Florida Senate - 2010         (PROPOSED COMMITTEE BILL) SPB 7018
       
       
       
       FOR CONSIDERATION By the Committee on Health Regulation
       
       
       
       
       588-01025-10                                          20107018__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 429.07, F.S.; deleting the requirement for
    4         an assisted living facility to obtain an additional
    5         license in order to provide limited nursing services;
    6         deleting the requirement for the Agency for Health
    7         Care Administration to conduct quarterly monitoring
    8         visits of facilities that hold a license to provide
    9         extended congregate care services; deleting the
   10         requirement for the Agency for Health Care
   11         Administration to conduct monitoring visits at least
   12         twice a year to facilities providing limited nursing
   13         services; establishing a monitoring fee for each
   14         quarter in which a facility provides limited nursing
   15         services; amending s. 429.17, F.S.; deleting
   16         provisions related to the limited nursing services
   17         license; amending s. 429.41, F.S.; conforming
   18         provisions to changes made by the act; requiring the
   19         Department of Elderly Affairs to adopt rules that
   20         establish the frequency of monitoring visits to
   21         licensed facilities providing limited nursing services
   22         or extended congregate care services, that provide for
   23         collecting monitoring fees, and that require the
   24         quarterly submission of data concerning the facility’s
   25         resident population; amending s. 429.54, F.S.;
   26         requiring licensed assisted living facilities to
   27         submit reports electronically each quarter to the
   28         Agency for Health Care Administration; requiring the
   29         first data submission to cover data for the first
   30         calendar quarter of 2011; providing effective dates.
   31  
   32  Be It Enacted by the Legislature of the State of Florida:
   33  
   34         Section 1. Effective April 1, 2011, subsections (3) and (4)
   35  of section 429.07, Florida Statutes, are amended to read:
   36         429.07 License required; fee.—
   37         (3) In addition to the requirements of s. 408.806, each
   38  license granted by the agency must state the type of care for
   39  which the license is granted. Licenses shall be issued for one
   40  or more of the following categories of care: standard, extended
   41  congregate care, limited nursing services, or limited mental
   42  health.
   43         (a) A standard license shall be issued to facilities
   44  providing one or more of the personal services identified in s.
   45  429.02. Such facilities may provide limited nursing services as
   46  provided in this paragraph and may also employ or contract with
   47  a person licensed under part I of chapter 464 to administer
   48  medications and perform other tasks as specified in s. 429.255.
   49         1. A facility that provides limited nursing services shall
   50  maintain a written progress report for each person who receives
   51  such nursing services, and the report must describe the type,
   52  amount, duration, scope, and outcome of services that are
   53  rendered and the general status of the resident’s health. A
   54  registered nurse representing the agency shall visit such
   55  facility to monitor residents who are receiving limited nursing
   56  services and to determine if the facility is in compliance with
   57  applicable provisions of this part, part II of chapter 408, and
   58  related rules. The frequency of monitoring visits shall be
   59  determined by rule. The monitoring visits may be provided
   60  through contractual arrangements with appropriate community
   61  agencies. A registered nurse shall also serve as part of the
   62  team that inspects such facility.
   63         2.A person who receives limited nursing services under
   64  this paragraph must meet the admission and continued residency
   65  criteria established by the agency for assisted living
   66  facilities. When a resident no longer meets the admission and
   67  continued residency criteria for a facility licensed under this
   68  paragraph, arrangements for relocating the person shall be made
   69  in accordance with s. 429.28(1)(k), unless the facility is
   70  licensed to provide extended congregate care services.
   71         (b) An extended congregate care license shall be issued to
   72  facilities providing, directly or through contract, services
   73  beyond those authorized in paragraph (a), including acts
   74  performed pursuant to part I of chapter 464 by persons licensed
   75  thereunder, and supportive services defined by rule to persons
   76  who otherwise would be disqualified from continued residence in
   77  a facility licensed under this part.
   78         1. In order for extended congregate care services to be
   79  provided in a facility licensed under this part, the agency must
   80  first determine that all requirements established in law and
   81  rule are met and must specifically designate, on the facility’s
   82  license, that such services may be provided and whether the
   83  designation applies to all or part of a facility. Such
   84  designation may be made at the time of initial licensure or
   85  relicensure, or upon request in writing by a licensee under this
   86  part and part II of chapter 408. Notification of approval or
   87  denial of such request shall be made in accordance with part II
   88  of chapter 408. An existing facility facilities qualifying to
   89  provide extended congregate care services must have maintained a
   90  standard license and may not have been subject to administrative
   91  sanctions during the previous 2 years, or since initial
   92  licensure if the facility has been licensed for less than 2
   93  years, for any of the following reasons:
   94         a. A class I or class II violation;
   95         b. Three or more repeat or recurring class III violations
   96  of identical or similar resident care standards as specified in
   97  rule from which a pattern of noncompliance is found by the
   98  agency;
   99         c. Three or more class III violations that were not
  100  corrected in accordance with the corrective action plan approved
  101  by the agency;
  102         d. Violation of resident care standards resulting in a
  103  requirement to employ the services of a consultant pharmacist or
  104  consultant dietitian;
  105         e. Denial, suspension, or revocation of a license for
  106  another facility under this part in which the applicant for an
  107  extended congregate care license has at least 25 percent
  108  ownership interest; or
  109         f. Imposition of a moratorium pursuant to this part or part
  110  II of chapter 408 or initiation of injunctive proceedings.
  111         2. A facility Facilities that is are licensed to provide
  112  extended congregate care services shall maintain a written
  113  progress report for on each person who receives such services,
  114  and the which report must describe describes the type, amount,
  115  duration, scope, and outcome of services that are rendered and
  116  the general status of the resident’s health. A registered nurse,
  117  or appropriate designee, representing the agency shall visit
  118  such facility facilities at least quarterly to monitor residents
  119  who are receiving extended congregate care services and to
  120  determine if the facility is in compliance with this part, part
  121  II of chapter 408, and rules that relate to extended congregate
  122  care. The frequency of monitoring visits shall be determined by
  123  rule. One of these visits may be in conjunction with the regular
  124  survey. The monitoring visits may be provided through
  125  contractual arrangements with appropriate community agencies. A
  126  registered nurse shall serve as part of the team that inspects
  127  such facility. The agency may waive one of the required yearly
  128  monitoring visits for a facility that has been licensed for at
  129  least 24 months to provide extended congregate care services,
  130  if, during the inspection, the registered nurse determines that
  131  extended congregate care services are being provided
  132  appropriately, and if the facility has no class I or class II
  133  violations and no uncorrected class III violations. Before such
  134  decision is made, the agency shall consult with the long-term
  135  care ombudsman council for the area in which the facility is
  136  located to determine if any complaints have been made and
  137  substantiated about the quality of services or care. The agency
  138  may not waive one of the required yearly monitoring visits if
  139  complaints have been made and substantiated.
  140         3. Facilities that are licensed to provide extended
  141  congregate care services shall:
  142         a. Demonstrate the capability to meet unanticipated
  143  resident service needs.
  144         b. Offer a physical environment that promotes a homelike
  145  setting, provides for resident privacy, promotes resident
  146  independence, and allows sufficient congregate space as defined
  147  by rule.
  148         c. Have sufficient staff available, taking into account the
  149  physical plant and firesafety features of the building, to
  150  assist with the evacuation of residents in an emergency, as
  151  necessary.
  152         d. Adopt and follow policies and procedures that maximize
  153  resident independence, dignity, choice, and decisionmaking to
  154  permit residents to age in place to the extent possible, so that
  155  moves due to changes in functional status are minimized or
  156  avoided.
  157         e. Allow residents or, if applicable, a resident’s
  158  representative, designee, surrogate, guardian, or attorney in
  159  fact to make a variety of personal choices, participate in
  160  developing service plans, and share responsibility in
  161  decisionmaking.
  162         f. Implement the concept of managed risk.
  163         g. Provide, either directly or through contract, the
  164  services of a person licensed pursuant to part I of chapter 464.
  165         h. In addition to the training mandated in s. 429.52,
  166  provide specialized training as defined by rule for facility
  167  staff.
  168         4. Facilities licensed to provide extended congregate care
  169  services are exempt from the criteria for continued residency as
  170  set forth in rules adopted under s. 429.41. Facilities so
  171  licensed shall adopt their own requirements within guidelines
  172  for continued residency set forth by rule. However, such
  173  facilities may not serve residents who require 24-hour nursing
  174  supervision. Facilities licensed to provide extended congregate
  175  care services shall provide each resident with a written copy of
  176  facility policies governing admission and retention.
  177         5. The primary purpose of extended congregate care services
  178  is to allow residents, as they become more impaired, the option
  179  of remaining in a familiar setting from which they would
  180  otherwise be disqualified for continued residency. A facility
  181  licensed to provide extended congregate care services may also
  182  admit an individual who exceeds the admission criteria for a
  183  facility with a standard license, if the individual is
  184  determined appropriate for admission to the extended congregate
  185  care facility.
  186         6. Before admission of an individual to a facility licensed
  187  to provide extended congregate care services, the individual
  188  must undergo a medical examination as provided in s. 429.26(4)
  189  and the facility must develop a preliminary service plan for the
  190  individual.
  191         7. When a facility can no longer provide or arrange for
  192  services in accordance with the resident’s service plan and
  193  needs and the facility’s policy, the facility shall make
  194  arrangements for relocating the person in accordance with s.
  195  429.28(1)(k).
  196         8. Failure to provide extended congregate care services may
  197  result in denial of extended congregate care license renewal.
  198         9. No later than January 1 of each year, the department, in
  199  consultation with the agency, shall prepare and submit to the
  200  Governor, the President of the Senate, the Speaker of the House
  201  of Representatives, and the chairs of appropriate legislative
  202  committees, a report on the status of, and recommendations
  203  related to, extended congregate care services. The status report
  204  must include, but need not be limited to, the following
  205  information:
  206         a. A description of the facilities licensed to provide such
  207  services, including total number of beds licensed under this
  208  part.
  209         b. The number and characteristics of residents receiving
  210  such services.
  211         c. The types of services rendered that could not be
  212  provided through a standard license.
  213         d. An analysis of deficiencies cited during licensure
  214  inspections.
  215         e. The number of residents who required extended congregate
  216  care services at admission and the source of admission.
  217         f. Recommendations for statutory or regulatory changes.
  218         g. The availability of extended congregate care to state
  219  clients residing in facilities licensed under this part and in
  220  need of additional services, and recommendations for
  221  appropriations to subsidize extended congregate care services
  222  for such persons.
  223         h. Such other information as the department considers
  224  appropriate.
  225         (c)A limited nursing services license shall be issued to a
  226  facility that provides services beyond those authorized in
  227  paragraph (a) and as specified in this paragraph.
  228         1.In order for limited nursing services to be provided in
  229  a facility licensed under this part, the agency must first
  230  determine that all requirements established in law and rule are
  231  met and must specifically designate, on the facility’s license,
  232  that such services may be provided. Such designation may be made
  233  at the time of initial licensure or relicensure, or upon request
  234  in writing by a licensee under this part and part II of chapter
  235  408. Notification of approval or denial of such request shall be
  236  made in accordance with part II of chapter 408. Existing
  237  facilities qualifying to provide limited nursing services shall
  238  have maintained a standard license and may not have been subject
  239  to administrative sanctions that affect the health, safety, and
  240  welfare of residents for the previous 2 years or since initial
  241  licensure if the facility has been licensed for less than 2
  242  years.
  243         2.Facilities that are licensed to provide limited nursing
  244  services shall maintain a written progress report on each person
  245  who receives such nursing services, which report describes the
  246  type, amount, duration, scope, and outcome of services that are
  247  rendered and the general status of the resident’s health. A
  248  registered nurse representing the agency shall visit such
  249  facilities at least twice a year to monitor residents who are
  250  receiving limited nursing services and to determine if the
  251  facility is in compliance with applicable provisions of this
  252  part, part II of chapter 408, and related rules. The monitoring
  253  visits may be provided through contractual arrangements with
  254  appropriate community agencies. A registered nurse shall also
  255  serve as part of the team that inspects such facility.
  256         3.A person who receives limited nursing services under
  257  this part must meet the admission criteria established by the
  258  agency for assisted living facilities. When a resident no longer
  259  meets the admission criteria for a facility licensed under this
  260  part, arrangements for relocating the person shall be made in
  261  accordance with s. 429.28(1)(k), unless the facility is licensed
  262  to provide extended congregate care services.
  263         (4) In accordance with s. 408.805, an applicant or licensee
  264  shall pay a fee for each license application submitted under
  265  this part, part II of chapter 408, and applicable rules. The
  266  amount of the fee shall be established by rule.
  267         (a) The biennial license fee required of a facility is $300
  268  per license, with an additional fee of $50 per resident based on
  269  the total licensed resident capacity of the facility, except
  270  that no additional fee will be assessed for beds designated for
  271  recipients of optional state supplementation payments provided
  272  for in s. 409.212. The total fee under this paragraph may not
  273  exceed $10,000.
  274         (b) In addition to the total fee assessed under paragraph
  275  (a), the agency shall require facilities that are licensed to
  276  provide extended congregate care services under this part to pay
  277  an additional fee per licensed facility. The amount of the
  278  biennial fee shall be $400 per license, with an additional fee
  279  of $10 per resident based on the total licensed resident
  280  capacity of the facility.
  281         (c) In addition to the total fee assessed under paragraph
  282  (a), the agency shall require facilities that are licensed to
  283  provide limited nursing services under this part to pay an
  284  additional monitoring fee quarterly for each quarter in which
  285  the facility provides limited nursing services. The quarterly
  286  monitoring fee shall be $75 plus $10 for each resident who
  287  received limited nursing services during the quarter. This
  288  monitoring fee shall be adjusted by not more than the change in
  289  the Consumer Price Index based on the 12 months immediately
  290  preceding the increase. fee per licensed facility. The amount of
  291  the biennial fee shall be $250 per license, with an additional
  292  fee of $10 per resident based on the total licensed resident
  293  capacity of the facility.
  294         Section 2. Effective April 1, 2011, subsections (1) and (5)
  295  of section 429.17, Florida Statutes, are amended to read:
  296         429.17 Expiration of license; renewal; conditional
  297  license.—
  298         (1) Limited nursing, Extended congregate care, and limited
  299  mental health licenses shall expire at the same time as the
  300  facility’s standard license, regardless of when issued.
  301         (5) When an extended care or limited nursing license is
  302  requested during a facility’s biennial license period, the fee
  303  shall be prorated in order to permit the additional license to
  304  expire at the end of the biennial license period. The fee shall
  305  be calculated as of the date the additional license application
  306  is received by the agency.
  307         Section 3. Paragraphs (i) and (j) of subsection (1) of
  308  section 429.41, Florida Statutes, are amended, and paragraphs
  309  (m), (n), and (o) are added to that subsection, to read:
  310         429.41 Rules establishing standards.—
  311         (1) It is the intent of the Legislature that rules
  312  published and enforced pursuant to this section shall include
  313  criteria by which a reasonable and consistent quality of
  314  resident care and quality of life may be ensured and the results
  315  of such resident care may be demonstrated. Such rules shall also
  316  ensure a safe and sanitary environment that is residential and
  317  noninstitutional in design or nature. It is further intended
  318  that reasonable efforts be made to accommodate the needs and
  319  preferences of residents to enhance the quality of life in a
  320  facility. The agency, in consultation with the department, may
  321  adopt rules to administer the requirements of part II of chapter
  322  408. In order to provide safe and sanitary facilities and the
  323  highest quality of resident care accommodating the needs and
  324  preferences of residents, the department, in consultation with
  325  the agency, the Department of Children and Family Services, and
  326  the Department of Health, shall adopt rules, policies, and
  327  procedures to administer this part, which must include
  328  reasonable and fair minimum standards in relation to:
  329         (i) Facilities holding an a limited nursing, extended
  330  congregate care, or limited mental health license.
  331         (j) The establishment of specific criteria to define
  332  appropriateness of resident admission and continued residency in
  333  a facility holding a standard, limited nursing, extended
  334  congregate care, and limited mental health license.
  335         (m) The frequency of the monitoring visits to licensed
  336  facilities that provide limited nursing services or extended
  337  congregate care services. The frequency of monitoring visits
  338  shall be based on factors such as, but not limited to: the
  339  number of residents receiving limited nursing services or
  340  extended congregate care services; the type, amount, duration,
  341  and scope of limited nursing services or extended congregate
  342  care services provided by the facility; the health status of the
  343  residents receiving the limited nursing services or extended
  344  congregate services; whether the registered nurse has determined
  345  during inspections that have occurred within the last 24 months
  346  that the facility has provided limited nursing services or
  347  extended congregate care services appropriately; whether the
  348  facility has no class I or class II violations and no
  349  uncorrected class III violations; and the existence of any
  350  complaints made to and substantiated by the long-term care
  351  ombudsman council for the area in which the facility is located
  352  concerning the limited nursing services or extended congregate
  353  care services provided by that facility.
  354         (n) The process for collecting the monitoring fee from
  355  licensed facilities providing limited nursing services.
  356         (o) The submission of aggregate data concerning the
  357  resident population as required by s. 429.54.
  358         Section 4. Section 429.54, Florida Statutes, is amended to
  359  read:
  360         429.54 Collection of information; local subsidy.—
  361         (1)Facilities that are licensed under this part must
  362  report electronically to the agency quarterly data related to
  363  the characteristics, attributes, and health status of the
  364  resident population and the type, amount, duration, and scope of
  365  services provided to residents. The department, in consultation
  366  with the agency, shall adopt rules for the submission of
  367  aggregate data. The first data submission to the agency shall
  368  cover data for the calendar quarter January 1 through March 31,
  369  2011.
  370         (2)(1) To enable the department to collect the information
  371  requested by the Legislature regarding the actual cost of
  372  providing room, board, and personal care in facilities, the
  373  department is authorized to conduct field visits and audits of
  374  facilities as may be necessary. The owners of randomly sampled
  375  facilities shall submit such reports, audits, and accountings of
  376  cost as the department may require by rule; provided that such
  377  reports, audits, and accountings shall be the minimum necessary
  378  to implement the provisions of this section. Any facility
  379  selected to participate in the study shall cooperate with the
  380  department by providing cost of operation information to
  381  interviewers.
  382         (3)(2) Local governments or organizations may contribute to
  383  the cost of care of local facility residents by further
  384  subsidizing the rate of state-authorized payment to such
  385  facilities. Implementation of local subsidy shall require
  386  departmental approval and shall not result in reductions in the
  387  state supplement.
  388         Section 5. Except as otherwise expressly provided in this
  389  act, this act shall take effect July 1, 2010.