Florida Senate - 2010 SB 2138
By Senator Gardiner
9-01107-10 20102138__
1 A bill to be entitled
2 An act relating to health care; amending s. 1.01,
3 F.S.; defining the term “Joint Commission”; repealing
4 s. 112.0455(10)(e), F.S., relating to a prohibition
5 against applying the Drug-Free Workplace Act
6 retroactively; amending s. 154.11, F.S.; renaming the
7 Joint Commission on the Accreditation of Hospitals as
8 the “Joint Commission”; amending s. 318.21, F.S.;
9 requiring that certain fines received by the county
10 court for traffic infractions be remitted to the
11 Department of Revenue for deposit into the Brain and
12 Spinal Cord Injury Rehabilitation Trust Fund within
13 the Department of Health for use for Medicaid
14 recipients who have spinal cord injuries; repealing s.
15 383.325, F.S., relating to the requirement of a
16 licensed facility under s. 383.305, F.S., to maintain
17 inspection reports; amending s. 394.4787, F.S.;
18 conforming a cross-reference; amending s. 394.741,
19 F.S.; renaming the Joint Commission on the
20 Accreditation of Healthcare Organizations as the
21 “Joint Commission”; renaming the Council on
22 Accreditation for Children and Family Services as the
23 “Council on Accreditation”; amending s. 395.002, F.S.;
24 redefining the term “accrediting organizations” as it
25 relates to hospital licensure and regulation; deleting
26 the definitions for the terms “initial denial
27 determination,” “private review agent,” and
28 “utilization review plan” as they relate to hospital
29 licensure and regulation; amending s. 395.003, F.S.;
30 deleting a provision that prohibits the Agency for
31 Health Care Administration from authorizing emergency
32 departments that are located off the premises of a
33 licensed hospital; amending s. 395.0193, F.S.;
34 requiring the Division of Medical Quality Assurance
35 within the Department of Health to conduct the reviews
36 of the recordings of agendas and minutes of licensed
37 facilities; requiring the Division of Medical Quality
38 Assurance within the Department of Health to report
39 disciplinary actions rather than the Division of
40 Health Quality Assurance within the Agency for Health
41 Care Administration; amending s. 395.1023, F.S.;
42 requiring a licensed facility to adopt a protocol to
43 designate a physician in cases involving suspected
44 child abuse at the request of the Department of
45 Children and Family Services rather than the
46 Department of Health; amending s. 395.1041, F.S.;
47 deleting provisions that require the Agency for Health
48 Care Administration to request a hospital to identify
49 its services, notify each hospital of the service
50 capability to be included in the inventory, and
51 publish a final inventory; deleting obsolete
52 provisions; repealing s. 395.1046, F.S., relating to
53 the investigation of complaints regarding hospitals;
54 amending s. 395.1055, F.S.; requiring the agency to
55 adopt rules that ensure that licensed facility beds
56 conform to certain standards as specified by the
57 agency, the Florida Building Code, and the Florida
58 Fire Prevention Code; amending s. 395.10972, F.S.;
59 renaming the Florida Society of Healthcare Risk
60 Management as the “Florida Society for Healthcare Risk
61 Management and Patient Safety”; amending s. 395.2050,
62 F.S.; providing for an organ procurement organization
63 to be designated by the federal Centers for Medicare
64 and Medicaid Services rather than the federal Health
65 Care Financing Administration; amending s. 395.3036,
66 F.S.; correcting a cross-reference; repealing s.
67 395.3037, F.S.; deleting definitions relating to
68 obsolete provisions governing primary and
69 comprehensive stroke centers; amending s. 395.3038,
70 F.S.; renaming the Joint Commission on the
71 Accreditation of Healthcare Organizations as the
72 “Joint Commission”; amending s. 395.602, F.S.;
73 redefining the term “rural hospital” as it relates to
74 hospital licensure and regulation; amending s.
75 400.021, F.S.; redefining the term “geriatric
76 outpatient clinic” as it relates to nursing homes;
77 amending ss. 400.0239 and 400.063, F.S., relating to
78 trust funds; deleting obsolete provisions; amending s.
79 400.071, F.S.; revising the requirements for an
80 application for a license to operate a nursing home
81 facility; amending s. 400.0712, F.S.; deleting the
82 agency’s authority to issue an inactive license to a
83 nursing home facility; amending s. 400.111, F.S.;
84 requiring the agency to request a licensee to submit
85 an affidavit disclosing financial or ownership
86 interest that a controlling interest has held in
87 certain entities; amending s. 400.1183, F.S.;
88 requiring nursing home facilities to maintain records
89 of grievances for agency inspection; deleting a
90 requirement that a facility report the number of
91 grievances handled during the prior licensure period;
92 amending s. 400.141, F.S.; conforming a cross
93 reference; deleting the requirement that a facility
94 submit to the agency information regarding a
95 management company with which it has entered into an
96 agreement; specifying a fine for a nursing facility’s
97 failure to impose an admissions moratorium for not
98 complying with state minimum-staffing requirements;
99 deleting the requirement for a facility to report to
100 the agency any filing of bankruptcy protection,
101 divestiture, or corporate reorganization; amending s.
102 400.142, F.S.; deleting a provision that requires the
103 agency to adopt rules regarding orders not to
104 resuscitate; repealing s. 400.147(10), F.S., relating
105 to a requirement that a nursing home facility report
106 any notice of a filing of a claim for a violation of a
107 resident’s rights or a claim of negligence; repealing
108 s. 400.148, F.S., relating to the Medicaid “Up-or-Out”
109 Quality of Care Contract Management Program; amending
110 s. 400.19, F.S.; authorizing the agency to verify the
111 correction of certain deficiencies after an
112 unannounced inspection of a nursing home facility;
113 repealing s. 400.195, F.S., relating to agency
114 reporting requirements; amending s. 400.23, F.S.;
115 renaming the Children’s Medical Services of the
116 Department of Health as the “Children’s Medical
117 Services Network”; deleting an obsolete provision;
118 amending s. 400.275, F.S.; deleting a requirement that
119 the agency ensure that a newly hired nursing home
120 surveyor is assigned full time to a licensed nursing
121 home to observe facility operations; amending s.
122 400.462, F.S.; revising definitions with regard to the
123 Home Health Services Act; defining the terms “primary
124 home health agency” and “temporary” with regard to the
125 Home Health Services Act; amending s. 400.476, F.S.;
126 providing requirements for an alternative
127 administrator of a home health agency; revising the
128 duties of the administrator; revising the requirements
129 for a director of nursing for a specified number of
130 home health agencies; prohibiting a home health agency
131 from using an individual as a home health aide unless
132 the person has completed training and an evaluation
133 program; requiring a home health aide to meet certain
134 standards in order to be competent in performing
135 certain tasks; requiring a home health agency and
136 staff to comply with accepted professional standards;
137 providing certain requirements for a written contract
138 between certain personnel and the agency; requiring a
139 home health agency to provide certain services through
140 its employees; authorizing a home health agency to
141 provide additional services with another organization;
142 providing responsibilities of a home health agency
143 when it provides home health aide services through
144 another organization; requiring the home health agency
145 to coordinate personnel that provide home health
146 services; requiring personnel to communicate with the
147 home health agency; amending s. 400.484, F.S.;
148 redefining class I, II, III, and IV deficiencies as
149 class I, II, III, and IV violations; amending s.
150 400.487, F.S.; requiring a home health agency to
151 provide a copy of the agreement between the agency and
152 a patient which specifies the home health services to
153 be provided; providing the rights that are protected
154 by the home health agency; requiring the home health
155 agency to furnish nursing services by or under the
156 supervision of a registered nurse; requiring the home
157 health agency to provide therapy services through a
158 qualified therapist or therapy assistant; providing
159 the duties and qualifications of a therapist and
160 therapy assistant; requiring supervision by a physical
161 therapist or occupational therapist of a physical
162 therapist assistant or occupational therapist
163 assistant; providing duties of a physical therapist
164 assistant or occupational therapist assistant;
165 providing for speech therapy services to be provided
166 by a qualified speech pathologist or audiologist;
167 providing for a plan of care; providing that only the
168 staff of a home health agency may administer drugs and
169 treatments as ordered by certain health professionals;
170 providing requirements for verbal orders; providing
171 duties of a registered nurse, licensed practical
172 nurse, home health aide, and certified nursing
173 assistant who work for a home health agency; amending
174 s. 400.606, F.S.; revising the requirements for the
175 plan for the delivery of home, residential, and
176 homelike inpatient hospice services for terminally ill
177 patients and their families; amending s. 400.607,
178 F.S.; revising the grounds under which the agency may
179 take administrative action against a hospice; amending
180 s. 400.925, F.S.; renaming the Joint Commission on the
181 Accreditation of Healthcare Organizations as the
182 “Joint Commission” within the definition of the term
183 “accrediting organizations” as it relates to home
184 medical equipment providers; amending s. 400.931,
185 F.S.; deleting the requirement that an applicant for a
186 license to be a home medical equipment provider submit
187 a surety bond to the agency; amending s. 400.932,
188 F.S.; revising the grounds under which the agency may
189 take administrative action against a home medical
190 equipment provider; amending s. 400.933, F.S.;
191 prohibiting a home medical equipment provider from
192 submitting a survey or inspection of an accrediting
193 organization if the home medical equipment provider’s
194 licensure is conditional or provisional; amending s.
195 400.953, F.S.; deleting the requirement of a general
196 manager of a home medical equipment provider to
197 annually sign an affidavit regarding the background
198 screening of personnel; providing requirements for
199 submission of the affidavit; amending s. 400.967,
200 F.S.; redefining class I, II, III, and IV deficiencies
201 as class I, II, III, and IV violations as they relate
202 to intermediate care facilities for developmentally
203 disabled persons; amending s. 400.969, F.S.; revising
204 the grounds for an administrative or civil penalty;
205 amending s. 400.9905, F.S.; redefining the term
206 “portable service or equipment provider” as it relates
207 to the Health Care Clinic Act; amending s. 400.991,
208 F.S.; conforming a provision to changes made by the
209 act; revising application requirements to show proof
210 of financial ability to operate a health care clinic;
211 amending s. 400.9935, F.S.; renaming the Joint
212 Commission on the Accreditation of Healthcare
213 Organizations as the “Joint Commission” for purposes
214 of the Health Care Clinic Act; amending s. 408.034,
215 F.S.; prohibiting the agency from issuing a license to
216 a health care facility that applies for a license to
217 operate an intermediate care facility for
218 developmentally disabled persons under certain
219 conditions; amending s. 408.036, F.S., relating to
220 certificates of need; conforming a provision to
221 changes made by the act; amending s. 408.043, F.S.;
222 requiring a freestanding facility or a part of the
223 facility that is the inpatient hospice care component
224 of a hospice to obtain a certificate of need; amending
225 s. 408.05, F.S.; renaming the Joint Commission on the
226 Accreditation of Healthcare Organizations as the
227 “Joint Commission”; amending s. 408.061, F.S.;
228 revising requirements for the reporting of certified
229 data elements by health care facilities; amending s.
230 408.10, F.S.; authorizing the agency to provide
231 staffing for a toll-free phone number for the purpose
232 of handling consumer complaints regarding a health
233 care facility; repealing s. 408.802(11), F.S.,
234 relating to the applicability of the Health Care
235 Licensing Procedures Act to private review agents;
236 amending s. 408.804, F.S.; providing a criminal
237 penalty for altering, defacing, or falsifying a
238 license certificate of certain health care providers;
239 providing civil penalties for displaying an altered,
240 defaced, or falsified license certificate; amending s.
241 408.806, F.S.; requiring the agency to provide a
242 courtesy notice to a licensee regarding the expiration
243 of a licensee’s license; providing that failure of the
244 agency to provide the courtesy notice or failure of
245 the licensee to receive the notice is not an excuse
246 for the licensee to timely renew its license;
247 providing that payment of the late fee is required for
248 a later application; amending s. 408.810, F.S.;
249 revising the requirements for obtaining and
250 maintaining a license for certain health care
251 providers and those who own a controlling interest in
252 a health care provider; amending s. 408.811, F.S.;
253 providing that a licensee’s inspection report is not
254 subject to administrative challenge; amending s.
255 408.813, F.S.; authorizing the agency to impose
256 administrative fines for unclassified violations;
257 amending s. 408.815, F.S.; authorizing the agency to
258 extend the expiration date of a license for the
259 purpose of the safe and orderly discharge of clients;
260 authorizing the agency to impose conditions on the
261 extension; amending s. 409.906, F.S.; requiring the
262 agency, in consultation with the Department of Elderly
263 Affairs, to phase out the adult day health care waiver
264 program; requiring adult day health care waiver
265 providers, in consultation with resource centers for
266 the aged to assist in the transition of enrollees from
267 the waiver program; repealing s. 409.221(4)(k), F.S.,
268 relating to the responsibility of the agency, the
269 Department of Elderly Affairs, the Department of
270 Health, the Department of Children and Family
271 Services, and the Agency for Persons with Disabilities
272 to review and assess the implementation of the
273 consumer-directed care program and the agency’s
274 responsibility to submit a report to the Legislature;
275 repealing s. 409.912(15)(e), (f), and (g), F.S.,
276 relating to a requirement for the Agency for Health
277 Care Administration to submit a report to the
278 Legislature regarding the operations of the CARE
279 program; amending s. 429.11, F.S.; deleting provisions
280 relating to a provisional license to operate as an
281 assisted living facility; repealing s. 429.12(2),
282 F.S., relating to the sale or transfer of ownership of
283 an assisted living facility; amending s. 429.14, F.S.;
284 authorizing the agency to provide electronically or
285 through the agency’s Internet site information
286 regarding the denial, suspension, or revocation of a
287 license to the Division of Hotels and Restaurants of
288 the Department of Business and Professional
289 Regulation; amending s. 429.17, F.S.; revising the
290 requirements for a conditional license to operate an
291 assisted living facility; repealing s. 429.23(5),
292 F.S., relating to each assisted living facility’s
293 requirement to submit a report to the agency regarding
294 liability claims filed against it; amending s. 429.35,
295 F.S.; authorizing the agency to provide electronically
296 or through the agency’s Internet website information
297 regarding the results of an inspection to the local
298 ombudsman council; amending s. 429.53, F.S.; requiring
299 the agency, rather than the agency’s area offices of
300 licensure and certification, to provide consultation
301 to certain persons and licensees regarding assisted
302 living facilities; redefining the term “consultation”
303 as it relates to assisted living facilities; amending
304 s. 429.65, F.S.; redefining the term “adult family
305 care home” as it relates to the Adult Family-Care Home
306 Act; amending s. 429.71, F.S.; redefining class I, II,
307 III, and IV deficiencies as class I, II, III, and IV
308 violations as they relate to adult family-care homes;
309 repealing s. 429.911, F.S., relating to the denial,
310 suspension, or revocation of a license to operate an
311 adult day care center; amending s. 429.915, F.S.;
312 revising requirements for a conditional license to
313 operate an adult day care center; amending s. 430.80,
314 F.S.; conforming a cross-reference; renaming the Joint
315 Commission on the Accreditation of Healthcare
316 Organizations to the Joint Commission; amending s.
317 440.13, F.S.; renaming the Joint Commission on the
318 Accreditation of Healthcare Organizations as the
319 “Joint Commission”; amending s. 483.294, F.S.;
320 requiring the agency to biennially inspect the
321 premises and operations of multiphasic health testing
322 centers; amending ss. 627.645, 627.668, and 627.669,
323 F.S.; renaming the Joint Commission on the
324 Accreditation of Hospitals to the Joint Commission;
325 amending ss. 627.736 and 641.495 F.S.; renaming the
326 Joint Commission on the Accreditation of Healthcare
327 Organizations as the “Joint Commission”; amending s.
328 651.118, F.S.; conforming a cross-reference; amending
329 s. 766.1015, F.S.; renaming the Joint Commission on
330 the Accreditation of Healthcare Organizations as the
331 “Joint Commission”; providing effective dates.
332
333 Be It Enacted by the Legislature of the State of Florida:
334
335 Section 1. Subsection (16) is added to section 1.01,
336 Florida Statutes, to read:
337 1.01 Definitions.—In construing these statutes and each and
338 every word, phrase, or part hereof, where the context will
339 permit:
340 (16) The term “Joint Commission” means the independent,
341 not-for-profit organization that evaluates and accredits
342 hospitals and health care organizations and programs in the
343 United States. The Joint Commission was formerly known as the
344 Joint Commission on Accreditation of Hospitals (JCAH) and the
345 Joint Commission on Accreditation of Healthcare Organizations
346 (JCAHO).
347 Section 2. Paragraph (e) of subsection (10) of section
348 112.0455, Florida Statutes, is repealed.
349 Section 3. Paragraph (n) of subsection (1) of section
350 154.11, Florida Statutes, is amended to read:
351 154.11 Powers of board of trustees.—
352 (1) The board of trustees of each public health trust shall
353 be deemed to exercise a public and essential governmental
354 function of both the state and the county and in furtherance
355 thereof it shall, subject to limitation by the governing body of
356 the county in which such board is located, have all of the
357 powers necessary or convenient to carry out the operation and
358 governance of designated health care facilities, including, but
359 without limiting the generality of, the foregoing:
360 (n) To appoint originally the staff of physicians to
361 practice in any designated facility owned or operated by the
362 board and to approve the bylaws and rules to be adopted by the
363 medical staff of any designated facility owned and operated by
364 the board, such governing regulations to be in accordance with
365 the standards of the Joint Commission on the Accreditation of
366 Hospitals which provide, among other things, for the method of
367 appointing additional staff members and for the removal of staff
368 members.
369 Section 4. Subsection (15) of section 318.21, Florida
370 Statutes, is amended to read:
371 318.21 Disposition of civil penalties by county courts.—All
372 civil penalties received by a county court pursuant to the
373 provisions of this chapter shall be distributed and paid monthly
374 as follows:
375 (15) Of the additional fine assessed under s. 318.18(3)(e)
376 for a violation of s. 316.1893, 50 percent of the moneys
377 received from the fines shall be remitted to the Department of
378 Revenue and deposited into Brain and Spinal Cord Injury
379 Rehabilitation Trust Fund within Department of Health and shall
380 be appropriated to the Department of Health Agency for Health
381 Care Administration as general revenue to provide an enhanced
382 Medicaid payment to nursing homes that serve Medicaid recipients
383 with brain and spinal cord injuries that are medically complex,
384 technologically dependent, and respiratory dependent. The
385 remaining 50 percent of the moneys received from the enhanced
386 fine imposed under s. 318.18(3)(e) shall be remitted to the
387 Department of Revenue and deposited into the Department of
388 Health Administrative Trust Fund to provide financial support to
389 certified trauma centers in the counties where enhanced penalty
390 zones are established to ensure the availability and
391 accessibility of trauma services. Funds deposited into the
392 Administrative Trust Fund under this subsection shall be
393 allocated as follows:
394 (a) Fifty percent shall be allocated equally among all
395 Level I, Level II, and pediatric trauma centers in recognition
396 of readiness costs for maintaining trauma services.
397 (b) Fifty percent shall be allocated among Level I, Level
398 II, and pediatric trauma centers based on each center’s relative
399 volume of trauma cases as reported in the Department of Health
400 Trauma Registry.
401 Section 5. Section 383.325, Florida Statutes, is repealed.
402 Section 6. Subsection (7) of section 394.4787, Florida
403 Statutes, is amended to read:
404 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
405 394.4789.—As used in this section and ss. 394.4786, 394.4788,
406 and 394.4789:
407 (7) “Specialty psychiatric hospital” means a hospital
408 licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
409 and part II of chapter 408 as a specialty psychiatric hospital.
410 Section 7. Subsection (2) of section 394.741, Florida
411 Statutes, is amended to read:
412 394.741 Accreditation requirements for providers of
413 behavioral health care services.—
414 (2) Notwithstanding any provision of law to the contrary,
415 accreditation shall be accepted by the agency and department in
416 lieu of the agency’s and department’s facility licensure onsite
417 review requirements and shall be accepted as a substitute for
418 the department’s administrative and program monitoring
419 requirements, except as required by subsections (3) and (4),
420 for:
421 (a) Any organization from which the department purchases
422 behavioral health care services that is accredited by the Joint
423 Commission on Accreditation of Healthcare Organizations or the
424 Council on Accreditation for Children and Family Services, or
425 has those services that are being purchased by the department
426 accredited by CARF—the Rehabilitation Accreditation Commission.
427 (b) Any mental health facility licensed by the agency or
428 any substance abuse component licensed by the department that is
429 accredited by the Joint Commission on Accreditation of
430 Healthcare Organizations, CARF—the Rehabilitation Accreditation
431 Commission, or the Council on Accreditation of Children and
432 Family Services.
433 (c) Any network of providers from which the department or
434 the agency purchases behavioral health care services accredited
435 by the Joint Commission on Accreditation of Healthcare
436 Organizations, CARF—the Rehabilitation Accreditation Commission,
437 the Council on Accreditation of Children and Family Services, or
438 the National Committee for Quality Assurance. A provider
439 organization, which is part of an accredited network, is
440 afforded the same rights under this part.
441 Section 8. Section 395.002, Florida Statutes, is amended to
442 read:
443 395.002 Definitions.—As used in this chapter, the term:
444 (1) “Accrediting organizations” means nationally recognized
445 or approved accrediting organizations whose standards
446 incorporate comparable licensure requirements as determined by
447 the agency. the Joint Commission on Accreditation of Healthcare
448 Organizations, the American Osteopathic Association, the
449 Commission on Accreditation of Rehabilitation Facilities, and
450 the Accreditation Association for Ambulatory Health Care, Inc.
451 (2) “Agency” means the Agency for Health Care
452 Administration.
453 (3) “Ambulatory surgical center” or “mobile surgical
454 facility” means a facility the primary purpose of which is to
455 provide elective surgical care, in which the patient is admitted
456 to and discharged from such facility within the same working day
457 and is not permitted to stay overnight, and which is not part of
458 a hospital. However, a facility existing for the primary purpose
459 of performing terminations of pregnancy, an office maintained by
460 a physician for the practice of medicine, or an office
461 maintained for the practice of dentistry shall not be construed
462 to be an ambulatory surgical center, provided that any facility
463 or office which is certified or seeks certification as a
464 Medicare ambulatory surgical center shall be licensed as an
465 ambulatory surgical center pursuant to s. 395.003. Any structure
466 or vehicle in which a physician maintains an office and
467 practices surgery, and which can appear to the public to be a
468 mobile office because the structure or vehicle operates at more
469 than one address, shall be construed to be a mobile surgical
470 facility.
471 (4) “Biomedical waste” means any solid or liquid waste as
472 defined in s. 381.0098(2)(a).
473 (5) “Clinical privileges” means the privileges granted to a
474 physician or other licensed health care practitioner to render
475 patient care services in a hospital, but does not include the
476 privilege of admitting patients.
477 (6) “Department” means the Department of Health.
478 (7) “Director” means any member of the official board of
479 directors as reported in the organization’s annual corporate
480 report to the Florida Department of State, or, if no such report
481 is made, any member of the operating board of directors. The
482 term excludes members of separate, restricted boards that serve
483 only in an advisory capacity to the operating board.
484 (8) “Emergency medical condition” means:
485 (a) A medical condition manifesting itself by acute
486 symptoms of sufficient severity, which may include severe pain,
487 such that the absence of immediate medical attention could
488 reasonably be expected to result in any of the following:
489 1. Serious jeopardy to patient health, including a pregnant
490 woman or fetus.
491 2. Serious impairment to bodily functions.
492 3. Serious dysfunction of any bodily organ or part.
493 (b) With respect to a pregnant woman:
494 1. That there is inadequate time to effect safe transfer to
495 another hospital prior to delivery;
496 2. That a transfer may pose a threat to the health and
497 safety of the patient or fetus; or
498 3. That there is evidence of the onset and persistence of
499 uterine contractions or rupture of the membranes.
500 (9) “Emergency services and care” means medical screening,
501 examination, and evaluation by a physician, or, to the extent
502 permitted by applicable law, by other appropriate personnel
503 under the supervision of a physician, to determine if an
504 emergency medical condition exists and, if it does, the care,
505 treatment, or surgery by a physician necessary to relieve or
506 eliminate the emergency medical condition, within the service
507 capability of the facility.
508 (10) “General hospital” means any facility which meets the
509 provisions of subsection (12) and which regularly makes its
510 facilities and services available to the general population.
511 (11) “Governmental unit” means the state or any county,
512 municipality, or other political subdivision, or any department,
513 division, board, or other agency of any of the foregoing.
514 (12) “Hospital” means any establishment that:
515 (a) Offers services more intensive than those required for
516 room, board, personal services, and general nursing care, and
517 offers facilities and beds for use beyond 24 hours by
518 individuals requiring diagnosis, treatment, or care for illness,
519 injury, deformity, infirmity, abnormality, disease, or
520 pregnancy; and
521 (b) Regularly makes available at least clinical laboratory
522 services, diagnostic X-ray services, and treatment facilities
523 for surgery or obstetrical care, or other definitive medical
524 treatment of similar extent, except that a critical access
525 hospital, as defined in s. 408.07, shall not be required to make
526 available treatment facilities for surgery, obstetrical care, or
527 similar services as long as it maintains its critical access
528 hospital designation and shall be required to make such
529 facilities available only if it ceases to be designated as a
530 critical access hospital.
531
532 However, the provisions of this chapter do not apply to any
533 institution conducted by or for the adherents of any well
534 recognized church or religious denomination that depends
535 exclusively upon prayer or spiritual means to heal, care for, or
536 treat any person. For purposes of local zoning matters, the term
537 “hospital” includes a medical office building located on the
538 same premises as a hospital facility, provided the land on which
539 the medical office building is constructed is zoned for use as a
540 hospital; provided the premises were zoned for hospital purposes
541 on January 1, 1992.
542 (13) “Hospital bed” means a hospital accommodation which is
543 ready for immediate occupancy, or is capable of being made ready
544 for occupancy within 48 hours, excluding provision of staffing,
545 and which conforms to minimum space, equipment, and furnishings
546 standards as specified by rule of the agency for the provision
547 of services specified in this section to a single patient.
548 (14) “Initial denial determination” means a determination
549 by a private review agent that the health care services
550 furnished or proposed to be furnished to a patient are
551 inappropriate, not medically necessary, or not reasonable.
552 (14)(15) “Intensive residential treatment programs for
553 children and adolescents” means a specialty hospital accredited
554 by an accrediting organization as defined in subsection (1)
555 which provides 24-hour care and which has the primary functions
556 of diagnosis and treatment of patients under the age of 18
557 having psychiatric disorders in order to restore such patients
558 to an optimal level of functioning.
559 (15)(16) “Licensed facility” means a hospital, ambulatory
560 surgical center, or mobile surgical facility licensed in
561 accordance with this chapter.
562 (16)(17) “Lifesafety” means the control and prevention of
563 fire and other life-threatening conditions on a premises for the
564 purpose of preserving human life.
565 (17)(18) “Managing employee” means the administrator or
566 other similarly titled individual who is responsible for the
567 daily operation of the facility.
568 (18)(19) “Medical staff” means physicians licensed under
569 chapter 458 or chapter 459 with privileges in a licensed
570 facility, as well as other licensed health care practitioners
571 with clinical privileges as approved by a licensed facility’s
572 governing board.
573 (19)(20) “Medically necessary transfer” means a transfer
574 made necessary because the patient is in immediate need of
575 treatment for an emergency medical condition for which the
576 facility lacks service capability or is at service capacity.
577 (20)(21) “Mobile surgical facility” is a mobile facility in
578 which licensed health care professionals provide elective
579 surgical care under contract with the Department of Corrections
580 or a private correctional facility operating pursuant to chapter
581 957 and in which inmate patients are admitted to and discharged
582 from said facility within the same working day and are not
583 permitted to stay overnight. However, mobile surgical facilities
584 may only provide health care services to the inmate patients of
585 the Department of Corrections, or inmate patients of a private
586 correctional facility operating pursuant to chapter 957, and not
587 to the general public.
588 (21)(22) “Person” means any individual, partnership,
589 corporation, association, or governmental unit.
590 (22)(23) “Premises” means those buildings, beds, and
591 equipment located at the address of the licensed facility and
592 all other buildings, beds, and equipment for the provision of
593 hospital, ambulatory surgical, or mobile surgical care located
594 in such reasonable proximity to the address of the licensed
595 facility as to appear to the public to be under the dominion and
596 control of the licensee. For any licensee that is a teaching
597 hospital as defined in s. 408.07(45), reasonable proximity
598 includes any buildings, beds, services, programs, and equipment
599 under the dominion and control of the licensee that are located
600 at a site with a main address that is within 1 mile of the main
601 address of the licensed facility; and all such buildings, beds,
602 and equipment may, at the request of a licensee or applicant, be
603 included on the facility license as a single premises.
604 (24) “Private review agent” means any person or entity
605 which performs utilization review services for third-party
606 payors on a contractual basis for outpatient or inpatient
607 services. However, the term shall not include full-time
608 employees, personnel, or staff of health insurers, health
609 maintenance organizations, or hospitals, or wholly owned
610 subsidiaries thereof or affiliates under common ownership, when
611 performing utilization review for their respective hospitals,
612 health maintenance organizations, or insureds of the same
613 insurance group. For this purpose, health insurers, health
614 maintenance organizations, and hospitals, or wholly owned
615 subsidiaries thereof or affiliates under common ownership,
616 include such entities engaged as administrators of self
617 insurance as defined in s. 624.031.
618 (23)(25) “Service capability” means all services offered by
619 the facility where identification of services offered is
620 evidenced by the appearance of the service in a patient’s
621 medical record or itemized bill.
622 (24)(26) “At service capacity” means the temporary
623 inability of a hospital to provide a service which is within the
624 service capability of the hospital, due to maximum use of the
625 service at the time of the request for the service.
626 (25)(27) “Specialty bed” means a bed, other than a general
627 bed, designated on the face of the hospital license for a
628 dedicated use.
629 (26)(28) “Specialty hospital” means any facility which
630 meets the provisions of subsection (12), and which regularly
631 makes available either:
632 (a) The range of medical services offered by general
633 hospitals, but restricted to a defined age or gender group of
634 the population;
635 (b) A restricted range of services appropriate to the
636 diagnosis, care, and treatment of patients with specific
637 categories of medical or psychiatric illnesses or disorders; or
638 (c) Intensive residential treatment programs for children
639 and adolescents as defined in subsection (14) (15).
640 (27)(29) “Stabilized” means, with respect to an emergency
641 medical condition, that no material deterioration of the
642 condition is likely, within reasonable medical probability, to
643 result from the transfer of the patient from a hospital.
644 (30) “Utilization review” means a system for reviewing the
645 medical necessity or appropriateness in the allocation of health
646 care resources of hospital services given or proposed to be
647 given to a patient or group of patients.
648 (31) “Utilization review plan” means a description of the
649 policies and procedures governing utilization review activities
650 performed by a private review agent.
651 (28)(32) “Validation inspection” means an inspection of the
652 premises of a licensed facility by the agency to assess whether
653 a review by an accrediting organization has adequately evaluated
654 the licensed facility according to minimum state standards.
655 Section 9. Subsection (1) of section 395.003, Florida
656 Statutes, is amended to read:
657 395.003 Licensure; denial, suspension, and revocation.—
658 (1)(a) The requirements of part II of chapter 408 apply to
659 the provision of services that require licensure pursuant to ss.
660 395.001-395.1065 and part II of chapter 408 and to entities
661 licensed by or applying for such licensure from the Agency for
662 Health Care Administration pursuant to ss. 395.001-395.1065. A
663 license issued by the agency is required in order to operate a
664 hospital, ambulatory surgical center, or mobile surgical
665 facility in this state.
666 (b)1. It is unlawful for a person to use or advertise to
667 the public, in any way or by any medium whatsoever, any facility
668 as a “hospital,” “ambulatory surgical center,” or “mobile
669 surgical facility” unless such facility has first secured a
670 license under the provisions of this part.
671 2. This part does not apply to veterinary hospitals or to
672 commercial business establishments using the word “hospital,”
673 “ambulatory surgical center,” or “mobile surgical facility” as a
674 part of a trade name if no treatment of human beings is
675 performed on the premises of such establishments.
676 (c) Until July 1, 2006, additional emergency departments
677 located off the premises of licensed hospitals may not be
678 authorized by the agency.
679 Section 10. Paragraph (e) of subsection (2) and subsection
680 (4) of section 395.0193, Florida Statutes, are amended to read:
681 395.0193 Licensed facilities; peer review; disciplinary
682 powers; agency or partnership with physicians.—
683 (2) Each licensed facility, as a condition of licensure,
684 shall provide for peer review of physicians who deliver health
685 care services at the facility. Each licensed facility shall
686 develop written, binding procedures by which such peer review
687 shall be conducted. Such procedures shall include:
688 (e) Recording of agendas and minutes which do not contain
689 confidential material, for review by the Division of Medical
690 Quality Assurance of the department Health Quality Assurance of
691 the agency.
692 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
693 actions taken under subsection (3) shall be reported in writing
694 to the Division of Medical Quality Assurance of the department
695 Health Quality Assurance of the agency within 30 working days
696 after its initial occurrence, regardless of the pendency of
697 appeals to the governing board of the hospital. The notification
698 shall identify the disciplined practitioner, the action taken,
699 and the reason for such action. All final disciplinary actions
700 taken under subsection (3), if different from those which were
701 reported to the department agency within 30 days after the
702 initial occurrence, shall be reported within 10 working days to
703 the Division of Medical Quality Assurance of the department
704 Health Quality Assurance of the agency in writing and shall
705 specify the disciplinary action taken and the specific grounds
706 therefor. The division shall review each report and determine
707 whether it potentially involved conduct by the licensee that is
708 subject to disciplinary action, in which case s. 456.073 shall
709 apply. The reports are not subject to inspection under s.
710 119.07(1) even if the division’s investigation results in a
711 finding of probable cause.
712 Section 11. Section 395.1023, Florida Statutes, is amended
713 to read:
714 395.1023 Child abuse and neglect cases; duties.—Each
715 licensed facility shall adopt a protocol that, at a minimum,
716 requires the facility to:
717 (1) Incorporate a facility policy that every staff member
718 has an affirmative duty to report, pursuant to chapter 39, any
719 actual or suspected case of child abuse, abandonment, or
720 neglect; and
721 (2) In any case involving suspected child abuse,
722 abandonment, or neglect, designate, at the request of the
723 Department of Children and Family Services, a staff physician to
724 act as a liaison between the hospital and the Department of
725 Children and Family Services office which is investigating the
726 suspected abuse, abandonment, or neglect, and the child
727 protection team, as defined in s. 39.01, when the case is
728 referred to such a team.
729
730 Each general hospital and appropriate specialty hospital shall
731 comply with the provisions of this section and shall notify the
732 agency and the Department of Children and Family Services of its
733 compliance by sending a copy of its policy to the agency and the
734 Department of Children and Family Services as required by rule.
735 The failure by a general hospital or appropriate specialty
736 hospital to comply shall be punished by a fine not exceeding
737 $1,000, to be fixed, imposed, and collected by the agency. Each
738 day in violation is considered a separate offense.
739 Section 12. Subsection (2) and paragraph (d) of subsection
740 (3) of section 395.1041, Florida Statutes, are amended to read:
741 395.1041 Access to emergency services and care.—
742 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
743 shall establish and maintain an inventory of hospitals with
744 emergency services. The inventory shall list all services within
745 the service capability of the hospital, and such services shall
746 appear on the face of the hospital license. Each hospital having
747 emergency services shall notify the agency of its service
748 capability in the manner and form prescribed by the agency. The
749 agency shall use the inventory to assist emergency medical
750 services providers and others in locating appropriate emergency
751 medical care. The inventory shall also be made available to the
752 general public. On or before August 1, 1992, the agency shall
753 request that each hospital identify the services which are
754 within its service capability. On or before November 1, 1992,
755 the agency shall notify each hospital of the service capability
756 to be included in the inventory. The hospital has 15 days from
757 the date of receipt to respond to the notice. By December 1,
758 1992, the agency shall publish a final inventory. Each hospital
759 shall reaffirm its service capability when its license is
760 renewed and shall notify the agency of the addition of a new
761 service or the termination of a service prior to a change in its
762 service capability.
763 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
764 FACILITY OR HEALTH CARE PERSONNEL.—
765 (d)1. Every hospital shall ensure the provision of services
766 within the service capability of the hospital, at all times,
767 either directly or indirectly through an arrangement with
768 another hospital, through an arrangement with one or more
769 physicians, or as otherwise made through prior arrangements. A
770 hospital may enter into an agreement with another hospital for
771 purposes of meeting its service capability requirement, and
772 appropriate compensation or other reasonable conditions may be
773 negotiated for these backup services.
774 2. If any arrangement requires the provision of emergency
775 medical transportation, such arrangement must be made in
776 consultation with the applicable provider and may not require
777 the emergency medical service provider to provide transportation
778 that is outside the routine service area of that provider or in
779 a manner that impairs the ability of the emergency medical
780 service provider to timely respond to prehospital emergency
781 calls.
782 3. A hospital shall not be required to ensure service
783 capability at all times as required in subparagraph 1. if, prior
784 to the receiving of any patient needing such service capability,
785 such hospital has demonstrated to the agency that it lacks the
786 ability to ensure such capability and it has exhausted all
787 reasonable efforts to ensure such capability through backup
788 arrangements. In reviewing a hospital’s demonstration of lack of
789 ability to ensure service capability, the agency shall consider
790 factors relevant to the particular case, including the
791 following:
792 a. Number and proximity of hospitals with the same service
793 capability.
794 b. Number, type, credentials, and privileges of
795 specialists.
796 c. Frequency of procedures.
797 d. Size of hospital.
798 4. The agency shall publish proposed rules implementing a
799 reasonable exemption procedure by November 1, 1992. Subparagraph
800 1. shall become effective upon the effective date of said rules
801 or January 31, 1993, whichever is earlier. For a period not to
802 exceed 1 year from the effective date of subparagraph 1., a
803 hospital requesting an exemption shall be deemed to be exempt
804 from offering the service until the agency initially acts to
805 deny or grant the original request. The agency has 45 days from
806 the date of receipt of the request to approve or deny the
807 request. After the first year from the effective date of
808 subparagraph 1., If the agency fails to initially act within the
809 time period, the hospital is deemed to be exempt from offering
810 the service until the agency initially acts to deny the request.
811 Section 13. Section 395.1046, Florida Statutes, is
812 repealed.
813 Section 14. Paragraph (e) of subsection (1) of section
814 395.1055, Florida Statutes, is amended to read:
815 395.1055 Rules and enforcement.—
816 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
817 and 120.54 to implement the provisions of this part, which shall
818 include reasonable and fair minimum standards for ensuring that:
819 (e) Licensed facility beds conform to minimum space,
820 equipment, and furnishings standards as specified by the agency,
821 the Florida Building Code, and the Florida Fire Prevention Code
822 department.
823 Section 15. Subsection (1) of section 395.10972, Florida
824 Statutes, is amended to read:
825 395.10972 Health Care Risk Manager Advisory Council.—The
826 Secretary of Health Care Administration may appoint a seven
827 member advisory council to advise the agency on matters
828 pertaining to health care risk managers. The members of the
829 council shall serve at the pleasure of the secretary. The
830 council shall designate a chair. The council shall meet at the
831 call of the secretary or at those times as may be required by
832 rule of the agency. The members of the advisory council shall
833 receive no compensation for their services, but shall be
834 reimbursed for travel expenses as provided in s. 112.061. The
835 council shall consist of individuals representing the following
836 areas:
837 (1) Two shall be active health care risk managers,
838 including one risk manager who is recommended by and a member of
839 the Florida Society for of Healthcare Risk Management and
840 Patient Safety.
841 Section 16. Subsection (3) of section 395.2050, Florida
842 Statutes, is amended to read:
843 395.2050 Routine inquiry for organ and tissue donation;
844 certification for procurement activities; death records review.—
845 (3) Each organ procurement organization designated by the
846 federal Centers for Medicare and Medicaid Services Health Care
847 Financing Administration and licensed by the state shall conduct
848 an annual death records review in the organ procurement
849 organization’s affiliated donor hospitals. The organ procurement
850 organization shall enlist the services of every Florida licensed
851 tissue bank and eye bank affiliated with or providing service to
852 the donor hospital and operating in the same service area to
853 participate in the death records review.
854 Section 17. Subsection (2) of section 395.3036, Florida
855 Statutes, is amended to read:
856 395.3036 Confidentiality of records and meetings of
857 corporations that lease public hospitals or other public health
858 care facilities.—The records of a private corporation that
859 leases a public hospital or other public health care facility
860 are confidential and exempt from the provisions of s. 119.07(1)
861 and s. 24(a), Art. I of the State Constitution, and the meetings
862 of the governing board of a private corporation are exempt from
863 s. 286.011 and s. 24(b), Art. I of the State Constitution when
864 the public lessor complies with the public finance
865 accountability provisions of s. 155.40(5) with respect to the
866 transfer of any public funds to the private lessee and when the
867 private lessee meets at least three of the five following
868 criteria:
869 (2) The public lessor and the private lessee do not
870 commingle any of their funds in any account maintained by either
871 of them, other than the payment of the rent and administrative
872 fees or the transfer of funds pursuant to subsection (5) (2).
873 Section 18. Section 395.3037, Florida Statutes, is
874 repealed.
875 Section 19. Subsections (1), (4), and (5) of section
876 395.3038, Florida Statutes, are amended to read:
877 395.3038 State-listed primary stroke centers and
878 comprehensive stroke centers; notification of hospitals.—
879 (1) The agency shall make available on its website and to
880 the department a list of the name and address of each hospital
881 that meets the criteria for a primary stroke center and the name
882 and address of each hospital that meets the criteria for a
883 comprehensive stroke center. The list of primary and
884 comprehensive stroke centers shall include only those hospitals
885 that attest in an affidavit submitted to the agency that the
886 hospital meets the named criteria, or those hospitals that
887 attest in an affidavit submitted to the agency that the hospital
888 is certified as a primary or a comprehensive stroke center by
889 the Joint Commission on Accreditation of Healthcare
890 Organizations.
891 (4) The agency shall adopt by rule criteria for a primary
892 stroke center which are substantially similar to the
893 certification standards for primary stroke centers of the Joint
894 Commission on Accreditation of Healthcare Organizations.
895 (5) The agency shall adopt by rule criteria for a
896 comprehensive stroke center. However, if the Joint Commission on
897 Accreditation of Healthcare Organizations establishes criteria
898 for a comprehensive stroke center, the agency shall establish
899 criteria for a comprehensive stroke center which are
900 substantially similar to those criteria established by the Joint
901 Commission on Accreditation of Healthcare Organizations.
902 Section 20. Subsection (2) of section 395.602, Florida
903 Statutes, is amended to read:
904 395.602 Rural hospitals.—
905 (2) DEFINITIONS.—As used in this part:
906 (e) “Rural hospital” means an acute care hospital licensed
907 under this chapter, having 100 or fewer licensed beds and an
908 emergency room, which is:
909 1. The sole provider within a county with a population
910 density of no greater than 100 persons per square mile;
911 2. An acute care hospital, in a county with a population
912 density of no greater than 100 persons per square mile, which is
913 at least 30 minutes of travel time, on normally traveled roads
914 under normal traffic conditions, from any other acute care
915 hospital within the same county;
916 3. A hospital supported by a tax district or subdistrict
917 whose boundaries encompass a population of 100 persons or fewer
918 per square mile;
919 4. A hospital in a constitutional charter county with a
920 population of over 1 million persons that has imposed a local
921 option health service tax pursuant to law and in an area that
922 was directly impacted by a catastrophic event on August 24,
923 1992, for which the Governor of Florida declared a state of
924 emergency pursuant to chapter 125, and has 120 beds or less that
925 serves an agricultural community with an emergency room
926 utilization of no less than 20,000 visits and a Medicaid
927 inpatient utilization rate greater than 15 percent;
928 4.5. A hospital with a service area that has a population
929 of 100 persons or fewer per square mile. As used in this
930 subparagraph, the term “service area” means the fewest number of
931 zip codes that account for 75 percent of the hospital’s
932 discharges for the most recent 5-year period, based on
933 information available from the hospital inpatient discharge
934 database in the Florida Center for Health Information and Policy
935 Analysis at the Agency for Health Care Administration; or
936 5.6. A hospital designated as a critical access hospital,
937 as defined in s. 408.07(15).
938
939 Population densities used in this paragraph must be based upon
940 the most recently completed United States census. A hospital
941 that received funds under s. 409.9116 for a quarter beginning no
942 later than July 1, 2002, is deemed to have been and shall
943 continue to be a rural hospital from that date through June 30,
944 2015, if the hospital continues to have 100 or fewer licensed
945 beds and an emergency room, or meets the criteria of
946 subparagraph 4. An acute care hospital that has not previously
947 been designated as a rural hospital and that meets the criteria
948 of this paragraph shall be granted such designation upon
949 application, including supporting documentation to the Agency
950 for Health Care Administration.
951 Section 21. Subsection (8) of section 400.021, Florida
952 Statutes, is amended to read:
953 400.021 Definitions.—When used in this part, unless the
954 context otherwise requires, the term:
955 (8) “Geriatric outpatient clinic” means a site for
956 providing outpatient health care to persons 60 years of age or
957 older, which is staffed by a registered nurse, or a physician
958 assistant, a licensed practical nurse under the direct
959 supervision of a registered nurse, or an advanced registered
960 nurse practitioner.
961 Section 22. Paragraph (g) of subsection (2) of section
962 400.0239, Florida Statutes, is amended to read:
963 400.0239 Quality of Long-Term Care Facility Improvement
964 Trust Fund.—
965 (2) Expenditures from the trust fund shall be allowable for
966 direct support of the following:
967 (g) Other initiatives authorized by the Centers for
968 Medicare and Medicaid Services for the use of federal civil
969 monetary penalties, including projects recommended through the
970 Medicaid “Up-or-Out” Quality of Care Contract Management Program
971 pursuant to s. 400.148.
972 Section 23. Subsection (2) of section 400.063, Florida
973 Statutes, is amended to read:
974 400.063 Resident protection.—
975 (2) The agency is authorized to establish for each
976 facility, subject to intervention by the agency, a separate bank
977 account for the deposit to the credit of the agency of any
978 moneys received from the Health Care Trust Fund or any other
979 moneys received for the maintenance and care of residents in the
980 facility, and the agency is authorized to disburse moneys from
981 such account to pay obligations incurred for the purposes of
982 this section. The agency is authorized to requisition moneys
983 from the Health Care Trust Fund in advance of an actual need for
984 cash on the basis of an estimate by the agency of moneys to be
985 spent under the authority of this section. Any bank account
986 established under this section need not be approved in advance
987 of its creation as required by s. 17.58, but shall be secured by
988 depository insurance equal to or greater than the balance of
989 such account or by the pledge of collateral security in
990 conformance with criteria established in s. 18.11. The agency
991 shall notify the Chief Financial Officer of any such account so
992 established and shall make a quarterly accounting to the Chief
993 Financial Officer for all moneys deposited in such account.
994 Section 24. Subsections (1) and (5) of section 400.071,
995 Florida Statutes, are amended to read:
996 400.071 Application for license.—
997 (1) In addition to the requirements of part II of chapter
998 408, the application for a license shall be under oath and must
999 contain the following:
1000 (a) The location of the facility for which a license is
1001 sought and an indication, as in the original application, that
1002 such location conforms to the local zoning ordinances.
1003 (b) A signed affidavit disclosing any financial or
1004 ownership interest that a controlling interest as defined in
1005 part II of chapter 408 has held in the last 5 years in any
1006 entity licensed by this state or any other state to provide
1007 health or residential care which has closed voluntarily or
1008 involuntarily; has filed for bankruptcy; has had a receiver
1009 appointed; has had a license denied, suspended, or revoked; or
1010 has had an injunction issued against it which was initiated by a
1011 regulatory agency. The affidavit must disclose the reason any
1012 such entity was closed, whether voluntarily or involuntarily.
1013 (c) The total number of beds and the total number of
1014 Medicare and Medicaid certified beds.
1015 (b)(d) Information relating to the applicant and employees
1016 which the agency requires by rule. The applicant must
1017 demonstrate that sufficient numbers of qualified staff, by
1018 training or experience, will be employed to properly care for
1019 the type and number of residents who will reside in the
1020 facility.
1021 (c)(e) Copies of any civil verdict or judgment involving
1022 the applicant rendered within the 10 years preceding the
1023 application, relating to medical negligence, violation of
1024 residents’ rights, or wrongful death. As a condition of
1025 licensure, the licensee agrees to provide to the agency copies
1026 of any new verdict or judgment involving the applicant, relating
1027 to such matters, within 30 days after filing with the clerk of
1028 the court. The information required in this paragraph shall be
1029 maintained in the facility’s licensure file and in an agency
1030 database which is available as a public record.
1031 (5) As a condition of licensure, each facility must
1032 establish and submit with its application a plan for quality
1033 assurance and for conducting risk management.
1034 Section 25. Section 400.0712, Florida Statutes, is amended
1035 to read:
1036 400.0712 Application for inactive license.—
1037 (1) As specified in this section, the agency may issue an
1038 inactive license to a nursing home facility for all or a portion
1039 of its beds. Any request by a licensee that a nursing home or
1040 portion of a nursing home become inactive must be submitted to
1041 the agency in the approved format. The facility may not initiate
1042 any suspension of services, notify residents, or initiate
1043 inactivity before receiving approval from the agency; and a
1044 licensee that violates this provision may not be issued an
1045 inactive license.
1046 (1)(2) In addition to the authority granted in part II of
1047 chapter 408, the agency may issue an inactive license to a
1048 nursing home that chooses to use an unoccupied contiguous
1049 portion of the facility for an alternative use to meet the needs
1050 of elderly persons through the use of less restrictive, less
1051 institutional services.
1052 (a) An inactive license issued under this subsection may be
1053 granted for a period not to exceed the current licensure
1054 expiration date but may be renewed by the agency at the time of
1055 licensure renewal.
1056 (b) A request to extend the inactive license must be
1057 submitted to the agency in the approved format and approved by
1058 the agency in writing.
1059 (c) Nursing homes that receive an inactive license to
1060 provide alternative services shall not receive preference for
1061 participation in the Assisted Living for the Elderly Medicaid
1062 waiver.
1063 (2)(3) The agency shall adopt rules pursuant to ss.
1064 120.536(1) and 120.54 necessary to administer implement this
1065 section.
1066 Section 26. Section 400.111, Florida Statutes, is amended
1067 to read:
1068 400.111 Disclosure of controlling interest.—In addition to
1069 the requirements of part II of chapter 408, when requested by
1070 the agency, the licensee shall submit a signed affidavit
1071 disclosing any financial or ownership interest that a
1072 controlling interest has held within the last 5 years in any
1073 entity licensed by the state or any other state to provide
1074 health or residential care which entity has closed voluntarily
1075 or involuntarily; has filed for bankruptcy; has had a receiver
1076 appointed; has had a license denied, suspended, or revoked; or
1077 has had an injunction issued against it which was initiated by a
1078 regulatory agency. The affidavit must disclose the reason such
1079 entity was closed, whether voluntarily or involuntarily.
1080 Section 27. Section 400.1183, Florida Statutes, is amended
1081 to read:
1082 400.1183 Resident grievance procedures.—
1083 (1) Every nursing home must have a grievance procedure
1084 available to its residents and their families. The grievance
1085 procedure must include:
1086 (a) An explanation of how to pursue redress of a grievance.
1087 (b) The names, job titles, and telephone numbers of the
1088 employees responsible for implementing the facility’s grievance
1089 procedure. The list must include the address and the toll-free
1090 telephone numbers of the ombudsman and the agency.
1091 (c) A simple description of the process through which a
1092 resident may, at any time, contact the toll-free telephone
1093 hotline of the ombudsman or the agency to report the unresolved
1094 grievance.
1095 (d) A procedure for providing assistance to residents who
1096 cannot prepare a written grievance without help.
1097 (2) Each facility shall maintain records of all grievances
1098 for agency inspection and shall report to the agency at the time
1099 of relicensure the total number of grievances handled during the
1100 prior licensure period, a categorization of the cases underlying
1101 the grievances, and the final disposition of the grievances.
1102 (3) Each facility must respond to the grievance within a
1103 reasonable time after its submission.
1104 (4) The agency may investigate any grievance at any time.
1105 Section 28. Subsection (1) of section 400.141, Florida
1106 Statutes, is amended to read:
1107 400.141 Administration and management of nursing home
1108 facilities.—
1109 (1) Every licensed facility shall comply with all
1110 applicable standards and rules of the agency and shall:
1111 (a) Be under the administrative direction and charge of a
1112 licensed administrator.
1113 (b) Appoint a medical director licensed pursuant to chapter
1114 458 or chapter 459. The agency may establish by rule more
1115 specific criteria for the appointment of a medical director.
1116 (c) Have available the regular, consultative, and emergency
1117 services of physicians licensed by the state.
1118 (d) Provide for resident use of a community pharmacy as
1119 specified in s. 400.022(1)(q). Any other law to the contrary
1120 notwithstanding, a registered pharmacist licensed in Florida,
1121 that is under contract with a facility licensed under this
1122 chapter or chapter 429, shall repackage a nursing facility
1123 resident’s bulk prescription medication which has been packaged
1124 by another pharmacist licensed in any state in the United States
1125 into a unit dose system compatible with the system used by the
1126 nursing facility, if the pharmacist is requested to offer such
1127 service. In order to be eligible for the repackaging, a resident
1128 or the resident’s spouse must receive prescription medication
1129 benefits provided through a former employer as part of his or
1130 her retirement benefits, a qualified pension plan as specified
1131 in s. 4972 of the Internal Revenue Code, a federal retirement
1132 program as specified under 5 C.F.R. s. 831, or a long-term care
1133 policy as defined in s. 627.9404(1). A pharmacist who correctly
1134 repackages and relabels the medication and the nursing facility
1135 which correctly administers such repackaged medication under
1136 this paragraph may not be held liable in any civil or
1137 administrative action arising from the repackaging. In order to
1138 be eligible for the repackaging, a nursing facility resident for
1139 whom the medication is to be repackaged shall sign an informed
1140 consent form provided by the facility which includes an
1141 explanation of the repackaging process and which notifies the
1142 resident of the immunities from liability provided in this
1143 paragraph. A pharmacist who repackages and relabels prescription
1144 medications, as authorized under this paragraph, may charge a
1145 reasonable fee for costs resulting from the implementation of
1146 this provision.
1147 (e) Provide for the access of the facility residents to
1148 dental and other health-related services, recreational services,
1149 rehabilitative services, and social work services appropriate to
1150 their needs and conditions and not directly furnished by the
1151 licensee. When a geriatric outpatient nurse clinic is conducted
1152 in accordance with rules adopted by the agency, outpatients
1153 attending such clinic shall not be counted as part of the
1154 general resident population of the nursing home facility, nor
1155 shall the nursing staff of the geriatric outpatient clinic be
1156 counted as part of the nursing staff of the facility, until the
1157 outpatient clinic load exceeds 15 a day.
1158 (f) Be allowed and encouraged by the agency to provide
1159 other needed services under certain conditions. If the facility
1160 has a standard licensure status, and has had no class I or class
1161 II deficiencies during the past 2 years or has been awarded a
1162 Gold Seal under the program established in s. 400.235, it may be
1163 encouraged by the agency to provide services, including, but not
1164 limited to, respite and adult day services, which enable
1165 individuals to move in and out of the facility. A facility is
1166 not subject to any additional licensure requirements for
1167 providing these services. Respite care may be offered to persons
1168 in need of short-term or temporary nursing home services.
1169 Respite care must be provided in accordance with this part and
1170 rules adopted by the agency. However, the agency shall, by rule,
1171 adopt modified requirements for resident assessment, resident
1172 care plans, resident contracts, physician orders, and other
1173 provisions, as appropriate, for short-term or temporary nursing
1174 home services. The agency shall allow for shared programming and
1175 staff in a facility which meets minimum standards and offers
1176 services pursuant to this paragraph, but, if the facility is
1177 cited for deficiencies in patient care, may require additional
1178 staff and programs appropriate to the needs of service
1179 recipients. A person who receives respite care may not be
1180 counted as a resident of the facility for purposes of the
1181 facility’s licensed capacity unless that person receives 24-hour
1182 respite care. A person receiving either respite care for 24
1183 hours or longer or adult day services must be included when
1184 calculating minimum staffing for the facility. Any costs and
1185 revenues generated by a nursing home facility from
1186 nonresidential programs or services shall be excluded from the
1187 calculations of Medicaid per diems for nursing home
1188 institutional care reimbursement.
1189 (g) If the facility has a standard license or is a Gold
1190 Seal facility, exceeds the minimum required hours of licensed
1191 nursing and certified nursing assistant direct care per resident
1192 per day, and is part of a continuing care facility licensed
1193 under chapter 651 or a retirement community that offers other
1194 services pursuant to part III of this chapter or part I or part
1195 III of chapter 429 on a single campus, be allowed to share
1196 programming and staff. At the time of inspection and in the
1197 semiannual report required pursuant to paragraph (n) (o), a
1198 continuing care facility or retirement community that uses this
1199 option must demonstrate through staffing records that minimum
1200 staffing requirements for the facility were met. Licensed nurses
1201 and certified nursing assistants who work in the nursing home
1202 facility may be used to provide services elsewhere on campus if
1203 the facility exceeds the minimum number of direct care hours
1204 required per resident per day and the total number of residents
1205 receiving direct care services from a licensed nurse or a
1206 certified nursing assistant does not cause the facility to
1207 violate the staffing ratios required under s. 400.23(3)(a).
1208 Compliance with the minimum staffing ratios shall be based on
1209 total number of residents receiving direct care services,
1210 regardless of where they reside on campus. If the facility
1211 receives a conditional license, it may not share staff until the
1212 conditional license status ends. This paragraph does not
1213 restrict the agency’s authority under federal or state law to
1214 require additional staff if a facility is cited for deficiencies
1215 in care which are caused by an insufficient number of certified
1216 nursing assistants or licensed nurses. The agency may adopt
1217 rules for the documentation necessary to determine compliance
1218 with this provision.
1219 (h) Maintain the facility premises and equipment and
1220 conduct its operations in a safe and sanitary manner.
1221 (i) If the licensee furnishes food service, provide a
1222 wholesome and nourishing diet sufficient to meet generally
1223 accepted standards of proper nutrition for its residents and
1224 provide such therapeutic diets as may be prescribed by attending
1225 physicians. In making rules to implement this paragraph, the
1226 agency shall be guided by standards recommended by nationally
1227 recognized professional groups and associations with knowledge
1228 of dietetics.
1229 (j) Keep full records of resident admissions and
1230 discharges; medical and general health status, including medical
1231 records, personal and social history, and identity and address
1232 of next of kin or other persons who may have responsibility for
1233 the affairs of the residents; and individual resident care plans
1234 including, but not limited to, prescribed services, service
1235 frequency and duration, and service goals. The records shall be
1236 open to inspection by the agency.
1237 (k) Keep such fiscal records of its operations and
1238 conditions as may be necessary to provide information pursuant
1239 to this part.
1240 (l) Furnish copies of personnel records for employees
1241 affiliated with such facility, to any other facility licensed by
1242 this state requesting this information pursuant to this part.
1243 Such information contained in the records may include, but is
1244 not limited to, disciplinary matters and any reason for
1245 termination. Any facility releasing such records pursuant to
1246 this part shall be considered to be acting in good faith and may
1247 not be held liable for information contained in such records,
1248 absent a showing that the facility maliciously falsified such
1249 records.
1250 (m) Publicly display a poster provided by the agency
1251 containing the names, addresses, and telephone numbers for the
1252 state’s abuse hotline, the State Long-Term Care Ombudsman, the
1253 Agency for Health Care Administration consumer hotline, the
1254 Advocacy Center for Persons with Disabilities, the Florida
1255 Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1256 with a clear description of the assistance to be expected from
1257 each.
1258 (n) Submit to the agency the information specified in s.
1259 400.071(1)(b) for a management company within 30 days after the
1260 effective date of the management agreement.
1261 (n)(o)1. Submit semiannually to the agency, or more
1262 frequently if requested by the agency, information regarding
1263 facility staff-to-resident ratios, staff turnover, and staff
1264 stability, including information regarding certified nursing
1265 assistants, licensed nurses, the director of nursing, and the
1266 facility administrator. For purposes of this reporting:
1267 a. Staff-to-resident ratios must be reported in the
1268 categories specified in s. 400.23(3)(a) and applicable rules.
1269 The ratio must be reported as an average for the most recent
1270 calendar quarter.
1271 b. Staff turnover must be reported for the most recent 12
1272 month period ending on the last workday of the most recent
1273 calendar quarter prior to the date the information is submitted.
1274 The turnover rate must be computed quarterly, with the annual
1275 rate being the cumulative sum of the quarterly rates. The
1276 turnover rate is the total number of terminations or separations
1277 experienced during the quarter, excluding any employee
1278 terminated during a probationary period of 3 months or less,
1279 divided by the total number of staff employed at the end of the
1280 period for which the rate is computed, and expressed as a
1281 percentage.
1282 c. The formula for determining staff stability is the total
1283 number of employees that have been employed for more than 12
1284 months, divided by the total number of employees employed at the
1285 end of the most recent calendar quarter, and expressed as a
1286 percentage.
1287 d. A nursing facility that has failed to comply with state
1288 minimum-staffing requirements for 2 consecutive days is
1289 prohibited from accepting new admissions until the facility has
1290 achieved the minimum-staffing requirements for a period of 6
1291 consecutive days. For the purposes of this sub-subparagraph, any
1292 person who was a resident of the facility and was absent from
1293 the facility for the purpose of receiving medical care at a
1294 separate location or was on a leave of absence is not considered
1295 a new admission. The agency shall fine the nursing facility
1296 $1,000 if it fails Failure to impose such an admissions
1297 moratorium constitutes a class II deficiency.
1298 e. A nursing facility which does not have a conditional
1299 license may be cited for failure to comply with the standards in
1300 s. 400.23(3)(a)1.a. only if it has failed to meet those
1301 standards on 2 consecutive days or if it has failed to meet at
1302 least 97 percent of those standards on any one day.
1303 f. A facility which has a conditional license must be in
1304 compliance with the standards in s. 400.23(3)(a) at all times.
1305 2. This paragraph does not limit the agency’s ability to
1306 impose a deficiency or take other actions if a facility does not
1307 have enough staff to meet the residents’ needs.
1308 (o)(p) Notify a licensed physician when a resident exhibits
1309 signs of dementia or cognitive impairment or has a change of
1310 condition in order to rule out the presence of an underlying
1311 physiological condition that may be contributing to such
1312 dementia or impairment. The notification must occur within 30
1313 days after the acknowledgment of such signs by facility staff.
1314 If an underlying condition is determined to exist, the facility
1315 shall arrange, with the appropriate health care provider, the
1316 necessary care and services to treat the condition.
1317 (p)(q) If the facility implements a dining and hospitality
1318 attendant program, ensure that the program is developed and
1319 implemented under the supervision of the facility director of
1320 nursing. A licensed nurse, licensed speech or occupational
1321 therapist, or a registered dietitian must conduct training of
1322 dining and hospitality attendants. A person employed by a
1323 facility as a dining and hospitality attendant must perform
1324 tasks under the direct supervision of a licensed nurse.
1325 (r) Report to the agency any filing for bankruptcy
1326 protection by the facility or its parent corporation,
1327 divestiture or spin-off of its assets, or corporate
1328 reorganization within 30 days after the completion of such
1329 activity.
1330 (q)(s) Maintain general and professional liability
1331 insurance coverage that is in force at all times. In lieu of
1332 general and professional liability insurance coverage, a state
1333 designated teaching nursing home and its affiliated assisted
1334 living facilities created under s. 430.80 may demonstrate proof
1335 of financial responsibility as provided in s. 430.80(3)(h).
1336 (r)(t) Maintain in the medical record for each resident a
1337 daily chart of certified nursing assistant services provided to
1338 the resident. The certified nursing assistant who is caring for
1339 the resident must complete this record by the end of his or her
1340 shift. This record must indicate assistance with activities of
1341 daily living, assistance with eating, and assistance with
1342 drinking, and must record each offering of nutrition and
1343 hydration for those residents whose plan of care or assessment
1344 indicates a risk for malnutrition or dehydration.
1345 (s)(u) Before November 30 of each year, subject to the
1346 availability of an adequate supply of the necessary vaccine,
1347 provide for immunizations against influenza viruses to all its
1348 consenting residents in accordance with the recommendations of
1349 the United States Centers for Disease Control and Prevention,
1350 subject to exemptions for medical contraindications and
1351 religious or personal beliefs. Subject to these exemptions, any
1352 consenting person who becomes a resident of the facility after
1353 November 30 but before March 31 of the following year must be
1354 immunized within 5 working days after becoming a resident.
1355 Immunization shall not be provided to any resident who provides
1356 documentation that he or she has been immunized as required by
1357 this paragraph. This paragraph does not prohibit a resident from
1358 receiving the immunization from his or her personal physician if
1359 he or she so chooses. A resident who chooses to receive the
1360 immunization from his or her personal physician shall provide
1361 proof of immunization to the facility. The agency may adopt and
1362 enforce any rules necessary to comply with or administer
1363 implement this paragraph subsection.
1364 (t)(v) Assess all residents for eligibility for
1365 pneumococcal polysaccharide vaccination (PPV) and vaccinate
1366 residents when indicated within 60 days after the effective date
1367 of this act in accordance with the recommendations of the United
1368 States Centers for Disease Control and Prevention, subject to
1369 exemptions for medical contraindications and religious or
1370 personal beliefs. Residents admitted after the effective date of
1371 this act shall be assessed within 5 working days of admission
1372 and, when indicated, vaccinated within 60 days in accordance
1373 with the recommendations of the United States Centers for
1374 Disease Control and Prevention, subject to exemptions for
1375 medical contraindications and religious or personal beliefs.
1376 Immunization shall not be provided to any resident who provides
1377 documentation that he or she has been immunized as required by
1378 this paragraph. This paragraph does not prohibit a resident from
1379 receiving the immunization from his or her personal physician if
1380 he or she so chooses. A resident who chooses to receive the
1381 immunization from his or her personal physician shall provide
1382 proof of immunization to the facility. The agency may adopt and
1383 enforce any rules necessary to comply with or administer
1384 implement this paragraph.
1385 (u)(w) Annually encourage and promote to its employees the
1386 benefits associated with immunizations against influenza viruses
1387 in accordance with the recommendations of the United States
1388 Centers for Disease Control and Prevention. The agency may adopt
1389 and enforce any rules necessary to comply with or administer
1390 implement this paragraph.
1391 Section 29. Subsection (3) of section 400.142, Florida
1392 Statutes, is amended to read:
1393 400.142 Emergency medication kits; orders not to
1394 resuscitate.—
1395 (3) Facility staff may withhold or withdraw cardiopulmonary
1396 resuscitation if presented with an order not to resuscitate
1397 executed pursuant to s. 401.45. The agency shall adopt rules
1398 providing for the implementation of such orders. Facility staff
1399 and facilities shall not be subject to criminal prosecution or
1400 civil liability, nor be considered to have engaged in negligent
1401 or unprofessional conduct, for withholding or withdrawing
1402 cardiopulmonary resuscitation pursuant to such an order and
1403 rules adopted by the agency. The absence of an order not to
1404 resuscitate executed pursuant to s. 401.45 does not preclude a
1405 physician from withholding or withdrawing cardiopulmonary
1406 resuscitation as otherwise permitted by law.
1407 Section 30. Subsection (10) of section 400.147, Florida
1408 Statutes, is repealed.
1409 Section 31. Section 400.148, Florida Statutes, is repealed.
1410 Section 32. Subsection (3) of section 400.19, Florida
1411 Statutes, is amended to read:
1412 400.19 Right of entry and inspection.—
1413 (3) The agency shall every 15 months conduct at least one
1414 unannounced inspection to determine compliance by the licensee
1415 with statutes, and with rules promulgated under the provisions
1416 of those statutes, governing minimum standards of construction,
1417 quality and adequacy of care, and rights of residents. The
1418 survey shall be conducted every 6 months for the next 2-year
1419 period if the facility has been cited for a class I deficiency,
1420 has been cited for two or more class II deficiencies arising
1421 from separate surveys or investigations within a 60-day period,
1422 or has had three or more substantiated complaints within a 6
1423 month period, each resulting in at least one class I or class II
1424 deficiency. In addition to any other fees or fines in this part,
1425 the agency shall assess a fine for each facility that is subject
1426 to the 6-month survey cycle. The fine for the 2-year period
1427 shall be $6,000, one-half to be paid at the completion of each
1428 survey. The agency may adjust this fine by the change in the
1429 Consumer Price Index, based on the 12 months immediately
1430 preceding the increase, to cover the cost of the additional
1431 surveys. The agency shall verify through subsequent inspection
1432 that any deficiency identified during inspection is corrected.
1433 However, the agency may verify the correction of a class III or
1434 class IV deficiency unrelated to resident rights or resident
1435 care without reinspecting the facility if adequate written
1436 documentation has been received from the facility, which
1437 provides assurance that the deficiency has been corrected. The
1438 giving or causing to be given of advance notice of such
1439 unannounced inspections by an employee of the agency to any
1440 unauthorized person shall constitute cause for suspension of not
1441 fewer than 5 working days according to the provisions of chapter
1442 110.
1443 Section 33. Section 400.195, Florida Statutes, is repealed.
1444 Section 34. Subsection (5) of section 400.23, Florida
1445 Statutes, is amended to read:
1446 400.23 Rules; evaluation and deficiencies; licensure
1447 status.—
1448 (5) The agency, in collaboration with the Division of
1449 Children’s Medical Services Network of the Department of Health,
1450 must, no later than December 31, 1993, adopt rules for minimum
1451 standards of care for persons under 21 years of age who reside
1452 in nursing home facilities. The rules must include a methodology
1453 for reviewing a nursing home facility under ss. 408.031-408.045
1454 which serves only persons under 21 years of age. A facility may
1455 be exempt from these standards for specific persons between 18
1456 and 21 years of age, if the person’s physician agrees that
1457 minimum standards of care based on age are not necessary.
1458 Section 35. Subsection (1) of section 400.275, Florida
1459 Statutes, is amended to read:
1460 400.275 Agency duties.—
1461 (1) The agency shall ensure that each newly hired nursing
1462 home surveyor, as a part of basic training, is assigned full
1463 time to a licensed nursing home for at least 2 days within a 7
1464 day period to observe facility operations outside of the survey
1465 process before the surveyor begins survey responsibilities. Such
1466 observations may not be the sole basis of a deficiency citation
1467 against the facility. The agency may not assign an individual to
1468 be a member of a survey team for purposes of a survey,
1469 evaluation, or consultation visit at a nursing home facility in
1470 which the surveyor was an employee within the preceding 5 years.
1471 Section 36. Subsections (2) and (14) of section 400.462,
1472 Florida Statutes, are amended, present subsections (27), (28),
1473 and (29) of that section are renumbered as subsections (28),
1474 (29), and (30), respectively, and new subsections (27) and (31)
1475 are added to that section, to read:
1476 400.462 Definitions.—As used in this part, the term:
1477 (2) “Admission” means a decision by the home health agency,
1478 during or after an evaluation visit with the patient to the
1479 patient’s home, that there is reasonable expectation that the
1480 patient’s medical, nursing, and social needs for skilled care
1481 can be adequately met by the agency in the patient’s place of
1482 residence. Admission includes completion of an agreement with
1483 the patient or the patient’s legal representative to provide
1484 home health services as required in s. 400.487(1).
1485 (14) “Home health services” means health and medical
1486 services and medical supplies furnished by an organization to an
1487 individual in the individual’s home or place of residence. The
1488 term includes organizations that provide one or more of the
1489 following:
1490 (a) Nursing care.
1491 (b) Physical, occupational, respiratory, or speech therapy.
1492 (c) Home health aide services.
1493 (d) Dietetics and nutrition practice and nutrition
1494 counseling.
1495 (e) Medical supplies and durable medical equipment,
1496 restricted to drugs and biologicals prescribed by a physician.
1497 (27) “Primary home health agency” means the agency that is
1498 responsible for the services furnished to patients and for
1499 implementation of the plan of care.
1500 (31) “Temporary” means short term, such as for employee
1501 absences, temporary skill shortages, seasonal workloads.
1502 Section 37. Section 400.476, Florida Statutes, is amended
1503 to read:
1504 400.476 Staffing requirements; notifications; limitations
1505 on staffing services.—
1506 (1) ADMINISTRATOR.—
1507 (a) An administrator may manage only one home health
1508 agency, except that an administrator may manage up to five home
1509 health agencies if all five home health agencies have identical
1510 controlling interests as defined in s. 408.803 and are located
1511 within one agency geographic service area or within an
1512 immediately contiguous county. If the home health agency is
1513 licensed under this chapter and is part of a retirement
1514 community that provides multiple levels of care, an employee of
1515 the retirement community may administer the home health agency
1516 and up to a maximum of four entities licensed under this chapter
1517 or chapter 429 which all have identical controlling interests as
1518 defined in s. 408.803. An administrator shall designate, in
1519 writing, for each licensed entity, a qualified alternate
1520 administrator to serve during the administrator’s absence. An
1521 alternate administrator must meet the requirements in this
1522 paragraph and s. 400.462(1).
1523 (b) An administrator of a home health agency who is a
1524 licensed physician, physician assistant, or registered nurse
1525 licensed to practice in this state may also be the director of
1526 nursing for a home health agency. An administrator may serve as
1527 a director of nursing for up to the number of entities
1528 authorized in subsection (2) only if there are 10 or fewer full
1529 time equivalent employees and contracted personnel in each home
1530 health agency.
1531 (c) The administrator shall organize and direct the
1532 agency’s ongoing functions, maintain an ongoing liaison with the
1533 board members and the staff, employ qualified personnel and
1534 ensure adequate staff education and evaluations, ensures the
1535 accuracy of public informational materials and activities,
1536 implement an effective budgeting and accounting system, and
1537 ensures that the home health agency operates in compliance with
1538 this part and part II of chapter 408 and rules adopted for these
1539 laws.
1540 (d) The administrator shall clearly set forth in writing
1541 the organizational chart, services furnished, administrative
1542 control, and lines of authority for the delegation of
1543 responsibilities for patient care. These responsibilities must
1544 be readily identifiable. Administrative and supervisory
1545 functions may not be delegated to another agency or
1546 organization, and the primary home health agency shall monitor
1547 and control all services that are not furnished directly,
1548 including services provided through contracts.
1549 (2) DIRECTOR OF NURSING.—
1550 (a) A director of nursing may be the director of nursing
1551 for:
1552 1. Up to two licensed home health agencies if the agencies
1553 have identical controlling interests as defined in s. 408.803
1554 and are located within one agency geographic service area or
1555 within an immediately contiguous county; or
1556 2. Up to five licensed home health agencies if:
1557 a. All of the home health agencies have identical
1558 controlling interests as defined in s. 408.803;
1559 b. All of the home health agencies are located within one
1560 agency geographic service area or within an immediately
1561 contiguous county; and
1562 c. Each home health agency has a registered nurse who meets
1563 the qualifications of a director of nursing and who has a
1564 written delegation from the director of nursing to serve as the
1565 director of nursing for that home health agency when the
1566 director of nursing is not present; and.
1567 d. This person, or similarly qualified alternate, is
1568 available at all times during operating hours and participates
1569 in all activities relevant to the professional services
1570 furnished, including, but not limited to, the oversight of
1571 nursing services, home health aides, and certified nursing
1572 assistants, and assignment of personnel.
1573
1574 If a home health agency licensed under this chapter is part of a
1575 retirement community that provides multiple levels of care, an
1576 employee of the retirement community may serve as the director
1577 of nursing of the home health agency and up to a maximum of four
1578 entities, other than home health agencies, licensed under this
1579 chapter or chapter 429 which all have identical controlling
1580 interests as defined in s. 408.803.
1581 (b) A home health agency that provides skilled nursing care
1582 may not operate for more than 30 calendar days without a
1583 director of nursing. A home health agency that provides skilled
1584 nursing care and the director of nursing of a home health agency
1585 must notify the agency within 10 business days after termination
1586 of the services of the director of nursing for the home health
1587 agency. A home health agency that provides skilled nursing care
1588 must notify the agency of the identity and qualifications of the
1589 new director of nursing within 10 days after the new director is
1590 hired. If a home health agency that provides skilled nursing
1591 care operates for more than 30 calendar days without a director
1592 of nursing, the home health agency commits a class II
1593 deficiency. In addition to the fine for a class II deficiency,
1594 the agency may issue a moratorium in accordance with s. 408.814
1595 or revoke the license. The agency shall fine a home health
1596 agency that fails to notify the agency as required in this
1597 paragraph $1,000 for the first violation and $2,000 for a repeat
1598 violation. The agency may not take administrative action against
1599 a home health agency if the director of nursing fails to notify
1600 the department upon termination of services as the director of
1601 nursing for the home health agency.
1602 (c) A home health agency that is not Medicare or Medicaid
1603 certified and does not provide skilled care or provides only
1604 physical, occupational, or speech therapy is not required to
1605 have a director of nursing and is exempt from paragraph (b).
1606 (3) TRAINING.—A home health agency shall ensure that each
1607 certified nursing assistant employed by or under contract with
1608 the home health agency and each home health aide employed by or
1609 under contract with the home health agency is adequately trained
1610 to perform the tasks of a home health aide in the home setting.
1611 (a) The home health agency may not use as a home health
1612 aide on a full-time, temporary, per diem, or other basis, any
1613 individual to provide services unless the individual has
1614 completed a training and competency evaluation program, or a
1615 competency evaluation program, as permitted in s. 400.497 which
1616 meets the minimum standards established by the agency in state
1617 rules.
1618 (b) A home health aide is not competent in any task for
1619 which he or she is evaluated as “unsatisfactory.” The aide must
1620 perform any such task only under direct supervision by a
1621 licensed nurse until he or she receives training in the task and
1622 satisfactorily passes a subsequent evaluation in performing the
1623 task. A home health aide has not successfully passed a
1624 competency evaluation if the aide does not have a passing score
1625 on the test as specified by agency rule.
1626 (4) STAFFING.—Staffing services may be provided anywhere
1627 within the state.
1628 (5) PERSONNEL.—
1629 (a) The home health agency and its staff must comply with
1630 accepted professional standards and principles that apply to
1631 professionals, including, but not limited to, the state practice
1632 acts and the home health agency’s policies and procedures.
1633 (b) If personnel under hourly or per-visit contracts are
1634 used by the home health agency, there must be a written contract
1635 between those personnel and the agency which specifies the
1636 following requirements:
1637 1. Acceptance for care only of patients by the primary home
1638 health agency.
1639 2. The services to be furnished.
1640 3. The necessity to conform to all applicable agency
1641 policies, including personnel qualifications.
1642 4. The responsibility for participating in developing plans
1643 of care.
1644 5. The manner in which services are controlled,
1645 coordinated, and evaluated by the primary home health agency.
1646 6. The procedures for submitting clinical and progress
1647 notes, scheduling of visits, and periodic patient evaluation.
1648 7. The procedures for payment for services furnished under
1649 the contract.
1650 (c) A home health agency shall directly provide at least
1651 one of the types of services through home health agency
1652 employees, but may provide additional services under
1653 arrangements with another agency or organization. Services
1654 furnished under such arrangements must have a written contract
1655 conforming with the requirements specified in paragraph (b).
1656 (d) If home health aide services are provided by an
1657 individual who is not employed directly by the home health
1658 agency, the services of the home health aide must be provided
1659 under arrangements as stated in paragraphs (b) and (c). If the
1660 home health agency chooses to provide home health aide services
1661 under arrangements with another organization, the
1662 responsibilities of the home health agency include, but are not
1663 limited to:
1664 1. Ensuring the overall quality of the care provided by the
1665 aide;
1666 2. Supervising the aide’s services as described in s.
1667 400.487; and
1668 3. Ensuring that each home health aide providing services
1669 under arrangements with another organization has met the
1670 training requirements or competency evaluation requirements of
1671 s. 400.497.
1672 (e) The home health agency shall coordinate the efforts of
1673 all personnel furnishing services, and the personnel shall
1674 maintain communication with the home health agency to ensure
1675 that personnel efforts support the objectives outlined in the
1676 plan of care. The clinical record or minutes of case conferences
1677 shall ensure that effective interchange, reporting, and
1678 coordination of patient care occurs.
1679 Section 38. Section 400.484, Florida Statutes, is amended
1680 to read:
1681 400.484 Right of inspection; violations deficiencies;
1682 fines.—
1683 (1) In addition to the requirements of s. 408.811, the
1684 agency may make such inspections and investigations as are
1685 necessary in order to determine the state of compliance with
1686 this part, part II of chapter 408, and applicable rules.
1687 (2) The agency shall impose fines for various classes of
1688 deficiencies in accordance with the following schedule:
1689 (a) Class I violations are defined in s. 408.813. A class I
1690 deficiency is any act, omission, or practice that results in a
1691 patient’s death, disablement, or permanent injury, or places a
1692 patient at imminent risk of death, disablement, or permanent
1693 injury. Upon finding a class I violation deficiency, the agency
1694 shall impose an administrative fine in the amount of $15,000 for
1695 each occurrence and each day that the violation deficiency
1696 exists.
1697 (b) Class II violations are defined in s. 408.813. A class
1698 II deficiency is any act, omission, or practice that has a
1699 direct adverse effect on the health, safety, or security of a
1700 patient. Upon finding a class II violation deficiency, the
1701 agency shall impose an administrative fine in the amount of
1702 $5,000 for each occurrence and each day that the violation
1703 deficiency exists.
1704 (c) Class III violations are defined in s. 408.813. A class
1705 III deficiency is any act, omission, or practice that has an
1706 indirect, adverse effect on the health, safety, or security of a
1707 patient. Upon finding an uncorrected or repeated class III
1708 violation deficiency, the agency shall impose an administrative
1709 fine not to exceed $1,000 for each occurrence and each day that
1710 the uncorrected or repeated violation deficiency exists.
1711 (d) Class IV violations are defined in s. 408.813. A class
1712 IV deficiency is any act, omission, or practice related to
1713 required reports, forms, or documents which does not have the
1714 potential of negatively affecting patients. These violations are
1715 of a type that the agency determines do not threaten the health,
1716 safety, or security of patients. Upon finding an uncorrected or
1717 repeated class IV violation deficiency, the agency shall impose
1718 an administrative fine not to exceed $500 for each occurrence
1719 and each day that the uncorrected or repeated violation
1720 deficiency exists.
1721 (3) In addition to any other penalties imposed pursuant to
1722 this section or part, the agency may assess costs related to an
1723 investigation that results in a successful prosecution,
1724 excluding costs associated with an attorney’s time.
1725 Section 39. Section 400.487, Florida Statutes, is amended
1726 to read:
1727 400.487 Home health service agreements; physician’s,
1728 physician assistant’s, and advanced registered nurse
1729 practitioner’s treatment orders; patient assessment;
1730 establishment and review of plan of care; provision of services;
1731 orders not to resuscitate.—
1732 (1) Services provided by a home health agency must be
1733 covered by an agreement between the home health agency and the
1734 patient or the patient’s legal representative specifying the
1735 home health services to be provided, the rates or charges for
1736 services paid with private funds, and the sources of payment,
1737 which may include Medicare, Medicaid, private insurance,
1738 personal funds, or a combination thereof. The home health agency
1739 shall provide a copy of the agreement to the patient or the
1740 patient’s legal representative. A home health agency providing
1741 skilled care must make an assessment of the patient’s needs
1742 within 48 hours after the start of services.
1743 (2) When required by the provisions of chapter 464; part I,
1744 part III, or part V of chapter 468; or chapter 486, the
1745 attending physician, physician assistant, or advanced registered
1746 nurse practitioner, acting within his or her respective scope of
1747 practice, shall establish treatment orders for a patient who is
1748 to receive skilled care. The treatment orders must be signed by
1749 the physician, physician assistant, or advanced registered nurse
1750 practitioner before a claim for payment for the skilled services
1751 is submitted by the home health agency. If the claim is
1752 submitted to a managed care organization, the treatment orders
1753 must be signed within the time allowed under the provider
1754 agreement. The treatment orders shall be reviewed, as frequently
1755 as the patient’s illness requires, by the physician, physician
1756 assistant, or advanced registered nurse practitioner in
1757 consultation with the home health agency.
1758 (3) A home health agency shall arrange for supervisory
1759 visits by a registered nurse to the home of a patient receiving
1760 home health aide services as specified in subsection (9) in
1761 accordance with the patient’s direction, approval, and agreement
1762 to pay the charge for the visits.
1763 (4) The home health agency shall protect and promote the
1764 rights of each individual under its care, including each of the
1765 following rights:
1766 (a) Notice of rights.—The home health agency shall provide
1767 the patient with a written notice of the patient’s rights in
1768 advance of furnishing care to the patient or during the initial
1769 evaluation visit before the initiation of treatment. The home
1770 health agency must maintain documentation showing that it has
1771 complied with the requirements of this section.
1772 (b) Exercise of rights and respect for property and
1773 person.—
1774 1. The patient has the right to exercise his or her rights
1775 as a patient of the home health agency.
1776 2. The patient has the right to have his or her property
1777 treated with respect.
1778 3. The patient has the right to voice grievances regarding
1779 treatment or care that is or fails to be furnished, or regarding
1780 the lack of respect for property by anyone who is furnishing
1781 services on behalf of the home health agency, and not be
1782 subjected to discrimination or reprisal for doing so.
1783 4. The home health agency must investigate complaints made
1784 by a patient or the patient’s family or guardian regarding
1785 treatment or care that is or fails to be furnished, or regarding
1786 the lack of respect for the patient’s property by anyone
1787 furnishing services on behalf of the home health agency. The
1788 home health agency shall document the existence of the complaint
1789 and its resolution.
1790 5. The patient and his or her immediate family or
1791 representative must be informed of the right to report
1792 complaints via the statewide toll-free telephone number to the
1793 agency as required in s. 408.810.
1794 (c) Right to be informed and to participate in planning
1795 care and treatment.—
1796 1. The patient has the right to be informed, in advance,
1797 about the care to be furnished and of any changes in the care to
1798 be furnished. The home health agency shall advise the patient in
1799 advance of which disciplines will furnish care and the frequency
1800 of visits proposed to be furnished. The home health agency must
1801 advise the patient in advance of any change in the plan of care
1802 before the change is made.
1803 2. The patient has the right to participate in the planning
1804 of the care. The home health agency must advise the patient in
1805 advance of the right to participate in planning the care or
1806 treatment and in planning changes in the care or treatment. Each
1807 patient has the right to be informed of and to participate in
1808 the planning of his or her care. Each patient must be provided,
1809 upon request, a copy of the plan of care established and
1810 maintained for that patient by the home health agency.
1811 (5) When nursing services are ordered, the home health
1812 agency to which a patient has been admitted for care must
1813 provide the initial admission visit, all service evaluation
1814 visits, and the discharge visit by a direct employee. Services
1815 provided by others under contractual arrangements to a home
1816 health agency must be monitored and managed by the admitting
1817 home health agency. The admitting home health agency is fully
1818 responsible for ensuring that all care provided through its
1819 employees or contract staff is delivered in accordance with this
1820 part and applicable rules.
1821 (6) The skilled care services provided by a home health
1822 agency, directly or under contract, must be supervised and
1823 coordinated in accordance with the plan of care. The home health
1824 agency shall furnish skilled nursing services by or under the
1825 supervision of a registered nurse and in accordance with the
1826 plan of care. Any therapy services offered directly or under
1827 arrangement by the home health agency must be provided by a
1828 qualified therapist or by a qualified therapy assistant under
1829 the supervision of a qualified therapist and in accordance with
1830 the plan of care.
1831 (a) Duties and qualifications.—A qualified therapist shall
1832 assist the physician in evaluating the level of function, help
1833 develop or revise the plan of care, prepare clinical and
1834 progress notes, advise and consult with the family and other
1835 agency personnel, and participate in in-service programs. The
1836 therapist or therapy assistant must meet the qualifications in
1837 the state practice acts and related applicable rules.
1838 (b) Physical therapy assistants and occupational therapy
1839 assistants.—Services provided by a physical therapy assistant or
1840 occupational therapy assistant must be under the supervision of
1841 a qualified physical therapist or occupational therapist as
1842 required in chapter 486 and part III of chapter 468,
1843 respectively, and related applicable rules. A physical therapy
1844 assistant or occupational therapy assistant shall perform
1845 services planned, delegated, and supervised by the therapist,
1846 assist in preparing clinical notes and progress reports,
1847 participate in educating the patient and his or her family, and
1848 participate in in-service programs.
1849 (c) Speech therapy services.—Speech therapy services shall
1850 be furnished only by or under supervision of a qualified speech
1851 pathologist or audiologist as required in part I of chapter 468
1852 and related applicable rules.
1853 (d) Care follows a written plan of care.—The plan of care
1854 shall be reviewed by the physician or health professional who
1855 provided the treatment orders pursuant to subsection (2) and
1856 home health agency personnel as often as the severity of the
1857 patient’s condition requires, but at least once every 60 days or
1858 more when there is a beneficiary-elected transfer, a significant
1859 change in condition resulting in a change in the case-mix
1860 assignment, or a discharge and return to the same home health
1861 agency during the 60-day episode. Professional staff of a home
1862 health agency shall promptly alert the physician or other health
1863 professional who provided the treatment orders of any change
1864 that suggests a need to alter the plan of care.
1865 (e) Administration of drugs and treatment.—Only
1866 professional staff of a home health agency may administer drugs
1867 and treatments as ordered by the physician or health
1868 professional pursuant to subsection (2), with the exception of
1869 influenza and pneumococcal polysaccharide vaccines, which may be
1870 administered according to the policy of the home health agency
1871 developed in consultation with a physician and after an
1872 assessment for contraindications. The physician or health
1873 professional, as provided in subsection (2), shall put any
1874 verbal order in writing and sign and date it with the date of
1875 receipt by the registered nurse or qualified therapist who is
1876 responsible for furnishing or supervising the ordered service. A
1877 verbal order may be accepted only by personnel who are
1878 authorized to do so by applicable state laws, rules, and
1879 internal policies of the home health agency.
1880 (7) A registered nurse shall conduct the initial evaluation
1881 visit, regularly reevaluate the patient’s nursing needs,
1882 initiate the plan of care and necessary revisions, furnish those
1883 services requiring substantial and specialized nursing skill,
1884 initiate appropriate preventive and rehabilitative nursing
1885 procedures, prepare clinical and progress notes, coordinate
1886 services, inform the physician and other personnel of changes in
1887 the patient’s condition and needs, counsel the patient and his
1888 or her family in meeting nursing and related needs, participate
1889 in in-service programs, and supervise and teach other nursing
1890 personnel.
1891 (8) A licensed practical nurse shall furnish services in
1892 accordance with agency policies, prepare clinical and progress
1893 notes, assist the physician and registered nurse in performing
1894 specialized procedures, prepare equipment and materials for
1895 treatments observing aseptic technique as required, and assist
1896 the patient in learning appropriate self-care techniques.
1897 (9) A home health aide and certified nursing assistant
1898 shall provide services that are ordered by the physician in the
1899 plan of care and that the aide or assistant is permitted to
1900 perform under state law. The duties of a home health aide or
1901 certified nursing assistant include the provision of hands-on
1902 personal care, performance of simple procedures as an extension
1903 of therapy or nursing services, assistance in ambulation or
1904 exercises, and assistance in administering medications that are
1905 ordinarily self-administered and are specified in agency rules.
1906 Any services by a home health aide which are offered by a home
1907 health agency must be provided by a qualified home health aide
1908 or certified nursing assistant.
1909 (a) Assignment and duties.—A home health aide or certified
1910 nursing assistant shall be assigned to a specific patient by a
1911 registered nurse. Written patient care instructions for the home
1912 health aide and certified nursing assistant must be prepared by
1913 the registered nurse or other appropriate professional who is
1914 responsible for the supervision of the home health aide and
1915 certified nursing assistant as stated in this section.
1916 (b) Supervision.—If a patient receives skilled nursing
1917 care, the registered nurse shall perform the supervisory visit.
1918 If the patient is not receiving skilled nursing care but is
1919 receiving physical therapy, occupational therapy, or speech
1920 language pathology services, the appropriate therapist may
1921 provide the supervision. A registered nurse or other
1922 professional must make an onsite visit to the patient’s home at
1923 least once every 2 weeks. The visit is not required while the
1924 aide is providing care.
1925 (c) Supervising visits.—If home health aide services are
1926 provided to a patient who is not receiving skilled nursing care,
1927 physical or occupational therapy, or speech-language pathology
1928 services, a registered nurse must make a supervisory visit to
1929 the patient’s home at least once every 60 days. The registered
1930 nurse shall ensure that the aide is properly caring for the
1931 patient and each supervisory visit must occur while the home
1932 health aide is providing patient care.
1933 (10)(7) Home health agency personnel may withhold or
1934 withdraw cardiopulmonary resuscitation if presented with an
1935 order not to resuscitate executed pursuant to s. 401.45. The
1936 agency shall adopt rules providing for the implementation of
1937 such orders. Home health personnel and agencies shall not be
1938 subject to criminal prosecution or civil liability, nor be
1939 considered to have engaged in negligent or unprofessional
1940 conduct, for withholding or withdrawing cardiopulmonary
1941 resuscitation pursuant to such an order and rules adopted by the
1942 agency.
1943 Section 40. Subsections (1) and (4) of section 400.606,
1944 Florida Statutes, are amended to read:
1945 400.606 License; application; renewal; conditional license
1946 or permit; certificate of need.—
1947 (1) In addition to the requirements of part II of chapter
1948 408, the initial application and change of ownership application
1949 must be accompanied by a plan for the delivery of home,
1950 residential, and homelike inpatient hospice services to
1951 terminally ill persons and their families. Such plan must
1952 contain, but need not be limited to:
1953 (a) The estimated average number of terminally ill persons
1954 to be served monthly.
1955 (b) The geographic area in which hospice services will be
1956 available.
1957 (c) A listing of services which are or will be provided,
1958 either directly by the applicant or through contractual
1959 arrangements with existing providers.
1960 (d) Provisions for the implementation of hospice home care
1961 within 3 months after licensure.
1962 (e) Provisions for the implementation of hospice homelike
1963 inpatient care within 12 months after licensure.
1964 (f) The number and disciplines of professional staff to be
1965 employed.
1966 (g) The name and qualifications of any existing or
1967 potential contractee.
1968 (h) A plan for attracting and training volunteers.
1969 (i) The projected annual operating cost of the hospice.
1970
1971 If the applicant is an existing licensed health care provider,
1972 the application must be accompanied by a copy of the most recent
1973 profit-loss statement and, if applicable, the most recent
1974 licensure inspection report.
1975 (4) A freestanding hospice facility that is primarily
1976 engaged in providing inpatient and related services and that is
1977 not otherwise licensed as a health care facility shall be
1978 required to obtain a certificate of need. However, a
1979 freestanding hospice facility with six or fewer beds shall not
1980 be required to comply with institutional standards such as, but
1981 not limited to, standards requiring sprinkler systems, emergency
1982 electrical systems, or special lavatory devices.
1983 Section 41. Subsection (2) of section 400.607, Florida
1984 Statutes, is amended to read:
1985 400.607 Denial, suspension, revocation of license;
1986 emergency actions; imposition of administrative fine; grounds.—
1987 (2) A violation of the provisions of this part, part II of
1988 chapter 408, or applicable rules Any of the following actions by
1989 a licensed hospice or any of its employees shall be grounds for
1990 administrative action by the agency against a hospice.:
1991 (a) A violation of the provisions of this part, part II of
1992 chapter 408, or applicable rules.
1993 (b) An intentional or negligent act materially affecting
1994 the health or safety of a patient.
1995 Section 42. Subsection (1) of section 400.925, Florida
1996 Statutes, is amended to read:
1997 400.925 Definitions.—As used in this part, the term:
1998 (1) “Accrediting organizations” means the Joint Commission
1999 on Accreditation of Healthcare Organizations or other national
2000 accreditation agencies whose standards for accreditation are
2001 comparable to those required by this part for licensure.
2002 Section 43. Section 400.931, Florida Statutes, is amended
2003 to read:
2004 400.931 Application for license; fee; provisional license;
2005 temporary permit.—
2006 (1) In addition to the requirements of part II of chapter
2007 408, the applicant must file with the application satisfactory
2008 proof that the home medical equipment provider is in compliance
2009 with this part and applicable rules, including:
2010 (a) A report, by category, of the equipment to be provided,
2011 indicating those offered either directly by the applicant or
2012 through contractual arrangements with existing providers.
2013 Categories of equipment include:
2014 1. Respiratory modalities.
2015 2. Ambulation aids.
2016 3. Mobility aids.
2017 4. Sickroom setup.
2018 5. Disposables.
2019 (b) A report, by category, of the services to be provided,
2020 indicating those offered either directly by the applicant or
2021 through contractual arrangements with existing providers.
2022 Categories of services include:
2023 1. Intake.
2024 2. Equipment selection.
2025 3. Delivery.
2026 4. Setup and installation.
2027 5. Patient training.
2028 6. Ongoing service and maintenance.
2029 7. Retrieval.
2030 (c) A listing of those with whom the applicant contracts,
2031 both the providers the applicant uses to provide equipment or
2032 services to its consumers and the providers for whom the
2033 applicant provides services or equipment.
2034 (2) As an alternative to submitting proof of financial
2035 ability to operate as required in s. 408.810(8), the applicant
2036 may submit a $50,000 surety bond to the agency.
2037 (2)(3) As specified in part II of chapter 408, the home
2038 medical equipment provider must also obtain and maintain
2039 professional and commercial liability insurance. Proof of
2040 liability insurance, as defined in s. 624.605, must be submitted
2041 with the application. The agency shall set the required amounts
2042 of liability insurance by rule, but the required amount must not
2043 be less than $250,000 per claim. In the case of contracted
2044 services, it is required that the contractor have liability
2045 insurance not less than $250,000 per claim.
2046 (3)(4) When a change of the general manager of a home
2047 medical equipment provider occurs, the licensee must notify the
2048 agency of the change within 45 days.
2049 (4)(5) In accordance with s. 408.805, an applicant or a
2050 licensee shall pay a fee for each license application submitted
2051 under this part, part II of chapter 408, and applicable rules.
2052 The amount of the fee shall be established by rule and may not
2053 exceed $300 per biennium. The agency shall set the fees in an
2054 amount that is sufficient to cover its costs in carrying out its
2055 responsibilities under this part. However, state, county, or
2056 municipal governments applying for licenses under this part are
2057 exempt from the payment of license fees.
2058 (5)(6) An applicant for initial licensure, renewal, or
2059 change of ownership shall also pay an inspection fee not to
2060 exceed $400, which shall be paid by all applicants except those
2061 not subject to licensure inspection by the agency as described
2062 in s. 400.933.
2063 Section 44. Subsection (2) of section 400.932, Florida
2064 Statutes, is amended to read:
2065 400.932 Administrative penalties.—
2066 (2) A violation of this part, part II of chapter 408, or
2067 applicable rules Any of the following actions by an employee of
2068 a home medical equipment provider are grounds for administrative
2069 action or penalties by the agency.:
2070 (a) Violation of this part, part II of chapter 408, or
2071 applicable rules.
2072 (b) An intentional, reckless, or negligent act that
2073 materially affects the health or safety of a patient.
2074 Section 45. Subsection (2) of section 400.933, Florida
2075 Statutes, is amended to read:
2076 400.933 Licensure inspections and investigations.—
2077 (2) The agency shall accept, in lieu of its own periodic
2078 inspections for licensure, submission of the following:
2079 (a) The survey or inspection of an accrediting
2080 organization, provided the accreditation of the licensed home
2081 medical equipment provider is not conditional or provisional and
2082 provided the licensed home medical equipment provider authorizes
2083 release of, and the agency receives the report of, the
2084 accrediting organization; or
2085 (b) A copy of a valid medical oxygen retail establishment
2086 permit issued by the Department of Health, pursuant to chapter
2087 499.
2088 Section 46. Subsection (2) of section 400.953, Florida
2089 Statutes, is amended to read:
2090 400.953 Background screening of home medical equipment
2091 provider personnel.—The agency shall require employment
2092 screening as provided in chapter 435, using the level 1
2093 standards for screening set forth in that chapter, for home
2094 medical equipment provider personnel.
2095 (2) The general manager of each home medical equipment
2096 provider must sign an affidavit annually, under penalty of
2097 perjury, stating that all home medical equipment provider
2098 personnel hired on or after July 1, 1999, who enter the home of
2099 a patient in the capacity of their employment have been screened
2100 and that its remaining personnel have worked for the home
2101 medical equipment provider continuously since before July 1,
2102 1999. This attestation must be submitted in accordance with s.
2103 408.809(6).
2104 Section 47. Section 400.967, Florida Statutes, is amended
2105 to read:
2106 400.967 Rules and classification of violations
2107 deficiencies.—
2108 (1) It is the intent of the Legislature that rules adopted
2109 and enforced under this part and part II of chapter 408 include
2110 criteria by which a reasonable and consistent quality of
2111 resident care may be ensured, the results of such resident care
2112 can be demonstrated, and safe and sanitary facilities can be
2113 provided.
2114 (2) Pursuant to the intention of the Legislature, the
2115 agency, in consultation with the Agency for Persons with
2116 Disabilities and the Department of Elderly Affairs, shall adopt
2117 and enforce rules to administer this part and part II of chapter
2118 408, which shall include reasonable and fair criteria governing:
2119 (a) The location and construction of the facility;
2120 including fire and life safety, plumbing, heating, cooling,
2121 lighting, ventilation, and other housing conditions that will
2122 ensure the health, safety, and comfort of residents. The agency
2123 shall establish standards for facilities and equipment to
2124 increase the extent to which new facilities and a new wing or
2125 floor added to an existing facility after July 1, 2000, are
2126 structurally capable of serving as shelters only for residents,
2127 staff, and families of residents and staff, and equipped to be
2128 self-supporting during and immediately following disasters. The
2129 Agency for Health Care Administration shall work with facilities
2130 licensed under this part and report to the Governor and the
2131 Legislature by April 1, 2000, its recommendations for cost
2132 effective renovation standards to be applied to existing
2133 facilities. In making such rules, the agency shall be guided by
2134 criteria recommended by nationally recognized, reputable
2135 professional groups and associations having knowledge concerning
2136 such subject matters. The agency shall update or revise such
2137 criteria as the need arises. All facilities must comply with
2138 those lifesafety code requirements and building code standards
2139 applicable at the time of approval of their construction plans.
2140 The agency may require alterations to a building if it
2141 determines that an existing condition constitutes a distinct
2142 hazard to life, health, or safety. The agency shall adopt fair
2143 and reasonable rules setting forth conditions under which
2144 existing facilities undergoing additions, alterations,
2145 conversions, renovations, or repairs are required to comply with
2146 the most recent updated or revised standards.
2147 (b) The number and qualifications of all personnel,
2148 including management, medical nursing, and other personnel,
2149 having responsibility for any part of the care given to
2150 residents.
2151 (c) All sanitary conditions within the facility and its
2152 surroundings, including water supply, sewage disposal, food
2153 handling, and general hygiene, which will ensure the health and
2154 comfort of residents.
2155 (d) The equipment essential to the health and welfare of
2156 the residents.
2157 (e) A uniform accounting system.
2158 (f) The care, treatment, and maintenance of residents and
2159 measurement of the quality and adequacy thereof.
2160 (g) The preparation and annual update of a comprehensive
2161 emergency management plan. The agency shall adopt rules
2162 establishing minimum criteria for the plan after consultation
2163 with the Department of Community Affairs. At a minimum, the
2164 rules must provide for plan components that address emergency
2165 evacuation transportation; adequate sheltering arrangements;
2166 postdisaster activities, including emergency power, food, and
2167 water; postdisaster transportation; supplies; staffing;
2168 emergency equipment; individual identification of residents and
2169 transfer of records; and responding to family inquiries. The
2170 comprehensive emergency management plan is subject to review and
2171 approval by the local emergency management agency. During its
2172 review, the local emergency management agency shall ensure that
2173 the following agencies, at a minimum, are given the opportunity
2174 to review the plan: the Department of Elderly Affairs, the
2175 Agency for Persons with Disabilities, the Agency for Health Care
2176 Administration, and the Department of Community Affairs. Also,
2177 appropriate volunteer organizations must be given the
2178 opportunity to review the plan. The local emergency management
2179 agency shall complete its review within 60 days and either
2180 approve the plan or advise the facility of necessary revisions.
2181 (h) The use of restraint and seclusion. Such rules must be
2182 consistent with recognized best practices; prohibit inherently
2183 dangerous restraint or seclusion procedures; establish
2184 limitations on the use and duration of restraint and seclusion;
2185 establish measures to ensure the safety of clients and staff
2186 during an incident of restraint or seclusion; establish
2187 procedures for staff to follow before, during, and after
2188 incidents of restraint or seclusion, including individualized
2189 plans for the use of restraints or seclusion in emergency
2190 situations; establish professional qualifications of and
2191 training for staff who may order or be engaged in the use of
2192 restraint or seclusion; establish requirements for facility data
2193 collection and reporting relating to the use of restraint and
2194 seclusion; and establish procedures relating to the
2195 documentation of the use of restraint or seclusion in the
2196 client’s facility or program record.
2197 (3) The agency shall adopt rules to provide that, when the
2198 criteria established under this part and part II of chapter 408
2199 are not met, such violations deficiencies shall be classified
2200 according to the nature of the violation deficiency. The agency
2201 shall indicate the classification on the face of the notice of
2202 violations deficiencies as follows:
2203 (a) Class I violations deficiencies are defined in s.
2204 408.813. those which the agency determines present an imminent
2205 danger to the residents or guests of the facility or a
2206 substantial probability that death or serious physical harm
2207 would result therefrom. The condition or practice constituting a
2208 class I violation must be abated or eliminated immediately,
2209 unless a fixed period of time, as determined by the agency, is
2210 required for correction. A class I violation deficiency is
2211 subject to a civil penalty in an amount not less than $5,000 and
2212 not exceeding $10,000 for each violation deficiency. A fine may
2213 be levied notwithstanding the correction of the violation
2214 deficiency.
2215 (b) Class II violations deficiencies are defined in s.
2216 408.813. those which the agency determines have a direct or
2217 immediate relationship to the health, safety, or security of the
2218 facility residents, other than class I deficiencies. A class II
2219 violation deficiency is subject to a civil penalty in an amount
2220 not less than $1,000 and not exceeding $5,000 for each
2221 deficiency. A citation for a class II violation deficiency shall
2222 specify the time within which the violation deficiency must be
2223 corrected. If a class II violation deficiency is corrected
2224 within the time specified, no civil penalty shall be imposed,
2225 unless it is a repeated offense.
2226 (c) Class III violations deficiencies are defined in s.
2227 408.813. those which the agency determines to have an indirect
2228 or potential relationship to the health, safety, or security of
2229 the facility residents, other than class I or class II
2230 deficiencies. A class III violation deficiency is subject to a
2231 civil penalty of not less than $500 and not exceeding $1,000 for
2232 each violation deficiency. A citation for a class III violation
2233 deficiency shall specify the time within which the violation
2234 deficiency must be corrected. If a class III violation
2235 deficiency is corrected within the time specified, no civil
2236 penalty shall be imposed, unless it is a repeated offense.
2237 (d) Class IV violations are defined in s. 408.813.
2238 (4) The agency shall approve or disapprove the plans and
2239 specifications within 60 days after receipt of the final plans
2240 and specifications. The agency may be granted one 15-day
2241 extension for the review period, if the secretary of the agency
2242 so approves. If the agency fails to act within the specified
2243 time, it is deemed to have approved the plans and
2244 specifications. When the agency disapproves plans and
2245 specifications, it must set forth in writing the reasons for
2246 disapproval. Conferences and consultations may be provided as
2247 necessary.
2248 (5) The agency may charge an initial fee of $2,000 for
2249 review of plans and construction on all projects, no part of
2250 which is refundable. The agency may also collect a fee, not to
2251 exceed 1 percent of the estimated construction cost or the
2252 actual cost of review, whichever is less, for the portion of the
2253 review which encompasses initial review through the initial
2254 revised construction document review. The agency may collect its
2255 actual costs on all subsequent portions of the review and
2256 construction inspections. Initial fee payment must accompany the
2257 initial submission of plans and specifications. Any subsequent
2258 payment that is due is payable upon receipt of the invoice from
2259 the agency. Notwithstanding any other provision of law, all
2260 money received by the agency under this section shall be deemed
2261 to be trust funds, to be held and applied solely for the
2262 operations required under this section.
2263 Section 48. Subsection (1) of section 400.969, Florida
2264 Statutes, is amended to read:
2265 400.969 Violation of part; penalties.—
2266 (1) In addition to the requirements of part II of chapter
2267 408, and except as provided in s. 400.967(3), a violation of any
2268 provision of federal certification required pursuant to
2269 400.960(8), this part, part II of chapter 408, or applicable
2270 rules is punishable by payment of an administrative or civil
2271 penalty not to exceed $5,000.
2272 Section 49. Subsection (7) of section 400.9905, Florida
2273 Statutes, is amended to read:
2274 400.9905 Definitions.—
2275 (7) “Portable service or equipment provider” means an
2276 entity that contracts with or employs persons to provide
2277 portable service or equipment to multiple locations which
2278 performing treatment or diagnostic testing of individuals, that
2279 bills third-party payors for those services, and that otherwise
2280 meets the definition of a clinic in subsection (4).
2281 Section 50. Subsections (1) and (4) of section 400.991,
2282 Florida Statutes, are amended to read:
2283 400.991 License requirements; background screenings;
2284 prohibitions.—
2285 (1)(a) The requirements of part II of chapter 408 apply to
2286 the provision of services that require licensure pursuant to
2287 this part and part II of chapter 408 and to entities licensed by
2288 or applying for such licensure from the agency pursuant to this
2289 part. A license issued by the agency is required in order to
2290 operate a clinic in this state. Each clinic location shall be
2291 licensed separately regardless of whether the clinic is operated
2292 under the same business name or management as another clinic.
2293 (b) Each mobile clinic must obtain a separate health care
2294 clinic license and must provide to the agency, at least
2295 quarterly, its projected street location to enable the agency to
2296 locate and inspect such clinic. A portable equipment and health
2297 services provider must obtain a health care clinic license for a
2298 single administrative office and is not required to submit
2299 quarterly projected street locations.
2300 (4) In addition to the requirements of part II of chapter
2301 408, the applicant must file with the application satisfactory
2302 proof that the clinic is in compliance with this part and
2303 applicable rules, including:
2304 (a) A listing of services to be provided either directly by
2305 the applicant or through contractual arrangements with existing
2306 providers;
2307 (b) The number and discipline of each professional staff
2308 member to be employed; and
2309 (c) Proof of financial ability to operate as required under
2310 ss. 408.810(8) and 408.8065 s. 408.810(8). As an alternative to
2311 submitting proof of financial ability to operate as required
2312 under s. 408.810(8), the applicant may file a surety bond of at
2313 least $500,000 which guarantees that the clinic will act in full
2314 conformity with all legal requirements for operating a clinic,
2315 payable to the agency. The agency may adopt rules to specify
2316 related requirements for such surety bond.
2317 Section 51. Paragraph (g) of subsection (1) and paragraph
2318 (a) of subsection (7) of section 400.9935, Florida Statutes, are
2319 amended to read:
2320 400.9935 Clinic responsibilities.—
2321 (1) Each clinic shall appoint a medical director or clinic
2322 director who shall agree in writing to accept legal
2323 responsibility for the following activities on behalf of the
2324 clinic. The medical director or the clinic director shall:
2325 (g) Conduct systematic reviews of clinic billings to ensure
2326 that the billings are not fraudulent or unlawful. Upon discovery
2327 of an unlawful charge, the medical director or clinic director
2328 shall take immediate corrective action. If the clinic performs
2329 only the technical component of magnetic resonance imaging,
2330 static radiographs, computed tomography, or positron emission
2331 tomography, and provides the professional interpretation of such
2332 services, in a fixed facility that is accredited by the Joint
2333 Commission on Accreditation of Healthcare Organizations or the
2334 Accreditation Association for Ambulatory Health Care, and the
2335 American College of Radiology; and if, in the preceding quarter,
2336 the percentage of scans performed by that clinic which was
2337 billed to all personal injury protection insurance carriers was
2338 less than 15 percent, the chief financial officer of the clinic
2339 may, in a written acknowledgment provided to the agency, assume
2340 the responsibility for the conduct of the systematic reviews of
2341 clinic billings to ensure that the billings are not fraudulent
2342 or unlawful.
2343 (7)(a) Each clinic engaged in magnetic resonance imaging
2344 services must be accredited by the Joint Commission on
2345 Accreditation of Healthcare Organizations, the American College
2346 of Radiology, or the Accreditation Association for Ambulatory
2347 Health Care, within 1 year after licensure. A clinic that is
2348 accredited by the American College of Radiology or is within the
2349 original 1-year period after licensure and replaces its core
2350 magnetic resonance imaging equipment shall be given 1 year after
2351 the date on which the equipment is replaced to attain
2352 accreditation. However, a clinic may request a single, 6-month
2353 extension if it provides evidence to the agency establishing
2354 that, for good cause shown, such clinic cannot be accredited
2355 within 1 year after licensure, and that such accreditation will
2356 be completed within the 6-month extension. After obtaining
2357 accreditation as required by this subsection, each such clinic
2358 must maintain accreditation as a condition of renewal of its
2359 license. A clinic that files a change of ownership application
2360 must comply with the original accreditation timeframe
2361 requirements of the transferor. The agency shall deny a change
2362 of ownership application if the clinic is not in compliance with
2363 the accreditation requirements. When a clinic adds, replaces, or
2364 modifies magnetic resonance imaging equipment and the
2365 accreditation agency requires new accreditation, the clinic must
2366 be accredited within 1 year after the date of the addition,
2367 replacement, or modification but may request a single, 6-month
2368 extension if the clinic provides evidence of good cause to the
2369 agency.
2370 Section 52. Subsection (2) of section 408.034, Florida
2371 Statutes, is amended to read:
2372 408.034 Duties and responsibilities of agency; rules.—
2373 (2) In the exercise of its authority to issue licenses to
2374 health care facilities and health service providers, as provided
2375 under chapters 393 and 395 and parts II, and IV, and VIII of
2376 chapter 400, the agency may not issue a license to any health
2377 care facility or health service provider that fails to receive a
2378 certificate of need or an exemption for the licensed facility or
2379 service.
2380 Section 53. Paragraph (d) of subsection (1) of section
2381 408.036, Florida Statutes, is amended to read:
2382 408.036 Projects subject to review; exemptions.—
2383 (1) APPLICABILITY.—Unless exempt under subsection (3), all
2384 health-care-related projects, as described in paragraphs (a)
2385 (g), are subject to review and must file an application for a
2386 certificate of need with the agency. The agency is exclusively
2387 responsible for determining whether a health-care-related
2388 project is subject to review under ss. 408.031-408.045.
2389 (d) The establishment of a hospice or hospice inpatient
2390 facility, except as provided in s. 408.043.
2391 Section 54. Subsection (2) of section 408.043, Florida
2392 Statutes, is amended to read:
2393 408.043 Special provisions.—
2394 (2) HOSPICES.—When an application is made for a certificate
2395 of need to establish or to expand a hospice, the need for such
2396 hospice shall be determined on the basis of the need for and
2397 availability of hospice services in the community. The formula
2398 on which the certificate of need is based shall discourage
2399 regional monopolies and promote competition. The inpatient
2400 hospice care component of a hospice which is a freestanding
2401 facility, or a part of a facility, which is primarily engaged in
2402 providing inpatient care and related services and is not
2403 licensed as a health care facility shall also be required to
2404 obtain a certificate of need. Provision of hospice care by any
2405 current provider of health care is a significant change in
2406 service and therefore requires a certificate of need for such
2407 services.
2408 Section 55. Paragraph (k) of subsection (3) of section
2409 408.05, Florida Statutes, is amended to read:
2410 408.05 Florida Center for Health Information and Policy
2411 Analysis.—
2412 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
2413 produce comparable and uniform health information and statistics
2414 for the development of policy recommendations, the agency shall
2415 perform the following functions:
2416 (k) Develop, in conjunction with the State Consumer Health
2417 Information and Policy Advisory Council, and implement a long
2418 range plan for making available health care quality measures and
2419 financial data that will allow consumers to compare health care
2420 services. The health care quality measures and financial data
2421 the agency must make available shall include, but is not limited
2422 to, pharmaceuticals, physicians, health care facilities, and
2423 health plans and managed care entities. The agency shall submit
2424 the initial plan to the Governor, the President of the Senate,
2425 and the Speaker of the House of Representatives by January 1,
2426 2006, and shall update the plan and report on the status of its
2427 implementation annually thereafter. The agency shall also make
2428 the plan and status report available to the public on its
2429 Internet website. As part of the plan, the agency shall identify
2430 the process and timeframes for implementation, any barriers to
2431 implementation, and recommendations of changes in the law that
2432 may be enacted by the Legislature to eliminate the barriers. As
2433 preliminary elements of the plan, the agency shall:
2434 1. Make available patient-safety indicators, inpatient
2435 quality indicators, and performance outcome and patient charge
2436 data collected from health care facilities pursuant to s.
2437 408.061(1)(a) and (2). The terms “patient-safety indicators” and
2438 “inpatient quality indicators” shall be as defined by the
2439 Centers for Medicare and Medicaid Services, the National Quality
2440 Forum, the Joint Commission on Accreditation of Healthcare
2441 Organizations, the Agency for Healthcare Research and Quality,
2442 the Centers for Disease Control and Prevention, or a similar
2443 national entity that establishes standards to measure the
2444 performance of health care providers, or by other states. The
2445 agency shall determine which conditions, procedures, health care
2446 quality measures, and patient charge data to disclose based upon
2447 input from the council. When determining which conditions and
2448 procedures are to be disclosed, the council and the agency shall
2449 consider variation in costs, variation in outcomes, and
2450 magnitude of variations and other relevant information. When
2451 determining which health care quality measures to disclose, the
2452 agency:
2453 a. Shall consider such factors as volume of cases; average
2454 patient charges; average length of stay; complication rates;
2455 mortality rates; and infection rates, among others, which shall
2456 be adjusted for case mix and severity, if applicable.
2457 b. May consider such additional measures that are adopted
2458 by the Centers for Medicare and Medicaid Studies, National
2459 Quality Forum, the Joint Commission on Accreditation of
2460 Healthcare Organizations, the Agency for Healthcare Research and
2461 Quality, Centers for Disease Control and Prevention, or a
2462 similar national entity that establishes standards to measure
2463 the performance of health care providers, or by other states.
2464
2465 When determining which patient charge data to disclose, the
2466 agency shall include such measures as the average of
2467 undiscounted charges on frequently performed procedures and
2468 preventive diagnostic procedures, the range of procedure charges
2469 from highest to lowest, average net revenue per adjusted patient
2470 day, average cost per adjusted patient day, and average cost per
2471 admission, among others.
2472 2. Make available performance measures, benefit design, and
2473 premium cost data from health plans licensed pursuant to chapter
2474 627 or chapter 641. The agency shall determine which health care
2475 quality measures and member and subscriber cost data to
2476 disclose, based upon input from the council. When determining
2477 which data to disclose, the agency shall consider information
2478 that may be required by either individual or group purchasers to
2479 assess the value of the product, which may include membership
2480 satisfaction, quality of care, current enrollment or membership,
2481 coverage areas, accreditation status, premium costs, plan costs,
2482 premium increases, range of benefits, copayments and
2483 deductibles, accuracy and speed of claims payment, credentials
2484 of physicians, number of providers, names of network providers,
2485 and hospitals in the network. Health plans shall make available
2486 to the agency any such data or information that is not currently
2487 reported to the agency or the office.
2488 3. Determine the method and format for public disclosure of
2489 data reported pursuant to this paragraph. The agency shall make
2490 its determination based upon input from the State Consumer
2491 Health Information and Policy Advisory Council. At a minimum,
2492 the data shall be made available on the agency’s Internet
2493 website in a manner that allows consumers to conduct an
2494 interactive search that allows them to view and compare the
2495 information for specific providers. The website must include
2496 such additional information as is determined necessary to ensure
2497 that the website enhances informed decisionmaking among
2498 consumers and health care purchasers, which shall include, at a
2499 minimum, appropriate guidance on how to use the data and an
2500 explanation of why the data may vary from provider to provider.
2501 The data specified in subparagraph 1. shall be released no later
2502 than January 1, 2006, for the reporting of infection rates, and
2503 no later than October 1, 2005, for mortality rates and
2504 complication rates. The data specified in subparagraph 2. shall
2505 be released no later than October 1, 2006.
2506 4. Publish on its website undiscounted charges for no fewer
2507 than 150 of the most commonly performed adult and pediatric
2508 procedures, including outpatient, inpatient, diagnostic, and
2509 preventative procedures.
2510 Section 56. Paragraph (a) of subsection (1) of section
2511 408.061, Florida Statutes, is amended to read:
2512 408.061 Data collection; uniform systems of financial
2513 reporting; information relating to physician charges;
2514 confidential information; immunity.—
2515 (1) The agency shall require the submission by health care
2516 facilities, health care providers, and health insurers of data
2517 necessary to carry out the agency’s duties. Specifications for
2518 data to be collected under this section shall be developed by
2519 the agency with the assistance of technical advisory panels
2520 including representatives of affected entities, consumers,
2521 purchasers, and such other interested parties as may be
2522 determined by the agency.
2523 (a) Data submitted by health care facilities, including the
2524 facilities as defined in chapter 395, shall include, but are not
2525 limited to: case-mix data, patient admission and discharge data,
2526 hospital emergency department data which shall include the
2527 number of patients treated in the emergency department of a
2528 licensed hospital reported by patient acuity level, data on
2529 hospital-acquired infections as specified by rule, data on
2530 complications as specified by rule, data on readmissions as
2531 specified by rule, with patient and provider-specific
2532 identifiers included, actual charge data by diagnostic groups,
2533 financial data, accounting data, operating expenses, expenses
2534 incurred for rendering services to patients who cannot or do not
2535 pay, interest charges, depreciation expenses based on the
2536 expected useful life of the property and equipment involved, and
2537 demographic data. The agency shall adopt nationally recognized
2538 risk adjustment methodologies or software consistent with the
2539 standards of the Agency for Healthcare Research and Quality and
2540 as selected by the agency for all data submitted as required by
2541 this section. Data may be obtained from documents such as, but
2542 not limited to: leases, contracts, debt instruments, itemized
2543 patient bills, medical record abstracts, and related diagnostic
2544 information. Reported data elements shall be reported
2545 electronically and in accordance with rule 59E-7.012, Florida
2546 Administrative Code. Data submitted shall be certified by the
2547 chief executive officer or an appropriate and duly authorized
2548 representative or employee of the licensed facility that the
2549 information submitted is true and accurate.
2550 Section 57. Subsection (1) of section 408.10, Florida
2551 Statutes, is amended to read:
2552 408.10 Consumer complaints.—The agency shall:
2553 (1) Publish and make available to the public a toll-free
2554 telephone number for the purpose of handling consumer complaints
2555 and shall serve as a liaison between consumer entities and other
2556 private entities and governmental entities for the disposition
2557 of problems identified by consumers of health care. The agency
2558 may provide staffing for this toll-free number through agency
2559 staff or other arrangements.
2560 Section 58. Subsection (11) of section 408.802, Florida
2561 Statutes, is repealed.
2562 Section 59. Effective October 1, 2010, subsection (3) is
2563 added to section 408.804, Florida Statutes, to read:
2564 408.804 License required; display.—
2565 (3) Any person who knowingly alters, defaces, or falsifies
2566 any license certificate issued by the agency, or causes or
2567 procures any person to commit such an offense, commits a
2568 misdemeanor of the second degree, punishable as provided in s.
2569 775.082 or s. 775.083. Any licensee or provider who displays an
2570 altered, defaced, or falsified license certificate is subject to
2571 the penalties set forth in s. 408.815 and an administrative fine
2572 of $1,000 for each day of illegal display.
2573 Section 60. Paragraph (d) of subsection (2) of section
2574 408.806, Florida Statutes, is amended to read:
2575 408.806 License application process.—
2576 (2)(d) The agency shall notify the licensee by mail or
2577 electronically at least 90 days before the expiration of a
2578 license that a renewal license is necessary to continue
2579 operation. The licensee’s failure to timely file submit a
2580 renewal application and license application fee with the agency
2581 shall result in a $50 per day late fee charged to the licensee
2582 by the agency; however, the aggregate amount of the late fee may
2583 not exceed 50 percent of the licensure fee or $500, whichever is
2584 less. The agency shall provide a courtesy notice to the licensee
2585 by United States mail, electronically, or by any other manner at
2586 its address of record at least 90 days before the expiration of
2587 a license informing the licensee of the expiration of the
2588 license. Any failure of the agency to provide the courtesy
2589 notice or any failure of the licensee to receive the courtesy
2590 notice does not excuse the licensee from the legal obligation to
2591 timely file the renewal application and license application fee
2592 with the agency and does not mitigate the late fee. Payment of
2593 the late fee is required in order for any late application to be
2594 complete, and failure to pay the late fee is an omission from
2595 the application. If an application is received after the
2596 required filing date and exhibits a hand-canceled postmark
2597 obtained from a United States post office dated on or before the
2598 required filing date, no fine will be levied.
2599 Section 61. Subsections (6) and (9) of section 408.810,
2600 Florida Statutes, are amended to read:
2601 408.810 Minimum licensure requirements.—In addition to the
2602 licensure requirements specified in this part, authorizing
2603 statutes, and applicable rules, each applicant and licensee must
2604 comply with the requirements of this section in order to obtain
2605 and maintain a license.
2606 (6)(a) An applicant must provide the agency with proof of
2607 the applicant’s legal right to occupy the property before a
2608 license may be issued. Proof may include, but need not be
2609 limited to, copies of warranty deeds, lease or rental
2610 agreements, contracts for deeds, quitclaim deeds, or other such
2611 documentation.
2612 (b) If the property is encumbered by a mortgage or is
2613 leased, an applicant must provide the agency with proof that the
2614 mortgagor or landlord has received written notice of the
2615 applicant’s intent as mortgagee or tenant to provide services
2616 that require licensure and instructions that the agency be
2617 served by certified mail with copies of any actions initiated by
2618 the mortgagor or landlord against applicant.
2619 (9) A controlling interest may not withhold from the agency
2620 any evidence of financial instability, including, but not
2621 limited to, checks returned due to insufficient funds,
2622 delinquent accounts, nonpayment of withholding taxes, unpaid
2623 utility expenses, nonpayment for essential services, or adverse
2624 court action concerning the financial viability of the provider
2625 or any other provider licensed under this part that is under the
2626 control of the controlling interest. A controlling interest
2627 shall notify the agency within 10 days after a court action,
2628 including, but not limited to, the initiation of bankruptcy
2629 proceedings, foreclosure, or eviction proceedings, in which the
2630 controlling interest is a petitioner or defendant. Any person
2631 who violates this subsection commits a misdemeanor of the second
2632 degree, punishable as provided in s. 775.082 or s. 775.083. Each
2633 day of continuing violation is a separate offense.
2634 Section 62. Paragraph (a) of subsection (6) of section
2635 408.811, Florida Statutes, is amended to read:
2636 408.811 Right of inspection; copies; inspection reports;
2637 plan for correction of deficiencies.—
2638 (6)(a) Each licensee shall maintain as public information,
2639 available upon request, records of all inspection reports
2640 pertaining to that provider that have been filed by the agency
2641 unless those reports are exempt from or contain information that
2642 is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
2643 Constitution or is otherwise made confidential by law. Effective
2644 October 1, 2006, copies of such reports shall be retained in the
2645 records of the provider for at least 3 years following the date
2646 the reports are filed and issued, regardless of a change of
2647 ownership. The inspection report is not subject to challenge
2648 under s. 120.569 or s. 120.57.
2649 Section 63. Subsection (2) of section 408.813, Florida
2650 Statutes, is amended to read:
2651 408.813 Administrative fines; violations.—As a penalty for
2652 any violation of this part, authorizing statutes, or applicable
2653 rules, the agency may impose an administrative fine.
2654 (2)(a) Violations of this part, authorizing statutes, or
2655 applicable rules shall be classified according to the nature of
2656 the violation and the gravity of its probable effect on clients.
2657 The scope of a violation may be cited as an isolated, patterned,
2658 or widespread deficiency. An isolated deficiency is a deficiency
2659 affecting one or a very limited number of clients, or involving
2660 one or a very limited number of staff, or a situation that
2661 occurred only occasionally or in a very limited number of
2662 locations. A patterned deficiency is a deficiency in which more
2663 than a very limited number of clients are affected, or more than
2664 a very limited number of staff are involved, or the situation
2665 has occurred in several locations, or the same client or clients
2666 have been affected by repeated occurrences of the same deficient
2667 practice but the effect of the deficient practice is not found
2668 to be pervasive throughout the provider. A widespread deficiency
2669 is a deficiency in which the problems causing the deficiency are
2670 pervasive in the provider or represent systemic failure that has
2671 affected or has the potential to affect a large portion of the
2672 provider’s clients. This subsection does not affect the
2673 legislative determination of the amount of a fine imposed under
2674 authorizing statutes. Violations shall be classified on the
2675 written notice as follows:
2676 1.(a) Class “I” violations are those conditions or
2677 occurrences related to the operation and maintenance of a
2678 provider or to the care of clients which the agency determines
2679 present an imminent danger to the clients of the provider or a
2680 substantial probability that death or serious physical or
2681 emotional harm would result therefrom. The condition or practice
2682 constituting a class I violation shall be abated or eliminated
2683 within 24 hours, unless a fixed period, as determined by the
2684 agency, is required for correction. The agency shall impose an
2685 administrative fine as provided by law for a cited class I
2686 violation. A fine shall be levied notwithstanding the correction
2687 of the violation.
2688 2.(b) Class “II” violations are those conditions or
2689 occurrences related to the operation and maintenance of a
2690 provider or to the care of clients which the agency determines
2691 directly threaten the physical or emotional health, safety, or
2692 security of the clients, other than class I violations. The
2693 agency shall impose an administrative fine as provided by law
2694 for a cited class II violation. A fine shall be levied
2695 notwithstanding the correction of the violation.
2696 3.(c) Class “III” violations are those conditions or
2697 occurrences related to the operation and maintenance of a
2698 provider or to the care of clients which the agency determines
2699 indirectly or potentially threaten the physical or emotional
2700 health, safety, or security of clients, other than class I or
2701 class II violations. The agency shall impose an administrative
2702 fine as provided in this section for a cited class III
2703 violation. A citation for a class III violation must specify the
2704 time within which the violation is required to be corrected. If
2705 a class III violation is corrected within the time specified, a
2706 fine may not be imposed.
2707 4.(d) Class “IV” violations are those conditions or
2708 occurrences related to the operation and maintenance of a
2709 provider or to required reports, forms, or documents that do not
2710 have the potential of negatively affecting clients. These
2711 violations are of a type that the agency determines do not
2712 threaten the health, safety, or security of clients. The agency
2713 shall impose an administrative fine as provided in this section
2714 for a cited class IV violation. A citation for a class IV
2715 violation must specify the time within which the violation is
2716 required to be corrected. If a class IV violation is corrected
2717 within the time specified, a fine may not be imposed.
2718 (b) The agency may impose an administrative fine for
2719 violations that do not qualify as class I, class II, class III,
2720 or class IV violations. The amount of the fine may not exceed
2721 $500 for each violation. Unclassified violations may include:
2722 1. Violating any term or condition of a license.
2723 2. Violating any provision of this part, authorizing
2724 statutes, or applicable rules.
2725 3. Exceeding licensed capacity without authorization.
2726 4. Providing services beyond the scope of the license.
2727 5. Violating a moratorium.
2728 Section 64. Subsection (5) is added to section 408.815,
2729 Florida Statutes, to read:
2730 408.815 License or application denial; revocation.—
2731 (5) In order to ensure the health, safety, and welfare of
2732 clients where a license has been denied, revoked, or is set to
2733 terminate, the agency may extend the license expiration date for
2734 up to 60 days after denial, revocation, or termination the sole
2735 purpose of allowing the safe and orderly discharge of clients.
2736 The agency may impose conditions on the extension, including,
2737 but not limited to, prohibiting or limiting admissions,
2738 expediting discharge planning, submitting required status
2739 reports, and mandatory monitoring by the agency or third
2740 parties. The agency may terminate the extension or modify the
2741 conditions at any time at its discretion. Upon the discharge of
2742 the final client, the extension shall immediately terminate and
2743 the provider shall cease operation and promptly surrender its
2744 license certificate to the agency. During the extension, the
2745 provider must continue to meet all other requirements of this
2746 part, authorizing statutes, and applicable rules. This authority
2747 is in addition to any other authority granted to the agency
2748 under chapter 120, this part, and the authorizing statutes, but
2749 does not create any right or entitlement to an extension of a
2750 license expiration date.
2751 Section 65. Paragraph (d) is added to subsection (13) of
2752 section 409.906, Florida Statutes, to read:
2753 409.906 Optional Medicaid services.—Subject to specific
2754 appropriations, the agency may make payments for services which
2755 are optional to the state under Title XIX of the Social Security
2756 Act and are furnished by Medicaid providers to recipients who
2757 are determined to be eligible on the dates on which the services
2758 were provided. Any optional service that is provided shall be
2759 provided only when medically necessary and in accordance with
2760 state and federal law. Optional services rendered by providers
2761 in mobile units to Medicaid recipients may be restricted or
2762 prohibited by the agency. Nothing in this section shall be
2763 construed to prevent or limit the agency from adjusting fees,
2764 reimbursement rates, lengths of stay, number of visits, or
2765 number of services, or making any other adjustments necessary to
2766 comply with the availability of moneys and any limitations or
2767 directions provided for in the General Appropriations Act or
2768 chapter 216. If necessary to safeguard the state’s systems of
2769 providing services to elderly and disabled persons and subject
2770 to the notice and review provisions of s. 216.177, the Governor
2771 may direct the Agency for Health Care Administration to amend
2772 the Medicaid state plan to delete the optional Medicaid service
2773 known as “Intermediate Care Facilities for the Developmentally
2774 Disabled.” Optional services may include:
2775 (13) HOME AND COMMUNITY-BASED SERVICES.—
2776 (d) The agency, in consultation with the Department of
2777 Elderly Affairs, shall phase out the adult day health care
2778 waiver program and transfer existing waiver enrollees to other
2779 appropriate home and community-based service programs. Effective
2780 July 1, 2010, the adult day health care waiver program shall
2781 cease to enroll new members. Existing enrollees in the adult day
2782 health care program shall receive counseling regarding available
2783 options and shall be offered an alternative home and community
2784 based services program based on eligibility and personal choice.
2785 Each enrollee in the waiver program shall continue to receive
2786 home and community-based services without interruption in the
2787 enrollee’s program of choice. The providers of the adult day
2788 health care waiver program, in consultation with the resource
2789 centers for the aged, shall assist in the transition of
2790 enrollees and cease provision of adult day health care waiver
2791 services by December 31, 2010. The agency may seek federal
2792 waiver approval to administer this change.
2793 Section 66. Paragraph (k) of subsection (4) of section
2794 409.221, Florida Statutes, is repealed.
2795 Section 67. Paragraphs (e), (f), and (g) of subsection (15)
2796 of section 409.912, Florida Statutes, are repealed.
2797 Section 68. Section 429.11, Florida Statutes, is amended to
2798 read:
2799 429.11 Initial application for license; provisional
2800 license.—
2801 (1) Each applicant for licensure must comply with all
2802 provisions of part II of chapter 408 and must:
2803 (a) Identify all other homes or facilities, including the
2804 addresses and the license or licenses under which they operate,
2805 if applicable, which are currently operated by the applicant or
2806 administrator and which provide housing, meals, and personal
2807 services to residents.
2808 (b) Provide the location of the facility for which a
2809 license is sought and documentation, signed by the appropriate
2810 local government official, which states that the applicant has
2811 met local zoning requirements.
2812 (c) Provide the name, address, date of birth, social
2813 security number, education, and experience of the administrator,
2814 if different from the applicant.
2815 (2) The applicant shall provide proof of liability
2816 insurance as defined in s. 624.605.
2817 (3) If the applicant is a community residential home, the
2818 applicant must provide proof that it has met the requirements
2819 specified in chapter 419.
2820 (4) The applicant must furnish proof that the facility has
2821 received a satisfactory firesafety inspection. The local
2822 authority having jurisdiction or the State Fire Marshal must
2823 conduct the inspection within 30 days after written request by
2824 the applicant.
2825 (5) The applicant must furnish documentation of a
2826 satisfactory sanitation inspection of the facility by the county
2827 health department.
2828 (6) In addition to the license categories available in s.
2829 408.808, a provisional license may be issued to an applicant
2830 making initial application for licensure or making application
2831 for a change of ownership. A provisional license shall be
2832 limited in duration to a specific period of time not to exceed 6
2833 months, as determined by the agency.
2834 (6)(7) A county or municipality may not issue an
2835 occupational license that is being obtained for the purpose of
2836 operating a facility regulated under this part without first
2837 ascertaining that the applicant has been licensed to operate
2838 such facility at the specified location or locations by the
2839 agency. The agency shall furnish to local agencies responsible
2840 for issuing occupational licenses sufficient instruction for
2841 making such determinations.
2842 Section 69. Subsection (2) of section 429.12, Florida
2843 Statutes, is repealed.
2844 Section 70. Subsections (5) and (6) of section 429.14,
2845 Florida Statutes, are amended to read:
2846 429.14 Administrative penalties.—
2847 (5) An action taken by the agency to suspend, deny, or
2848 revoke a facility’s license under this part or part II of
2849 chapter 408, in which the agency claims that the facility owner
2850 or an employee of the facility has threatened the health,
2851 safety, or welfare of a resident of the facility shall be heard
2852 by the Division of Administrative Hearings of the Department of
2853 Management Services within 120 days after receipt of the
2854 facility’s request for a hearing, unless that time limitation is
2855 waived by both parties. The administrative law judge must render
2856 a decision within 30 days after receipt of a proposed
2857 recommended order.
2858 (6) The agency shall provide to the Division of Hotels and
2859 Restaurants of the Department of Business and Professional
2860 Regulation, on a monthly basis, a list of those assisted living
2861 facilities that have had their licenses denied, suspended, or
2862 revoked or that are involved in an appellate proceeding pursuant
2863 to s. 120.60 related to the denial, suspension, or revocation of
2864 a license. This information may be provided electronically or
2865 through the agency’s Internet website.
2866 Section 71. Subsection (4) of section 429.17, Florida
2867 Statutes, is amended to read:
2868 429.17 Expiration of license; renewal; conditional
2869 license.—
2870 (4) In addition to the license categories available in s.
2871 408.808, a conditional license may be issued to an applicant for
2872 license renewal if the applicant fails to meet all standards and
2873 requirements for licensure. A conditional license issued under
2874 this subsection shall be limited in duration to a specific
2875 period of time not to exceed 6 months, as determined by the
2876 agency, and shall be accompanied by an agency-approved plan of
2877 correction.
2878 Section 72. Subsection (5) of section 429.23, Florida
2879 Statutes, is repealed.
2880 Section 73. Subsection (2) of section 429.35, Florida
2881 Statutes, is amended to read:
2882 429.35 Maintenance of records; reports.—
2883 (2) Within 60 days after the date of the biennial
2884 inspection visit required under s. 408.811 or within 30 days
2885 after the date of any interim visit, the agency shall forward
2886 the results of the inspection to the local ombudsman council in
2887 whose planning and service area, as defined in part II of
2888 chapter 400, the facility is located; to at least one public
2889 library or, in the absence of a public library, the county seat
2890 in the county in which the inspected assisted living facility is
2891 located; and, when appropriate, to the district Adult Services
2892 and Mental Health Program Offices. This information may be
2893 provided electronically or through the agency’s Internet site.
2894 Section 74. Section 429.53, Florida Statutes, is amended to
2895 read:
2896 429.53 Consultation by the agency.—
2897 (1) The area offices of licensure and certification of the
2898 agency shall provide consultation to the following upon request:
2899 (a) A licensee of a facility.
2900 (b) A person interested in obtaining a license to operate a
2901 facility under this part.
2902 (2) As used in this section, “consultation” includes:
2903 (a) An explanation of the requirements of this part and
2904 rules adopted pursuant thereto;
2905 (b) An explanation of the license application and renewal
2906 procedures; and
2907 (c) The provision of a checklist of general local and state
2908 approvals required prior to constructing or developing a
2909 facility and a listing of the types of agencies responsible for
2910 such approvals;
2911 (d) An explanation of benefits and financial assistance
2912 available to a recipient of supplemental security income
2913 residing in a facility;
2914 (c)(e) Any other information that which the agency deems
2915 necessary to promote compliance with the requirements of this
2916 part.; and
2917 (f) A preconstruction review of a facility to ensure
2918 compliance with agency rules and this part.
2919 (3) The agency may charge a fee commensurate with the cost
2920 of providing consultation under this section.
2921 Section 75. Subsections (2) and (11) of section 429.65,
2922 Florida Statutes, are amended to read:
2923 429.65 Definitions.—As used in this part, the term:
2924 (2) “Adult family-care home” means a full-time, family-type
2925 living arrangement, in a private home, under which up to two
2926 individuals a person who reside in the home and own or rent owns
2927 or rents the home provide provides room, board, and personal
2928 care, on a 24-hour basis, for no more than five disabled adults
2929 or frail elders who are not relatives. The following family-type
2930 living arrangements are not required to be licensed as an adult
2931 family-care home:
2932 (a) An arrangement whereby the person who resides in the
2933 home and owns or rents the home provides room, board, and
2934 personal services for not more than two adults who do not
2935 receive optional state supplementation under s. 409.212. The
2936 person who provides the housing, meals, and personal care must
2937 own or rent the home and reside therein.
2938 (b) An arrangement whereby the person who owns or rents the
2939 home provides room, board, and personal services only to his or
2940 her relatives.
2941 (c) An establishment that is licensed as an assisted living
2942 facility under this chapter.
2943 (11) “Provider” means one or two individuals a person who
2944 are is licensed to operate an adult family-care home.
2945 Section 76. Section 429.71, Florida Statutes, is amended to
2946 read:
2947 429.71 Classification of violations deficiencies;
2948 administrative fines.—
2949 (1) In addition to the requirements of part II of chapter
2950 408 and in addition to any other liability or penalty provided
2951 by law, the agency may impose an administrative fine on a
2952 provider according to the following classification:
2953 (a) Class I violations are defined in s. 408.813. those
2954 conditions or practices related to the operation and maintenance
2955 of an adult family-care home or to the care of residents which
2956 the agency determines present an imminent danger to the
2957 residents or guests of the facility or a substantial probability
2958 that death or serious physical or emotional harm would result
2959 therefrom. The condition or practice that constitutes a class I
2960 violation must be abated or eliminated within 24 hours, unless a
2961 fixed period, as determined by the agency, is required for
2962 correction. A class I violation deficiency is subject to an
2963 administrative fine in an amount not less than $500 and not
2964 exceeding $1,000 for each violation. A fine may be levied
2965 notwithstanding the correction of the violation deficiency.
2966 (b) Class II violations are defined in s. 408.813. those
2967 conditions or practices related to the operation and maintenance
2968 of an adult family-care home or to the care of residents which
2969 the agency determines directly threaten the physical or
2970 emotional health, safety, or security of the residents, other
2971 than class I violations. A class II violation is subject to an
2972 administrative fine in an amount not less than $250 and not
2973 exceeding $500 for each violation. A citation for a class II
2974 violation must specify the time within which the violation is
2975 required to be corrected. If a class II violation is corrected
2976 within the time specified, no civil penalty shall be imposed,
2977 unless it is a repeated offense.
2978 (c) Class III violations are defined in s. 408.813. those
2979 conditions or practices related to the operation and maintenance
2980 of an adult family-care home or to the care of residents which
2981 the agency determines indirectly or potentially threaten the
2982 physical or emotional health, safety, or security of residents,
2983 other than class I or class II violations. A class III violation
2984 is subject to an administrative fine in an amount not less than
2985 $100 and not exceeding $250 for each violation. A citation for a
2986 class III violation shall specify the time within which the
2987 violation is required to be corrected. If a class III violation
2988 is corrected within the time specified, no civil penalty shall
2989 be imposed, unless it is a repeated offense.
2990 (d) Class IV violations are defined in s. 408.813. those
2991 conditions or occurrences related to the operation and
2992 maintenance of an adult family-care home, or related to the
2993 required reports, forms, or documents, which do not have the
2994 potential of negatively affecting the residents. A provider that
2995 does not correct A class IV violation within the time limit
2996 specified by the agency is subject to an administrative fine in
2997 an amount not less than $50 and not exceeding $100 for each
2998 violation. Any class IV violation that is corrected during the
2999 time the agency survey is conducted will be identified as an
3000 agency finding and not as a violation.
3001 (2) The agency may impose an administrative fine for
3002 violations which do not qualify as class I, class II, class III,
3003 or class IV violations. The amount of the fine may shall not
3004 exceed $250 for each violation or $2,000 in the aggregate.
3005 Unclassified violations may include:
3006 (a) Violating any term or condition of a license.
3007 (b) Violating any provision of this part, part II of
3008 chapter 408, or applicable rules.
3009 (c) Failure to follow the criteria and procedures provided
3010 under part I of chapter 394 relating to the transportation,
3011 voluntary admission, and involuntary examination of adult
3012 family-care home residents.
3013 (d) Exceeding licensed capacity.
3014 (e) Providing services beyond the scope of the license.
3015 (f) Violating a moratorium.
3016 (3) Each day during which a violation occurs constitutes a
3017 separate offense.
3018 (4) In determining whether a penalty is to be imposed, and
3019 in fixing the amount of any penalty to be imposed, the agency
3020 must consider:
3021 (a) The gravity of the violation.
3022 (b) Actions taken by the provider to correct a violation.
3023 (c) Any previous violation by the provider.
3024 (d) The financial benefit to the provider of committing or
3025 continuing the violation.
3026 (5) As an alternative to or in conjunction with an
3027 administrative action against a provider, the agency may request
3028 a plan of corrective action that demonstrates a good faith
3029 effort to remedy each violation by a specific date, subject to
3030 the approval of the agency.
3031 Section 77. Section 429.911, Florida Statutes, is repealed.
3032 Section 78. Section 429.915, Florida Statutes, is amended
3033 to read:
3034 429.915 Conditional license.—In addition to the license
3035 categories available in part II of chapter 408, the agency may
3036 issue a conditional license to an applicant for license renewal
3037 or change of ownership if the applicant fails to meet all
3038 standards and requirements for licensure. A conditional license
3039 issued under this subsection must be limited to a specific
3040 period not exceeding 6 months, as determined by the agency, and
3041 must be accompanied by an approved plan of correction.
3042 Section 79. Subsection (3) of section 430.80, Florida
3043 Statutes, is amended to read:
3044 430.80 Implementation of a teaching nursing home pilot
3045 project.—
3046 (3) To be designated as a teaching nursing home, a nursing
3047 home licensee must, at a minimum:
3048 (a) Provide a comprehensive program of integrated senior
3049 services that include institutional services and community-based
3050 services;
3051 (b) Participate in a nationally recognized accreditation
3052 program and hold a valid accreditation, such as the
3053 accreditation awarded by the Joint Commission on Accreditation
3054 of Healthcare Organizations;
3055 (c) Have been in business in this state for a minimum of 10
3056 consecutive years;
3057 (d) Demonstrate an active program in multidisciplinary
3058 education and research that relates to gerontology;
3059 (e) Have a formalized contractual relationship with at
3060 least one accredited health profession education program located
3061 in this state;
3062 (f) Have a formalized contractual relationship with an
3063 accredited hospital that is designated by law as a teaching
3064 hospital; and
3065 (g) Have senior staff members who hold formal faculty
3066 appointments at universities, which must include at least one
3067 accredited health profession education program.
3068 (h) Maintain insurance coverage pursuant to s.
3069 400.141(1)(q) s. 400.141(1)(s) or proof of financial
3070 responsibility in a minimum amount of $750,000. Such proof of
3071 financial responsibility may include:
3072 1. Maintaining an escrow account consisting of cash or
3073 assets eligible for deposit in accordance with s. 625.52; or
3074 2. Obtaining and maintaining pursuant to chapter 675 an
3075 unexpired, irrevocable, nontransferable and nonassignable letter
3076 of credit issued by any bank or savings association organized
3077 and existing under the laws of this state or any bank or savings
3078 association organized under the laws of the United States that
3079 has its principal place of business in this state or has a
3080 branch office which is authorized to receive deposits in this
3081 state. The letter of credit shall be used to satisfy the
3082 obligation of the facility to the claimant upon presentment of a
3083 final judgment indicating liability and awarding damages to be
3084 paid by the facility or upon presentment of a settlement
3085 agreement signed by all parties to the agreement when such final
3086 judgment or settlement is a result of a liability claim against
3087 the facility.
3088 Section 80. Paragraph (a) of subsection (2) of section
3089 440.13, Florida Statutes, is amended to read:
3090 440.13 Medical services and supplies; penalty for
3091 violations; limitations.—
3092 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3093 (a) Subject to the limitations specified elsewhere in this
3094 chapter, the employer shall furnish to the employee such
3095 medically necessary remedial treatment, care, and attendance for
3096 such period as the nature of the injury or the process of
3097 recovery may require, which is in accordance with established
3098 practice parameters and protocols of treatment as provided for
3099 in this chapter, including medicines, medical supplies, durable
3100 medical equipment, orthoses, prostheses, and other medically
3101 necessary apparatus. Remedial treatment, care, and attendance,
3102 including work-hardening programs or pain-management programs
3103 accredited by the Commission on Accreditation of Rehabilitation
3104 Facilities or the Joint Commission on the Accreditation of
3105 Health Organizations or pain-management programs affiliated with
3106 medical schools, shall be considered as covered treatment only
3107 when such care is given based on a referral by a physician as
3108 defined in this chapter. Medically necessary treatment, care,
3109 and attendance does not include chiropractic services in excess
3110 of 24 treatments or rendered 12 weeks beyond the date of the
3111 initial chiropractic treatment, whichever comes first, unless
3112 the carrier authorizes additional treatment or the employee is
3113 catastrophically injured.
3114
3115 Failure of the carrier to timely comply with this subsection
3116 shall be a violation of this chapter and the carrier shall be
3117 subject to penalties as provided for in s. 440.525.
3118 Section 81. Section 483.294, Florida Statutes, is amended
3119 to read:
3120 483.294 Inspection of centers.—In accordance with s.
3121 408.811, the agency shall biennially, at least once annually,
3122 inspect the premises and operations of all centers subject to
3123 licensure under this part.
3124 Section 82. Subsection (1) of section 627.645, Florida
3125 Statutes, is amended to read:
3126 627.645 Denial of health insurance claims restricted.—
3127 (1) A No claim for payment under a health insurance policy
3128 or self-insured program of health benefits for treatment, care,
3129 or services in a licensed hospital which is accredited by the
3130 Joint Commission on the Accreditation of Hospitals, the American
3131 Osteopathic Association, or the Commission on the Accreditation
3132 of Rehabilitative Facilities may not shall be denied because
3133 such hospital lacks major surgical facilities and is primarily
3134 of a rehabilitative nature, if such rehabilitation is
3135 specifically for treatment of physical disability.
3136 Section 83. Paragraph (c) of subsection (2) of section
3137 627.668, Florida Statutes, is amended to read:
3138 627.668 Optional coverage for mental and nervous disorders
3139 required; exception.—
3140 (2) Under group policies or contracts, inpatient hospital
3141 benefits, partial hospitalization benefits, and outpatient
3142 benefits consisting of durational limits, dollar amounts,
3143 deductibles, and coinsurance factors shall not be less favorable
3144 than for physical illness generally, except that:
3145 (c) Partial hospitalization benefits shall be provided
3146 under the direction of a licensed physician. For purposes of
3147 this part, the term “partial hospitalization services” is
3148 defined as those services offered by a program accredited by the
3149 Joint Commission on Accreditation of Hospitals (JCAH) or in
3150 compliance with equivalent standards. Alcohol rehabilitation
3151 programs accredited by the Joint Commission on Accreditation of
3152 Hospitals or approved by the state and licensed drug abuse
3153 rehabilitation programs shall also be qualified providers under
3154 this section. In any benefit year, if partial hospitalization
3155 services or a combination of inpatient and partial
3156 hospitalization are utilized, the total benefits paid for all
3157 such services shall not exceed the cost of 30 days of inpatient
3158 hospitalization for psychiatric services, including physician
3159 fees, which prevail in the community in which the partial
3160 hospitalization services are rendered. If partial
3161 hospitalization services benefits are provided beyond the limits
3162 set forth in this paragraph, the durational limits, dollar
3163 amounts, and coinsurance factors thereof need not be the same as
3164 those applicable to physical illness generally.
3165 Section 84. Subsection (3) of section 627.669, Florida
3166 Statutes, is amended to read:
3167 627.669 Optional coverage required for substance abuse
3168 impaired persons; exception.—
3169 (3) The benefits provided under this section shall be
3170 applicable only if treatment is provided by, or under the
3171 supervision of, or is prescribed by, a licensed physician or
3172 licensed psychologist and if services are provided in a program
3173 accredited by the Joint Commission on Accreditation of Hospitals
3174 or approved by the state.
3175 Section 85. Paragraph (a) of subsection (1) of section
3176 627.736, Florida Statutes, is amended to read:
3177 627.736 Required personal injury protection benefits;
3178 exclusions; priority; claims.—
3179 (1) REQUIRED BENEFITS.—Every insurance policy complying
3180 with the security requirements of s. 627.733 shall provide
3181 personal injury protection to the named insured, relatives
3182 residing in the same household, persons operating the insured
3183 motor vehicle, passengers in such motor vehicle, and other
3184 persons struck by such motor vehicle and suffering bodily injury
3185 while not an occupant of a self-propelled vehicle, subject to
3186 the provisions of subsection (2) and paragraph (4)(e), to a
3187 limit of $10,000 for loss sustained by any such person as a
3188 result of bodily injury, sickness, disease, or death arising out
3189 of the ownership, maintenance, or use of a motor vehicle as
3190 follows:
3191 (a) Medical benefits.—Eighty percent of all reasonable
3192 expenses for medically necessary medical, surgical, X-ray,
3193 dental, and rehabilitative services, including prosthetic
3194 devices, and medically necessary ambulance, hospital, and
3195 nursing services. However, the medical benefits shall provide
3196 reimbursement only for such services and care that are lawfully
3197 provided, supervised, ordered, or prescribed by a physician
3198 licensed under chapter 458 or chapter 459, a dentist licensed
3199 under chapter 466, or a chiropractic physician licensed under
3200 chapter 460 or that are provided by any of the following persons
3201 or entities:
3202 1. A hospital or ambulatory surgical center licensed under
3203 chapter 395.
3204 2. A person or entity licensed under ss. 401.2101-401.45
3205 that provides emergency transportation and treatment.
3206 3. An entity wholly owned by one or more physicians
3207 licensed under chapter 458 or chapter 459, chiropractic
3208 physicians licensed under chapter 460, or dentists licensed
3209 under chapter 466 or by such practitioner or practitioners and
3210 the spouse, parent, child, or sibling of that practitioner or
3211 those practitioners.
3212 4. An entity wholly owned, directly or indirectly, by a
3213 hospital or hospitals.
3214 5. A health care clinic licensed under ss. 400.990-400.995
3215 that is:
3216 a. Accredited by the Joint Commission on Accreditation of
3217 Healthcare Organizations, the American Osteopathic Association,
3218 the Commission on Accreditation of Rehabilitation Facilities, or
3219 the Accreditation Association for Ambulatory Health Care, Inc.;
3220 or
3221 b. A health care clinic that:
3222 (I) Has a medical director licensed under chapter 458,
3223 chapter 459, or chapter 460;
3224 (II) Has been continuously licensed for more than 3 years
3225 or is a publicly traded corporation that issues securities
3226 traded on an exchange registered with the United States
3227 Securities and Exchange Commission as a national securities
3228 exchange; and
3229 (III) Provides at least four of the following medical
3230 specialties:
3231 (A) General medicine.
3232 (B) Radiography.
3233 (C) Orthopedic medicine.
3234 (D) Physical medicine.
3235 (E) Physical therapy.
3236 (F) Physical rehabilitation.
3237 (G) Prescribing or dispensing outpatient prescription
3238 medication.
3239 (H) Laboratory services.
3240
3241 The Financial Services Commission shall adopt by rule the form
3242 that must be used by an insurer and a health care provider
3243 specified in subparagraph 3., subparagraph 4., or subparagraph
3244 5. to document that the health care provider meets the criteria
3245 of this paragraph, which rule must include a requirement for a
3246 sworn statement or affidavit.
3247
3248 Only insurers writing motor vehicle liability insurance in this
3249 state may provide the required benefits of this section, and no
3250 such insurer shall require the purchase of any other motor
3251 vehicle coverage other than the purchase of property damage
3252 liability coverage as required by s. 627.7275 as a condition for
3253 providing such required benefits. Insurers may not require that
3254 property damage liability insurance in an amount greater than
3255 $10,000 be purchased in conjunction with personal injury
3256 protection. Such insurers shall make benefits and required
3257 property damage liability insurance coverage available through
3258 normal marketing channels. Any insurer writing motor vehicle
3259 liability insurance in this state who fails to comply with such
3260 availability requirement as a general business practice shall be
3261 deemed to have violated part IX of chapter 626, and such
3262 violation shall constitute an unfair method of competition or an
3263 unfair or deceptive act or practice involving the business of
3264 insurance; and any such insurer committing such violation shall
3265 be subject to the penalties afforded in such part, as well as
3266 those which may be afforded elsewhere in the insurance code.
3267 Section 86. Subsection (12) of section 641.495, Florida
3268 Statutes, is amended to read:
3269 641.495 Requirements for issuance and maintenance of
3270 certificate.—
3271 (12) The provisions of part I of chapter 395 do not apply
3272 to a health maintenance organization that, on or before January
3273 1, 1991, provides not more than 10 outpatient holding beds for
3274 short-term and hospice-type patients in an ambulatory care
3275 facility for its members, provided that such health maintenance
3276 organization maintains current accreditation by the Joint
3277 Commission on Accreditation of Health Care Organizations, the
3278 Accreditation Association for Ambulatory Health Care, or the
3279 National Committee for Quality Assurance.
3280 Section 87. Subsection (13) of section 651.118, Florida
3281 Statutes, is amended to read:
3282 651.118 Agency for Health Care Administration; certificates
3283 of need; sheltered beds; community beds.—
3284 (13) Residents, as defined in this chapter, are not
3285 considered new admissions for the purpose of s. 400.141(1)(n)1.d
3286 s. 400.141(1)(o)1.d.
3287 Section 88. Subsection (2) of section 766.1015, Florida
3288 Statutes, is amended to read:
3289 766.1015 Civil immunity for members of or consultants to
3290 certain boards, committees, or other entities.—
3291 (2) Such committee, board, group, commission, or other
3292 entity must be established in accordance with state law or in
3293 accordance with requirements of the Joint Commission on
3294 Accreditation of Healthcare Organizations, established and duly
3295 constituted by one or more public or licensed private hospitals
3296 or behavioral health agencies, or established by a governmental
3297 agency. To be protected by this section, the act, decision,
3298 omission, or utterance may not be made or done in bad faith or
3299 with malicious intent.
3300 Section 89. Except as otherwise expressly provided in this
3301 act, this act shall take effect July 1, 2010.