection has been provided.
538
539	Nothing in this paragraph is intended to prohibit a physician
540	from providing any additional information which the physician
541	deems material to the woman's informed decision to terminate her
542	pregnancy.
543	(b)  In the event a medical emergency exists and a
544	physician cannot comply with the requirements for informed
545	consent, a physician may terminate a pregnancy if he or she has
546	obtained at least one corroborative medical opinion attesting to
547	the medical necessity for emergency medical procedures and to
548	the fact that to a reasonable degree of medical certainty the
549	continuation of the pregnancy would threaten the life of the
550	pregnant woman. In the event no second physician is available
551	for a corroborating opinion, the physician may proceed but shall
552	document reasons for the medical necessity in the patient's
553	medical records.
554	(c)  Violation of this subsection by a physician
555	constitutes grounds for disciplinary action under s. 458.331 or
556	s. 459.015. Substantial compliance or reasonable belief that
557	complying with the requirements of informed consent would
558	threaten the life or health of the patient is a defense to any
559	action brought under this paragraph.
560	Section 10.  Paragraph (d) of subsection (3) of section
561	390.012, Florida Statutes, is amended to read:
562	390.012  Powers of agency; rules; disposal of fetal
563	remains.-
564	(3)  For clinics that perform or claim to perform abortions
565	after the first trimester of pregnancy, the agency shall adopt
566	rules pursuant to ss. 120.536(1) and 120.54 to implement the
567	provisions of this chapter, including the following:
568	(d)  Rules relating to the medical screening and evaluation
569	of each abortion clinic patient. At a minimum, these rules shall
570	require:
571	1.  A medical history including reported allergies to
572	medications, antiseptic solutions, or latex; past surgeries; and
573	an obstetric and gynecological history.
574	2.  A physical examination, including a bimanual
575	examination estimating uterine size and palpation of the adnexa.
576	3.  The appropriate laboratory tests, including:
577	a.  For an abortion in which an ultrasound examination is
578	not performed before the abortion procedure, Urine or blood
579	tests for pregnancy performed before the abortion procedure.
580	b.  A test for anemia.
581	c.  Rh typing, unless reliable written documentation of
582	blood type is available.
583	d.  Other tests as indicated from the physical examination.
584	4.  An ultrasound evaluation for all patients who elect to
585	have an abortion after the first trimester. The rules shall
586	require that if a person who is not a physician performs an
587	ultrasound examination, that person shall have documented
588	evidence that he or she has completed a course in the operation
589	of ultrasound equipment as prescribed in rule. The physician,
590	registered nurse, licensed practical nurse, advanced registered
591	nurse practitioner, or physician assistant shall review and
592	explain, at the request of the patient, the live ultrasound
593	images evaluation results, including an estimate of the probable
594	gestational age of the fetus, with the patient before the
595	abortion procedure is performed, unless the patient declines
596	pursuant to s. 390.0111. If the patient declines to view the
597	live ultrasound images, the applicable rules established by the
598	department shall require that s. 390.0111 be complied with in
599	all other respects.
600	5.  That the physician is responsible for estimating the
601	gestational age of the fetus based on the ultrasound examination
602	and obstetric standards in keeping with established standards of
603	care regarding the estimation of fetal age as defined in rule
604	and shall write the estimate in the patient's medical history.
605	The physician shall keep original prints of each ultrasound
606	examination of a patient in the patient's medical history file.
607	Section 11.  Present subsections (15) through (32) of
608	section 395.002, Florida Statutes, are renumbered as subsections
609	(14) through (28), respectively, and present subsections (1),
610	(14), (24), (30), and (31), and paragraph (c) of present
611	subsection (28) of that section are amended to read:
612	395.002  Definitions.-As used in this chapter:
613	(1)  "Accrediting organizations" means nationally
614	recognized or approved accrediting organizations whose standards
615	incorporate comparable licensure requirements as determined by
616	the agency the Joint Commission on Accreditation of Healthcare
617	Organizations, the American Osteopathic Association, the
618	Commission on Accreditation of Rehabilitation Facilities, and
619	the Accreditation Association for Ambulatory Health Care, Inc.
620	(14)  "Initial denial determination" means a determination
621	by a private review agent that the health care services
622	furnished or proposed to be furnished to a patient are
623	inappropriate, not medically necessary, or not reasonable.
624	(24)  "Private review agent" means any person or entity
625	which performs utilization review services for third-party
626	payors on a contractual basis for outpatient or inpatient
627	services. However, the term shall not include full-time
628	employees, personnel, or staff of health insurers, health
629	maintenance organizations, or hospitals, or wholly owned
630	subsidiaries thereof or affiliates under common ownership, when
631	performing utilization review for their respective hospitals,
632	health maintenance organizations, or insureds of the same
633	insurance group. For this purpose, health insurers, health
634	maintenance organizations, and hospitals, or wholly owned
635	subsidiaries thereof or affiliates under common ownership,
636	include such entities engaged as administrators of self-
637	insurance as defined in s. 624.031.
638	(26)(28)  "Specialty hospital" means any facility which
639	meets the provisions of subsection (12), and which regularly
640	makes available either:
641	(c)  Intensive residential treatment programs for children
642	and adolescents as defined in subsection (14) (15).
643	(30)  "Utilization review" means a system for reviewing the
644	medical necessity or appropriateness in the allocation of health
645	care resources of hospital services given or proposed to be
646	given to a patient or group of patients.
647	(31)  "Utilization review plan" means a description of the
648	policies and procedures governing utilization review activities
649	performed by a private review agent.
650	Section 12.  Paragraph (c) of subsection (1) and paragraph
651	(b) of subsection (2) of section 395.003, Florida Statutes, are
652	amended to read:
653	395.003  Licensure; denial, suspension, and revocation.-
654	(1)
655	(c)  Until July 1, 2006, additional emergency departments
656	located off the premises of licensed hospitals may not be
657	authorized by the agency.
658	(2)
659	(b)  The agency shall, at the request of a licensee that is
660	a teaching hospital as defined in s. 408.07(45), issue a single
661	license to a licensee for facilities that have been previously
662	licensed as separate premises, provided such separately licensed
663	facilities, taken together, constitute the same premises as
664	defined in s. 395.002(22)(23). Such license for the single
665	premises shall include all of the beds, services, and programs
666	that were previously included on the licenses for the separate
667	premises. The granting of a single license under this paragraph
668	shall not in any manner reduce the number of beds, services, or
669	programs operated by the licensee.
670	Section 13.  Paragraph (e) of subsection (2) and subsection
671	(4) of section 395.0193, Florida Statutes, are amended to read:
672	395.0193  Licensed facilities; peer review; disciplinary
673	powers; agency or partnership with physicians.-
674	(2)  Each licensed facility, as a condition of licensure,
675	shall provide for peer review of physicians who deliver health
676	care services at the facility. Each licensed facility shall
677	develop written, binding procedures by which such peer review
678	shall be conducted. Such procedures shall include:
679	(e)  Recording of agendas and minutes which do not contain
680	confidential material, for review by the Division of Medical
681	Quality Assurance of the department Health Quality Assurance of
682	the agency.
683	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
684	actions taken under subsection (3) shall be reported in writing
685	to the Division of Medical Quality Assurance of the department
686	Health Quality Assurance of the agency within 30 working days
687	after its initial occurrence, regardless of the pendency of
688	appeals to the governing board of the hospital. The notification
689	shall identify the disciplined practitioner, the action taken,
690	and the reason for such action. All final disciplinary actions
691	taken under subsection (3), if different from those which were
692	reported to the department agency within 30 days after the
693	initial occurrence, shall be reported within 10 working days to
694	the Division of Medical Quality Assurance of the department
695	Health Quality Assurance of the agency in writing and shall
696	specify the disciplinary action taken and the specific grounds
697	therefor. The division shall review each report and determine
698	whether it potentially involved conduct by the licensee that is
699	subject to disciplinary action, in which case s. 456.073 shall
700	apply. The reports are not subject to inspection under s.
701	119.07(1) even if the division's investigation results in a
702	finding of probable cause.
703	Section 14.  Section 395.1023, Florida Statutes, is amended
704	to read:
705	395.1023  Child abuse and neglect cases; duties.-Each
706	licensed facility shall adopt a protocol that, at a minimum,
707	requires the facility to:
708	(1)  Incorporate a facility policy that every staff member
709	has an affirmative duty to report, pursuant to chapter 39, any
710	actual or suspected case of child abuse, abandonment, or
711	neglect; and
712	(2)  In any case involving suspected child abuse,
713	abandonment, or neglect, designate, at the request of the
714	Department of Children and Family Services, a staff physician to
715	act as a liaison between the hospital and the Department of
716	Children and Family Services office which is investigating the
717	suspected abuse, abandonment, or neglect, and the child
718	protection team, as defined in s. 39.01, when the case is
719	referred to such a team.
720
721	Each general hospital and appropriate specialty hospital shall
722	comply with the provisions of this section and shall notify the
723	agency and the Department of Children and Family Services of its
724	compliance by sending a copy of its policy to the agency and the
725	Department of Children and Family Services as required by rule.
726	The failure by a general hospital or appropriate specialty
727	hospital to comply shall be punished by a fine not exceeding
728	$1,000, to be fixed, imposed, and collected by the agency. Each
729	day in violation is considered a separate offense.
730	Section 15.  Subsection (2) and paragraph (d) of subsection
731	(3) of section 395.1041, Florida Statutes, are amended to read:
732	395.1041  Access to emergency services and care.-
733	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
734	shall establish and maintain an inventory of hospitals with
735	emergency services. The inventory shall list all services within
736	the service capability of the hospital, and such services shall
737	appear on the face of the hospital license. Each hospital having
738	emergency services shall notify the agency of its service
739	capability in the manner and form prescribed by the agency. The
740	agency shall use the inventory to assist emergency medical
741	services providers and others in locating appropriate emergency
742	medical care. The inventory shall also be made available to the
743	general public. On or before August 1, 1992, the agency shall
744	request that each hospital identify the services which are
745	within its service capability. On or before November 1, 1992,
746	the agency shall notify each hospital of the service capability
747	to be included in the inventory. The hospital has 15 days from
748	the date of receipt to respond to the notice. By December 1,
749	1992, the agency shall publish a final inventory. Each hospital
750	shall reaffirm its service capability when its license is
751	renewed and shall notify the agency of the addition of a new
752	service or the termination of a service prior to a change in its
753	service capability.
754	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
755	FACILITY OR HEALTH CARE PERSONNEL.-
756	(d)1.  Every hospital shall ensure the provision of
757	services within the service capability of the hospital, at all
758	times, either directly or indirectly through an arrangement with
759	another hospital, through an arrangement with one or more
760	physicians, or as otherwise made through prior arrangements. A
761	hospital may enter into an agreement with another hospital for
762	purposes of meeting its service capability requirement, and
763	appropriate compensation or other reasonable conditions may be
764	negotiated for these backup services.
765	2.  If any arrangement requires the provision of emergency
766	medical transportation, such arrangement must be made in
767	consultation with the applicable provider and may not require
768	the emergency medical service provider to provide transportation
769	that is outside the routine service area of that provider or in
770	a manner that impairs the ability of the emergency medical
771	service provider to timely respond to prehospital emergency
772	calls.
773	3.  A hospital shall not be required to ensure service
774	capability at all times as required in subparagraph 1. if, prior
775	to the receiving of any patient needing such service capability,
776	such hospital has demonstrated to the agency that it lacks the
777	ability to ensure such capability and it has exhausted all
778	reasonable efforts to ensure such capability through backup
779	arrangements. In reviewing a hospital's demonstration of lack of
780	ability to ensure service capability, the agency shall consider
781	factors relevant to the particular case, including the
782	following:
783	a.  Number and proximity of hospitals with the same service
784	capability.
785	b.  Number, type, credentials, and privileges of
786	specialists.
787	c.  Frequency of procedures.
788	d.  Size of hospital.
789	4.  The agency shall publish proposed rules implementing a
790	reasonable exemption procedure by November 1, 1992. Subparagraph
791	1. shall become effective upon the effective date of said rules
792	or January 31, 1993, whichever is earlier. For a period not to
793	exceed 1 year from the effective date of subparagraph 1., a
794	hospital requesting an exemption shall be deemed to be exempt
795	from offering the service until the agency initially acts to
796	deny or grant the original request. The agency has 45 days from
797	the date of receipt of the request to approve or deny the
798	request. After the first year from the effective date of
799	subparagraph 1., If the agency fails to initially act within the
800	time period, the hospital is deemed to be exempt from offering
801	the service until the agency initially acts to deny the request.
802	Section 16.  Section 395.1046, Florida Statutes, is
803	repealed.
804	Section 17.  Paragraph (e) of subsection (1) of section
805	395.1055, Florida Statutes, is amended to read:
806	395.1055  Rules and enforcement.-
807	(1)  The agency shall adopt rules pursuant to ss.
808	120.536(1) and 120.54 to implement the provisions of this part,
809	which shall include reasonable and fair minimum standards for
810	ensuring that:
811	(e)  Licensed facility beds conform to minimum space,
812	equipment, and furnishings standards as specified by the agency,
813	the Florida Building Code, and the Florida Fire Prevention Code
814	department.
815	Section 18.  Subsection (1) of section 395.10972, Florida
816	Statutes, is amended to read:
817	395.10972  Health Care Risk Manager Advisory Council.-The
818	Secretary of Health Care Administration may appoint a seven-
819	member advisory council to advise the agency on matters
820	pertaining to health care risk managers. The members of the
821	council shall serve at the pleasure of the secretary. The
822	council shall designate a chair. The council shall meet at the
823	call of the secretary or at those times as may be required by
824	rule of the agency. The members of the advisory council shall
825	receive no compensation for their services, but shall be
826	reimbursed for travel expenses as provided in s. 112.061. The
827	council shall consist of individuals representing the following
828	areas:
829	(1)  Two shall be active health care risk managers,
830	including one risk manager who is recommended by and a member of
831	the Florida Society for of Healthcare Risk Management and
832	Patient Safety.
833	Section 19.  Subsection (3) of section 395.2050, Florida
834	Statutes, is amended to read:
835	395.2050  Routine inquiry for organ and tissue donation;
836	certification for procurement activities; death records review.-
837	(3)  Each organ procurement organization designated by the
838	federal Centers for Medicare and Medicaid Services Health Care
839	Financing Administration and licensed by the state shall conduct
840	an annual death records review in the organ procurement
841	organization's affiliated donor hospitals. The organ procurement
842	organization shall enlist the services of every Florida licensed
843	tissue bank and eye bank affiliated with or providing service to
844	the donor hospital and operating in the same service area to
845	participate in the death records review.
846	Section 20.  Subsection (2) of section 395.3036, Florida
847	Statutes, is amended to read:
848	395.3036  Confidentiality of records and meetings of
849	corporations that lease public hospitals or other public health
850	care facilities.-The records of a private corporation that
851	leases a public hospital or other public health care facility
852	are confidential and exempt from the provisions of s. 119.07(1)
853	and s. 24(a), Art. I of the State Constitution, and the meetings
854	of the governing board of a private corporation are exempt from
855	s. 286.011 and s. 24(b), Art. I of the State Constitution when
856	the public lessor complies with the public finance
857	accountability provisions of s. 155.40(5) with respect to the
858	transfer of any public funds to the private lessee and when the
859	private lessee meets at least three of the five following
860	criteria:
861	(2)  The public lessor and the private lessee do not
862	commingle any of their funds in any account maintained by either
863	of them, other than the payment of the rent and administrative
864	fees or the transfer of funds pursuant to s. 155.40     (2)
865	subsection (2).
866	Section 21.  Section 395.3037, Florida Statutes, is
867	repealed.
868	Section 22.  Subsections (1), (4), and (5) of section
869	395.3038, Florida Statutes, are amended to read:
870	395.3038  State-listed primary stroke centers and
871	comprehensive stroke centers; notification of hospitals.-
872	(1)  The agency shall make available on its website and to
873	the department a list of the name and address of each hospital
874	that meets the criteria for a primary stroke center and the name
875	and address of each hospital that meets the criteria for a
876	comprehensive stroke center. The list of primary and
877	comprehensive stroke centers shall include only those hospitals
878	that attest in an affidavit submitted to the agency that the
879	hospital meets the named criteria, or those hospitals that
880	attest in an affidavit submitted to the agency that the hospital
881	is certified as a primary or a comprehensive stroke center by
882	The Joint Commission on Accreditation of Healthcare
883	Organizations.
884	(4)  The agency shall adopt by rule criteria for a primary
885	stroke center which are substantially similar to the
886	certification standards for primary stroke centers of The Joint
887	Commission on Accreditation of Healthcare Organizations.
888	(5)  The agency shall adopt by rule criteria for a
889	comprehensive stroke center. However, if The Joint Commission on
890	Accreditation of Healthcare Organizations establishes criteria
891	for a comprehensive stroke center, the agency shall establish
892	criteria for a comprehensive stroke center which are
893	substantially similar to those criteria established by The Joint
894	Commission on Accreditation of Healthcare Organizations.
895	Section 23.  Paragraph (e) of subsection (2) of section
896	395.602, Florida Statutes, is amended to read:
897	395.602  Rural hospitals.-
898	(2)  DEFINITIONS.-As used in this part:
899	(e)  "Rural hospital" means an acute care hospital licensed
900	under this chapter, having 100 or fewer licensed beds and an
901	emergency room, which is:
902	1.  The sole provider within a county with a population
903	density of no greater than 100 persons per square mile;
904	2.  An acute care hospital, in a county with a population
905	density of no greater than 100 persons per square mile, which is
906	at least 30 minutes of travel time, on normally traveled roads
907	under normal traffic conditions, from any other acute care
908	hospital within the same county;
909	3.  A hospital supported by a tax district or subdistrict
910	whose boundaries encompass a population of 100 persons or fewer
911	per square mile;
912	4.  A hospital in a constitutional charter county with a
913	population of over 1 million persons that has imposed a local
914	option health service tax pursuant to law and in an area that
915	was directly impacted by a catastrophic event on August 24,
916	1992, for which the Governor of Florida declared a state of
917	emergency pursuant to chapter 125, and has 120 beds or less that
918	serves an agricultural community with an emergency room
919	utilization of no less than 20,000 visits and a Medicaid
920	inpatient utilization rate greater than 15 percent;
921	4.5.  A hospital with a service area that has a population
922	of 100 persons or fewer per square mile. As used in this
923	subparagraph, the term "service area" means the fewest number of
924	zip codes that account for 75 percent of the hospital's
925	discharges for the most recent 5-year period, based on
926	information available from the hospital inpatient discharge
927	database in the Florida Center for Health Information and Policy
928	Analysis at the Agency for Health Care Administration; or
929	5.6.  A hospital designated as a critical access hospital,
930	as defined in s. 408.07(15).
931
932	Population densities used in this paragraph must be based upon
933	the most recently completed United States census. A hospital
934	that received funds under s. 409.9116 for a quarter beginning no
935	later than July 1, 2002, is deemed to have been and shall
936	continue to be a rural hospital from that date through June 30,
937	2015, if the hospital continues to have 100 or fewer licensed
938	beds and an emergency room, or meets the criteria of
939	subparagraph 4. An acute care hospital that has not previously
940	been designated as a rural hospital and that meets the criteria
941	of this paragraph shall be granted such designation upon
942	application, including supporting documentation to the Agency
943	for Health Care Administration.
944	Section 24.  Subsection (8) of section 400.021, Florida
945	Statutes, is amended to read:
946	400.021  Definitions.-When used in this part, unless the
947	context otherwise requires, the term:
948	(8)  "Geriatric outpatient clinic" means a site for
949	providing outpatient health care to persons 60 years of age or
950	older, which is staffed by a registered nurse or a physician
951	assistant, or a licensed practical nurse under the direct
952	supervision of a registered nurse, advanced registered nurse
953	practitioner, or physician.
954	Section 25.  Paragraph (g) of subsection (2) of section
955	400.0239, Florida Statutes, is amended to read:
956	400.0239  Quality of Long-Term Care Facility Improvement
957	Trust Fund.-
958	(2)  Expenditures from the trust fund shall be allowable
959	for direct support of the following:
960	(g)  Other initiatives authorized by the Centers for
961	Medicare and Medicaid Services for the use of federal civil
962	monetary penalties, including projects recommended through the
963	Medicaid "Up-or-Out" Quality of Care Contract Management Program
964	pursuant to s. 400.148.
965	Section 26.  Subsection (15) of section 400.0255, Florida
966	Statutes, is amended to read
967	400.0255  Resident transfer or discharge; requirements and
968	procedures; hearings.-
969	(15)(a)  The department's Office of Appeals Hearings shall
970	conduct hearings under this section. The office shall notify the
971	facility of a resident's request for a hearing.
972	(b)  The department shall, by rule, establish procedures to
973	be used for fair hearings requested by residents. These
974	procedures shall be equivalent to the procedures used for fair
975	hearings for other Medicaid cases appearing in s. 409.285 and
976	applicable rules, chapter 10-2, part VI, Florida Administrative
977	Code. The burden of proof must be clear and convincing evidence.
978	A hearing decision must be rendered within 90 days after receipt
979	of the request for hearing.
980	(c)  If the hearing decision is favorable to the resident
981	who has been transferred or discharged, the resident must be
982	readmitted to the facility's first available bed.
983	(d)  The decision of the hearing officer shall be final.
984	Any aggrieved party may appeal the decision to the district
985	court of appeal in the appellate district where the facility is
986	located. Review procedures shall be conducted in accordance with
987	the Florida Rules of Appellate Procedure.
988	Section 27.  Subsection (2) of section 400.063, Florida
989	Statutes, is amended to read:
990	400.063  Resident protection.-
991	(2)  The agency is authorized to establish for each
992	facility, subject to intervention by the agency, a separate bank
993	account for the deposit to the credit of the agency of any
994	moneys received from the Health Care Trust Fund or any other
995	moneys received for the maintenance and care of residents in the
996	facility, and the agency is authorized to disburse moneys from
997	such account to pay obligations incurred for the purposes of
998	this section. The agency is authorized to requisition moneys
999	from the Health Care Trust Fund in advance of an actual need for
1000	cash on the basis of an estimate by the agency of moneys to be
1001	spent under the authority of this section. Any bank account
1002	established under this section need not be approved in advance
1003	of its creation as required by s. 17.58, but shall be secured by
1004	depository insurance equal to or greater than the balance of
1005	such account or by the pledge of collateral security in
1006	conformance with criteria established in s. 18.11. The agency
1007	shall notify the Chief Financial Officer of any such account so
1008	established and shall make a quarterly accounting to the Chief
1009	Financial Officer for all moneys deposited in such account.
1010	Section 28.  Subsections (1) and (5) of section 400.071,
1011	Florida Statutes, are amended to read:
1012	400.071  Application for license.-
1013	(1)  In addition to the requirements of part II of chapter
1014	408, the application for a license shall be under oath and must
1015	contain the following:
1016	(a)  The location of the facility for which a license is
1017	sought and an indication, as in the original application, that
1018	such location conforms to the local zoning ordinances.
1019	(b)  A signed affidavit disclosing any financial or
1020	ownership interest that a controlling interest as defined in
1021	part II of chapter 408 has held in the last 5 years in any
1022	entity licensed by this state or any other state to provide
1023	health or residential care which has closed voluntarily or
1024	involuntarily; has filed for bankruptcy; has had a receiver
1025	appointed; has had a license denied, suspended, or revoked; or
1026	has had an injunction issued against it which was initiated by a
1027	regulatory agency. The affidavit must disclose the reason any
1028	such entity was closed, whether voluntarily or involuntarily.
1029	(c)  The total number of beds and the total number of
1030	Medicare and Medicaid certified beds.
1031	(b)(d)  Information relating to the applicant and employees
1032	which the agency requires by rule. The applicant must
1033	demonstrate that sufficient numbers of qualified staff, by
1034	training or experience, will be employed to properly care for
1035	the type and number of residents who will reside in the
1036	facility.
1037	(c)(e)  Copies of any civil verdict or judgment involving
1038	the applicant rendered within the 10 years preceding the
1039	application, relating to medical negligence, violation of
1040	residents' rights, or wrongful death. As a condition of
1041	licensure, the licensee agrees to provide to the agency copies
1042	of any new verdict or judgment involving the applicant, relating
1043	to such matters, within 30 days after filing with the clerk of
1044	the court. The information required in this paragraph shall be
1045	maintained in the facility's licensure file and in an agency
1046	database which is available as a public record.
1047	(5)  As a condition of licensure, each facility must
1048	establish and submit with its application a plan for quality
1049	assurance and for conducting risk management.
1050	Section 29.  Section 400.0712, Florida Statutes, is amended
1051	to read:
1052	400.0712  Application for inactive license.-
1053	(1)  As specified in this section, the agency may issue an
1054	inactive license to a nursing home facility for all or a portion
1055	of its beds. Any request by a licensee that a nursing home or
1056	portion of a nursing home become inactive must be submitted to
1057	the agency in the approved format. The facility may not initiate
1058	any suspension of services, notify residents, or initiate
1059	inactivity before receiving approval from the agency; and a
1060	licensee that violates this provision may not be issued an
1061	inactive license.
1062	(1)(2)  In addition to the powers granted under part II of
1063	chapter 408, the agency may issue an inactive license to a
1064	nursing home that chooses to use an unoccupied contiguous
1065	portion of the facility for an alternative use to meet the needs
1066	of elderly persons through the use of less restrictive, less
1067	institutional services.
1068	(a)  An inactive license issued under this subsection may
1069	be granted for a period not to exceed the current licensure
1070	expiration date but may be renewed by the agency at the time of
1071	licensure renewal.
1072	(b)  A request to extend the inactive license must be
1073	submitted to the agency in the approved format and approved by
1074	the agency in writing.
1075	(c)  Nursing homes that receive an inactive license to
1076	provide alternative services shall not receive preference for
1077	participation in the Assisted Living for the Elderly Medicaid
1078	waiver.
1079	(2)(3)  The agency shall adopt rules pursuant to ss.
1080	120.536(1) and 120.54 necessary to implement this section.
1081	Section 30.  Section 400.111, Florida Statutes, is amended
1082	to read:
1083	400.111  Disclosure of controlling interest.-In addition to
1084	the requirements of part II of chapter 408, when requested by
1085	the agency, the licensee shall submit a signed affidavit
1086	disclosing any financial or ownership interest that a
1087	controlling interest has held within the last 5 years in any
1088	entity licensed by the state or any other state to provide
1089	health or residential care which entity has closed voluntarily
1090	or involuntarily; has filed for bankruptcy; has had a receiver
1091	appointed; has had a license denied, suspended, or revoked; or
1092	has had an injunction issued against it which was initiated by a
1093	regulatory agency. The affidavit must disclose the reason such
1094	entity was closed, whether voluntarily or involuntarily.
1095	Section 31.  Subsection (2) of section 400.1183, Florida
1096	Statutes, is amended to read:
1097	400.1183  Resident grievance procedures.-
1098	(2)  Each facility shall maintain records of all grievances
1099	for agency inspection and shall report to the agency at the time
1100	of relicensure the total number of grievances handled during the
1101	prior licensure period, a categorization of the cases underlying
1102	the grievances, and the final disposition of the grievances.
1103	Section 32.  Paragraphs (o) through (w) of subsection (1)
1104	of section 400.141, Florida Statutes, are redesignated as
1105	paragraphs (n) through (u), respectively, and present paragraphs
1106	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
1107	to read:
1108	400.141  Administration and management of nursing home
1109	facilities.-
1110	(1)  Every licensed facility shall comply with all
1111	applicable standards and rules of the agency and shall:
1112	(f)  Be allowed and encouraged by the agency to provide
1113	other needed services under certain conditions. If the facility
1114	has a standard licensure status, and has had no class I or class
1115	II deficiencies during the past 2 years or has been awarded a
1116	Gold Seal under the program established in s. 400.235, it may be
1117	encouraged by the agency to provide services, including, but not
1118	limited to, respite and adult day services, which enable
1119	individuals to move in and out of the facility. A facility is
1120	not subject to any additional licensure requirements for
1121	providing these services.
1122	1.  Respite care may be offered to persons in need of
1123	short-term or temporary nursing home services. For each person
1124	admitted under the respite care program, the facility licensee
1125	must:
1126	a.  Have a written abbreviated plan of care that, at a
1127	minimum, includes nutritional requirements, medication orders,
1128	physician orders, nursing assessments, and dietary preferences.
1129	The nursing or physician assessments may take the place of all
1130	other assessments required for full-time residents.
1131	b.  Have a contract that, at a minimum, specifies the
1132	services to be provided to the respite resident, including
1133	charges for services, activities, equipment, emergency medical
1134	services, and the administration of medications. If multiple
1135	respite admissions for a single person are anticipated, the
1136	original contract is valid for 1 year after the date of
1137	execution.
1138	c.  Ensure that each resident is released to his or her
1139	caregiver or an individual designated in writing by the
1140	caregiver.
1141	2.  A person admitted under the respite care program is:
1142	a.  Exempt from requirements in rule related to discharge
1143	planning.
1144	b.  Covered by the resident's rights set forth in s.
1145	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
1146	shall not be considered trust funds subject to the requirements
1147	of s. 400.022(1)(h) until the resident has been in the facility
1148	for more than 14 consecutive days.
1149	c.  Allowed to use his or her personal medications for the
1150	respite stay if permitted by facility policy. The facility must
1151	obtain a physician's orders for the medications. The caregiver
1152	may provide information regarding the medications as part of the
1153	nursing assessment, which must agree with the physician's
1154	orders. Medications shall be released with the resident upon
1155	discharge in accordance with current orders.
1156	3.  A person receiving respite care is entitled to a total
1157	of 60 days in the facility within a contract year or a calendar
1158	year if the contract is for less than 12 months. However, each
1159	single stay may not exceed 14 days. If a stay exceeds 14
1160	consecutive days, the facility must comply with all assessment
1161	and care planning requirements applicable to nursing home
1162	residents.
1163	4.  A person receiving respite care must reside in a
1164	licensed nursing home bed.
1165	5.  A prospective respite resident must provide medical
1166	information from a physician, a physician assistant, or a nurse
1167	practitioner and other information from the primary caregiver as
1168	may be required by the facility prior to or at the time of
1169	admission to receive respite care. The medical information must
1170	include a physician's order for respite care and proof of a
1171	physical examination by a licensed physician, physician
1172	assistant, or nurse practitioner. The physician's order and
1173	physical examination may be used to provide intermittent respite
1174	care for up to 12 months after the date the order is written.
1175	6.  The facility must assume the duties of the primary
1176	caregiver. To ensure continuity of care and services, the
1177	resident is entitled to retain his or her personal physician and
1178	must have access to medically necessary services such as
1179	physical therapy, occupational therapy, or speech therapy, as
1180	needed. The facility must arrange for transportation to these
1181	services if necessary. Respite care must be provided in
1182	accordance with this part and rules adopted by the agency.
1183	However, the agency shall, by rule, adopt modified requirements
1184	for resident assessment, resident care plans, resident
1185	contracts, physician orders, and other provisions, as
1186	appropriate, for short-term or temporary nursing home services.
1187	7.  The agency shall allow for shared programming and staff
1188	in a facility which meets minimum standards and offers services
1189	pursuant to this paragraph, but, if the facility is cited for
1190	deficiencies in patient care, may require additional staff and
1191	programs appropriate to the needs of service recipients. A
1192	person who receives respite care may not be counted as a
1193	resident of the facility for purposes of the facility's licensed
1194	capacity unless that person receives 24-hour respite care. A
1195	person receiving either respite care for 24 hours or longer or
1196	adult day services must be included when calculating minimum
1197	staffing for the facility. Any costs and revenues generated by a
1198	nursing home facility from nonresidential programs or services
1199	shall be excluded from the calculations of Medicaid per diems
1200	for nursing home institutional care reimbursement.
1201	(g)  If the facility has a standard license or is a Gold
1202	Seal facility, exceeds the minimum required hours of licensed
1203	nursing and certified nursing assistant direct care per resident
1204	per day, and is part of a continuing care facility licensed
1205	under chapter 651 or a retirement community that offers other
1206	services pursuant to part III of this chapter or part I or part
1207	III of chapter 429 on a single campus, be allowed to share
1208	programming and staff. At the time of inspection and in the
1209	semiannual report required pursuant to paragraph (n) (o), a
1210	continuing care facility or retirement community that uses this
1211	option must demonstrate through staffing records that minimum
1212	staffing requirements for the facility were met. Licensed nurses
1213	and certified nursing assistants who work in the nursing home
1214	facility may be used to provide services elsewhere on campus if
1215	the facility exceeds the minimum number of direct care hours
1216	required per resident per day and the total number of residents
1217	receiving direct care services from a licensed nurse or a
1218	certified nursing assistant does not cause the facility to
1219	violate the staffing ratios required under s. 400.23(3)(a).
1220	Compliance with the minimum staffing ratios shall be based on
1221	total number of residents receiving direct care services,
1222	regardless of where they reside on campus. If the facility
1223	receives a conditional license, it may not share staff until the
1224	conditional license status ends. This paragraph does not
1225	restrict the agency's authority under federal or state law to
1226	require additional staff if a facility is cited for deficiencies
1227	in care which are caused by an insufficient number of certified
1228	nursing assistants or licensed nurses. The agency may adopt
1229	rules for the documentation necessary to determine compliance
1230	with this provision.
1231	(j)  Keep full records of resident admissions and
1232	discharges; medical and general health status, including medical
1233	records, personal and social history, and identity and address
1234	of next of kin or other persons who may have responsibility for
1235	the affairs of the residents; and individual resident care plans
1236	including, but not limited to, prescribed services, service
1237	frequency and duration, and service goals. The records shall be
1238	open to inspection by the agency. The facility must maintain
1239	clinical records on each resident in accordance with accepted
1240	professional standards and practices that are complete,
1241	accurately documented, readily accessible, and systematically
1242	organized.
1243	(n)  Submit to the agency the information specified in s.
1244	400.071(1)(b) for a management company within 30 days after the
1245	effective date of the management agreement.
1246	(n)(o)1.  Submit semiannually to the agency, or more
1247	frequently if requested by the agency, information regarding
1248	facility staff-to-resident ratios, staff turnover, and staff
1249	stability, including information regarding certified nursing
1250	assistants, licensed nurses, the director of nursing, and the
1251	facility administrator. For purposes of this reporting:
1252	a.  Staff-to-resident ratios must be reported in the
1253	categories specified in s. 400.23(3)(a) and applicable rules.
1254	The ratio must be reported as an average for the most recent
1255	calendar quarter.
1256	b.  Staff turnover must be reported for the most recent 12-
1257	month period ending on the last workday of the most recent
1258	calendar quarter prior to the date the information is submitted.
1259	The turnover rate must be computed quarterly, with the annual
1260	rate being the cumulative sum of the quarterly rates. The
1261	turnover rate is the total number of terminations or separations
1262	experienced during the quarter, excluding any employee
1263	terminated during a probationary period of 3 months or less,
1264	divided by the total number of staff employed at the end of the
1265	period for which the rate is computed, and expressed as a
1266	percentage.
1267	c.  The formula for determining staff stability is the
1268	total number of employees that have been employed for more than
1269	12 months, divided by the total number of employees employed at
1270	the end of the most recent calendar quarter, and expressed as a
1271	percentage.
1272	d.  A nursing facility that has failed to comply with state
1273	minimum-staffing requirements for 2 consecutive days is
1274	prohibited from accepting new admissions until the facility has
1275	achieved the minimum-staffing requirements for a period of 6
1276	consecutive days. For the purposes of this sub-subparagraph, any
1277	person who was a resident of the facility and was absent from
1278	the facility for the purpose of receiving medical care at a
1279	separate location or was on a leave of absence is not considered
1280	a new admission. Failure to impose such an admissions moratorium
1281	is subject to a $1,000 fine constitutes a class II deficiency.
1282	e.  A nursing facility which does not have a conditional
1283	license may be cited for failure to comply with the standards in
1284	s. 400.23(3)(a)1.a. only if it has failed to meet those
1285	standards on 2 consecutive days or if it has failed to meet at
1286	least 97 percent of those standards on any one day.
1287	f.  A facility which has a conditional license must be in
1288	compliance with the standards in s. 400.23(3)(a) at all times.
1289	2.  This paragraph does not limit the agency's ability to
1290	impose a deficiency or take other actions if a facility does not
1291	have enough staff to meet the residents' needs.
1292	(r)  Report to the agency any filing for bankruptcy
1293	protection by the facility or its parent corporation,
1294	divestiture or spin-off of its assets, or corporate
1295	reorganization within 30 days after the completion of such
1296	activity.
1297	Section 33.  Subsection (3) of section 400.142, Florida
1298	Statutes, is amended to read:
1299	400.142  Emergency medication kits; orders not to
1300	resuscitate.-
1301	(3)  Facility staff may withhold or withdraw
1302	cardiopulmonary resuscitation if presented with an order not to
1303	resuscitate executed pursuant to s. 401.45. The agency shall
1304	adopt rules providing for the implementation of such orders.
1305	Facility staff and facilities shall not be subject to criminal
1306	prosecution or civil liability, nor be considered to have
1307	engaged in negligent or unprofessional conduct, for withholding
1308	or withdrawing cardiopulmonary resuscitation pursuant to such an
1309	order and rules adopted by the agency. The absence of an order
1310	not to resuscitate executed pursuant to s. 401.45 does not
1311	preclude a physician from withholding or withdrawing
1312	cardiopulmonary resuscitation as otherwise permitted by law.
1313	Section 34.  Subsections (11) through (15) of section
1314	400.147, Florida Statutes, are renumbered as subsections (10)
1315	through (14), respectively, and present subsection (10) is
1316	amended to read:
1317	400.147  Internal risk management and quality assurance
1318	program.-
1319	(10)  By the 10th of each month, each facility subject to
1320	this section shall report any notice received pursuant to s.
1321	400.0233(2) and each initial complaint that was filed with the
1322	clerk of the court and served on the facility during the
1323	previous month by a resident or a resident's family member,
1324	guardian, conservator, or personal legal representative. The
1325	report must include the name of the resident, the resident's
1326	date of birth and social security number, the Medicaid
1327	identification number for Medicaid-eligible persons, the date or
1328	dates of the incident leading to the claim or dates of
1329	residency, if applicable, and the type of injury or violation of
1330	rights alleged to have occurred. Each facility shall also submit
1331	a copy of the notices received pursuant to s. 400.0233(2) and
1332	complaints filed with the clerk of the court. This report is
1333	confidential as provided by law and is not discoverable or
1334	admissible in any civil or administrative action, except in such
1335	actions brought by the agency to enforce the provisions of this
1336	part.
1337	Section 35.  Section 400.148, Florida Statutes, is
1338	repealed.
1339	Section 36.  Paragraph (f) of subsection (5) of section
1340	400.162, Florida Statutes, is amended to read:
1341	400.162  Property and personal affairs of residents.-
1342	(5)
1343	(f)  At least every 3 months, the licensee shall furnish
1344	the resident and the guardian, trustee, or conservator, if any,
1345	for the resident a complete and verified statement of all funds
1346	and other property to which this subsection applies, detailing
1347	the amounts and items received, together with their sources and
1348	disposition. For resident property, the licensee shall furnish
1349	such a statement annually and within 7 calendar days after a
1350	request for a statement. In any event, the licensee shall
1351	furnish such statements a statement annually and upon the
1352	discharge or transfer of a resident. Any governmental agency or
1353	private charitable agency contributing funds or other property
1354	on account of a resident also shall be entitled to receive such
1355	statements statement annually and upon discharge or transfer and
1356	such other report as it may require pursuant to law.
1357	Section 37.  Paragraphs (d) and (e) of subsection (2) of
1358	section 400.179, Florida Statutes, are amended to read:
1359	400.179  Liability for Medicaid underpayments and
1360	overpayments.-
1361	(2)  Because any transfer of a nursing facility may expose
1362	the fact that Medicaid may have underpaid or overpaid the
1363	transferor, and because in most instances, any such underpayment
1364	or overpayment can only be determined following a formal field
1365	audit, the liabilities for any such underpayments or
1366	overpayments shall be as follows:
1367	(d)  Where the transfer involves a facility that has been
1368	leased by the transferor:
1369	1.  The transferee shall, as a condition to being issued a
1370	license by the agency, acquire, maintain, and provide proof to
1371	the agency of a bond with a term of 30 months, renewable
1372	annually, in an amount not less than the total of 3 months'
1373	Medicaid payments to the facility computed on the basis of the
1374	preceding 12-month average Medicaid payments to the facility.
1375	2.  A leasehold licensee may meet the requirements of
1376	subparagraph 1. by payment of a nonrefundable fee, paid at
1377	initial licensure, paid at the time of any subsequent change of
1378	ownership, and paid annually thereafter, in the amount of 1
1379	percent of the total of 3 months' Medicaid payments to the
1380	facility computed on the basis of the preceding 12-month average
1381	Medicaid payments to the facility. If a preceding 12-month
1382	average is not available, projected Medicaid payments may be
1383	used. The fee shall be deposited into the Grants and Donations
1384	Trust Fund and shall be accounted for separately as a Medicaid
1385	nursing home overpayment account. These fees shall be used at
1386	the sole discretion of the agency to repay nursing home Medicaid
1387	overpayments. Payment of this fee shall not release the licensee
1388	from any liability for any Medicaid overpayments, nor shall
1389	payment bar the agency from seeking to recoup overpayments from
1390	the licensee and any other liable party. As a condition of
1391	exercising this lease bond alternative, licensees paying this
1392	fee must maintain an existing lease bond through the end of the
1393	30-month term period of that bond. The agency is herein granted
1394	specific authority to promulgate all rules pertaining to the
1395	administration and management of this account, including
1396	withdrawals from the account, subject to federal review and
1397	approval. This provision shall take effect upon becoming law and
1398	shall apply to any leasehold license application. The financial
1399	viability of the Medicaid nursing home overpayment account shall
1400	be determined by the agency through annual review of the account
1401	balance and the amount of total outstanding, unpaid Medicaid
1402	overpayments owing from leasehold licensees to the agency as
1403	determined by final agency audits. By March 31 of each year, the
1404	agency shall assess the cumulative fees collected under this
1405	subparagraph, minus any amounts used to repay nursing home
1406	Medicaid overpayments and amounts transferred to contribute to
1407	the General Revenue Fund pursuant to s. 215.20. If the net
1408	cumulative collections, minus amounts utilized to repay nursing
1409	home Medicaid overpayments, exceed $25 million, the provisions
1410	of this paragraph shall not apply for the subsequent fiscal
1411	year.
1412	3.  The leasehold licensee may meet the bond requirement
1413	through other arrangements acceptable to the agency. The agency
1414	is herein granted specific authority to promulgate rules
1415	pertaining to lease bond arrangements.
1416	4.  All existing nursing facility licensees, operating the
1417	facility as a leasehold, shall acquire, maintain, and provide
1418	proof to the agency of the 30-month bond required in
1419	subparagraph 1., above, on and after July 1, 1993, for each
1420	license renewal.
1421	5.  It shall be the responsibility of all nursing facility
1422	operators, operating the facility as a leasehold, to renew the
1423	30-month bond and to provide proof of such renewal to the agency
1424	annually.
1425	6.  Any failure of the nursing facility operator to
1426	acquire, maintain, renew annually, or provide proof to the
1427	agency shall be grounds for the agency to deny, revoke, and
1428	suspend the facility license to operate such facility and to
1429	take any further action, including, but not limited to,
1430	enjoining the facility, asserting a moratorium pursuant to part
1431	II of chapter 408, or applying for a receiver, deemed necessary
1432	to ensure compliance with this section and to safeguard and
1433	protect the health, safety, and welfare of the facility's
1434	residents. A lease agreement required as a condition of bond
1435	financing or refinancing under s. 154.213 by a health facilities
1436	authority or required under s. 159.30 by a county or
1437	municipality is not a leasehold for purposes of this paragraph
1438	and is not subject to the bond requirement of this paragraph.
1439	(e)  For the 2009-2010 fiscal year only, the provisions of
1440	paragraph (d) shall not apply. This paragraph expires July 1,
1441	2010.
1442	Section 38.  Subsection (3) of section 400.19, Florida
1443	Statutes, is amended to read:
1444	400.19  Right of entry and inspection.-
1445	(3)  The agency shall every 15 months conduct at least one
1446	unannounced inspection to determine compliance by the licensee
1447	with statutes, and with rules promulgated under the provisions
1448	of those statutes, governing minimum standards of construction,
1449	quality and adequacy of care, and rights of residents. The
1450	survey shall be conducted every 6 months for the next 2-year
1451	period if the facility has been cited for a class I deficiency,
1452	has been cited for two or more class II deficiencies arising
1453	from separate surveys or investigations within a 60-day period,
1454	or has had three or more substantiated complaints within a 6-
1455	month period, each resulting in at least one class I or class II
1456	deficiency. In addition to any other fees or fines in this part,
1457	the agency shall assess a fine for each facility that is subject
1458	to the 6-month survey cycle. The fine for the 2-year period
1459	shall be $6,000, one-half to be paid at the completion of each
1460	survey. The agency may adjust this fine by the change in the
1461	Consumer Price Index, based on the 12 months immediately
1462	preceding the increase, to cover the cost of the additional
1463	surveys. The agency shall verify through subsequent inspection
1464	that any deficiency identified during inspection is corrected.
1465	However, the agency may verify the correction of a class III or
1466	class IV deficiency unrelated to resident rights or resident
1467	care without reinspecting the facility if adequate written
1468	documentation has been received from the facility, which
1469	provides assurance that the deficiency has been corrected. The
1470	giving or causing to be given of advance notice of such
1471	unannounced inspections by an employee of the agency to any
1472	unauthorized person shall constitute cause for suspension of not
1473	fewer than 5 working days according to the provisions of chapter
1474	110.
1475	Section 39.  Section 400.195, Florida Statutes, is
1476	repealed.
1477	Section 40.  Subsection (5) of section 400.23, Florida
1478	Statutes, is amended to read:
1479	400.23  Rules; evaluation and deficiencies; licensure
1480	status.-
1481	(5)(a)  The agency, in collaboration with the Division of
1482	Children's Medical Services Network of the Department of Health,
1483	must, no later than December 31, 1993, adopt rules for minimum
1484	standards of care for persons under 21 years of age who reside
1485	in nursing home facilities. The rules must include a methodology
1486	for reviewing a nursing home facility under ss. 408.031-408.045
1487	which serves only persons under 21 years of age. A facility may
1488	be exempt from these standards for specific persons between 18
1489	and 21 years of age, if the person's physician agrees that
1490	minimum standards of care based on age are not necessary.
1491	(b)  The agency, in collaboration with the Division of
1492	Children's Medical Services Network, shall adopt rules for
1493	minimum staffing requirements for nursing home facilities that
1494	serve persons under 21 years of age, which shall apply in lieu
1495	of the standards contained in subsection (3).
1496	1.  For persons under 21 years of age who require skilled
1497	care, the requirements shall include a minimum combined average
1498	of licensed nurses, respiratory therapists, respiratory care
1499	practitioners, and certified nursing assistants of 3.9 hours of
1500	direct care per resident per day for each nursing home facility.
1501	2.  For persons under 21 years of age who are fragile, the
1502	requirements shall include a minimum combined average of
1503	licensed nurses, respiratory therapists, respiratory care
1504	practitioners, and certified nursing assistants of 5 hours of
1505	direct care per resident per day for each nursing home facility.
1506	Section 41.  Subsection (1) of section 400.275, Florida
1507	Statutes, is amended to read:
1508	400.275  Agency duties.-
1509	(1)  The agency shall ensure that each newly hired nursing
1510	home surveyor, as a part of basic training, is assigned full-
1511	time to a licensed nursing home for at least 2 days within a 7-
1512	day period to observe facility operations outside of the survey
1513	process before the surveyor begins survey responsibilities. Such
1514	observations may not be the sole basis of a deficiency citation
1515	against the facility. The agency may not assign an individual to
1516	be a member of a survey team for purposes of a survey,
1517	evaluation, or consultation visit at a nursing home facility in
1518	which the surveyor was an employee within the preceding 2 5
1519	years.
1520	Section 42.  Subsection (2) of section 400.484, Florida
1521	Statutes, is amended to read:
1522	400.484  Right of inspection; violations deficiencies;
1523	fines.-
1524	(2)  The agency shall impose fines for various classes of
1525	violations deficiencies in accordance with the following
1526	schedule:
1527	(a)  Class I violations are defined in s. 408.813. A class
1528	I deficiency is any act, omission, or practice that results in a
1529	patient's death, disablement, or permanent injury, or places a
1530	patient at imminent risk of death, disablement, or permanent
1531	injury. Upon finding a class I violation deficiency, the agency
1532	shall impose an administrative fine in the amount of $15,000 for
1533	each occurrence and each day that the violation deficiency
1534	exists.
1535	(b)  Class II violations are defined in s. 408.813. A class
1536	II deficiency is any act, omission, or practice that has a
1537	direct adverse effect on the health, safety, or security of a
1538	patient. Upon finding a class II violation deficiency, the
1539	agency shall impose an administrative fine in the amount of
1540	$5,000 for each occurrence and each day that the violation
1541	deficiency exists.
1542	(c)  Class III violations are defined in s. 408.813. A
1543	class III deficiency is any act, omission, or practice that has
1544	an indirect, adverse effect on the health, safety, or security
1545	of a patient. Upon finding an uncorrected or repeated class III
1546	violation deficiency, the agency shall impose an administrative
1547	fine not to exceed $1,000 for each occurrence and each day that
1548	the uncorrected or repeated violation deficiency exists.
1549	(d)  Class IV violations are defined in s. 408.813. A class
1550	IV deficiency is any act, omission, or practice related to
1551	required reports, forms, or documents which does not have the
1552	potential of negatively affecting patients. These violations are
1553	of a type that the agency determines do not threaten the health,
1554	safety, or security of patients. Upon finding an uncorrected or
1555	repeated class IV violation deficiency, the agency shall impose
1556	an administrative fine not to exceed $500 for each occurrence
1557	and each day that the uncorrected or repeated violation
1558	deficiency exists.
1559	Section 43.  Paragraph (i) of subsection (1) and subsection
1560	(4) of section 400.606, Florida Statutes, are amended to read:
1561	400.606  License; application; renewal; conditional license
1562	or permit; certificate of need.-
1563	(1)  In addition to the requirements of part II of chapter
1564	408, the initial application and change of ownership application
1565	must be accompanied by a plan for the delivery of home,
1566	residential, and homelike inpatient hospice services to
1567	terminally ill persons and their families. Such plan must
1568	contain, but need not be limited to:
1569	(i)  The projected annual operating cost of the hospice.
1570
1571	If the applicant is an existing licensed health care provider,
1572	the application must be accompanied by a copy of the most recent
1573	profit-loss statement and, if applicable, the most recent
1574	licensure inspection report.
1575	(4)  A freestanding hospice facility that is primarily
1576	engaged in providing inpatient and related services and that is
1577	not otherwise licensed as a health care facility shall be
1578	required to obtain a certificate of need. However, a
1579	freestanding hospice facility with six or fewer beds shall not
1580	be required to comply with institutional standards such as, but
1581	not limited to, standards requiring sprinkler systems, emergency
1582	electrical systems, or special lavatory devices.
1583	Section 44.  Subsection (2) of section 400.607, Florida
1584	Statutes, is amended to read:
1585	400.607  Denial, suspension, revocation of license;
1586	emergency actions; imposition of administrative fine; grounds.-
1587	(2)  A violation of this part, part II of chapter 408, or
1588	applicable rules Any of the following actions by a licensed
1589	hospice or any of its employees shall be grounds for
1590	administrative action by the agency against a hospice.:
1591	(a)  A violation of the provisions of this part, part II of
1592	chapter 408, or applicable rules.
1593	(b)  An intentional or negligent act materially affecting
1594	the health or safety of a patient.
1595	Section 45.  Section 400.915, Florida Statutes, is amended
1596	to read:
1597	400.915  Construction and renovation; requirements.-The
1598	requirements for the construction or renovation of a PPEC center
1599	shall comply with:
1600	(1)  The provisions of chapter 553, which pertain to
1601	building construction standards, including plumbing, electrical
1602	code, glass, manufactured buildings, accessibility for the
1603	physically disabled;
1604	(2)  The provisions of s. 633.022 and applicable rules
1605	pertaining to physical minimum standards for nonresidential
1606	child care physical facilities in rule 10M-12.003, Florida
1607	Administrative Code, Child Care Standards; and
1608	(3)  The standards or rules adopted pursuant to this part
1609	and part II of chapter 408.
1610	Section 46.  Subsection (1) of section 400.925, Florida
1611	Statutes, is amended to read:
1612	400.925  Definitions.-As used in this part, the term:
1613	(1)  "Accrediting organizations" means The Joint Commission
1614	on Accreditation of Healthcare Organizations or other national
1615	accreditation agencies whose standards for accreditation are
1616	comparable to those required by this part for licensure.
1617	Section 47.  Subsections (3) through (6) of section
1618	400.931, Florida Statutes, are renumbered as subsections (2)
1619	through (5), respectively, and present subsection (2) of that
1620	section is amended to read:
1621	400.931  Application for license; fee; provisional license;
1622	temporary permit.-
1623	(2)  As an alternative to submitting proof of financial
1624	ability to operate as required in s. 408.810(8), the applicant
1625	may submit a $50,000 surety bond to the agency.
1626	Section 48.  Subsection (2) of section 400.932, Florida
1627	Statutes, is amended to read:
1628	400.932  Administrative penalties.-
1629	(2)  A violation of this part, part II of chapter 408, or
1630	applicable rules Any of the following actions by an employee of
1631	a home medical equipment provider shall be are grounds for
1632	administrative action or penalties by the agency.:
1633	(a)  Violation of this part, part II of chapter 408, or
1634	applicable rules.
1635	(b)  An intentional, reckless, or negligent act that
1636	materially affects the health or safety of a patient.
1637	Section 49.  Subsection (3) of section 400.967, Florida
1638	Statutes, is amended to read:
1639	400.967  Rules and classification of violations
1640	deficiencies.-
1641	(3)  The agency shall adopt rules to provide that, when the
1642	criteria established under this part and part II of chapter 408
1643	are not met, such violations deficiencies shall be classified
1644	according to the nature of the violation deficiency. The agency
1645	shall indicate the classification on the face of the notice of
1646	deficiencies as follows:
1647	(a)  Class I violations deficiencies are defined in s.
1648	408.813 those which the agency determines present an imminent
1649	danger to the residents or guests of the facility or a
1650	substantial probability that death or serious physical harm
1651	would result therefrom. The condition or practice constituting a
1652	class I violation must be abated or eliminated immediately,
1653	unless a fixed period of time, as determined by the agency, is
1654	required for correction. A class I violation deficiency is
1655	subject to a civil penalty in an amount not less than $5,000 and
1656	not exceeding $10,000 for each violation deficiency. A fine may
1657	be levied notwithstanding the correction of the violation
1658	deficiency.
1659	(b)  Class II violations deficiencies are defined in s.
1660	408.813 those which the agency determines have a direct or
1661	immediate relationship to the health, safety, or security of the
1662	facility residents, other than class I deficiencies. A class II
1663	violation deficiency is subject to a civil penalty in an amount
1664	not less than $1,000 and not exceeding $5,000 for each violation
1665	deficiency. A citation for a class II violation deficiency shall
1666	specify the time within which the violation deficiency must be
1667	corrected. If a class II violation deficiency is corrected
1668	within the time specified, no civil penalty shall be imposed,
1669	unless it is a repeated offense.
1670	(c)  Class III violations deficiencies are defined in s.
1671	408.813 those which the agency determines to have an indirect or
1672	potential relationship to the health, safety, or security of the
1673	facility residents, other than class I or class II deficiencies.
1674	A class III violation deficiency is subject to a civil penalty
1675	of not less than $500 and not exceeding $1,000 for each
1676	deficiency. A citation for a class III violation deficiency
1677	shall specify the time within which the violation deficiency
1678	must be corrected. If a class III violation deficiency is
1679	corrected within the time specified, no civil penalty shall be
1680	imposed, unless it is a repeated offense.
1681	(d)  Class IV violations are defined in s. 408.813. Upon
1682	finding an uncorrected or repeated class IV violation, the
1683	agency shall impose an administrative fine not to exceed $500
1684	for each occurrence and each day that the uncorrected or
1685	repeated violation exists.
1686	Section 50.  Subsections (4) and (7) of section 400.9905,
1687	Florida Statutes, are amended to read:
1688	400.9905  Definitions.-
1689	(4)  "Clinic" means an entity at which health care services
1690	are provided to individuals and which tenders charges for
1691	reimbursement for such services, including a mobile clinic and a
1692	portable health service or equipment provider. For purposes of
1693	this part, the term does not include and the licensure
1694	requirements of this part do not apply to:
1695	(a)  Entities licensed or registered by the state under
1696	chapter 395; or entities licensed or registered by the state and
1697	providing only health care services within the scope of services
1698	authorized under their respective licenses granted under ss.
1699	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1700	chapter except part X, chapter 429, chapter 463, chapter 465,
1701	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1702	chapter 651; end-stage renal disease providers authorized under
1703	42 C.F.R. part 405, subpart U; or providers certified under 42
1704	C.F.R. part 485, subpart B or subpart H; or any entity that
1705	provides neonatal or pediatric hospital-based health care
1706	services or other health care services by licensed practitioners
1707	solely within a hospital licensed under chapter 395.
1708	(b)  Entities that own, directly or indirectly, entities
1709	licensed or registered by the state pursuant to chapter 395; or
1710	entities that own, directly or indirectly, entities licensed or
1711	registered by the state and providing only health care services
1712	within the scope of services authorized pursuant to their
1713	respective licenses granted under ss. 383.30-383.335, chapter
1714	390, chapter 394, chapter 397, this chapter except part X,
1715	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1716	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1717	disease providers authorized under 42 C.F.R. part 405, subpart
1718	U; or providers certified under 42 C.F.R. part 485, subpart B or
1719	subpart H; or any entity that provides neonatal or pediatric
1720	hospital-based health care services by licensed practitioners
1721	solely within a hospital licensed under chapter 395.
1722	(c)  Entities that are owned, directly or indirectly, by an
1723	entity licensed or registered by the state pursuant to chapter
1724	395; or entities that are owned, directly or indirectly, by an
1725	entity licensed or registered by the state and providing only
1726	health care services within the scope of services authorized
1727	pursuant to their respective licenses granted under ss. 383.30-
1728	383.335, chapter 390, chapter 394, chapter 397, this chapter
1729	except part X, chapter 429, chapter 463, chapter 465, chapter
1730	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1731	651; end-stage renal disease providers authorized under 42
1732	C.F.R. part 405, subpart U; or providers certified under 42
1733	C.F.R. part 485, subpart B or subpart H; or any entity that
1734	provides neonatal or pediatric hospital-based health care
1735	services by licensed practitioners solely within a hospital
1736	under chapter 395.
1737	(d)  Entities that are under common ownership, directly or
1738	indirectly, with an entity licensed or registered by the state
1739	pursuant to chapter 395; or entities that are under common
1740	ownership, directly or indirectly, with an entity licensed or
1741	registered by the state and providing only health care services
1742	within the scope of services authorized pursuant to their
1743	respective licenses granted under ss. 383.30-383.335, chapter
1744	390, chapter 394, chapter 397, this chapter except part X,
1745	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1746	part I of chapter 483, chapter 484, or chapter 651; end-stage
1747	renal disease providers authorized under 42 C.F.R. part 405,
1748	subpart U; or providers certified under 42 C.F.R. part 485,
1749	subpart B or subpart H; or any entity that provides neonatal or
1750	pediatric hospital-based health care services by licensed
1751	practitioners solely within a hospital licensed under chapter
1752	395.
1753	(e)  An entity that is exempt from federal taxation under
1754	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1755	under 26 U.S.C. s. 409 that has a board of trustees not less
1756	than two-thirds of which are Florida-licensed health care
1757	practitioners and provides only physical therapy services under
1758	physician orders, any community college or university clinic,
1759	and any entity owned or operated by the federal or state
1760	government, including agencies, subdivisions, or municipalities
1761	thereof.
1762	(f)  A sole proprietorship, group practice, partnership, or
1763	corporation that provides health care services by physicians
1764	covered by s. 627.419, that is directly supervised by one or
1765	more of such physicians, and that is wholly owned by one or more
1766	of those physicians or by a physician and the spouse, parent,
1767	child, or sibling of that physician.
1768	(g)  A sole proprietorship, group practice, partnership, or
1769	corporation that provides health care services by licensed
1770	health care practitioners under chapter 457, chapter 458,
1771	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1772	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1773	chapter 490, chapter 491, or part I, part III, part X, part
1774	XIII, or part XIV of chapter 468, or s. 464.012, which are
1775	wholly owned by one or more licensed health care practitioners,
1776	or the licensed health care practitioners set forth in this
1777	paragraph and the spouse, parent, child, or sibling of a
1778	licensed health care practitioner, so long as one of the owners
1779	who is a licensed health care practitioner is supervising the
1780	business activities and is legally responsible for the entity's
1781	compliance with all federal and state laws. However, a health
1782	care practitioner may not supervise services beyond the scope of
1783	the practitioner's license, except that, for the purposes of
1784	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1785	provides only services authorized pursuant to s. 456.053(3)(b)
1786	may be supervised by a licensee specified in s. 456.053(3)(b).
1787	(h)  Clinical facilities affiliated with an accredited
1788	medical school at which training is provided for medical
1789	students, residents, or fellows.
1790	(i)  Entities that provide only oncology or radiation
1791	therapy services by physicians licensed under chapter 458 or
1792	chapter 459 or entities that provide oncology or radiation
1793	therapy services by physicians licensed under chapter 458 or
1794	chapter 459 which are owned by a corporation whose shares are
1795	publicly traded on a recognized stock exchange.
1796	(j)  Clinical facilities affiliated with a college of
1797	chiropractic accredited by the Council on Chiropractic Education
1798	at which training is provided for chiropractic students.
1799	(k)  Entities that provide licensed practitioners to staff
1800	emergency departments or to deliver anesthesia services in
1801	facilities licensed under chapter 395 and that derive at least
1802	90 percent of their gross annual revenues from the provision of
1803	such services. Entities claiming an exemption from licensure
1804	under this paragraph must provide documentation demonstrating
1805	compliance.
1806	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1807	perinatology clinical facilities that are a publicly traded
1808	corporation or that are wholly owned, directly or indirectly, by
1809	a publicly traded corporation. As used in this paragraph, a
1810	publicly traded corporation is a corporation that issues
1811	securities traded on an exchange registered with the United
1812	States Securities and Exchange Commission as a national
1813	securities exchange.
1814	(m)  Entities that are owned by a corporation that has $250
1815	million or more in total annual sales of health care services
1816	provided by licensed health care practitioners if one or more of
1817	the owners of the entity is a health care practitioner who is
1818	licensed in this state, is responsible for supervising the
1819	business activities of the entity, and is legally responsible
1820	for the entity's compliance with state law for purposes of this
1821	section.
1822	(n)  Entities that are owned or controlled, directly or
1823	indirectly, by a publicly traded entity with $100 million or
1824	more, in the aggregate, in total annual revenues derived from
1825	providing health care services by licensed health care
1826	practitioners that are employed or contracted by an entity
1827	described in this paragraph.
1828	(7)  "Portable health service or equipment provider" means
1829	an entity that contracts with or employs persons to provide
1830	portable health care services or equipment to multiple locations
1831	performing treatment or diagnostic testing of individuals, that
1832	bills third-party payors for those services, and that otherwise
1833	meets the definition of a clinic in subsection (4).
1834	Section 51.  Paragraph (b) of subsection (1) and paragraph
1835	(c) of subsection (4) of section 400.991, Florida Statutes, are
1836	amended to read:
1837	400.991  License requirements; background screenings;
1838	prohibitions.-
1839	(1)
1840	(b)  Each mobile clinic must obtain a separate health care
1841	clinic license and must provide to the agency, at least
1842	quarterly, its projected street location to enable the agency to
1843	locate and inspect such clinic. A portable health service or
1844	equipment provider must obtain a health care clinic license for
1845	a single administrative office and is not required to submit
1846	quarterly projected street locations.
1847	(4)  In addition to the requirements of part II of chapter
1848	408, the applicant must file with the application satisfactory
1849	proof that the clinic is in compliance with this part and
1850	applicable rules, including:
1851	(c)  Proof of financial ability to operate as required
1852	under ss. s. 408.810(8) and 408.8065. As an alternative to
1853	submitting proof of financial ability to operate as required
1854	under s. 408.810(8), the applicant may file a surety bond of at
1855	least $500,000 which guarantees that the clinic will act in full
1856	conformity with all legal requirements for operating a clinic,
1857	payable to the agency. The agency may adopt rules to specify
1858	related requirements for such surety bond.
1859	Section 52.  Paragraph (g) of subsection (1) and paragraph
1860	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1861	amended to read:
1862	400.9935  Clinic responsibilities.-
1863	(1)  Each clinic shall appoint a medical director or clinic
1864	director who shall agree in writing to accept legal
1865	responsibility for the following activities on behalf of the
1866	clinic. The medical director or the clinic director shall:
1867	(g)  Conduct systematic reviews of clinic billings to
1868	ensure that the billings are not fraudulent or unlawful. Upon
1869	discovery of an unlawful charge, the medical director or clinic
1870	director shall take immediate corrective action. If the clinic
1871	performs only the technical component of magnetic resonance
1872	imaging, static radiographs, computed tomography, or positron
1873	emission tomography, and provides the professional
1874	interpretation of such services, in a fixed facility that is
1875	accredited by The Joint Commission on Accreditation of
1876	Healthcare Organizations or the Accreditation Association for
1877	Ambulatory Health Care, and the American College of Radiology;
1878	and if, in the preceding quarter, the percentage of scans
1879	performed by that clinic which was billed to all personal injury
1880	protection insurance carriers was less than 15 percent, the
1881	chief financial officer of the clinic may, in a written
1882	acknowledgment provided to the agency, assume the responsibility
1883	for the conduct of the systematic reviews of clinic billings to
1884	ensure that the billings are not fraudulent or unlawful.
1885	(7)(a)  Each clinic engaged in magnetic resonance imaging
1886	services must be accredited by The Joint Commission on
1887	Accreditation of Healthcare Organizations, the American College
1888	of Radiology, or the Accreditation Association for Ambulatory
1889	Health Care, within 1 year after licensure. A clinic that is
1890	accredited by the American College of Radiology or is within the
1891	original 1-year period after licensure and replaces its core
1892	magnetic resonance imaging equipment shall be given 1 year after
1893	the date on which the equipment is replaced to attain
1894	accreditation. However, a clinic may request a single, 6-month
1895	extension if it provides evidence to the agency establishing
1896	that, for good cause shown, such clinic cannot be accredited
1897	within 1 year after licensure, and that such accreditation will
1898	be completed within the 6-month extension. After obtaining
1899	accreditation as required by this subsection, each such clinic
1900	must maintain accreditation as a condition of renewal of its
1901	license. A clinic that files a change of ownership application
1902	must comply with the original accreditation timeframe
1903	requirements of the transferor. The agency shall deny a change
1904	of ownership application if the clinic is not in compliance with
1905	the accreditation requirements. When a clinic adds, replaces, or
1906	modifies magnetic resonance imaging equipment and the
1907	accreditation agency requires new accreditation, the clinic must
1908	be accredited within 1 year after the date of the addition,
1909	replacement, or modification but may request a single, 6-month
1910	extension if the clinic provides evidence of good cause to the
1911	agency.
1912	Section 53.  Subsection (2) of section 408.034, Florida
1913	Statutes, is amended to read:
1914	408.034  Duties and responsibilities of agency; rules.-
1915	(2)  In the exercise of its authority to issue licenses to
1916	health care facilities and health service providers, as provided
1917	under chapters 393 and 395 and parts II, and IV, and VIII of
1918	chapter 400, the agency may not issue a license to any health
1919	care facility or health service provider that fails to receive a
1920	certificate of need or an exemption for the licensed facility or
1921	service.
1922	Section 54.  Paragraph (d) of subsection (1) of section
1923	408.036, Florida Statutes, is amended to read:
1924	408.036  Projects subject to review; exemptions.-
1925	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1926	health-care-related projects, as described in paragraphs (a)-
1927	(g), are subject to review and must file an application for a
1928	certificate of need with the agency. The agency is exclusively
1929	responsible for determining whether a health-care-related
1930	project is subject to review under ss. 408.031-408.045.
1931	(d)  The establishment of a hospice or hospice inpatient
1932	facility, except as provided in s. 408.043.
1933	Section 55.  Subsection (2) of section 408.043, Florida
1934	Statutes, is amended to read:
1935	408.043  Special provisions.-
1936	(2)  HOSPICES.-When an application is made for a
1937	certificate of need to establish or to expand a hospice, the
1938	need for such hospice shall be determined on the basis of the
1939	need for and availability of hospice services in the community.
1940	The formula on which the certificate of need is based shall
1941	discourage regional monopolies and promote competition. The
1942	inpatient hospice care component of a hospice which is a
1943	freestanding facility, or a part of a facility, which is
1944	primarily engaged in providing inpatient care and related
1945	services and is not licensed as a health care facility shall
1946	also be required to obtain a certificate of need. Provision of
1947	hospice care by any current provider of health care is a
1948	significant change in service and therefore requires a
1949	certificate of need for such services.
1950	Section 56.  Paragraph (k) of subsection (3) of section
1951	408.05, Florida Statutes, is amended to read:
1952	408.05  Florida Center for Health Information and Policy
1953	Analysis.-
1954	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1955	produce comparable and uniform health information and statistics
1956	for the development of policy recommendations, the agency shall
1957	perform the following functions:
1958	(k)  Develop, in conjunction with the State Consumer Health
1959	Information and Policy Advisory Council, and implement a long-
1960	range plan for making available health care quality measures and
1961	financial data that will allow consumers to compare health care
1962	services. The health care quality measures and financial data
1963	the agency must make available shall include, but is not limited
1964	to, pharmaceuticals, physicians, health care facilities, and
1965	health plans and managed care entities. The agency shall submit
1966	the initial plan to the Governor, the President of the Senate,
1967	and the Speaker of the House of Representatives by January 1,
1968	2006, and shall update the plan and report on the status of its
1969	implementation annually thereafter. The agency shall also make
1970	the plan and status report available to the public on its
1971	Internet website. As part of the plan, the agency shall identify
1972	the process and timeframes for implementation, any barriers to
1973	implementation, and recommendations of changes in the law that
1974	may be enacted by the Legislature to eliminate the barriers. As
1975	preliminary elements of the plan, the agency shall:
1976	1.  Make available patient-safety indicators, inpatient
1977	quality indicators, and performance outcome and patient charge
1978	data collected from health care facilities pursuant to s.
1979	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1980	"inpatient quality indicators" shall be as defined by the
1981	Centers for Medicare and Medicaid Services, the National Quality
1982	Forum, The Joint Commission on Accreditation of Healthcare
1983	Organizations, the Agency for Healthcare Research and Quality,
1984	the Centers for Disease Control and Prevention, or a similar
1985	national entity that establishes standards to measure the
1986	performance of health care providers, or by other states. The
1987	agency shall determine which conditions, procedures, health care
1988	quality measures, and patient charge data to disclose based upon
1989	input from the council. When determining which conditions and
1990	procedures are to be disclosed, the council and the agency shall
1991	consider variation in costs, variation in outcomes, and
1992	magnitude of variations and other relevant information. When
1993	determining which health care quality measures to disclose, the
1994	agency:
1995	a.  Shall consider such factors as volume of cases; average
1996	patient charges; average length of stay; complication rates;
1997	mortality rates; and infection rates, among others, which shall
1998	be adjusted for case mix and severity, if applicable.
1999	b.  May consider such additional measures that are adopted
2000	by the Centers for Medicare and Medicaid Studies, National
2001	Quality Forum, The Joint Commission on Accreditation of
2002	Healthcare Organizations, the Agency for Healthcare Research and
2003	Quality, Centers for Disease Control and Prevention, or a
2004	similar national entity that establishes standards to measure
2005	the performance of health care providers, or by other states.
2006
2007	When determining which patient charge data to disclose, the
2008	agency shall include such measures as the average of
2009	undiscounted charges on frequently performed procedures and
2010	preventive diagnostic procedures, the range of procedure charges
2011	from highest to lowest, average net revenue per adjusted patient
2012	day, average cost per adjusted patient day, and average cost per
2013	admission, among others.
2014	2.  Make available performance measures, benefit design,
2015	and premium cost data from health plans licensed pursuant to
2016	chapter 627 or chapter 641. The agency shall determine which
2017	health care quality measures and member and subscriber cost data
2018	to disclose, based upon input from the council. When determining
2019	which data to disclose, the agency shall consider information
2020	that may be required by either individual or group purchasers to
2021	assess the value of the product, which may include membership
2022	satisfaction, quality of care, current enrollment or membership,
2023	coverage areas, accreditation status, premium costs, plan costs,
2024	premium increases, range of benefits, copayments and
2025	deductibles, accuracy and speed of claims payment, credentials
2026	of physicians, number of providers, names of network providers,
2027	and hospitals in the network. Health plans shall make available
2028	to the agency any such data or information that is not currently
2029	reported to the agency or the office.
2030	3.  Determine the method and format for public disclosure
2031	of data reported pursuant to this paragraph. The agency shall
2032	make its determination based upon input from the State Consumer
2033	Health Information and Policy Advisory Council. At a minimum,
2034	the data shall be made available on the agency's Internet
2035	website in a manner that allows consumers to conduct an
2036	interactive search that allows them to view and compare the
2037	information for specific providers. The website must include
2038	such additional information as is determined necessary to ensure
2039	that the website enhances informed decisionmaking among
2040	consumers and health care purchasers, which shall include, at a
2041	minimum, appropriate guidance on how to use the data and an
2042	explanation of why the data may vary from provider to provider.
2043	The data specified in subparagraph 1. shall be released no later
2044	than January 1, 2006, for the reporting of infection rates, and
2045	no later than October 1, 2005, for mortality rates and
2046	complication rates. The data specified in subparagraph 2. shall
2047	be released no later than October 1, 2006.
2048	4.  Publish on its website undiscounted charges for no
2049	fewer than 150 of the most commonly performed adult and
2050	pediatric procedures, including outpatient, inpatient,
2051	diagnostic, and preventative procedures.
2052	Section 57.  Paragraph (a) of subsection (1) of section
2053	408.061, Florida Statutes, is amended to read:
2054	408.061  Data collection; uniform systems of financial
2055	reporting; information relating to physician charges;
2056	confidential information; immunity.-
2057	(1)  The agency shall require the submission by health care
2058	facilities, health care providers, and health insurers of data
2059	necessary to carry out the agency's duties. Specifications for
2060	data to be collected under this section shall be developed by
2061	the agency with the assistance of technical advisory panels
2062	including representatives of affected entities, consumers,
2063	purchasers, and such other interested parties as may be
2064	determined by the agency.
2065	(a)  Data submitted by health care facilities, including
2066	the facilities as defined in chapter 395, shall include, but are
2067	not limited to: case-mix data, patient admission and discharge
2068	data, hospital emergency department data which shall include the
2069	number of patients treated in the emergency department of a
2070	licensed hospital reported by patient acuity level, data on
2071	hospital-acquired infections as specified by rule, data on
2072	complications as specified by rule, data on readmissions as
2073	specified by rule, with patient and provider-specific
2074	identifiers included, actual charge data by diagnostic groups,
2075	financial data, accounting data, operating expenses, expenses
2076	incurred for rendering services to patients who cannot or do not
2077	pay, interest charges, depreciation expenses based on the
2078	expected useful life of the property and equipment involved, and
2079	demographic data. The agency shall adopt nationally recognized
2080	risk adjustment methodologies or software consistent with the
2081	standards of the Agency for Healthcare Research and Quality and
2082	as selected by the agency for all data submitted as required by
2083	this section. Data may be obtained from documents such as, but
2084	not limited to: leases, contracts, debt instruments, itemized
2085	patient bills, medical record abstracts, and related diagnostic
2086	information. Reported data elements shall be reported
2087	electronically and in accordance with rule 59E-7.012, Florida
2088	Administrative Code. Data submitted shall be certified by the
2089	chief executive officer or an appropriate and duly authorized
2090	representative or employee of the licensed facility that the
2091	information submitted is true and accurate.
2092	Section 58.  Subsection (43) of section 408.07, Florida
2093	Statutes, is amended to read:
2094	408.07  Definitions.-As used in this chapter, with the
2095	exception of ss. 408.031-408.045, the term:
2096	(43)  "Rural hospital" means an acute care hospital
2097	licensed under chapter 395, having 100 or fewer licensed beds
2098	and an emergency room, and which is:
2099	(a)  The sole provider within a county with a population
2100	density of no greater than 100 persons per square mile;
2101	(b)  An acute care hospital, in a county with a population
2102	density of no greater than 100 persons per square mile, which is
2103	at least 30 minutes of travel time, on normally traveled roads
2104	under normal traffic conditions, from another acute care
2105	hospital within the same county;
2106	(c)  A hospital supported by a tax district or subdistrict
2107	whose boundaries encompass a population of 100 persons or fewer
2108	per square mile;
2109	(d)  A hospital with a service area that has a population
2110	of 100 persons or fewer per square mile. As used in this
2111	paragraph, the term "service area" means the fewest number of
2112	zip codes that account for 75 percent of the hospital's
2113	discharges for the most recent 5-year period, based on
2114	information available from the hospital inpatient discharge
2115	database in the Florida Center for Health Information and Policy
2116	Analysis at the Agency for Health Care Administration; or
2117	(e)  A critical access hospital.
2118
2119	Population densities used in this subsection must be based upon
2120	the most recently completed United States census. A hospital
2121	that received funds under s. 409.9116 for a quarter beginning no
2122	later than July 1, 2002, is deemed to have been and shall
2123	continue to be a rural hospital from that date through June 30,
2124	2015, if the hospital continues to have 100 or fewer licensed
2125	beds and an emergency room, or meets the criteria of s.
2126	395.602(2)(e)4. An acute care hospital that has not previously
2127	been designated as a rural hospital and that meets the criteria
2128	of this subsection shall be granted such designation upon
2129	application, including supporting documentation, to the Agency
2130	for Health Care Administration.
2131	Section 59.  Section 408.10, Florida Statutes, is amended
2132	to read:
2133	408.10  Consumer complaints.-The agency shall:
2134	(1)  publish and make available to the public a toll-free
2135	telephone number for the purpose of handling consumer complaints
2136	and shall serve as a liaison between consumer entities and other
2137	private entities and governmental entities for the disposition
2138	of problems identified by consumers of health care.
2139	(2)  Be empowered to investigate consumer complaints
2140	relating to problems with health care facilities' billing
2141	practices and issue reports to be made public in any cases where
2142	the agency determines the health care facility has engaged in
2143	billing practices which are unreasonable and unfair to the
2144	consumer.
2145	Section 60.  Subsections (12) through (30) of section
2146	408.802, Florida Statutes, are renumbered as subsections (11)
2147	through (29), respectively, and present subsection (11) of that
2148	section is amended to read:
2149	408.802  Applicability.-The provisions of this part apply
2150	to the provision of services that require licensure as defined
2151	in this part and to the following entities licensed, registered,
2152	or certified by the agency, as described in chapters 112, 383,
2153	390, 394, 395, 400, 429, 440, 483, and 765:
2154	(11)  Private review agents, as provided under part I of
2155	chapter 395.
2156	Section 61.  Subsection (3) is added to section 408.804,
2157	Florida Statutes, to read:
2158	408.804  License required; display.-
2159	(3)  Any person who knowingly alters, defaces, or falsifies
2160	a license certificate issued by the agency, or causes or
2161	procures any person to commit such an offense, commits a
2162	misdemeanor of the second degree, punishable as provided in s.
2163	775.082 or s 775.083. Any licensee or provider who displays an
2164	altered, defaced, or falsified license certificate is subject to
2165	the penalties set forth in s. 408.815 and an administrative fine
2166	of $1,000 for each day of illegal display.
2167	Section 62.  Paragraph (d) of subsection (2) of section
2168	408.806, Florida Statutes, is amended, present subsections (3)
2169	through (8) are renumbered as subsections (4) through (9),
2170	respectively, and a new subsection (3) is added to that section,
2171	to read:
2172	408.806  License application process.-
2173	(2)
2174	(d)  The agency shall notify the licensee by mail or
2175	electronically at least 90 days before the expiration of a
2176	license that a renewal license is necessary to continue
2177	operation. The licensee's failure to timely file submit a
2178	renewal application and license application fee with the agency
2179	shall result in a $50 per day late fee charged to the licensee
2180	by the agency; however, the aggregate amount of the late fee may
2181	not exceed 50 percent of the licensure fee or $500, whichever is
2182	less. The agency shall provide a courtesy notice to the licensee
2183	by United States mail, electronically, or by any other manner at
2184	its address of record or mailing address, if provided, at least
2185	90 days prior to the expiration of a license informing the
2186	licensee of the expiration of the license. If the agency does
2187	not provide the courtesy notice or the licensee does not receive
2188	the courtesy notice, the licensee continues to be legally
2189	obligated to timely file the renewal application and license
2190	application fee with the agency and is not excused from the
2191	payment of a late fee. If an application is received after the
2192	required filing date and exhibits a hand-canceled postmark
2193	obtained from a United States post office dated on or before the
2194	required filing date, no fine will be levied.
2195	(3)  Payment of the late fee is required to consider any
2196	late application complete, and failure to pay the late fee is
2197	considered an omission from the application.
2198	Section 63.  Subsections (6) and (9) of section 408.810,
2199	Florida Statutes, are amended to read:
2200	408.810  Minimum licensure requirements.-In addition to the
2201	licensure requirements specified in this part, authorizing
2202	statutes, and applicable rules, each applicant and licensee must
2203	comply with the requirements of this section in order to obtain
2204	and maintain a license.
2205	(6)(a)  An applicant must provide the agency with proof of
2206	the applicant's legal right to occupy the property before a
2207	license may be issued. Proof may include, but need not be
2208	limited to, copies of warranty deeds, lease or rental
2209	agreements, contracts for deeds, quitclaim deeds, or other such
2210	documentation.
2211	(b)  In the event the property is encumbered by a mortgage
2212	or is leased, an applicant must provide the agency with proof
2213	that the mortgagor or landlord has been provided written notice
2214	of the applicant's intent as mortgagee or tenant to provide
2215	services that require licensure and instruct the mortgagor or
2216	landlord to serve the agency by certified mail with copies of
2217	any foreclosure or eviction actions initiated by the mortgagor
2218	or landlord against the applicant.
2219	(9)  A controlling interest may not withhold from the
2220	agency any evidence of financial instability, including, but not
2221	limited to, checks returned due to insufficient funds,
2222	delinquent accounts, nonpayment of withholding taxes, unpaid
2223	utility expenses, nonpayment for essential services, or adverse
2224	court action concerning the financial viability of the provider
2225	or any other provider licensed under this part that is under the
2226	control of the controlling interest. A controlling interest
2227	shall notify the agency within 10 days after a court action to
2228	initiate bankruptcy, foreclosure, or eviction proceedings
2229	concerning the provider, in which the controlling interest is a
2230	petitioner or defendant. Any person who violates this subsection
2231	commits a misdemeanor of the second degree, punishable as
2232	provided in s. 775.082 or s. 775.083. Each day of continuing
2233	violation is a separate offense.
2234	Section 64.  Subsection (3) is added to section 408.813,
2235	Florida Statutes, to read:
2236	408.813  Administrative fines; violations.-As a penalty for
2237	any violation of this part, authorizing statutes, or applicable
2238	rules, the agency may impose an administrative fine.
2239	(3)  The agency may impose an administrative fine for a
2240	violation that does not qualify as a class I, class II, class
2241	III, or class IV violation. Unless otherwise specified by law,
2242	the amount of the fine shall not exceed $500 for each violation.
2243	Unclassified violations may include:
2244	(a)  Violating any term or condition of a license.
2245	(b)  Violating any provision of this part, authorizing
2246	statutes, or applicable rules.
2247	(c)  Exceeding licensed capacity.
2248	(d)  Providing services beyond the scope of the license.
2249	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2250	Section 65.  Subsection (5) is added to section 408.815,
2251	Florida Statutes, to read:
2252	408.815  License or application denial; revocation.-
2253	(5)  In order to ensure the health, safety, and welfare of
2254	clients when a license has been denied, revoked, or is set to
2255	terminate, the agency may extend the license expiration date for
2256	a period of up to 30 days for the sole purpose of allowing the
2257	safe and orderly discharge of clients. The agency may impose
2258	conditions on the extension, including, but not limited to,
2259	prohibiting or limiting admissions, expedited discharge
2260	planning, required status reports, and mandatory monitoring by
2261	the agency or third parties. In imposing these conditions, the
2262	agency shall take into consideration the nature and number of
2263	clients, the availability and location of acceptable alternative
2264	placements, and the ability of the licensee to continue
2265	providing care to the clients. The agency may terminate the
2266	extension or modify the conditions at any time. This authority
2267	is in addition to any other authority granted to the agency
2268	under chapter 120, this part, and authorizing statutes but
2269	creates no right or entitlement to an extension of a license
2270	expiration date.
2271	Section 66.  Paragraph (k) of subsection (4) of section
2272	409.221, Florida Statutes, is amended to read:
2273	409.221  Consumer-directed care program.-
2274	(4)  CONSUMER-DIRECTED CARE.-
2275	(k)  Reviews and reports.-The agency and the Departments of
2276	Elderly Affairs, Health, and Children and Family Services and
2277	the Agency for Persons with Disabilities shall each, on an
2278	ongoing basis, review and assess the implementation of the
2279	consumer-directed care program. By January 15 of each year, the
2280	agency shall submit a written report to the Legislature that
2281	includes each department's review of the program and contains
2282	recommendations for improvements to the program.
2283	Section 67.  Subsection (1) of section 409.91196, Florida
2284	Statutes, is amended to read:
2285	409.91196  Supplemental rebate agreements; public records
2286	and public meetings exemption.-
2287	(1)  The rebate amount, percent of rebate, manufacturer's
2288	pricing, and supplemental rebate, and other trade secrets as
2289	defined in s. 688.002 that the agency has identified for use in
2290	negotiations, held by the Agency for Health Care Administration
2291	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2292	119.07(1) and s. 24(a), Art. I of the State Constitution.
2293	Section 68.  Paragraph (a) of subsection (39) of section
2294	409.912, Florida Statutes, is amended to read:
2295	409.912  Cost-effective purchasing of health care.-The
2296	agency shall purchase goods and services for Medicaid recipients
2297	in the most cost-effective manner consistent with the delivery
2298	of quality medical care. To ensure that medical services are
2299	effectively utilized, the agency may, in any case, require a
2300	confirmation or second physician's opinion of the correct
2301	diagnosis for purposes of authorizing future services under the
2302	Medicaid program. This section does not restrict access to
2303	emergency services or poststabilization care services as defined
2304	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2305	shall be rendered in a manner approved by the agency. The agency
2306	shall maximize the use of prepaid per capita and prepaid
2307	aggregate fixed-sum basis services when appropriate and other
2308	alternative service delivery and reimbursement methodologies,
2309	including competitive bidding pursuant to s. 287.057, designed
2310	to facilitate the cost-effective purchase of a case-managed
2311	continuum of care. The agency shall also require providers to
2312	minimize the exposure of recipients to the need for acute
2313	inpatient, custodial, and other institutional care and the
2314	inappropriate or unnecessary use of high-cost services. The
2315	agency shall contract with a vendor to monitor and evaluate the
2316	clinical practice patterns of providers in order to identify
2317	trends that are outside the normal practice patterns of a
2318	provider's professional peers or the national guidelines of a
2319	provider's professional association. The vendor must be able to
2320	provide information and counseling to a provider whose practice
2321	patterns are outside the norms, in consultation with the agency,
2322	to improve patient care and reduce inappropriate utilization.
2323	The agency may mandate prior authorization, drug therapy
2324	management, or disease management participation for certain
2325	populations of Medicaid beneficiaries, certain drug classes, or
2326	particular drugs to prevent fraud, abuse, overuse, and possible
2327	dangerous drug interactions. The Pharmaceutical and Therapeutics
2328	Committee shall make recommendations to the agency on drugs for
2329	which prior authorization is required. The agency shall inform
2330	the Pharmaceutical and Therapeutics Committee of its decisions
2331	regarding drugs subject to prior authorization. The agency is
2332	authorized to limit the entities it contracts with or enrolls as
2333	Medicaid providers by developing a provider network through
2334	provider credentialing. The agency may competitively bid single-
2335	source-provider contracts if procurement of goods or services
2336	results in demonstrated cost savings to the state without
2337	limiting access to care. The agency may limit its network based
2338	on the assessment of beneficiary access to care, provider
2339	availability, provider quality standards, time and distance
2340	standards for access to care, the cultural competence of the
2341	provider network, demographic characteristics of Medicaid
2342	beneficiaries, practice and provider-to-beneficiary standards,
2343	appointment wait times, beneficiary use of services, provider
2344	turnover, provider profiling, provider licensure history,
2345	previous program integrity investigations and findings, peer
2346	review, provider Medicaid policy and billing compliance records,
2347	clinical and medical record audits, and other factors. Providers
2348	shall not be entitled to enrollment in the Medicaid provider
2349	network. The agency shall determine instances in which allowing
2350	Medicaid beneficiaries to purchase durable medical equipment and
2351	other goods is less expensive to the Medicaid program than long-
2352	term rental of the equipment or goods. The agency may establish
2353	rules to facilitate purchases in lieu of long-term rentals in
2354	order to protect against fraud and abuse in the Medicaid program
2355	as defined in s. 409.913. The agency may seek federal waivers
2356	necessary to administer these policies.
2357	(39)(a)  The agency shall implement a Medicaid prescribed-
2358	drug spending-control program that includes the following
2359	components:
2360	1.  A Medicaid preferred drug list, which shall be a
2361	listing of cost-effective therapeutic options recommended by the
2362	Medicaid Pharmacy and Therapeutics Committee established
2363	pursuant to s. 409.91195 and adopted by the agency for each
2364	therapeutic class on the preferred drug list. At the discretion
2365	of the committee, and when feasible, the preferred drug list
2366	should include at least two products in a therapeutic class. The
2367	agency may post the preferred drug list and updates to the
2368	preferred drug list on an Internet website without following the
2369	rulemaking procedures of chapter 120. Antiretroviral agents are
2370	excluded from the preferred drug list. The agency shall also
2371	limit the amount of a prescribed drug dispensed to no more than
2372	a 34-day supply unless the drug products' smallest marketed
2373	package is greater than a 34-day supply, or the drug is
2374	determined by the agency to be a maintenance drug in which case
2375	a 100-day maximum supply may be authorized. The agency is
2376	authorized to seek any federal waivers necessary to implement
2377	these cost-control programs and to continue participation in the
2378	federal Medicaid rebate program, or alternatively to negotiate
2379	state-only manufacturer rebates. The agency may adopt rules to
2380	implement this subparagraph. The agency shall continue to
2381	provide unlimited contraceptive drugs and items. The agency must
2382	establish procedures to ensure that:
2383	a.  There is a response to a request for prior consultation
2384	by telephone or other telecommunication device within 24 hours
2385	after receipt of a request for prior consultation; and
2386	b.  A 72-hour supply of the drug prescribed is provided in
2387	an emergency or when the agency does not provide a response
2388	within 24 hours as required by sub-subparagraph a.
2389	2.  Reimbursement to pharmacies for Medicaid prescribed
2390	drugs shall be set at the lesser of: the average wholesale price
2391	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2392	plus 4.75 percent, the federal upper limit (FUL), the state
2393	maximum allowable cost (SMAC), or the usual and customary (UAC)
2394	charge billed by the provider.
2395	3.  For a prescribed drug billed as a 340B prescribed
2396	medication, the claim must meet the requirements of the Deficit
2397	Reduction Act of 2005 and the federal 340B program, contain a
2398	national drug code, and be billed at the actual acquisition cost
2399	or payment shall be denied.
2400	4.3.  The agency shall develop and implement a process for
2401	managing the drug therapies of Medicaid recipients who are using
2402	significant numbers of prescribed drugs each month. The
2403	management process may include, but is not limited to,
2404	comprehensive, physician-directed medical-record reviews, claims
2405	analyses, and case evaluations to determine the medical
2406	necessity and appropriateness of a patient's treatment plan and
2407	drug therapies. The agency may contract with a private
2408	organization to provide drug-program-management services. The
2409	Medicaid drug benefit management program shall include
2410	initiatives to manage drug therapies for HIV/AIDS patients,
2411	patients using 20 or more unique prescriptions in a 180-day
2412	period, and the top 1,000 patients in annual spending. The
2413	agency shall enroll any Medicaid recipient in the drug benefit
2414	management program if he or she meets the specifications of this
2415	provision and is not enrolled in a Medicaid health maintenance
2416	organization.
2417	5.4.  The agency may limit the size of its pharmacy network
2418	based on need, competitive bidding, price negotiations,
2419	credentialing, or similar criteria. The agency shall give
2420	special consideration to rural areas in determining the size and
2421	location of pharmacies included in the Medicaid pharmacy
2422	network. A pharmacy credentialing process may include criteria
2423	such as a pharmacy's full-service status, location, size,
2424	patient educational programs, patient consultation, disease
2425	management services, and other characteristics. The agency may
2426	impose a moratorium on Medicaid pharmacy enrollment when it is
2427	determined that it has a sufficient number of Medicaid-
2428	participating providers. The agency must allow dispensing
2429	practitioners to participate as a part of the Medicaid pharmacy
2430	network regardless of the practitioner's proximity to any other
2431	entity that is dispensing prescription drugs under the Medicaid
2432	program. A dispensing practitioner must meet all credentialing
2433	requirements applicable to his or her practice, as determined by
2434	the agency.
2435	6.5.  The agency shall develop and implement a program that
2436	requires Medicaid practitioners who prescribe drugs to use a
2437	counterfeit-proof prescription pad for Medicaid prescriptions.
2438	The agency shall require the use of standardized counterfeit-
2439	proof prescription pads by Medicaid-participating prescribers or
2440	prescribers who write prescriptions for Medicaid recipients. The
2441	agency may implement the program in targeted geographic areas or
2442	statewide.
2443	7.6.  The agency may enter into arrangements that require
2444	manufacturers of generic drugs prescribed to Medicaid recipients
2445	to provide rebates of at least 15.1 percent of the average
2446	manufacturer price for the manufacturer's generic products.
2447	These arrangements shall require that if a generic-drug
2448	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2449	at a level below 15.1 percent, the manufacturer must provide a
2450	supplemental rebate to the state in an amount necessary to
2451	achieve a 15.1-percent rebate level.
2452	8.7.  The agency may establish a preferred drug list as
2453	described in this subsection, and, pursuant to the establishment
2454	of such preferred drug list, it is authorized to negotiate
2455	supplemental rebates from manufacturers that are in addition to
2456	those required by Title XIX of the Social Security Act and at no
2457	less than 14 percent of the average manufacturer price as
2458	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2459	the federal or supplemental rebate, or both, equals or exceeds
2460	29 percent. There is no upper limit on the supplemental rebates
2461	the agency may negotiate. The agency may determine that specific
2462	products, brand-name or generic, are competitive at lower rebate
2463	percentages. Agreement to pay the minimum supplemental rebate
2464	percentage will guarantee a manufacturer that the Medicaid
2465	Pharmaceutical and Therapeutics Committee will consider a
2466	product for inclusion on the preferred drug list. However, a
2467	pharmaceutical manufacturer is not guaranteed placement on the
2468	preferred drug list by simply paying the minimum supplemental
2469	rebate. Agency decisions will be made on the clinical efficacy
2470	of a drug and recommendations of the Medicaid Pharmaceutical and
2471	Therapeutics Committee, as well as the price of competing
2472	products minus federal and state rebates. The agency is
2473	authorized to contract with an outside agency or contractor to
2474	conduct negotiations for supplemental rebates. For the purposes
2475	of this section, the term "supplemental rebates" means cash
2476	rebates. Effective July 1, 2004, value-added programs as a
2477	substitution for supplemental rebates are prohibited. The agency
2478	is authorized to seek any federal waivers to implement this
2479	initiative.
2480	9.8.  The Agency for Health Care Administration shall
2481	expand home delivery of pharmacy products. To assist Medicaid
2482	patients in securing their prescriptions and reduce program
2483	costs, the agency shall expand its current mail-order-pharmacy
2484	diabetes-supply program to include all generic and brand-name
2485	drugs used by Medicaid patients with diabetes. Medicaid
2486	recipients in the current program may obtain nondiabetes drugs
2487	on a voluntary basis. This initiative is limited to the
2488	geographic area covered by the current contract. The agency may
2489	seek and implement any federal waivers necessary to implement
2490	this subparagraph.
2491	10.9.  The agency shall limit to one dose per month any
2492	drug prescribed to treat erectile dysfunction.
2493	11.10.a.  The agency may implement a Medicaid behavioral
2494	drug management system. The agency may contract with a vendor
2495	that has experience in operating behavioral drug management
2496	systems to implement this program. The agency is authorized to
2497	seek federal waivers to implement this program.
2498	b.  The agency, in conjunction with the Department of
2499	Children and Family Services, may implement the Medicaid
2500	behavioral drug management system that is designed to improve
2501	the quality of care and behavioral health prescribing practices
2502	based on best practice guidelines, improve patient adherence to
2503	medication plans, reduce clinical risk, and lower prescribed
2504	drug costs and the rate of inappropriate spending on Medicaid
2505	behavioral drugs. The program may include the following
2506	elements:
2507	(I)  Provide for the development and adoption of best
2508	practice guidelines for behavioral health-related drugs such as
2509	antipsychotics, antidepressants, and medications for treating
2510	bipolar disorders and other behavioral conditions; translate
2511	them into practice; review behavioral health prescribers and
2512	compare their prescribing patterns to a number of indicators
2513	that are based on national standards; and determine deviations
2514	from best practice guidelines.
2515	(II)  Implement processes for providing feedback to and
2516	educating prescribers using best practice educational materials
2517	and peer-to-peer consultation.
2518	(III)  Assess Medicaid beneficiaries who are outliers in
2519	their use of behavioral health drugs with regard to the numbers
2520	and types of drugs taken, drug dosages, combination drug
2521	therapies, and other indicators of improper use of behavioral
2522	health drugs.
2523	(IV)  Alert prescribers to patients who fail to refill
2524	prescriptions in a timely fashion, are prescribed multiple same-
2525	class behavioral health drugs, and may have other potential
2526	medication problems.
2527	(V)  Track spending trends for behavioral health drugs and
2528	deviation from best practice guidelines.
2529	(VI)  Use educational and technological approaches to
2530	promote best practices, educate consumers, and train prescribers
2531	in the use of practice guidelines.
2532	(VII)  Disseminate electronic and published materials.
2533	(VIII)  Hold statewide and regional conferences.
2534	(IX)  Implement a disease management program with a model
2535	quality-based medication component for severely mentally ill
2536	individuals and emotionally disturbed children who are high
2537	users of care.
2538	12.11.a.  The agency shall implement a Medicaid
2539	prescription drug management system. The agency may contract
2540	with a vendor that has experience in operating prescription drug
2541	management systems in order to implement this system. Any
2542	management system that is implemented in accordance with this
2543	subparagraph must rely on cooperation between physicians and
2544	pharmacists to determine appropriate practice patterns and
2545	clinical guidelines to improve the prescribing, dispensing, and
2546	use of drugs in the Medicaid program. The agency may seek
2547	federal waivers to implement this program.
2548	b.  The drug management system must be designed to improve
2549	the quality of care and prescribing practices based on best
2550	practice guidelines, improve patient adherence to medication
2551	plans, reduce clinical risk, and lower prescribed drug costs and
2552	the rate of inappropriate spending on Medicaid prescription
2553	drugs. The program must:
2554	(I)  Provide for the development and adoption of best
2555	practice guidelines for the prescribing and use of drugs in the
2556	Medicaid program, including translating best practice guidelines
2557	into practice; reviewing prescriber patterns and comparing them
2558	to indicators that are based on national standards and practice
2559	patterns of clinical peers in their community, statewide, and
2560	nationally; and determine deviations from best practice
2561	guidelines.
2562	(II)  Implement processes for providing feedback to and
2563	educating prescribers using best practice educational materials
2564	and peer-to-peer consultation.
2565	(III)  Assess Medicaid recipients who are outliers in their
2566	use of a single or multiple prescription drugs with regard to
2567	the numbers and types of drugs taken, drug dosages, combination
2568	drug therapies, and other indicators of improper use of
2569	prescription drugs.
2570	(IV)  Alert prescribers to patients who fail to refill
2571	prescriptions in a timely fashion, are prescribed multiple drugs
2572	that may be redundant or contraindicated, or may have other
2573	potential medication problems.
2574	(V)  Track spending trends for prescription drugs and
2575	deviation from best practice guidelines.
2576	(VI)  Use educational and technological approaches to
2577	promote best practices, educate consumers, and train prescribers
2578	in the use of practice guidelines.
2579	(VII)  Disseminate electronic and published materials.
2580	(VIII)  Hold statewide and regional conferences.
2581	(IX)  Implement disease management programs in cooperation
2582	with physicians and pharmacists, along with a model quality-
2583	based medication component for individuals having chronic
2584	medical conditions.
2585	13.12.  The agency is authorized to contract for drug
2586	rebate administration, including, but not limited to,
2587	calculating rebate amounts, invoicing manufacturers, negotiating
2588	disputes with manufacturers, and maintaining a database of
2589	rebate collections.
2590	14.13.  The agency may specify the preferred daily dosing
2591	form or strength for the purpose of promoting best practices
2592	with regard to the prescribing of certain drugs as specified in
2593	the General Appropriations Act and ensuring cost-effective
2594	prescribing practices.
2595	15.14.  The agency may require prior authorization for
2596	Medicaid-covered prescribed drugs. The agency may, but is not
2597	required to, prior-authorize the use of a product:
2598	a.  For an indication not approved in labeling;
2599	b.  To comply with certain clinical guidelines; or
2600	c.  If the product has the potential for overuse, misuse,
2601	or abuse.
2602
2603	The agency may require the prescribing professional to provide
2604	information about the rationale and supporting medical evidence
2605	for the use of a drug. The agency may post prior authorization
2606	criteria and protocol and updates to the list of drugs that are
2607	subject to prior authorization on an Internet website without
2608	amending its rule or engaging in additional rulemaking.
2609	16.15.  The agency, in conjunction with the Pharmaceutical
2610	and Therapeutics Committee, may require age-related prior
2611	authorizations for certain prescribed drugs. The agency may
2612	preauthorize the use of a drug for a recipient who may not meet
2613	the age requirement or may exceed the length of therapy for use
2614	of this product as recommended by the manufacturer and approved
2615	by the Food and Drug Administration. Prior authorization may
2616	require the prescribing professional to provide information
2617	about the rationale and supporting medical evidence for the use
2618	of a drug.
2619	17.16.  The agency shall implement a step-therapy prior
2620	authorization approval process for medications excluded from the
2621	preferred drug list. Medications listed on the preferred drug
2622	list must be used within the previous 12 months prior to the
2623	alternative medications that are not listed. The step-therapy
2624	prior authorization may require the prescriber to use the
2625	medications of a similar drug class or for a similar medical
2626	indication unless contraindicated in the Food and Drug
2627	Administration labeling. The trial period between the specified
2628	steps may vary according to the medical indication. The step-
2629	therapy approval process shall be developed in accordance with
2630	the committee as stated in s. 409.91195(7) and (8). A drug
2631	product may be approved without meeting the step-therapy prior
2632	authorization criteria if the prescribing physician provides the
2633	agency with additional written medical or clinical documentation
2634	that the product is medically necessary because:
2635	a.  There is not a drug on the preferred drug list to treat
2636	the disease or medical condition which is an acceptable clinical
2637	alternative;
2638	b.  The alternatives have been ineffective in the treatment
2639	of the beneficiary's disease; or
2640	c.  Based on historic evidence and known characteristics of
2641	the patient and the drug, the drug is likely to be ineffective,
2642	or the number of doses have been ineffective.
2643
2644	The agency shall work with the physician to determine the best
2645	alternative for the patient. The agency may adopt rules waiving
2646	the requirements for written clinical documentation for specific
2647	drugs in limited clinical situations.
2648	18.17.  The agency shall implement a return and reuse
2649	program for drugs dispensed by pharmacies to institutional
2650	recipients, which includes payment of a $5 restocking fee for
2651	the implementation and operation of the program. The return and
2652	reuse program shall be implemented electronically and in a
2653	manner that promotes efficiency. The program must permit a
2654	pharmacy to exclude drugs from the program if it is not
2655	practical or cost-effective for the drug to be included and must
2656	provide for the return to inventory of drugs that cannot be
2657	credited or returned in a cost-effective manner. The agency
2658	shall determine if the program has reduced the amount of
2659	Medicaid prescription drugs which are destroyed on an annual
2660	basis and if there are additional ways to ensure more
2661	prescription drugs are not destroyed which could safely be
2662	reused. The agency's conclusion and recommendations shall be
2663	reported to the Legislature by December 1, 2005.
2664	Section 69.  Subsections (3) and (4) of section 429.07,
2665	Florida Statutes, are amended, and subsections (6) and (7) are
2666	added to that section, to read:
2667	429.07  License required; fee; inspections.-
2668	(3)  In addition to the requirements of s. 408.806, each
2669	license granted by the agency must state the type of care for
2670	which the license is granted. Licenses shall be issued for one
2671	or more of the following categories of care: standard, extended
2672	congregate care, limited nursing services, or limited mental
2673	health.
2674	(a)  A standard license shall be issued to a facility
2675	facilities providing one or more of the personal services
2676	identified in s. 429.02. Such licensee facilities may also
2677	employ or contract with a person licensed under part I of
2678	chapter 464 to administer medications and perform other tasks as
2679	specified in s. 429.255.
2680	(b)  An extended congregate care license shall be issued to
2681	a licensee facilities providing, directly or through contract,
2682	services beyond those authorized in paragraph (a), including
2683	acts performed pursuant to part I of chapter 464 by persons
2684	licensed thereunder, and supportive services defined by rule to
2685	persons who otherwise would be disqualified from continued
2686	residence in a facility licensed under this part.
2687	1.  In order for extended congregate care services to be
2688	provided in a facility licensed under this part, the agency must
2689	first determine that all requirements established in law and
2690	rule are met and must specifically designate, on the facility's
2691	license, that such services may be provided and whether the
2692	designation applies to all or part of a facility. Such
2693	designation may be made at the time of initial licensure or
2694	relicensure, or upon request in writing by a licensee under this
2695	part and part II of chapter 408. Notification of approval or
2696	denial of such request shall be made in accordance with part II
2697	of chapter 408. An existing licensee facilities qualifying to
2698	provide extended congregate care services must have maintained a
2699	standard license and may not have been subject to administrative
2700	sanctions during the previous 2 years, or since initial
2701	licensure if the facility has been licensed for less than 2
2702	years, for any of the following reasons:
2703	a.  A class I or class II violation;
2704	b.  Three or more repeat or recurring class III violations
2705	of identical or similar resident care standards as specified in
2706	rule from which a pattern of noncompliance is found by the
2707	agency;
2708	c.  Three or more class III violations that were not
2709	corrected in accordance with the corrective action plan approved
2710	by the agency;
2711	d.  Violation of resident care standards resulting in a
2712	requirement to employ the services of a consultant pharmacist or
2713	consultant dietitian;
2714	e.  Denial, suspension, or revocation of a license for
2715	another facility under this part in which the applicant for an
2716	extended congregate care license has at least 25 percent
2717	ownership interest; or
2718	f.  Imposition of a moratorium pursuant to this part or
2719	part II of chapter 408 or initiation of injunctive proceedings.
2720	2.  A licensee Facilities that is are licensed to provide
2721	extended congregate care services shall maintain a written
2722	progress report for on each person who receives such services,
2723	and the which report must describe describes the type, amount,
2724	duration, scope, and outcome of services that are rendered and
2725	the general status of the resident's health. A registered nurse,
2726	or appropriate designee, representing the agency shall visit
2727	such facilities at least quarterly to monitor residents who are
2728	receiving extended congregate care services and to determine if
2729	the facility is in compliance with this part, part II of chapter
2730	408, and rules that relate to extended congregate care. One of
2731	these visits may be in conjunction with the regular survey. The
2732	monitoring visits may be provided through contractual
2733	arrangements with appropriate community agencies. A registered
2734	nurse shall serve as part of the team that inspects such
2735	facility. The agency may waive one of the required yearly
2736	monitoring visits for a facility that has been licensed for at
2737	least 24 months to provide extended congregate care services,
2738	if, during the inspection, the registered nurse determines that
2739	extended congregate care services are being provided
2740	appropriately, and if the facility has no class I or class II
2741	violations and no uncorrected class III violations. Before such
2742	decision is made, the agency shall consult with the long-term
2743	care ombudsman council for the area in which the facility is
2744	located to determine if any complaints have been made and
2745	substantiated about the quality of services or care. The agency
2746	may not waive one of the required yearly monitoring visits if
2747	complaints have been made and substantiated.
2748	3.  Licensees Facilities that are licensed to provide
2749	extended congregate care services shall:
2750	a.  Demonstrate the capability to meet unanticipated
2751	resident service needs.
2752	b.  Offer a physical environment that promotes a homelike
2753	setting, provides for resident privacy, promotes resident
2754	independence, and allows sufficient congregate space as defined
2755	by rule.
2756	c.  Have sufficient staff available, taking into account
2757	the physical plant and firesafety features of the building, to
2758	assist with the evacuation of residents in an emergency, as
2759	necessary.
2760	d.  Adopt and follow policies and procedures that maximize
2761	resident independence, dignity, choice, and decisionmaking to
2762	permit residents to age in place to the extent possible, so that
2763	moves due to changes in functional status are minimized or
2764	avoided.
2765	e.  Allow residents or, if applicable, a resident's
2766	representative, designee, surrogate, guardian, or attorney in
2767	fact to make a variety of personal choices, participate in
2768	developing service plans, and share responsibility in
2769	decisionmaking.
2770	f.  Implement the concept of managed risk.
2771	g.  Provide, either directly or through contract, the
2772	services of a person licensed pursuant to part I of chapter 464.
2773	h.  In addition to the training mandated in s. 429.52,
2774	provide specialized training as defined by rule for facility
2775	staff.
2776	4.  Licensees Facilities licensed to provide extended
2777	congregate care services are exempt from the criteria for
2778	continued residency as set forth in rules adopted under s.
2779	429.41. Licensees Facilities so licensed shall adopt their own
2780	requirements within guidelines for continued residency set forth
2781	by rule. However, such licensees facilities may not serve
2782	residents who require 24-hour nursing supervision. Licensees
2783	Facilities licensed to provide extended congregate care services
2784	shall provide each resident with a written copy of facility
2785	policies governing admission and retention.
2786	5.  The primary purpose of extended congregate care
2787	services is to allow residents, as they become more impaired,
2788	the option of remaining in a familiar setting from which they
2789	would otherwise be disqualified for continued residency. A
2790	facility licensed to provide extended congregate care services
2791	may also admit an individual who exceeds the admission criteria
2792	for a facility with a standard license, if the individual is
2793	determined appropriate for admission to the extended congregate
2794	care facility.
2795	6.  Before admission of an individual to a facility
2796	licensed to provide extended congregate care services, the
2797	individual must undergo a medical examination as provided in s.
2798	429.26(4) and the facility must develop a preliminary service
2799	plan for the individual.
2800	7.  When a licensee facility can no longer provide or
2801	arrange for services in accordance with the resident's service
2802	plan and needs and the licensee's facility's policy, the
2803	licensee facility shall make arrangements for relocating the
2804	person in accordance with s. 429.28(1)(k).
2805	8.  Failure to provide extended congregate care services
2806	may result in denial of extended congregate care license
2807	renewal.
2808	9.  No later than January 1 of each year, the department,
2809	in consultation with the agency, shall prepare and submit to the
2810	Governor, the President of the Senate, the Speaker of the House
2811	of Representatives, and the chairs of appropriate legislative
2812	committees, a report on the status of, and recommendations
2813	related to, extended congregate care services. The status report
2814	must include, but need not be limited to, the following
2815	information:
2816	a.  A description of the facilities licensed to provide
2817	such services, including total number of beds licensed under
2818	this part.
2819	b.  The number and characteristics of residents receiving
2820	such services.
2821	c.  The types of services rendered that could not be
2822	provided through a standard license.
2823	d.  An analysis of deficiencies cited during licensure
2824	inspections.
2825	e.  The number of residents who required extended
2826	congregate care services at admission and the source of
2827	admission.
2828	f.  Recommendations for statutory or regulatory changes.
2829	g.  The availability of extended congregate care to state
2830	clients residing in facilities licensed under this part and in
2831	need of additional services, and recommendations for
2832	appropriations to subsidize extended congregate care services
2833	for such persons.
2834	h.  Such other information as the department considers
2835	appropriate.
2836	(c)  A limited nursing services license shall be issued to
2837	a facility that provides services beyond those authorized in
2838	paragraph (a) and as specified in this paragraph.
2839	1.  In order for limited nursing services to be provided in
2840	a facility licensed under this part, the agency must first
2841	determine that all requirements established in law and rule are
2842	met and must specifically designate, on the facility's license,
2843	that such services may be provided. Such designation may be made
2844	at the time of initial licensure or relicensure, or upon request
2845	in writing by a licensee under this part and part II of chapter
2846	408. Notification of approval or denial of such request shall be
2847	made in accordance with part II of chapter 408. Existing
2848	facilities qualifying to provide limited nursing services shall
2849	have maintained a standard license and may not have been subject
2850	to administrative sanctions that affect the health, safety, and
2851	welfare of residents for the previous 2 years or since initial
2852	licensure if the facility has been licensed for less than 2
2853	years.
2854	2.  Facilities that are licensed to provide limited nursing
2855	services shall maintain a written progress report on each person
2856	who receives such nursing services, which report describes the
2857	type, amount, duration, scope, and outcome of services that are
2858	rendered and the general status of the resident's health. A
2859	registered nurse representing the agency shall visit such
2860	facilities at least twice a year to monitor residents who are
2861	receiving limited nursing services and to determine if the
2862	facility is in compliance with applicable provisions of this
2863	part, part II of chapter 408, and related rules. The monitoring
2864	visits may be provided through contractual arrangements with
2865	appropriate community agencies. A registered nurse shall also
2866	serve as part of the team that inspects such facility.
2867	3.  A person who receives limited nursing services under
2868	this part must meet the admission criteria established by the
2869	agency for assisted living facilities. When a resident no longer
2870	meets the admission criteria for a facility licensed under this
2871	part, arrangements for relocating the person shall be made in
2872	accordance with s. 429.28(1)(k), unless the facility is licensed
2873	to provide extended congregate care services.
2874	(4)  In accordance with s. 408.805, an applicant or
2875	licensee shall pay a fee for each license application submitted
2876	under this part, part II of chapter 408, and applicable rules.
2877	The amount of the fee shall be established by rule.
2878	(a)  The biennial license fee required of a facility is
2879	$356 $300 per license, with an additional fee of $67.50 $50 per
2880	resident based on the total licensed resident capacity of the
2881	facility, except that no additional fee will be assessed for
2882	beds designated for recipients of optional state supplementation
2883	payments provided for in s. 409.212. The total fee may not
2884	exceed $18,000 $10,000.
2885	(b)  In addition to the total fee assessed under paragraph
2886	(a), the agency shall require facilities that are licensed to
2887	provide extended congregate care services under this part to pay
2888	an additional fee per licensed facility. The amount of the
2889	biennial fee shall be $501 $400 per license, with an additional
2890	fee of $10 per resident based on the total licensed resident
2891	capacity of the facility.
2892	(c)  In addition to the total fee assessed under paragraph
2893	(a), the agency shall require facilities that are licensed to
2894	provide limited nursing services under this part to pay an
2895	additional fee per licensed facility. The amount of the biennial
2896	fee shall be $250 per license, with an additional fee of $10 per
2897	resident based on the total licensed resident capacity of the
2898	facility.
2899	(6)  In order to determine whether the facility is
2900	adequately protecting residents' rights as provided in s.
2901	429.28, the biennial survey shall include private informal
2902	conversations with a sample of residents and consultation with
2903	the ombudsman council in the planning and service area in which
2904	the facility is located to discuss residents' experiences within
2905	the facility.
2906	(7)  An assisted living facility that has been cited within
2907	the previous 24-month period for a class I or class II
2908	violation, regardless of the status of any enforcement or
2909	disciplinary action, is subject to periodic unannounced
2910	monitoring to determine if the facility is in compliance with
2911	this part, part II of chapter 408, and applicable rules.
2912	Monitoring may occur through a desk review or an onsite
2913	assessment. If the class I or class II violation relates to
2914	providing or failing to provide nursing care, a registered nurse
2915	must participate in at least two onsite monitoring visits within
2916	a 12-month period.
2917	Section 70.  Subsection (7) of section 429.11, Florida
2918	Statutes, is renumbered as subsection (6), and present
2919	subsection (6) of that section is amended to read:
2920	429.11  Initial application for license; provisional
2921	license.-
2922	(6)  In addition to the license categories available in s.
2923	408.808, a provisional license may be issued to an applicant
2924	making initial application for licensure or making application
2925	for a change of ownership. A provisional license shall be
2926	limited in duration to a specific period of time not to exceed 6
2927	months, as determined by the agency.
2928	Section 71.  Section 429.12, Florida Statutes, is amended
2929	to read:
2930	429.12  Sale or transfer of ownership of a facility.-It is
2931	the intent of the Legislature to protect the rights of the
2932	residents of an assisted living facility when the facility is
2933	sold or the ownership thereof is transferred. Therefore, in
2934	addition to the requirements of part II of chapter 408, whenever
2935	a facility is sold or the ownership thereof is transferred,
2936	including leasing:.
2937	(1)  The transferee shall notify the residents, in writing,
2938	of the change of ownership within 7 days after receipt of the
2939	new license.
2940	(2)  The transferor of a facility the license of which is
2941	denied pending an administrative hearing shall, as a part of the
2942	written change-of-ownership contract, advise the transferee that
2943	a plan of correction must be submitted by the transferee and
2944	approved by the agency at least 7 days before the change of
2945	ownership and that failure to correct the condition which
2946	resulted in the moratorium pursuant to part II of chapter 408 or
2947	denial of licensure is grounds for denial of the transferee's
2948	license.
2949	Section 72.  Paragraphs (b) through (l) of subsection (1)
2950	of section 429.14, Florida Statutes, are redesignated as
2951	paragraphs (a) through (k), respectively, and present paragraph
2952	(a) of subsection (1) and subsections (5) and (6) of that
2953	section are amended to read:
2954	429.14  Administrative penalties.-
2955	(1)  In addition to the requirements of part II of chapter
2956	408, the agency may deny, revoke, and suspend any license issued
2957	under this part and impose an administrative fine in the manner
2958	provided in chapter 120 against a licensee of an assisted living
2959	facility for a violation of any provision of this part, part II
2960	of chapter 408, or applicable rules, or for any of the following
2961	actions by a licensee of an assisted living facility, for the
2962	actions of any person subject to level 2 background screening
2963	under s. 408.809, or for the actions of any facility employee:
2964	(a)  An intentional or negligent act seriously affecting
2965	the health, safety, or welfare of a resident of the facility.
2966	(5)  An action taken by the agency to suspend, deny, or
2967	revoke a facility's license under this part or part II of
2968	chapter 408, in which the agency claims that the facility owner
2969	or an employee of the facility has threatened the health,
2970	safety, or welfare of a resident of the facility shall be heard
2971	by the Division of Administrative Hearings of the Department of
2972	Management Services within 120 days after receipt of the
2973	facility's request for a hearing, unless that time limitation is
2974	waived by both parties. The administrative law judge must render
2975	a decision within 30 days after receipt of a proposed
2976	recommended order.
2977	(6)  The agency shall provide to the Division of Hotels and
2978	Restaurants of the Department of Business and Professional
2979	Regulation, on a monthly basis, a list of those assisted living
2980	facilities that have had their licenses denied, suspended, or
2981	revoked or that are involved in an appellate proceeding pursuant
2982	to s. 120.60 related to the denial, suspension, or revocation of
2983	a license. This information may be provided electronically or
2984	through the agency's Internet website.
2985	Section 73.  Subsections (1), (4), and (5) of section
2986	429.17, Florida Statutes, are amended to read:
2987	429.17  Expiration of license; renewal; conditional
2988	license.-
2989	(1)  Limited nursing, Extended congregate care, and limited
2990	mental health licenses shall expire at the same time as the
2991	facility's standard license, regardless of when issued.
2992	(4)  In addition to the license categories available in s.
2993	408.808, a conditional license may be issued to an applicant for
2994	license renewal if the applicant fails to meet all standards and
2995	requirements for licensure. A conditional license issued under
2996	this subsection shall be limited in duration to a specific
2997	period of time not to exceed 6 months, as determined by the
2998	agency, and shall be accompanied by an agency-approved plan of
2999	correction.
3000	(5)  When an extended congregate care or limited nursing
3001	license is requested during a facility's biennial license
3002	period, the fee shall be prorated in order to permit the
3003	additional license to expire at the end of the biennial license
3004	period. The fee shall be calculated as of the date the
3005	additional license application is received by the agency.
3006	Section 74.  Subsection (7) of section 429.19, Florida
3007	Statutes, is amended to read:
3008	429.19  Violations; imposition of administrative fines;
3009	grounds.-
3010	(7)  In addition to any administrative fines imposed, the
3011	agency may assess a survey or monitoring fee, equal to the
3012	lesser of one half of the facility's biennial license and bed
3013	fee or $500, to cover the cost of conducting initial complaint
3014	investigations that result in the finding of a violation that
3015	was the subject of the complaint or to monitor the health,
3016	safety, or security of residents under s. 429.07     (7) monitoring
3017	visits conducted under s. 429.28(3)(c) to verify the correction
3018	of the violations.
3019	Section 75.  Subsections (6) through (10) of section
3020	429.23, Florida Statutes, are renumbered as subsections (5)
3021	through (9), respectively, and present subsection (5) of that
3022	section is amended to read:
3023	429.23  Internal risk management and quality assurance
3024	program; adverse incidents and reporting requirements.-
3025	(5)  Each facility shall report monthly to the agency any
3026	liability claim filed against it. The report must include the
3027	name of the resident, the dates of the incident leading to the
3028	claim, if applicable, and the type of injury or violation of
3029	rights alleged to have occurred. This report is not discoverable
3030	in any civil or administrative action, except in such actions
3031	brought by the agency to enforce the provisions of this part.
3032	Section 76.  Paragraph (a) of subsection (1) and subsection
3033	(2) of section 429.255, Florida Statutes, are amended to read:
3034	429.255  Use of personnel; emergency care.-
3035	(1)(a)  Persons under contract to the facility or, facility
3036	staff, or volunteers, who are licensed according to part I of
3037	chapter 464, or those persons exempt under s. 464.022(1), and
3038	others as defined by rule, may administer medications to
3039	residents, take residents' vital signs, manage individual weekly
3040	pill organizers for residents who self-administer medication,
3041	give prepackaged enemas ordered by a physician, observe
3042	residents, document observations on the appropriate resident's
3043	record, report observations to the resident's physician, and
3044	contract or allow residents or a resident's representative,
3045	designee, surrogate, guardian, or attorney in fact to contract
3046	with a third party, provided residents meet the criteria for
3047	appropriate placement as defined in s. 429.26. Persons under
3048	contract to the facility or facility staff who are licensed
3049	according to part I of chapter 464 may provide limited nursing
3050	services. Nursing assistants certified pursuant to part II of
3051	chapter 464 may take residents' vital signs as directed by a
3052	licensed nurse or physician. The facility is responsible for
3053	maintaining documentation of services provided under this
3054	paragraph as required by rule and ensuring that staff are
3055	adequately trained to monitor residents receiving these
3056	services.
3057	(2)  In facilities licensed to provide extended congregate
3058	care, persons under contract to the facility or, facility staff,
3059	or volunteers, who are licensed according to part I of chapter
3060	464, or those persons exempt under s. 464.022(1), or those
3061	persons certified as nursing assistants pursuant to part II of
3062	chapter 464, may also perform all duties within the scope of
3063	their license or certification, as approved by the facility
3064	administrator and pursuant to this part.
3065	Section 77.  Subsection (3) of section 429.28, Florida
3066	Statutes, is amended to read:
3067	429.28  Resident bill of rights.-
3068	(3)(a)  The agency shall conduct a survey to determine
3069	general compliance with facility standards and compliance with
3070	residents' rights as a prerequisite to initial licensure or
3071	licensure renewal.
3072	(b)  In order to determine whether the facility is
3073	adequately protecting residents' rights, the biennial survey
3074	shall include private informal conversations with a sample of
3075	residents and consultation with the ombudsman council in the
3076	planning and service area in which the facility is located to
3077	discuss residents' experiences within the facility.
3078	(c)  During any calendar year in which no survey is
3079	conducted, the agency shall conduct at least one monitoring
3080	visit of each facility cited in the previous year for a class I
3081	or class II violation, or more than three uncorrected class III
3082	violations.
3083	(d)  The agency may conduct periodic followup inspections
3084	as necessary to monitor the compliance of facilities with a
3085	history of any class I, class II, or class III violations that
3086	threaten the health, safety, or security of residents.
3087	(e)  The agency may conduct complaint investigations as
3088	warranted to investigate any allegations of noncompliance with
3089	requirements required under this part or rules adopted under
3090	this part.
3091	Section 78.  Subsection (2) of section 429.35, Florida
3092	Statutes, is amended to read:
3093	429.35  Maintenance of records; reports.-
3094	(2)  Within 60 days after the date of the biennial
3095	inspection visit required under s. 408.811 or within 30 days
3096	after the date of any interim visit, the agency shall forward
3097	the results of the inspection to the local ombudsman council in
3098	whose planning and service area, as defined in part II of
3099	chapter 400, the facility is located; to at least one public
3100	library or, in the absence of a public library, the county seat
3101	in the county in which the inspected assisted living facility is
3102	located; and, when appropriate, to the district Adult Services
3103	and Mental Health Program Offices. This information may be
3104	provided electronically or through the agency's Internet
3105	website.
3106	Section 79.  Paragraphs (i) and (j) of subsection (1) of
3107	section 429.41, Florida Statutes, are amended to read:
3108	429.41  Rules establishing standards.-
3109	(1)  It is the intent of the Legislature that rules
3110	published and enforced pursuant to this section shall include
3111	criteria by which a reasonable and consistent quality of
3112	resident care and quality of life may be ensured and the results
3113	of such resident care may be demonstrated. Such rules shall also
3114	ensure a safe and sanitary environment that is residential and
3115	noninstitutional in design or nature. It is further intended
3116	that reasonable efforts be made to accommodate the needs and
3117	preferences of residents to enhance the quality of life in a
3118	facility. The agency, in consultation with the department, may
3119	adopt rules to administer the requirements of part II of chapter
3120	408. In order to provide safe and sanitary facilities and the
3121	highest quality of resident care accommodating the needs and
3122	preferences of residents, the department, in consultation with
3123	the agency, the Department of Children and Family Services, and
3124	the Department of Health, shall adopt rules, policies, and
3125	procedures to administer this part, which must include
3126	reasonable and fair minimum standards in relation to:
3127	(i)  Facilities holding an a limited nursing, extended
3128	congregate care, or limited mental health license.
3129	(j)  The establishment of specific criteria to define
3130	appropriateness of resident admission and continued residency in
3131	a facility holding a standard, limited nursing, extended
3132	congregate care, and limited mental health license.
3133	Section 80.  Subsections (1) and (2) of section 429.53,
3134	Florida Statutes, are amended to read:
3135	429.53  Consultation by the agency.-
3136	(1)  The area offices of licensure and certification of the
3137	agency shall provide consultation to the following upon request:
3138	(a)  A licensee of a facility.
3139	(b)  A person interested in obtaining a license to operate
3140	a facility under this part.
3141	(2)  As used in this section, "consultation" includes:
3142	(a)  An explanation of the requirements of this part and
3143	rules adopted pursuant thereto;
3144	(b)  An explanation of the license application and renewal
3145	procedures;
3146	(c)  The provision of a checklist of general local and
3147	state approvals required prior to constructing or developing a
3148	facility and a listing of the types of agencies responsible for
3149	such approvals;
3150	(d)  An explanation of benefits and financial assistance
3151	available to a recipient of supplemental security income
3152	residing in a facility;
3153	(c)(e)  Any other information which the agency deems
3154	necessary to promote compliance with the requirements of this
3155	part; and
3156	(f)  A preconstruction review of a facility to ensure
3157	compliance with agency rules and this part.
3158	Section 81.  Subsections (1) and (2) of section 429.54,
3159	Florida Statutes, are renumbered as subsections (2) and (3),
3160	respectively, and a new subsection (1) is added to that section
3161	to read:
3162	429.54  Collection of information; local subsidy.-
3163	(1)  A facility that is licensed under this part must
3164	report electronically to the agency semiannually data related to
3165	the facility, including, but not limited to, the total number of
3166	residents, the number of residents who are receiving limited
3167	mental health services, the number of residents who are
3168	receiving extended congregate care services, the number of
3169	residents who are receiving limited nursing services, and
3170	professional staffing employed by or under contract with the
3171	licensee to provide resident services. The department, in
3172	consultation with the agency, shall adopt rules to administer
3173	this subsection.
3174	Section 82.  Subsections (1) and (5) of section 429.71,
3175	Florida Statutes, are amended to read:
3176	429.71  Classification of violations deficiencies;
3177	administrative fines.-
3178	(1)  In addition to the requirements of part II of chapter
3179	408 and in addition to any other liability or penalty provided
3180	by law, the agency may impose an administrative fine on a
3181	provider according to the following classification:
3182	(a)  Class I violations are defined in s. 408.813 those
3183	conditions or practices related to the operation and maintenance
3184	of an adult family-care home or to the care of residents which
3185	the agency determines present an imminent danger to the
3186	residents or guests of the facility or a substantial probability
3187	that death or serious physical or emotional harm would result
3188	therefrom. The condition or practice that constitutes a class I
3189	violation must be abated or eliminated within 24 hours, unless a
3190	fixed period, as determined by the agency, is required for
3191	correction. A class I violation deficiency is subject to an
3192	administrative fine in an amount not less than $500 and not
3193	exceeding $1,000 for each violation. A fine may be levied
3194	notwithstanding the correction of the deficiency.
3195	(b)  Class II violations are defined in s. 408.813 those
3196	conditions or practices related to the operation and maintenance
3197	of an adult family-care home or to the care of residents which
3198	the agency determines directly threaten the physical or
3199	emotional health, safety, or security of the residents, other
3200	than class I violations. A class II violation is subject to an
3201	administrative fine in an amount not less than $250 and not
3202	exceeding $500 for each violation. A citation for a class II
3203	violation must specify the time within which the violation is
3204	required to be corrected. If a class II violation is corrected
3205	within the time specified, no civil penalty shall be imposed,
3206	unless it is a repeated offense.
3207	(c)  Class III violations are defined in s. 408.813 those
3208	conditions or practices related to the operation and maintenance
3209	of an adult family-care home or to the care of residents which
3210	the agency determines indirectly or potentially threaten the
3211	physical or emotional health, safety, or security of residents,
3212	other than class I or class II violations. A class III violation
3213	is subject to an administrative fine in an amount not less than
3214	$100 and not exceeding $250 for each violation. A citation for a
3215	class III violation shall specify the time within which the
3216	violation is required to be corrected. If a class III violation
3217	is corrected within the time specified, no civil penalty shall
3218	be imposed, unless it is a repeated violation offense.
3219	(d)  Class IV violations are defined in s. 408.813 those
3220	conditions or occurrences related to the operation and
3221	maintenance of an adult family-care home, or related to the
3222	required reports, forms, or documents, which do not have the
3223	potential of negatively affecting the residents. A provider that
3224	does not correct A class IV violation within the time limit
3225	specified by the agency is subject to an administrative fine in
3226	an amount not less than $50 and not exceeding $100 for each
3227	violation. Any class IV violation that is corrected during the
3228	time the agency survey is conducted will be identified as an
3229	agency finding and not as a violation, unless it is a repeat
3230	violation.
3231	(5)  As an alternative to or in conjunction with an
3232	administrative action against a provider, the agency may request
3233	a plan of corrective action that demonstrates a good faith
3234	effort to remedy each violation by a specific date, subject to
3235	the approval of the agency.
3236	Section 83.  Paragraphs (b) through (e) of subsection (2)
3237	of section 429.911, Florida Statutes, are redesignated as
3238	paragraphs (a) through (d), respectively, and present paragraph
3239	(a) of that subsection is amended to read:
3240	429.911  Denial, suspension, revocation of license;
3241	emergency action; administrative fines; investigations and
3242	inspections.-
3243	(2)  Each of the following actions by the owner of an adult
3244	day care center or by its operator or employee is a ground for
3245	action by the agency against the owner of the center or its
3246	operator or employee:
3247	(a)  An intentional or negligent act materially affecting
3248	the health or safety of center participants.
3249	Section 84.  Section 429.915, Florida Statutes, is amended
3250	to read:
3251	429.915  Conditional license.-In addition to the license
3252	categories available in part II of chapter 408, the agency may
3253	issue a conditional license to an applicant for license renewal
3254	or change of ownership if the applicant fails to meet all
3255	standards and requirements for licensure. A conditional license
3256	issued under this subsection must be limited to a specific
3257	period not exceeding 6 months, as determined by the agency, and
3258	must be accompanied by an approved plan of correction.
3259	Section 85.  Paragraphs (b) and (h) of subsection (3) of
3260	section 430.80, Florida Statutes, are amended to read:
3261	430.80  Implementation of a teaching nursing home pilot
3262	project.-
3263	(3)  To be designated as a teaching nursing home, a nursing
3264	home licensee must, at a minimum:
3265	(b)  Participate in a nationally recognized accreditation
3266	program and hold a valid accreditation, such as the
3267	accreditation awarded by The Joint Commission on Accreditation
3268	of Healthcare Organizations;
3269	(h)  Maintain insurance coverage pursuant to s.
3270	400.141(1)(q)(s) or proof of financial responsibility in a
3271	minimum amount of $750,000. Such proof of financial
3272	responsibility may include:
3273	1.  Maintaining an escrow account consisting of cash or
3274	assets eligible for deposit in accordance with s. 625.52; or
3275	2.  Obtaining and maintaining pursuant to chapter 675 an
3276	unexpired, irrevocable, nontransferable and nonassignable letter
3277	of credit issued by any bank or savings association organized
3278	and existing under the laws of this state or any bank or savings
3279	association organized under the laws of the United States that
3280	has its principal place of business in this state or has a
3281	branch office which is authorized to receive deposits in this
3282	state. The letter of credit shall be used to satisfy the
3283	obligation of the facility to the claimant upon presentment of a
3284	final judgment indicating liability and awarding damages to be
3285	paid by the facility or upon presentment of a settlement
3286	agreement signed by all parties to the agreement when such final
3287	judgment or settlement is a result of a liability claim against
3288	the facility.
3289	Section 86.  Paragraph (a) of subsection (2) of section
3290	440.13, Florida Statutes, is amended to read:
3291	440.13  Medical services and supplies; penalty for
3292	violations; limitations.-
3293	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3294	(a)  Subject to the limitations specified elsewhere in this
3295	chapter, the employer shall furnish to the employee such
3296	medically necessary remedial treatment, care, and attendance for
3297	such period as the nature of the injury or the process of
3298	recovery may require, which is in accordance with established
3299	practice parameters and protocols of treatment as provided for
3300	in this chapter, including medicines, medical supplies, durable
3301	medical equipment, orthoses, prostheses, and other medically
3302	necessary apparatus. Remedial treatment, care, and attendance,
3303	including work-hardening programs or pain-management programs
3304	accredited by the Commission on Accreditation of Rehabilitation
3305	Facilities or The Joint Commission on the Accreditation of
3306	Health Organizations or pain-management programs affiliated with
3307	medical schools, shall be considered as covered treatment only
3308	when such care is given based on a referral by a physician as
3309	defined in this chapter. Medically necessary treatment, care,
3310	and attendance does not include chiropractic services in excess
3311	of 24 treatments or rendered 12 weeks beyond the date of the
3312	initial chiropractic treatment, whichever comes first, unless
3313	the carrier authorizes additional treatment or the employee is
3314	catastrophically injured.
3315
3316	Failure of the carrier to timely comply with this subsection
3317	shall be a violation of this chapter and the carrier shall be
3318	subject to penalties as provided for in s. 440.525.
3319	Section 87.  Section 483.294, Florida Statutes, is amended
3320	to read:
3321	483.294  Inspection of centers.-In accordance with s.
3322	408.811, the agency shall biennially, at least once annually,
3323	inspect the premises and operations of all centers subject to
3324	licensure under this part.
3325	Section 88. Subsections (32) through (54) of section
3326	499.003, Florida Statutes, are renumbered as subsections (33)
3327	through (55) respectively, present subsection (42) is amended,
3328	and a new subsection (32) is added to that subsection, to read:
3329	499.003  Definitions of terms used in this part.-As used in
3330	this part, the term:
3331	(32)  "Medical convenience kit" means packages or units
3332	that contain combination products as defined in 21 C.F.R. s.
3333	3.2(e)(2).
3334	(43)(42)  "Prescription drug" means a prescription,
3335	medicinal, or legend drug, including, but not limited to,
3336	finished dosage forms or active ingredients subject to, defined
3337	by, or described by s. 503(b) of the Federal Food, Drug, and
3338	Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3339	(11), subsection (46) (45), or subsection (53) (52).
3340	Section 89.  Paragraph (i) is added to subsection (3) of
3341	section 499.01212, Florida Statutes, to read:
3342	499.01212  Pedigree paper.-
3343	(3)  EXCEPTIONS.-A pedigree paper is not required for:
3344	(i)  The wholesale distribution of prescription drugs
3345	contained within a medical convenience kit if:
3346	1.  The medical convenience kit is assembled in an
3347	establishment that is registered as a medical device
3348	manufacturer with the United States Food and Drug
3349	Administration;
3350	2.  The medical convenience kit manufacturer purchased the
3351	prescription drug directly from the manufacturer or from a
3352	wholesaler that purchased the prescription drug directly from
3353	the manufacturer;
3354	3.  The medical convenience kit manufacturer complies with
3355	federal law for the distribution of the prescription drugs
3356	within the kit; and
3357	4.  The drugs contained in the medical convenience kit are:
3358	a.  Intravenous solutions intended for the replenishment of
3359	fluids and electrolytes;
3360	b.  Products intended to maintain the equilibrium of water
3361	and minerals in the body;
3362	c.  Products intended for irrigation or reconstitution;
3363	d.  Anesthetics; or
3364	e.  Anticoagulants.
3365
3366	This exemption does not apply to a convenience kit containing
3367	any controlled substance that appears in a schedule contained in
3368	or subject to chapter 893 or the federal Comprehensive Drug
3369	Abuse Prevention and Control Act of 1970.
3370	Section 90.  Subsection (3) is added to section 626.9541,
3371	Florida Statutes, to read:
3372	626.9541  Unfair methods of competition and unfair or
3373	deceptive acts or practices defined; alternative rates of
3374	payment; wellness programs.-
3375	(3)  WELLNESS PROGRAMS.-An insurer issuing a group or
3376	individual health benefit plan may offer a voluntary wellness or
3377	health-improvement program that allows for rewards or
3378	incentives, including, but not limited to, merchandise, gift
3379	cards, debit cards, premium discounts or rebates, contributions
3380	towards a member's health savings account, modifications to
3381	copayment, deductible, or coinsurance amounts, or any
3382	combination of these incentives, to encourage or reward
3383	participation in the program. The health plan member may be
3384	required to provide verification, such as a statement from his
3385	or her physician, that a medical condition makes it unreasonably
3386	difficult or medically inadvisable for the individual to
3387	participate in the wellness program. Any reward or incentive
3388	established under this subsection is not an insurance benefit
3389	and does not violate this section. This subsection does not
3390	prohibit an insurer from offering incentives or rewards to
3391	members for adherence to wellness or health improvement programs
3392	if otherwise allowed by state or federal law. Notwithstanding
3393	any provision of this subsection, no insurer, nor its agent, may
3394	use any incentive authorized by this subsection for the purpose
3395	of redirecting patients from one health care insurance plan to
3396	another.
3397	Section 91.  Subsection (1) of section 627.645, Florida
3398	Statutes, is amended to read:
3399	627.645  Denial of health insurance claims restricted.-
3400	(1)  No claim for payment under a health insurance policy
3401	or self-insured program of health benefits for treatment, care,
3402	or services in a licensed hospital which is accredited by The
3403	Joint Commission on the Accreditation of Hospitals, the American
3404	Osteopathic Association, or the Commission on the Accreditation
3405	of Rehabilitative Facilities shall be denied because such
3406	hospital lacks major surgical facilities and is primarily of a
3407	rehabilitative nature, if such rehabilitation is specifically
3408	for treatment of physical disability.
3409	Section 92.  Paragraph (c) of subsection (2) of section
3410	627.668, Florida Statutes, is amended to read:
3411	627.668  Optional coverage for mental and nervous disorders
3412	required; exception.-
3413	(2)  Under group policies or contracts, inpatient hospital
3414	benefits, partial hospitalization benefits, and outpatient
3415	benefits consisting of durational limits, dollar amounts,
3416	deductibles, and coinsurance factors shall not be less favorable
3417	than for physical illness generally, except that:
3418	(c)  Partial hospitalization benefits shall be provided
3419	under the direction of a licensed physician. For purposes of
3420	this part, the term "partial hospitalization services" is
3421	defined as those services offered by a program accredited by The
3422	Joint Commission on Accreditation of Hospitals (JCAH) or in
3423	compliance with equivalent standards. Alcohol rehabilitation
3424	programs accredited by The Joint Commission on Accreditation of
3425	Hospitals or approved by the state and licensed drug abuse
3426	rehabilitation programs shall also be qualified providers under
3427	this section. In any benefit year, if partial hospitalization
3428	services or a combination of inpatient and partial
3429	hospitalization are utilized, the total benefits paid for all
3430	such services shall not exceed the cost of 30 days of inpatient
3431	hospitalization for psychiatric services, including physician
3432	fees, which prevail in the community in which the partial
3433	hospitalization services are rendered. If partial
3434	hospitalization services benefits are provided beyond the limits
3435	set forth in this paragraph, the durational limits, dollar
3436	amounts, and coinsurance factors thereof need not be the same as
3437	those applicable to physical illness generally.
3438	Section 93.  Subsection (3) of section 627.669, Florida
3439	Statutes, is amended to read:
3440	627.669  Optional coverage required for substance abuse
3441	impaired persons; exception.-
3442	(3)  The benefits provided under this section shall be
3443	applicable only if treatment is provided by, or under the
3444	supervision of, or is prescribed by, a licensed physician or
3445	licensed psychologist and if services are provided in a program
3446	accredited by The Joint Commission on Accreditation of Hospitals
3447	or approved by the state.
3448	Section 94.  Paragraph (a) of subsection (1) of section
3449	627.736, Florida Statutes, is amended to read:
3450	627.736  Required personal injury protection benefits;
3451	exclusions; priority; claims.-
3452	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3453	with the security requirements of s. 627.733 shall provide
3454	personal injury protection to the named insured, relatives
3455	residing in the same household, persons operating the insured
3456	motor vehicle, passengers in such motor vehicle, and other
3457	persons struck by such motor vehicle and suffering bodily injury
3458	while not an occupant of a self-propelled vehicle, subject to
3459	the provisions of subsection (2) and paragraph (4)(e), to a
3460	limit of $10,000 for loss sustained by any such person as a
3461	result of bodily injury, sickness, disease, or death arising out
3462	of the ownership, maintenance, or use of a motor vehicle as
3463	follows:
3464	(a)  Medical benefits.-Eighty percent of all reasonable
3465	expenses for medically necessary medical, surgical, X-ray,
3466	dental, and rehabilitative services, including prosthetic
3467	devices, and medically necessary ambulance, hospital, and
3468	nursing services. However, the medical benefits shall provide
3469	reimbursement only for such services and care that are lawfully
3470	provided, supervised, ordered, or prescribed by a physician
3471	licensed under chapter 458 or chapter 459, a dentist licensed
3472	under chapter 466, or a chiropractic physician licensed under
3473	chapter 460 or that are provided by any of the following persons
3474	or entities:
3475	1.  A hospital or ambulatory surgical center licensed under
3476	chapter 395.
3477	2.  A person or entity licensed under ss. 401.2101-401.45
3478	that provides emergency transportation and treatment.
3479	3.  An entity wholly owned by one or more physicians
3480	licensed under chapter 458 or chapter 459, chiropractic
3481	physicians licensed under chapter 460, or dentists licensed
3482	under chapter 466 or by such practitioner or practitioners and
3483	the spouse, parent, child, or sibling of that practitioner or
3484	those practitioners.
3485	4.  An entity wholly owned, directly or indirectly, by a
3486	hospital or hospitals.
3487	5.  A health care clinic licensed under ss. 400.990-400.995
3488	that is:
3489	a.  Accredited by The Joint Commission on Accreditation of
3490	Healthcare Organizations, the American Osteopathic Association,
3491	the Commission on Accreditation of Rehabilitation Facilities, or
3492	the Accreditation Association for Ambulatory Health Care, Inc.;
3493	or
3494	b.  A health care clinic that:
3495	(I)  Has a medical director licensed under chapter 458,
3496	chapter 459, or chapter 460;
3497	(II)  Has been continuously licensed for more than 3 years
3498	or is a publicly traded corporation that issues securities
3499	traded on an exchange registered with the United States
3500	Securities and Exchange Commission as a national securities
3501	exchange; and
3502	(III)  Provides at least four of the following medical
3503	specialties:
3504	(A)  General medicine.
3505	(B)  Radiography.
3506	(C)  Orthopedic medicine.
3507	(D)  Physical medicine.
3508	(E)  Physical therapy.
3509	(F)  Physical rehabilitation.
3510	(G)  Prescribing or dispensing outpatient prescription
3511	medication.
3512	(H)  Laboratory services.
3513
3514	The Financial Services Commission shall adopt by rule the form
3515	that must be used by an insurer and a health care provider
3516	specified in subparagraph 3., subparagraph 4., or subparagraph
3517	5. to document that the health care provider meets the criteria
3518	of this paragraph, which rule must include a requirement for a
3519	sworn statement or affidavit.
3520
3521	Only insurers writing motor vehicle liability insurance in this
3522	state may provide the required benefits of this section, and no
3523	such insurer shall require the purchase of any other motor
3524	vehicle coverage other than the purchase of property damage
3525	liability coverage as required by s. 627.7275 as a condition for
3526	providing such required benefits. Insurers may not require that
3527	property damage liability insurance in an amount greater than
3528	$10,000 be purchased in conjunction with personal injury
3529	protection. Such insurers shall make benefits and required
3530	property damage liability insurance coverage available through
3531	normal marketing channels. Any insurer writing motor vehicle
3532	liability insurance in this state who fails to comply with such
3533	availability requirement as a general business practice shall be
3534	deemed to have violated part IX of chapter 626, and such
3535	violation shall constitute an unfair method of competition or an
3536	unfair or deceptive act or practice involving the business of
3537	insurance; and any such insurer committing such violation shall
3538	be subject to the penalties afforded in such part, as well as
3539	those which may be afforded elsewhere in the insurance code.
3540	Section 95.  Section 633.081, Florida Statutes, is amended
3541	to read:
3542	633.081  Inspection of buildings and equipment; orders;
3543	firesafety inspection training requirements; certification;
3544	disciplinary action.-The State Fire Marshal and her or his
3545	agents shall, at any reasonable hour, when the department has
3546	reasonable cause to believe that a violation of this chapter or
3547	s. 509.215, or a rule promulgated thereunder, or a minimum
3548	firesafety code adopted by a local authority, may exist, inspect
3549	any and all buildings and structures which are subject to the
3550	requirements of this chapter or s. 509.215 and rules promulgated
3551	thereunder. The authority to inspect shall extend to all
3552	equipment, vehicles, and chemicals which are located within the
3553	premises of any such building or structure. The State Fire
3554	Marshal and her or his agents shall inspect nursing homes
3555	licensed under part II of chapter 400 only once every calendar
3556	year and upon receiving a complaint forming the basis of a
3557	reasonable cause to believe that a violation of this chapter or
3558	s. 509.215, or a rule promulgated thereunder, or a minimum
3559	firesafety code adopted by a local authority may exist and upon
3560	identifying such a violation in the course of conducting
3561	orientation or training activities within a nursing home.
3562	(1)  Each county, municipality, and special district that
3563	has firesafety enforcement responsibilities shall employ or
3564	contract with a firesafety inspector. The firesafety inspector
3565	must conduct all firesafety inspections that are required by
3566	law. The governing body of a county, municipality, or special
3567	district that has firesafety enforcement responsibilities may
3568	provide a schedule of fees to pay only the costs of inspections
3569	conducted pursuant to this subsection and related administrative
3570	expenses. Two or more counties, municipalities, or special
3571	districts that have firesafety enforcement responsibilities may
3572	jointly employ or contract with a firesafety inspector.
3573	(2)  Every firesafety inspection conducted pursuant to
3574	state or local firesafety requirements shall be by a person
3575	certified as having met the inspection training requirements set
3576	by the State Fire Marshal. Such person shall:
3577	(a)  Be a high school graduate or the equivalent as
3578	determined by the department;
3579	(b)  Not have been found guilty of, or having pleaded
3580	guilty or nolo contendere to, a felony or a crime punishable by
3581	imprisonment of 1 year or more under the law of the United
3582	States, or of any state thereof, which involves moral turpitude,
3583	without regard to whether a judgment of conviction has been
3584	entered by the court having jurisdiction of such cases;
3585	(c)  Have her or his fingerprints on file with the
3586	department or with an agency designated by the department;
3587	(d)  Have good moral character as determined by the
3588	department;
3589	(e)  Be at least 18 years of age;
3590	(f)  Have satisfactorily completed the firesafety inspector
3591	certification examination as prescribed by the department; and
3592	(g)1.  Have satisfactorily completed, as determined by the
3593	department, a firesafety inspector training program of not less
3594	than 200 hours established by the department and administered by
3595	agencies and institutions approved by the department for the
3596	purpose of providing basic certification training for firesafety
3597	inspectors; or
3598	2.  Have received in another state training which is
3599	determined by the department to be at least equivalent to that
3600	required by the department for approved firesafety inspector
3601	education and training programs in this state.
3602	(3)  Each special state firesafety inspection which is
3603	required by law and is conducted by or on behalf of an agency of
3604	the state must be performed by an individual who has met the
3605	provision of subsection (2), except that the duration of the
3606	training program shall not exceed 120 hours of specific training
3607	for the type of property that such special state firesafety
3608	inspectors are assigned to inspect.
3609	(4)  A firefighter certified pursuant to s. 633.35 may
3610	conduct firesafety inspections, under the supervision of a
3611	certified firesafety inspector, while on duty as a member of a
3612	fire department company conducting inservice firesafety
3613	inspections without being certified as a firesafety inspector,
3614	if such firefighter has satisfactorily completed an inservice
3615	fire department company inspector training program of at least
3616	24 hours' duration as provided by rule of the department.
3617	(5)  Every firesafety inspector or special state firesafety
3618	inspector certificate is valid for a period of 3 years from the
3619	date of issuance. Renewal of certification shall be subject to
3620	the affected person's completing proper application for renewal
3621	and meeting all of the requirements for renewal as established
3622	under this chapter or by rule promulgated thereunder, which
3623	shall include completion of at least 40 hours during the
3624	preceding 3-year period of continuing education as required by
3625	the rule of the department or, in lieu thereof, successful
3626	passage of an examination as established by the department.
3627	(6)  The State Fire Marshal may deny, refuse to renew,
3628	suspend, or revoke the certificate of a firesafety inspector or
3629	special state firesafety inspector if it finds that any of the
3630	following grounds exist:
3631	(a)  Any cause for which issuance of a certificate could
3632	have been refused had it then existed and been known to the
3633	State Fire Marshal.
3634	(b)  Violation of this chapter or any rule or order of the
3635	State Fire Marshal.
3636	(c)  Falsification of records relating to the certificate.
3637	(d)  Having been found guilty of or having pleaded guilty
3638	or nolo contendere to a felony, whether or not a judgment of
3639	conviction has been entered.
3640	(e)  Failure to meet any of the renewal requirements.
3641	(f)  Having been convicted of a crime in any jurisdiction
3642	which directly relates to the practice of fire code inspection,
3643	plan review, or administration.
3644	(g)  Making or filing a report or record that the
3645	certificateholder knows to be false, or knowingly inducing
3646	another to file a false report or record, or knowingly failing
3647	to file a report or record required by state or local law, or
3648	knowingly impeding or obstructing such filing, or knowingly
3649	inducing another person to impede or obstruct such filing.
3650	(h)  Failing to properly enforce applicable fire codes or
3651	permit requirements within this state which the
3652	certificateholder knows are applicable by committing willful
3653	misconduct, gross negligence, gross misconduct, repeated
3654	negligence, or negligence resulting in a significant danger to
3655	life or property.
3656	(i)  Accepting labor, services, or materials at no charge
3657	or at a noncompetitive rate from any person who performs work
3658	that is under the enforcement authority of the certificateholder
3659	and who is not an immediate family member of the
3660	certificateholder. For the purpose of this paragraph, the term
3661	"immediate family member" means a spouse, child, parent,
3662	sibling, grandparent, aunt, uncle, or first cousin of the person
3663	or the person's spouse or any person who resides in the primary
3664	residence of the certificateholder.
3665	(7)  The department shall provide by rule for the
3666	certification of firesafety inspectors.
3667	Section 96.  Subsection (12) of section 641.495, Florida
3668	Statutes, is amended to read:
3669	641.495  Requirements for issuance and maintenance of
3670	certificate.-
3671	(12)  The provisions of part I of chapter 395 do not apply
3672	to a health maintenance organization that, on or before January
3673	1, 1991, provides not more than 10 outpatient holding beds for
3674	short-term and hospice-type patients in an ambulatory care
3675	facility for its members, provided that such health maintenance
3676	organization maintains current accreditation by The Joint
3677	Commission on Accreditation of Health Care Organizations, the
3678	Accreditation Association for Ambulatory Health Care, or the
3679	National Committee for Quality Assurance.
3680	Section 97.  Subsection (13) of section 651.118, Florida
3681	Statutes, is amended to read:
3682	651.118  Agency for Health Care Administration;
3683	certificates of need; sheltered beds; community beds.-
3684	(13)  Residents, as defined in this chapter, are not
3685	considered new admissions for the purpose of s.
3686	400.141(1)(n)(o)1.d.
3687	Section 98.  Subsection (2) of section 766.1015, Florida
3688	Statutes, is amended to read:
3689	766.1015  Civil immunity for members of or consultants to
3690	certain boards, committees, or other entities.-
3691	(2)  Such committee, board, group, commission, or other
3692	entity must be established in accordance with state law or in
3693	accordance with requirements of The Joint Commission on
3694	Accreditation of Healthcare Organizations, established and duly
3695	constituted by one or more public or licensed private hospitals
3696	or behavioral health agencies, or established by a governmental
3697	agency. To be protected by this section, the act, decision,
3698	omission, or utterance may not be made or done in bad faith or
3699	with malicious intent.
3700	Section 99.  Subsection (4) of section 766.202, Florida
3701	Statutes, is amended to read:
3702	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3703	766.201-766.212, the term:
3704	(4)  "Health care provider" means any hospital, ambulatory
3705	surgical center, or mobile surgical facility as defined and
3706	licensed under chapter 395; a birth center licensed under
3707	chapter 383; any person licensed under chapter 458, chapter 459,
3708	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3709	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3710	or chapter 486; a clinical lab licensed under chapter 483; a
3711	health maintenance organization certificated under part I of
3712	chapter 641; a blood bank; a plasma center; an industrial
3713	clinic; a renal dialysis facility; or a professional association
3714	partnership, corporation, joint venture, or other association
3715	for professional activity by health care providers.
3716	Section 100.  (1)  It is hereby declared the public policy
3717	of this state that a federal, state, or local government may not
3718	compel a person to purchase health insurance or health services,
3719	except as a condition of:
3720	(a)  Public employment;
3721	(b)  Voluntary participation in a state or local benefit;
3722	(c)  Operating a dangerous instrumentality;
3723	(d)  Undertaking an occupation having a risk of
3724	occupational injury or illness; or
3725	(e)  An order of child support.
3726
3727	A federal, state, or local government may also compel a person
3728	to purchase health services in the case of an actual emergency
3729	declared by the Governor when the public health is immediately
3730	endangered.
3731	(2)  This section does not prohibit collection of debts
3732	lawfully incurred for health insurance or health services.
3733	(3)  The Attorney General may implement or otherwise
3734	advocate the public policy described in this section in any
3735	state or federal court or administrative forum on behalf of one
3736	or more persons within the state whose constitutional rights may
3737	be subject to infringement by an Act of Congress with respect to
3738	health insurance coverage, or subject to the implementation of a
3739	federal legislative program relating to or impacting the rights
3740	or interests of persons with respect to health insurance
3741	coverage.
3742	Section 101.  Section 627.64995, Florida Statutes, is
3743	created to read:
3744	627.64995  Restrictions on use of funds for state
3745	exchanges.-
3746	(1)  A health insurance policy or group health insurance
3747	policy purchased in whole or in part with state or federal funds
3748	through an exchange created pursuant to the federal Patient
3749	Protection and Affordable Care Act may not provide coverage for
3750	an abortion as defined in s. 390.011(1). A policy is deemed to
3751	be purchased with state or federal funds if it is a policy
3752	toward which any tax credit or cost-sharing credit is applied.
3753	(2)  This section does not prohibit coverage for an
3754	abortion that is performed to save the life or physical health
3755	of the mother or if the pregnancy resulted from an act of rape
3756	or incest.
3757	(3)  This section may not be construed to prevent a health
3758	insurance plan or group health insurance plan from providing any
3759	private person or entity with separate coverage for abortions,
3760	provided such coverage is not purchased, in whole or in part,
3761	with state or federal funds.
3762	(4)  For purposes of this section, the term "state" means
3763	the State of Florida or any of its political subdivisions.
3764	Section 102.  Section 641.31099, Florida Statutes, is
3765	created to read:
3766	641.31099  Restrictions on the use of funds for state
3767	exchanges.-
3768	(1)  A health maintenance contract under which coverage is
3769	purchased in whole or in part with state or federal funds
3770	through an exchange created pursuant to the federal Patient
3771	Protection and Affordable Care Act may not provide coverage for
3772	an abortion as defined in s. 390.011(1). Coverage under a health
3773	maintenance contract is deemed to be purchased with state or
3774	federal funds if the coverage is provided under a contract
3775	toward which any tax credit or cost-sharing credit is applied.
3776	(2)  This section does not prohibit coverage for an
3777	abortion that is performed to save the life or physical health
3778	of the mother or if the pregnancy resulted from an act of rape
3779	or incest.
3780	(3)  This section may not be construed to prevent a health
3781	maintenance contract from providing any private person or entity
3782	with separate coverage for abortions, provided such coverage is
3783	not purchased, in whole or in part, with state or federal funds.
3784	(4)  For purposes of this section, the term "state" means
3785	the State of Florida or any of its political subdivisions.
3786	Section 103.  This act shall take effect July 1, 2010.

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