Florida Senate - 2010 CS for SB 760
By the Committee on Health Regulation; and Senator Gaetz
588-04383A-10 2010760c1
1 A bill to be entitled
2 An act relating to health care; repealing s.
3 112.0455(10)(e), F.S., relating to a prohibition
4 against applying the Drug-Free Workplace Act
5 retroactively; amending ss. 154.11, 395.3038, 400.925,
6 400.9935, 408.05, 440.13, 627.645, 627.668, 627.669,
7 627.736, 641.495, and 766.1015, F.S.; changing
8 references to the Joint Commission on the
9 Accreditation of Healthcare Organizations to the
10 “Joint Commission”; amending s. 318.21, F.S.;
11 requiring that a specified percentage of fines
12 collected from certain civil penalties levied by
13 county courts for traffic infractions be deposited
14 into the Brain and Spinal Cord Injury Rehabilitation
15 Trust Fund within the Department of Health for use for
16 Medicaid recipients who have spinal cord injuries;
17 amending s. 381.06014, F.S.; defining the term
18 “volunteer donor”; requiring that certain blood
19 establishments disclose specified information on the
20 Internet; repealing s. 383.325, F.S., relating to
21 records of licensed birth center facilities; amending
22 s. 394.741 F.S.; changing references to the Council on
23 Accreditation for Children and Family Services to the
24 “Council on Accreditation”; amending s. 394.4787,
25 F.S.; conforming a cross-reference; amending s.
26 395.002, F.S.; redefining the term “accrediting
27 organizations” as it relates to hospital licensure and
28 regulation; deleting definitions of the terms “initial
29 denial determination,” “private review agent,”
30 “utilization review,” and “utilization review plan” as
31 they relate to hospital licensure and regulation;
32 amending s. 395.003, F.S.; deleting an obsolete
33 provision; conforming a cross-reference; amending s.
34 395.0193, F.S.; requiring the Division of Medical
35 Quality Assurance within the Department of Health
36 rather than the Agency for Health Care Administration
37 to review certain peer review reports and disciplinary
38 actions; amending s. 395.1023, F.S.; requiring a
39 licensed facility to adopt a protocol to designate a
40 physician to act as a liaison between the Department
41 of Children and Family Services, rather than the
42 Department of Health, and the licensed facility in
43 cases involving suspected child abuse; amending s.
44 395.1041, F.S., relating to emergency services;
45 deleting obsolete provisions; repealing s. 395.1046,
46 F.S., relating to the investigation of complaints
47 regarding hospitals; amending s. 395.1055, F.S.;
48 requiring the agency to adopt rules that ensure that
49 licensed facility beds conform to certain standards as
50 specified by the agency, the Florida Building Code,
51 and the Florida Fire Prevention Code; amending s.
52 395.10972, F.S.; changing a reference to the Florida
53 Society of Healthcare Risk Management to the “Florida
54 Society for Healthcare Risk Management and Patient
55 Safety”; amending s. 395.2050, F.S.; providing that
56 the federal Centers for Medicare and Medicaid
57 Services, rather than the federal Health Care
58 Financing Administration, designates organ procurement
59 organizations; amending s. 395.3036, F.S.; correcting
60 a cross-reference; repealing s. 395.3037, F.S.;
61 deleting obsolete definitions; amending s. 395.602,
62 F.S.; revising the definition of a “rural hospital” as
63 it relates to hospital licensure and regulation;
64 amending s. 400.021, F.S.; revising the definition of
65 a “geriatric outpatient clinic” with regard to
66 staffing; amending s. 400.0239, F.S.; deleting an
67 obsolete provision; amending s. 400.0255, F.S.;
68 correcting an obsolete cross-reference to
69 administrative rules; amending s. 400.063, F.S.;
70 removing an obsolete provision; amending s. 400.071,
71 F.S.; revising the requirements for an application for
72 a license to operate a nursing home facility; amending
73 s. 400.0712, F.S.; deleting a provision related to the
74 issuance of an inactive license to a nursing home;
75 amending s. 400.111, F.S.; specifying that the
76 required disclosure of a financial or ownership
77 interest is contingent upon a request by the agency;
78 amending s. 400.1183, F.S.; requiring nursing home
79 facilities to maintain records of grievances for
80 agency inspection; deleting a requirement that a
81 facility report the number of grievances handled
82 during the prior licensure period; amending s.
83 400.141, F.S.; conforming a cross-reference; deleting
84 the requirement that a facility submit to the agency
85 information regarding a management company with which
86 it has entered into an agreement; specifying a fine
87 for a nursing facility’s failure to impose an
88 admissions moratorium if it has failed to comply with
89 state minimum-staffing requirements; deleting the
90 requirement for a facility to report to the agency any
91 filing of bankruptcy protection, divestiture, or
92 corporate reorganization; amending s. 400.142, F.S.;
93 removing obsolete provisions requiring the agency to
94 adopt certain rules; repealing s. 400.147(10), F.S.,
95 relating to a requirement that a nursing home report
96 any notice of a filing of a claim for a violation of a
97 resident’s rights or a claim of negligence; repealing
98 s. 400.148, F.S., relating to the Medicaid “Up-or-Out”
99 Quality of Care Contract Management Program; amending
100 s. 400.19, F.S.; authorizing the agency to verify the
101 correction of certain violations without reinspection,
102 even when they are related to resident rights or
103 resident care, after an unannounced inspection of a
104 nursing home; repealing s. 400.195, F.S., relating to
105 reporting requirements; deleting obsolete provisions;
106 amending s. 400.23, F.S.; changing a reference to the
107 Division of Children’s Medical Services to the
108 “Division of Children’s Medical Services Network”;
109 deleting an obsolete provision; amending s. 400.275,
110 F.S.; deleting a requirement that the agency ensure
111 that a newly hired nursing home surveyor is assigned
112 full time to a licensed nursing home to observe
113 facility operations; amending ss. 400.484, 400.967,
114 and 429.71, F.S.; redesignating class I, II, III, and
115 IV deficiencies as class I, II, III, and IV
116 “violations”; amending s. 400.606, F.S.; eliminating a
117 requirement that the plan for the delivery of home,
118 residential, and homelike inpatient hospice services
119 for terminally ill patients and their families include
120 projected annual operating costs; amending s. 400.607,
121 F.S.; revising the grounds under which the agency may
122 take administrative action against a hospice; amending
123 s. 400.915, F.S.; correcting an obsolete cross
124 reference to administrative rules; amending s.
125 400.931, F.S.; deleting a provision allowing an
126 applicant for a license to be a home medical equipment
127 provider to submit a surety bond to the agency;
128 amending s. 400.932, F.S.; revising the grounds under
129 which the agency may take administrative action
130 against a home medical equipment provider; amending s.
131 400.933, F.S.; prohibiting a home medical equipment
132 provider from providing a survey or inspection of an
133 accrediting organization in lieu of periodic agency
134 inspection if the provider’s licensure is conditional;
135 amending s. 400.953, F.S.; deleting a requirement that
136 the general manager of a home medical equipment
137 provider annually sign an affidavit regarding the
138 background screening of personnel; providing
139 requirements for submission of the affidavit; amending
140 s. 400.9905, F.S.; specifying that certain licensure
141 requirements do not apply to certain orthotic,
142 prosthetic, pediatric cardiology, or perinatology
143 clinical facilities; redefining the term “portable
144 service or equipment provider” as it relates to the
145 Health Care Clinic Act; amending s. 400.991, F.S.;
146 conforming a provision to changes made by the act;
147 revising application requirements to show proof of
148 financial ability to operate a health care clinic;
149 amending s. 408.034, F.S.; prohibiting the agency from
150 issuing a license to a health care facility that
151 applies for a license to operate an intermediate care
152 facility for developmentally disabled persons under
153 certain circumstances; amending s. 408.036, F.S.,
154 relating to certificates of need; conforming a
155 provision to changes made by the act; amending s.
156 408.043, F.S.; requiring a freestanding facility or a
157 part of the facility that is the inpatient hospice
158 care component of a hospice to obtain a certificate of
159 need, regardless of whether it is primarily engaged in
160 providing inpatient care and related services;
161 amending s. 408.061, F.S.; revising requirements for
162 the reporting of certified data elements by health
163 care facilities; amending s. 408.10, F.S.; authorizing
164 the agency to provide staffing for a toll-free phone
165 number for the purpose of handling consumer complaints
166 regarding a health care facility; repealing s.
167 408.802(11), F.S., relating to the applicability of
168 the Health Care Licensing Procedures Act to private
169 review agents; amending s. 408.804, F.S.; providing a
170 criminal penalty for altering, defacing, or falsifying
171 a license certificate of certain health care
172 providers; providing civil penalties for displaying an
173 altered, defaced, or falsified license certificate;
174 amending s. 408.806, F.S.; requiring the agency to
175 provide a courtesy notice to a licensee regarding the
176 expiration of a licensee’s license; providing that
177 failure of the agency to provide the courtesy notice
178 or failure of the licensee to receive the notice does
179 not excuse the licensee from timely renewing its
180 license; providing that payment of the late fee is
181 required for a later application; amending s. 408.810,
182 F.S.; revising the requirements for obtaining and
183 maintaining a license for certain health care
184 providers and those who own a controlling interest in
185 a health care provider; amending s. 408.813, F.S.;
186 authorizing the agency to impose administrative fines
187 for unclassified violations and identifying some of
188 those violations; amending s. 408.815, F.S.;
189 authorizing the agency to extend the expiration date
190 of a license for the purpose of the safe and orderly
191 discharge of clients; authorizing the agency to impose
192 conditions on the extension; amending s. 409.906,
193 F.S.; requiring the agency, in consultation with the
194 Department of Elderly Affairs, to phase out the adult
195 day health care waiver program; requiring adult day
196 health care waiver providers, in consultation with
197 resource centers for the aged, to assist in the
198 transition of enrollees from the waiver program;
199 repealing s. 409.221(4)(k), F.S., relating to the
200 responsibility of the agency, the Department of
201 Elderly Affairs, the Department of Health, the
202 Department of Children and Family Services, and the
203 Agency for Persons with Disabilities to review and
204 assess the implementation of the consumer-directed
205 care program and the agency’s responsibility to submit
206 a report to the Legislature; repealing s.
207 409.912(15)(e), (f), and (g), F.S., relating to a
208 requirement that the Agency for Health Care
209 Administration submit a report to the Legislature
210 regarding the operation of the CARES program; amending
211 s. 429.07, F.S.; deleting the requirement for an
212 assisted living facility to obtain an additional
213 license in order to provide limited nursing services;
214 deleting the requirement for the Agency for Health
215 Care Administration to conduct quarterly monitoring
216 visits of facilities that hold a license to provide
217 extended congregate care services; deleting the
218 requirement for the Department of Elderly Affairs to
219 report annually on the status of and recommendations
220 related to extended congregate care; deleting the
221 requirement for the Agency for Health Care
222 Administration to conduct monitoring visits at least
223 twice a year to facilities providing limited nursing
224 services; increasing the licensure fees and the
225 maximum fee required for a standard license;
226 increasing the licensure fees for the extended
227 congregate care license; eliminating the license fee
228 for the limited nursing services license; transferring
229 from another provision of law the requirement that a
230 biennial survey of an assisted living facility include
231 specific actions to determine whether the facility is
232 adequately protecting residents’ rights; providing
233 that an assisted living facility that has been cited
234 for certain violations is subject to monitoring
235 visits; requiring a registered nurse to participate in
236 certain monitoring visits; amending s. 429.11, F.S.;
237 deleting a provision authorizing issuance of a
238 provisional license to operate as an assisted living
239 facility; repealing s. 429.12(2), F.S., relating to
240 the sale or transfer of ownership of an assisted
241 living facility; amending s. 429.14, F.S.; authorizing
242 the agency to provide to the Division of Hotels and
243 Restaurants of the Department of Business and
244 Professional Regulation, by electronic means or
245 through the agency’s website, information regarding
246 the denial, suspension, or revocation of a license;
247 amending s. 429.17, F.S.; deleting provisions related
248 to the limited nursing services license; revising the
249 requirements for a conditional license to operate an
250 assisted living facility; amending s. 429.19, F.S.;
251 clarifying that a monitoring fee may be assessed in
252 addition to an administrative fine; repealing s.
253 429.23(5), F.S., relating to a requirement that each
254 assisted living facility submit a report to the agency
255 regarding liability claims filed against it; amending
256 s. 429.255, F.S.; eliminating provisions authorizing
257 the use of volunteers to provide certain health-care
258 related services in assisted living facilities;
259 authorizing assisted living facilities to provide
260 limited nursing services; requiring an assisted living
261 facility to be responsible for certain recordkeeping
262 and staff to be trained to monitor residents receiving
263 certain health-care-related services; repealing s.
264 429.28(3), F.S., relating to a requirement for a
265 biennial survey of an assisted living facility, to
266 conform to changes made by the act; amending s.
267 429.35, F.S.; authorizing the agency to provide to the
268 local ombudsman council, electronically or through the
269 agency’s website, information regarding the results of
270 an inspection; amending s. 429.41, F.S., relating to
271 rulemaking; conforming provisions to changes made by
272 the act; amending s. 429.53, F.S.; requiring the
273 agency, rather than the agency’s area offices of
274 licensure and certification, to provide consultation
275 to certain persons and licensees regarding assisted
276 living facilities; redefining the term “consultation”
277 as it relates to assisted living facilities; amending
278 s. 429.54, F.S.; requiring licensed assisted living
279 facilities to electronically report certain data
280 semiannually to the Agency for Health Care
281 Administration in accordance with rules adopted by the
282 Department of Elderly Affairs; amending s. 429.65,
283 F.S.; redefining the term “adult family-care home” as
284 it relates to the Adult Family-Care Home Act;
285 repealing s. 429.901(5), F.S.; relating to the
286 definition of the term “multiple or repeated
287 violations”; repealing s. 429.911(2)(a), F.S.;
288 deleting a ground for agency action against an adult
289 day care center; amending s. 429.915, F.S.; revising
290 requirements for a conditional license to operate an
291 adult day care center; amending s. 430.80, F.S.;
292 conforming a cross-reference; amending s. 483.201,
293 F.S.; providing for disciplinary action against
294 clinical laboratories failing to disclose specified
295 information on the Internet; providing a maximum
296 annual administrative fine that may be imposed
297 annually against certain clinical laboratories for
298 failure to comply with such disclosure requirement;
299 amending s. 483.294, F.S.; requiring the agency to
300 biennially, rather than at least annually, inspect the
301 premises and operations of multiphasic health testing
302 centers; amending s. 499.003, F.S.; revising the
303 definition of the term “health care entity” to clarify
304 that a blood establishment may be a health care entity
305 and engage in certain activities; amending s. 499.005,
306 F.S.; clarifying provisions prohibiting the
307 unauthorized wholesale distribution of a prescription
308 drug that was purchased by a hospital or other health
309 care entity, to conform to changes made by the act;
310 amending s. 499.01, F.S.; exempting certain blood
311 establishments from the requirements to be permitted
312 as a prescription drug manufacturer and register
313 products; requiring that certain blood establishments
314 obtain a restricted prescription drug distributor
315 permit under specified conditions; limiting the
316 prescription drugs that a blood establishment may
317 distribute under the restricted prescription drug
318 distributor permit; authorizing the Department of
319 Health to adopt rules; providing effective dates.
320
321 Be It Enacted by the Legislature of the State of Florida:
322
323 Section 1. Paragraph (e) of subsection (10) of section
324 112.0455, Florida Statutes, is repealed.
325 Section 2. Paragraph (n) of subsection (1) of section
326 154.11, Florida Statutes, is amended to read:
327 154.11 Powers of board of trustees.—
328 (1) The board of trustees of each public health trust shall
329 be deemed to exercise a public and essential governmental
330 function of both the state and the county and in furtherance
331 thereof it shall, subject to limitation by the governing body of
332 the county in which such board is located, have all of the
333 powers necessary or convenient to carry out the operation and
334 governance of designated health care facilities, including, but
335 without limiting the generality of, the foregoing:
336 (n) To make original appointments of appoint originally the
337 staff of physicians to practice in any designated facility owned
338 or operated by the board and to approve the bylaws and rules to
339 be adopted by the medical staff of any designated facility owned
340 and operated by the board., Such governing regulations must to
341 be in accordance with the standards of the Joint Commission and
342 must on the Accreditation of Hospitals which provide, among
343 other things, for the method of appointing additional staff
344 members and for the removal of staff members.
345 Section 3. Subsection (15) of section 318.21, Florida
346 Statutes, is amended to read:
347 318.21 Disposition of civil penalties by county courts.—All
348 civil penalties received by a county court pursuant to the
349 provisions of this chapter shall be distributed and paid monthly
350 as follows:
351 (15) Of the additional fine assessed under s. 318.18(3)(e)
352 for a violation of s. 316.1893, 50 percent of the moneys
353 received from the fines shall be remitted to the Department of
354 Revenue and deposited into the Brain and Spinal Cord Injury
355 Trust Fund within the Department of Health and shall be
356 appropriated to the Department of Health Agency for Health Care
357 Administration as general revenue to provide an enhanced
358 Medicaid payment to nursing homes that serve adult Medicaid
359 recipients with brain and spinal cord injuries that are
360 medically complex and that are technologically and respiratory
361 dependent. The remaining 50 percent of the moneys received from
362 the enhanced fine imposed under s. 318.18(3)(e) shall be
363 remitted to the Department of Revenue and deposited into the
364 Department of Health Administrative Trust Fund to provide
365 financial support to certified trauma centers in the counties
366 where enhanced penalty zones are established to ensure the
367 availability and accessibility of trauma services. Funds
368 deposited into the Administrative Trust Fund under this
369 subsection shall be allocated as follows:
370 (a) Fifty percent shall be allocated equally among all
371 Level I, Level II, and pediatric trauma centers in recognition
372 of readiness costs for maintaining trauma services.
373 (b) Fifty percent shall be allocated among Level I, Level
374 II, and pediatric trauma centers based on each center’s relative
375 volume of trauma cases as reported in the Department of Health
376 Trauma Registry.
377 Section 4. Section 381.06014, Florida Statutes, is amended
378 to read:
379 381.06014 Blood establishments.—
380 (1) As used in this section, the term:
381 (a) “Blood establishment” means any person, entity, or
382 organization, operating within the state, which examines an
383 individual for the purpose of blood donation or which collects,
384 processes, stores, tests, or distributes blood or blood
385 components collected from the human body for the purpose of
386 transfusion, for any other medical purpose, or for the
387 production of any biological product.
388 (b) “Volunteer donor” means a person who does not receive
389 remuneration, other than an incentive, for a blood donation
390 intended for transfusion, and the product container of the
391 donation from the person qualifies for labeling with the
392 statement “volunteer donor” under 21 C.F.R. 606.121.
393 (2) Any blood establishment operating in the state may not
394 conduct any activity defined in subsection (1) unless that blood
395 establishment is operated in a manner consistent with the
396 provisions of Title 21 parts 211 and 600-640, Code of Federal
397 Regulations.
398 (3) Any blood establishment determined to be operating in
399 the state in a manner not consistent with the provisions of
400 Title 21 parts 211 and 600-640, Code of Federal Regulations, and
401 in a manner that constitutes a danger to the health or well
402 being of donors or recipients as evidenced by the federal Food
403 and Drug Administration’s inspection reports and the revocation
404 of the blood establishment’s license or registration shall be in
405 violation of this chapter and shall immediately cease all
406 operations in the state.
407 (4) The operation of a blood establishment in a manner not
408 consistent with the provisions of Title 21 parts 211 and 600
409 640, Code of Federal Regulations, and in a manner that
410 constitutes a danger to the health or well-being of blood donors
411 or recipients as evidenced by the federal Food and Drug
412 Administration’s inspection process is declared a nuisance and
413 inimical to the public health, welfare, and safety. The Agency
414 for Health Care Administration or any state attorney may bring
415 an action for an injunction to restrain such operations or
416 enjoin the future operation of the blood establishment.
417 (5) A blood establishment that collects blood or blood
418 components from volunteer donors must disclose on the Internet
419 information to educate and inform donors and the public about
420 the blood establishment’s activities. A hospital that collects
421 blood or blood components from volunteer donors for its own use
422 or for health care providers that are part of its business
423 entity is exempt from the disclosure requirements in this
424 subsection. The information required to be disclosed under this
425 subsection may be cumulative for all blood establishments within
426 a business entity. Disciplinary action against the blood
427 establishment’s clinical laboratory license may be taken as
428 provided in s. 483.201 for a blood establishment that is
429 required to disclose but fails to disclose on its website all of
430 the following information:
431 (a) A description of the steps involved in collecting,
432 processing, and distributing volunteer donations, presented in a
433 manner appropriate for the donating public.
434 (b) By March 1 of each year, the number of units of blood
435 components, identified by component, which were:
436 1. Produced by the blood establishment during the preceding
437 calendar year;
438 2. Obtained from other sources during the preceding
439 calendar year;
440 3. Distributed during the preceding year to health care
441 providers located outside this state. However, if the blood
442 establishment collects donations in a county outside this state,
443 distributions to health care providers in that county shall be
444 excluded. Such information shall be aggregated by health care
445 providers located within the United States and its territories
446 or outside the United States and its territories; and
447 4. Distributed to entities that are not health care
448 providers during the preceding year. Such information shall be
449 aggregated by purchasers located within the United States and
450 its territories or outside the United States and its
451 territories;
452
453 For purposes of this paragraph, the components that must be
454 reported include whole blood, red blood cells, leukoreduced red
455 blood cells, fresh frozen plasma or the equivalent, recovered
456 plasma, platelets, and cryoprecipitated antihemophilic factor.
457 (c) The blood establishment’s conflict-of-interest policy,
458 policy concerning related-party transactions, whistleblower
459 policy, and policy for determining executive compensation. If a
460 change to any of these documents occurs, the revised document
461 must be available on the blood establishment’s website by the
462 following March 1.
463 (d)1. The most recent 3 years of the Return of Organization
464 Exempt from Income Tax, Internal Revenue Service Form 990, if
465 the business entity for the blood establishment is eligible to
466 file such return. The Form 990 must be available on the blood
467 establishment’s website within 30 calendar days after filing it
468 with the Internal Revenue Service; or
469 2. If the business entity for the blood establishment is
470 not eligible to file the Form 990 return, a balance sheet,
471 income statement, statement of changes in cash flow, and the
472 expression of an opinion thereon by an independent certified
473 public accountant who audited or reviewed such financial
474 statements. Such documents must be available on the blood
475 establishment’s website within 120 days after the end of the
476 blood establishment’s fiscal year and must remain on the blood
477 establishment’s website for at least 36 months.
478 Section 5. Section 383.325, Florida Statutes, is repealed.
479 Section 6. Subsection (2) of section 394.741, Florida
480 Statutes, is amended to read:
481 394.741 Accreditation requirements for providers of
482 behavioral health care services.—
483 (2) Notwithstanding any provision of law to the contrary,
484 accreditation shall be accepted by the agency and department in
485 lieu of the agency’s and department’s facility licensure onsite
486 review requirements and shall be accepted as a substitute for
487 the department’s administrative and program monitoring
488 requirements, except as required by subsections (3) and (4),
489 for:
490 (a) Any organization from which the department purchases
491 behavioral health care services that is accredited by the Joint
492 Commission on Accreditation of Healthcare Organizations or the
493 Council on Accreditation for Children and Family Services, or
494 has those services that are being purchased by the department
495 accredited by CARF—the Rehabilitation Accreditation Commission.
496 (b) Any mental health facility licensed by the agency or
497 any substance abuse component licensed by the department that is
498 accredited by the Joint Commission on Accreditation of
499 Healthcare Organizations, CARF—the Rehabilitation Accreditation
500 Commission, or the Council on Accreditation of Children and
501 Family Services.
502 (c) Any network of providers from which the department or
503 the agency purchases behavioral health care services accredited
504 by the Joint Commission on Accreditation of Healthcare
505 Organizations, CARF—the Rehabilitation Accreditation Commission,
506 the Council on Accreditation of Children and Family Services, or
507 the National Committee for Quality Assurance. A provider
508 organization that, which is part of an accredited network, is
509 afforded the same rights under this part.
510 Section 7. Subsection (7) of section 394.4787, Florida
511 Statutes, is amended to read:
512 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
513 394.4789.—As used in this section and ss. 394.4786, 394.4788,
514 and 394.4789:
515 (7) “Specialty psychiatric hospital” means a hospital
516 licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
517 and part II of chapter 408 as a specialty psychiatric hospital.
518 Section 8. Section 395.002, Florida Statutes, is amended to
519 read:
520 395.002 Definitions.—As used in this chapter the term:
521 (1) “Accrediting organizations” means nationally recognized
522 or approved accrediting organizations whose standards
523 incorporate comparable licensure requirements as determined by
524 the agency the Joint Commission on Accreditation of Healthcare
525 Organizations, the American Osteopathic Association, the
526 Commission on Accreditation of Rehabilitation Facilities, and
527 the Accreditation Association for Ambulatory Health Care, Inc.
528 (2) “Agency” means the Agency for Health Care
529 Administration.
530 (3) “Ambulatory surgical center” or “mobile surgical
531 facility” means a facility that has as its the primary purpose
532 the provision of which is to provide elective surgical care, in
533 which the patient is admitted to and discharged from the such
534 facility within the same working day and is not permitted to
535 stay overnight, and which is not part of a hospital. However, a
536 facility existing for the primary purpose of performing
537 terminations of pregnancy, an office maintained by a physician
538 for the practice of medicine, or an office maintained for the
539 practice of dentistry shall not be construed to be an ambulatory
540 surgical center, provided that any facility or office that which
541 is certified or seeks certification as a Medicare ambulatory
542 surgical center shall be licensed as an ambulatory surgical
543 center pursuant to s. 395.003. Any structure or vehicle in which
544 a physician maintains an office and practices surgery, and which
545 can appear to the public to be a mobile office because the
546 structure or vehicle operates at more than one address, shall be
547 construed to be a mobile surgical facility.
548 (4) “Biomedical waste” means any solid or liquid waste as
549 defined in s. 381.0098(2)(a).
550 (5) “Clinical privileges” means the privileges granted to a
551 physician or other licensed health care practitioner to render
552 patient care services in a hospital, but does not include the
553 privilege of admitting patients.
554 (6) “Department” means the Department of Health.
555 (7) “Director” means any member of the official board of
556 directors as reported in the organization’s annual corporate
557 report to the Florida Department of State, or, if no such report
558 is made, any member of the operating board of directors. The
559 term excludes members of separate, restricted boards that serve
560 only in an advisory capacity to the operating board.
561 (8) “Emergency medical condition” means:
562 (a) A medical condition manifesting itself by acute
563 symptoms of sufficient severity, which may include severe pain,
564 such that the absence of immediate medical attention could
565 reasonably be expected to result in any of the following:
566 1. Serious jeopardy to patient health, including a pregnant
567 woman or fetus.
568 2. Serious impairment to bodily functions.
569 3. Serious dysfunction of any bodily organ or part.
570 (b) With respect to a pregnant woman:
571 1. That there is inadequate time to effect safe transfer to
572 another hospital prior to delivery;
573 2. That a transfer may pose a threat to the health and
574 safety of the patient or fetus; or
575 3. That there is evidence of the onset and persistence of
576 uterine contractions or rupture of the membranes.
577 (9) “Emergency services and care” means medical screening,
578 examination, and evaluation by a physician, or, to the extent
579 permitted by applicable law, by other appropriate personnel
580 under the supervision of a physician, to determine if an
581 emergency medical condition exists and, if it does, the care,
582 treatment, or surgery by a physician necessary to relieve or
583 eliminate the emergency medical condition, within the service
584 capability of the facility.
585 (10) “General hospital” means any facility that which meets
586 the provisions of subsection (12) and which regularly makes its
587 facilities and services available to the general population.
588 (11) “Governmental unit” means the state or any county,
589 municipality, or other political subdivision, or any department,
590 division, board, or other agency of any of the foregoing.
591 (12) “Hospital” means any establishment that:
592 (a) Offers services more intensive than those required for
593 room, board, personal services, and general nursing care, and
594 offers facilities and beds for use beyond 24 hours by
595 individuals requiring diagnosis, treatment, or care for illness,
596 injury, deformity, infirmity, abnormality, disease, or
597 pregnancy; and
598 (b) Regularly makes available at least clinical laboratory
599 services, diagnostic X-ray services, and treatment facilities
600 for surgery or obstetrical care, or other definitive medical
601 treatment of similar extent, except that a critical access
602 hospital, as defined in s. 408.07, shall not be required to make
603 available treatment facilities for surgery, obstetrical care, or
604 similar services as long as it maintains its critical access
605 hospital designation and shall be required to make such
606 facilities available only if it ceases to be designated as a
607 critical access hospital.
608
609 However, the provisions of this chapter does do not apply to any
610 institution conducted by or for the adherents of any well
611 recognized church or religious denomination that depends
612 exclusively upon prayer or spiritual means to heal, care for, or
613 treat any person. For purposes of local zoning matters, the term
614 “hospital” includes a medical office building located on the
615 same premises as a hospital facility, provided the land on which
616 the medical office building is constructed is zoned for use as a
617 hospital; provided the premises were zoned for hospital purposes
618 on January 1, 1992.
619 (13) “Hospital bed” means a hospital accommodation that
620 which is ready for immediate occupancy, or is capable of being
621 made ready for occupancy within 48 hours, excluding provision of
622 staffing, and which conforms to minimum space, equipment, and
623 furnishings standards as specified by rule of the agency for the
624 provision of services specified in this section to a single
625 patient.
626 (14) “Initial denial determination” means a determination
627 by a private review agent that the health care services
628 furnished or proposed to be furnished to a patient are
629 inappropriate, not medically necessary, or not reasonable.
630 (14)(15) “Intensive residential treatment programs for
631 children and adolescents” means a specialty hospital accredited
632 by an accrediting organization as defined in subsection (1)
633 which provides 24-hour care and which has the primary functions
634 of diagnosis and treatment of patients under the age of 18
635 having psychiatric disorders in order to restore such patients
636 to an optimal level of functioning.
637 (15)(16) “Licensed facility” means a hospital, ambulatory
638 surgical center, or mobile surgical facility licensed in
639 accordance with this chapter.
640 (16)(17) “Lifesafety” means the control and prevention of
641 fire and other life-threatening conditions on a premises for the
642 purpose of preserving human life.
643 (17)(18) “Managing employee” means the administrator or
644 other similarly titled individual who is responsible for the
645 daily operation of the facility.
646 (18)(19) “Medical staff” means physicians licensed under
647 chapter 458 or chapter 459 with privileges in a licensed
648 facility, as well as other licensed health care practitioners
649 with clinical privileges as approved by a licensed facility’s
650 governing board.
651 (19)(20) “Medically necessary transfer” means a transfer
652 made necessary because the patient is in immediate need of
653 treatment for an emergency medical condition for which the
654 facility lacks service capability or is at service capacity.
655 (20)(21) “Mobile surgical facility” is a mobile facility in
656 which licensed health care professionals provide elective
657 surgical care under contract with the Department of Corrections
658 or a private correctional facility operating pursuant to chapter
659 957 and in which inmate patients are admitted to and discharged
660 from said facility within the same working day and are not
661 permitted to stay overnight. However, mobile surgical facilities
662 may only provide health care services to the inmate patients of
663 the Department of Corrections, or inmate patients of a private
664 correctional facility operating pursuant to chapter 957, and not
665 to the general public.
666 (21)(22) “Person” means any individual, partnership,
667 corporation, association, or governmental unit.
668 (22)(23) “Premises” means those buildings, beds, and
669 equipment located at the address of the licensed facility and
670 all other buildings, beds, and equipment for the provision of
671 hospital, ambulatory surgical, or mobile surgical care located
672 in such reasonable proximity to the address of the licensed
673 facility as to appear to the public to be under the dominion and
674 control of the licensee. For any licensee that is a teaching
675 hospital as defined in s. 408.07(45), reasonable proximity
676 includes any buildings, beds, services, programs, and equipment
677 under the dominion and control of the licensee that are located
678 at a site with a main address that is within 1 mile of the main
679 address of the licensed facility; and all such buildings, beds,
680 and equipment may, at the request of a licensee or applicant, be
681 included on the facility license as a single premises.
682 (24) “Private review agent” means any person or entity
683 which performs utilization review services for third-party
684 payors on a contractual basis for outpatient or inpatient
685 services. However, the term shall not include full-time
686 employees, personnel, or staff of health insurers, health
687 maintenance organizations, or hospitals, or wholly owned
688 subsidiaries thereof or affiliates under common ownership, when
689 performing utilization review for their respective hospitals,
690 health maintenance organizations, or insureds of the same
691 insurance group. For this purpose, health insurers, health
692 maintenance organizations, and hospitals, or wholly owned
693 subsidiaries thereof or affiliates under common ownership,
694 include such entities engaged as administrators of self
695 insurance as defined in s. 624.031.
696 (23)(25) “Service capability” means all services offered by
697 the facility where identification of services offered is
698 evidenced by the appearance of the service in a patient’s
699 medical record or itemized bill.
700 (24)(26) “At service capacity” means the temporary
701 inability of a hospital to provide a service that which is
702 within the service capability of the hospital, due to maximum
703 use of the service at the time of the request for the service.
704 (25)(27) “Specialty bed” means a bed, other than a general
705 bed, designated on the face of the hospital license for a
706 dedicated use.
707 (26)(28) “Specialty hospital” means any facility that which
708 meets the provisions of subsection (12), and which regularly
709 makes available either:
710 (a) The range of medical services offered by general
711 hospitals, but restricted to a defined age or gender group of
712 the population;
713 (b) A restricted range of services appropriate to the
714 diagnosis, care, and treatment of patients with specific
715 categories of medical or psychiatric illnesses or disorders; or
716 (c) Intensive residential treatment programs for children
717 and adolescents as defined in subsection (15).
718 (27)(29) “Stabilized” means, with respect to an emergency
719 medical condition, that no material deterioration of the
720 condition is likely, within reasonable medical probability, to
721 result from the transfer of the patient from a hospital.
722 (30) “Utilization review” means a system for reviewing the
723 medical necessity or appropriateness in the allocation of health
724 care resources of hospital services given or proposed to be
725 given to a patient or group of patients.
726 (31) “Utilization review plan” means a description of the
727 policies and procedures governing utilization review activities
728 performed by a private review agent.
729 (28)(32) “Validation inspection” means an inspection of the
730 premises of a licensed facility by the agency to assess whether
731 a review by an accrediting organization has adequately evaluated
732 the licensed facility according to minimum state standards.
733 Section 9. Subsection (1) and paragraph (b) of subsection
734 (2) of section 395.003, Florida Statutes, are amended to read:
735 395.003 Licensure; denial, suspension, and revocation.—
736 (1)(a) The requirements of part II of chapter 408 apply to
737 the provision of services that require licensure pursuant to ss.
738 395.001-395.1065 and part II of chapter 408 and to entities
739 licensed by or applying for such licensure from the Agency for
740 Health Care Administration pursuant to ss. 395.001-395.1065. A
741 license issued by the agency is required in order to operate a
742 hospital, ambulatory surgical center, or mobile surgical
743 facility in this state.
744 (b)1. It is unlawful for a person to use or advertise to
745 the public, in any way or by any medium whatsoever, any facility
746 as a “hospital,” “ambulatory surgical center,” or “mobile
747 surgical facility” unless such facility has first secured a
748 license under the provisions of this part.
749 2. This part does not apply to veterinary hospitals or to
750 commercial business establishments using the word “hospital,”
751 “ambulatory surgical center,” or “mobile surgical facility” as a
752 part of a trade name if no treatment of human beings is
753 performed on the premises of such establishments.
754 (c) Until July 1, 2006, additional emergency departments
755 located off the premises of licensed hospitals may not be
756 authorized by the agency.
757 (2)
758 (b) The agency shall, at the request of a licensee that is
759 a teaching hospital as defined in s. 408.07(45), issue a single
760 license to a licensee for facilities that have been previously
761 licensed as separate premises, provided such separately licensed
762 facilities, taken together, constitute the same premises as
763 defined in s. 395.002(22) s. 395.002(23). Such license for the
764 single premises shall include all of the beds, services, and
765 programs that were previously included on the licenses for the
766 separate premises. The granting of a single license under this
767 paragraph shall not in any manner reduce the number of beds,
768 services, or programs operated by the licensee.
769 Section 10. Paragraph (e) of subsection (2) and subsection
770 (4) of section 395.0193, Florida Statutes, are amended to read:
771 395.0193 Licensed facilities; peer review; disciplinary
772 powers; agency or partnership with physicians.—
773 (2) Each licensed facility, as a condition of licensure,
774 shall provide for peer review of physicians who deliver health
775 care services at the facility. Each licensed facility shall
776 develop written, binding procedures by which such peer review
777 shall be conducted. Such procedures shall include:
778 (e) Recording of agendas and minutes that which do not
779 contain confidential material, for review by the Division of
780 Medical Quality Assurance of the department Health Quality
781 Assurance of the agency.
782 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
783 actions taken under subsection (3) shall be reported in writing
784 to the Division of Medical Quality Assurance of the department
785 Health Quality Assurance of the agency within 30 working days
786 after its initial occurrence, regardless of the pendency of
787 appeals to the governing board of the hospital. The notification
788 shall identify the disciplined practitioner, the action taken,
789 and the reason for such action. All final disciplinary actions
790 taken under subsection (3), if different from those which were
791 reported to the department agency within 30 days after the
792 initial occurrence, shall be reported within 10 working days to
793 the Division of Medical Quality Assurance of the department
794 Health Quality Assurance of the agency in writing and shall
795 specify the disciplinary action taken and the specific grounds
796 therefor. The division shall review each report and determine
797 whether it potentially involved conduct by the licensee that is
798 subject to disciplinary action, in which case s. 456.073 shall
799 apply. The reports are not subject to inspection under s.
800 119.07(1) even if the division’s investigation results in a
801 finding of probable cause.
802 Section 11. Section 395.1023, Florida Statutes, is amended
803 to read:
804 395.1023 Child abuse and neglect cases; duties.—Each
805 licensed facility shall adopt a protocol that, at a minimum,
806 requires the facility to:
807 (1) Incorporate a facility policy that every staff member
808 has an affirmative duty to report, pursuant to chapter 39, any
809 actual or suspected case of child abuse, abandonment, or
810 neglect; and
811 (2) In any case involving suspected child abuse,
812 abandonment, or neglect, designate, at the request of the
813 Department of Children and Family Services department, a staff
814 physician to act as a liaison between the hospital and the
815 Department of Children and Family Services office that which is
816 investigating the suspected abuse, abandonment, or neglect, and
817 the child protection team, as defined in s. 39.01, when the case
818 is referred to such a team.
819
820 Each general hospital and appropriate specialty hospital shall
821 comply with the provisions of this section and shall notify the
822 agency and the Department of Children and Family Services
823 department of its compliance by sending a copy of its policy to
824 the agency and the Department of Children and Family Services
825 department as required by rule. The failure by a general
826 hospital or appropriate specialty hospital to comply shall be
827 punished by a fine not exceeding $1,000, to be fixed, imposed,
828 and collected by the agency. Each day in violation is considered
829 a separate offense.
830 Section 12. Subsection (2) and paragraph (d) of subsection
831 (3) of section 395.1041, Florida Statutes, are amended to read:
832 395.1041 Access to emergency services and care.—
833 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
834 shall establish and maintain an inventory of hospitals with
835 emergency services. The inventory shall list all services within
836 the service capability of the hospital, and such services shall
837 appear on the face of the hospital license. Each hospital having
838 emergency services shall notify the agency of its service
839 capability in the manner and form prescribed by the agency. The
840 agency shall use the inventory to assist emergency medical
841 services providers and others in locating appropriate emergency
842 medical care. The inventory shall also be made available to the
843 general public. On or before August 1, 1992, the agency shall
844 request that each hospital identify the services which are
845 within its service capability. On or before November 1, 1992,
846 the agency shall notify each hospital of the service capability
847 to be included in the inventory. The hospital has 15 days from
848 the date of receipt to respond to the notice. By December 1,
849 1992, the agency shall publish a final inventory. Each hospital
850 shall reaffirm its service capability when its license is
851 renewed and shall notify the agency of the addition of a new
852 service or the termination of a service prior to a change in its
853 service capability.
854 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
855 FACILITY OR HEALTH CARE PERSONNEL.—
856 (d)1. Every hospital shall ensure the provision of services
857 within the service capability of the hospital, at all times,
858 either directly or indirectly through an arrangement with
859 another hospital, through an arrangement with one or more
860 physicians, or as otherwise made through prior arrangements. A
861 hospital may enter into an agreement with another hospital for
862 purposes of meeting its service capability requirement, and
863 appropriate compensation or other reasonable conditions may be
864 negotiated for these backup services.
865 2. If any arrangement requires the provision of emergency
866 medical transportation, such arrangement must be made in
867 consultation with the applicable provider and may not require
868 the emergency medical service provider to provide transportation
869 that is outside the routine service area of that provider or in
870 a manner that impairs the ability of the emergency medical
871 service provider to timely respond to prehospital emergency
872 calls.
873 3. A hospital shall not be required to ensure service
874 capability at all times as required in subparagraph 1. if, prior
875 to the receiving of any patient needing such service capability,
876 such hospital has demonstrated to the agency that it lacks the
877 ability to ensure such capability and it has exhausted all
878 reasonable efforts to ensure such capability through backup
879 arrangements. In reviewing a hospital’s demonstration of lack of
880 ability to ensure service capability, the agency shall consider
881 factors relevant to the particular case, including the
882 following:
883 a. Number and proximity of hospitals with the same service
884 capability.
885 b. Number, type, credentials, and privileges of
886 specialists.
887 c. Frequency of procedures.
888 d. Size of hospital.
889 4. The agency shall publish proposed rules implementing a
890 reasonable exemption procedure by November 1, 1992. Subparagraph
891 1. shall become effective upon the effective date of said rules
892 or January 31, 1993, whichever is earlier. For a period not to
893 exceed 1 year from the effective date of subparagraph 1., a
894 hospital requesting an exemption shall be deemed to be exempt
895 from offering the service until the agency initially acts to
896 deny or grant the original request. The agency has 45 days from
897 the date of receipt of the request to approve or deny the
898 request. After the first year from the effective date of
899 subparagraph 1., If the agency fails to initially act within the
900 time period, the hospital is deemed to be exempt from offering
901 the service until the agency initially acts to deny the request.
902 Section 13. Section 395.1046, Florida Statutes, is
903 repealed.
904 Section 14. Paragraph (e) of subsection (1) of section
905 395.1055, Florida Statutes, is amended to read:
906 395.1055 Rules and enforcement.—
907 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
908 and 120.54 to implement the provisions of this part, which shall
909 include reasonable and fair minimum standards for ensuring that:
910 (e) Licensed facility beds conform to minimum space,
911 equipment, and furnishings standards as specified by the agency,
912 the Florida Building Code, and the Florida Fire Prevention Code
913 department.
914 Section 15. Subsection (1) of section 395.10972, Florida
915 Statutes, is amended to read:
916 395.10972 Health Care Risk Manager Advisory Council.—The
917 Secretary of Health Care Administration may appoint a seven
918 member advisory council to advise the agency on matters
919 pertaining to health care risk managers. The members of the
920 council shall serve at the pleasure of the secretary. The
921 council shall designate a chair. The council shall meet at the
922 call of the secretary or at those times as may be required by
923 rule of the agency. The members of the advisory council shall
924 receive no compensation for their services, but shall be
925 reimbursed for travel expenses as provided in s. 112.061. The
926 council shall consist of individuals representing the following
927 areas:
928 (1) Two shall be active health care risk managers,
929 including one risk manager who is recommended by and a member of
930 the Florida Society for of Healthcare Risk Management and
931 Patient Safety.
932 Section 16. Subsection (3) of section 395.2050, Florida
933 Statutes, is amended to read:
934 395.2050 Routine inquiry for organ and tissue donation;
935 certification for procurement activities; death records review.—
936 (3) Each organ procurement organization designated by the
937 federal Centers for Medicare and Medicaid Services Health Care
938 Financing Administration and licensed by the state shall conduct
939 an annual death records review in the organ procurement
940 organization’s affiliated donor hospitals. The organ procurement
941 organization shall enlist the services of every Florida licensed
942 tissue bank and eye bank affiliated with or providing service to
943 the donor hospital and operating in the same service area to
944 participate in the death records review.
945 Section 17. Subsection (2) of section 395.3036, Florida
946 Statutes, is amended to read:
947 395.3036 Confidentiality of records and meetings of
948 corporations that lease public hospitals or other public health
949 care facilities.—The records of a private corporation that
950 leases a public hospital or other public health care facility
951 are confidential and exempt from the provisions of s. 119.07(1)
952 and s. 24(a), Art. I of the State Constitution, and the meetings
953 of the governing board of a private corporation are exempt from
954 s. 286.011 and s. 24(b), Art. I of the State Constitution when
955 the public lessor complies with the public finance
956 accountability provisions of s. 155.40(5) with respect to the
957 transfer of any public funds to the private lessee and when the
958 private lessee meets at least three of the five following
959 criteria:
960 (2) The public lessor and the private lessee do not
961 commingle any of their funds in any account maintained by either
962 of them, other than the payment of the rent and administrative
963 fees or the transfer of funds pursuant to subsection (5)(2).
964 Section 18. Section 395.3037, Florida Statutes, is
965 repealed.
966 Section 19. Subsections (1), (4), and (5) of section
967 395.3038, Florida Statutes, are amended to read:
968 395.3038 State-listed primary stroke centers and
969 comprehensive stroke centers; notification of hospitals.—
970 (1) The agency shall make available on its website and to
971 the department a list of the name and address of each hospital
972 that meets the criteria for a primary stroke center and the name
973 and address of each hospital that meets the criteria for a
974 comprehensive stroke center. The list of primary and
975 comprehensive stroke centers shall include only those hospitals
976 that attest in an affidavit submitted to the agency that the
977 hospital meets the named criteria, or those hospitals that
978 attest in an affidavit submitted to the agency that the hospital
979 is certified as a primary or a comprehensive stroke center by
980 the Joint Commission on Accreditation of Healthcare
981 Organizations.
982 (4) The agency shall adopt by rule criteria for a primary
983 stroke center which are substantially similar to the
984 certification standards for primary stroke centers of the Joint
985 Commission on Accreditation of Healthcare Organizations.
986 (5) The agency shall adopt by rule criteria for a
987 comprehensive stroke center. However, if the Joint Commission on
988 Accreditation of Healthcare Organizations establishes criteria
989 for a comprehensive stroke center, the agency shall establish
990 criteria for a comprehensive stroke center which are
991 substantially similar to those criteria established by the Joint
992 Commission on Accreditation of Healthcare Organizations.
993 Section 20. Subsection (2) of section 395.602, Florida
994 Statutes, is amended to read:
995 395.602 Rural hospitals.—
996 (2) DEFINITIONS.—As used in this part:
997 (a) “Emergency care hospital” means a medical facility that
998 which provides:
999 1. Emergency medical treatment; and
1000 2. Inpatient care to ill or injured persons prior to their
1001 transportation to another hospital or provides inpatient medical
1002 care to persons needing care for a period of up to 96 hours. The
1003 96-hour limitation on inpatient care does not apply to respite,
1004 skilled nursing, hospice, or other nonacute care patients.
1005 (b) “Essential access community hospital” means any
1006 facility that which:
1007 1. Has at least 100 beds;
1008 2. Is located more than 35 miles from any other essential
1009 access community hospital, rural referral center, or urban
1010 hospital meeting criteria for classification as a regional
1011 referral center;
1012 3. Is part of a network that includes rural primary care
1013 hospitals;
1014 4. Provides emergency and medical backup services to rural
1015 primary care hospitals in its rural health network;
1016 5. Extends staff privileges to rural primary care hospital
1017 physicians in its network; and
1018 6. Accepts patients transferred from rural primary care
1019 hospitals in its network.
1020 (c) “Inactive rural hospital bed” means a licensed acute
1021 care hospital bed, as defined in s. 395.002(13), that is
1022 inactive in that it cannot be occupied by acute care inpatients.
1023 (d) “Rural area health education center” means an area
1024 health education center (AHEC), as authorized by Pub. L. No. 94
1025 484, which provides services in a county with a population
1026 density of no greater than 100 persons per square mile.
1027 (e) “Rural hospital” means an acute care hospital licensed
1028 under this chapter which has, having 100 or fewer licensed beds
1029 and an emergency room and, which is:
1030 1. The sole provider within a county with a population
1031 density of no greater than 100 persons per square mile;
1032 2. An acute care hospital, in a county with a population
1033 density of no greater than 100 persons per square mile, which is
1034 at least 30 minutes of travel time, on normally traveled roads
1035 under normal traffic conditions, from any other acute care
1036 hospital within the same county;
1037 3. A hospital supported by a tax district or subdistrict
1038 whose boundaries encompass a population of 100 persons or fewer
1039 per square mile;
1040 4. A hospital in a constitutional charter county with a
1041 population of over 1 million persons that has imposed a local
1042 option health service tax pursuant to law and in an area that
1043 was directly impacted by a catastrophic event on August 24,
1044 1992, for which the Governor of Florida declared a state of
1045 emergency pursuant to chapter 125, and has 120 beds or less that
1046 serves an agricultural community with an emergency room
1047 utilization of no less than 20,000 visits and a Medicaid
1048 inpatient utilization rate greater than 15 percent;
1049 4.5. A hospital with a service area that has a population
1050 of 100 persons or fewer per square mile. As used in this
1051 subparagraph, the term “service area” means the fewest number of
1052 zip codes that account for 75 percent of the hospital’s
1053 discharges for the most recent 5-year period, based on
1054 information available from the hospital inpatient discharge
1055 database in the Florida Center for Health Information and Policy
1056 Analysis at the Agency for Health Care Administration; or
1057 5.6. A hospital designated as a critical access hospital,
1058 as defined in s. 408.07(15).
1059
1060 Population densities used in this paragraph must be based upon
1061 the most recently completed United States census. A hospital
1062 that received funds under s. 409.9116 for a quarter beginning no
1063 later than July 1, 2002, is deemed to have been and shall
1064 continue to be a rural hospital from that date through June 30,
1065 2015, if the hospital continues to have 100 or fewer licensed
1066 beds and an emergency room, or meets the criteria of
1067 subparagraph 4. An acute care hospital that has not previously
1068 been designated as a rural hospital and that meets the criteria
1069 of this paragraph shall be granted such designation upon
1070 application, including supporting documentation to the Agency
1071 for Health Care Administration.
1072 (f) “Rural primary care hospital” means any facility
1073 meeting the criteria in paragraph (e) or s. 395.605 which
1074 provides:
1075 1. Twenty-four-hour emergency medical care;
1076 2. Temporary inpatient care for periods of 72 hours or less
1077 to patients requiring stabilization before discharge or transfer
1078 to another hospital. The 72-hour limitation does not apply to
1079 respite, skilled nursing, hospice, or other nonacute care
1080 patients; and
1081 3. Has no more than six licensed acute care inpatient beds.
1082 (g) “Swing-bed” means a bed that which can be used
1083 interchangeably as either a hospital, skilled nursing facility
1084 (SNF), or intermediate care facility (ICF) bed pursuant to 42
1085 C.F.R. parts 405, 435, 440, 442, and 447.
1086 Section 21. Subsection (8) of section 400.021, Florida
1087 Statutes, is amended to read:
1088 400.021 Definitions.—When used in this part, unless the
1089 context otherwise requires, the term:
1090 (8) “Geriatric outpatient clinic” means a site for
1091 providing outpatient health care to persons 60 years of age or
1092 older, which is staffed by a registered nurse or a physician
1093 assistant, a licensed practical nurse under the direct
1094 supervision of a registered nurse, or an advanced registered
1095 nurse practitioner.
1096 Section 22. Paragraph (g) of subsection (2) of section
1097 400.0239, Florida Statutes, is amended to read:
1098 400.0239 Quality of Long-Term Care Facility Improvement
1099 Trust Fund.—
1100 (2) Expenditures from the trust fund shall be allowable for
1101 direct support of the following:
1102 (g) Other initiatives authorized by the Centers for
1103 Medicare and Medicaid Services for the use of federal civil
1104 monetary penalties, including projects recommended through the
1105 Medicaid “Up-or-Out” Quality of Care Contract Management Program
1106 pursuant to s. 400.148.
1107 Section 23. Subsection (15) of section 400.0255, Florida
1108 Statutes, is amended to read
1109 400.0255 Resident transfer or discharge; requirements and
1110 procedures; hearings.—
1111 (15)(a) The department’s Office of Appeals Hearings shall
1112 conduct hearings under this section. The office shall notify the
1113 facility of a resident’s request for a hearing.
1114 (b) The department shall, by rule, establish procedures to
1115 be used for fair hearings requested by residents. These
1116 procedures shall be equivalent to the procedures used for fair
1117 hearings for other Medicaid cases appearing in s. 409.285 and
1118 applicable rules, chapter 10-2, part VI, Florida Administrative
1119 Code. The burden of proof must be clear and convincing evidence.
1120 A hearing decision must be rendered within 90 days after receipt
1121 of the request for hearing.
1122 (c) If the hearing decision is favorable to the resident
1123 who has been transferred or discharged, the resident must be
1124 readmitted to the facility’s first available bed.
1125 (d) The decision of the hearing officer shall be final. Any
1126 aggrieved party may appeal the decision to the district court of
1127 appeal in the appellate district where the facility is located.
1128 Review procedures shall be conducted in accordance with the
1129 Florida Rules of Appellate Procedure.
1130 Section 24. Subsection (2) of section 400.063, Florida
1131 Statutes, is amended to read:
1132 400.063 Resident protection.—
1133 (2) The agency is authorized to establish for each
1134 facility, subject to intervention by the agency, a separate bank
1135 account for the deposit to the credit of the agency of any
1136 moneys received from the Health Care Trust Fund or any other
1137 moneys received for the maintenance and care of residents in the
1138 facility, and the agency is authorized to disburse moneys from
1139 such account to pay obligations incurred for the purposes of
1140 this section. The agency is authorized to requisition moneys
1141 from the Health Care Trust Fund in advance of an actual need for
1142 cash on the basis of an estimate by the agency of moneys to be
1143 spent under the authority of this section. Any bank account
1144 established under this section need not be approved in advance
1145 of its creation as required by s. 17.58, but shall be secured by
1146 depository insurance equal to or greater than the balance of
1147 such account or by the pledge of collateral security in
1148 conformance with criteria established in s. 18.11. The agency
1149 shall notify the Chief Financial Officer of any such account so
1150 established and shall make a quarterly accounting to the Chief
1151 Financial Officer for all moneys deposited in such account.
1152 Section 25. Subsections (1) and (5) of section 400.071,
1153 Florida Statutes, are amended to read:
1154 400.071 Application for license.—
1155 (1) In addition to the requirements of part II of chapter
1156 408, the application for a license shall be under oath and must
1157 contain the following:
1158 (a) The location of the facility for which a license is
1159 sought and an indication, as in the original application, that
1160 such location conforms to the local zoning ordinances.
1161 (b) A signed affidavit disclosing any financial or
1162 ownership interest that a controlling interest as defined in
1163 part II of chapter 408 has held in the last 5 years in any
1164 entity licensed by this state or any other state to provide
1165 health or residential care which has closed voluntarily or
1166 involuntarily; has filed for bankruptcy; has had a receiver
1167 appointed; has had a license denied, suspended, or revoked; or
1168 has had an injunction issued against it which was initiated by a
1169 regulatory agency. The affidavit must disclose the reason any
1170 such entity was closed, whether voluntarily or involuntarily.
1171 (c) The total number of beds and the total number of
1172 Medicare and Medicaid certified beds.
1173 (b)(d) Information relating to the applicant and employees
1174 which the agency requires by rule. The applicant must
1175 demonstrate that sufficient numbers of qualified staff, by
1176 training or experience, will be employed to properly care for
1177 the type and number of residents who will reside in the
1178 facility.
1179 (c)(e) Copies of any civil verdict or judgment involving
1180 the applicant rendered within the 10 years preceding the
1181 application, relating to medical negligence, violation of
1182 residents’ rights, or wrongful death. As a condition of
1183 licensure, the licensee agrees to provide to the agency copies
1184 of any new verdict or judgment involving the applicant, relating
1185 to such matters, within 30 days after filing with the clerk of
1186 the court. The information required in this paragraph shall be
1187 maintained in the facility’s licensure file and in an agency
1188 database that which is available as a public record.
1189 (5) As a condition of licensure, each facility must
1190 establish and submit with its application a plan for quality
1191 assurance and for conducting risk management.
1192 Section 26. Section 400.0712, Florida Statutes, is amended
1193 to read:
1194 400.0712 Application for inactive license.—
1195 (1) As specified in this section, the agency may issue an
1196 inactive license to a nursing home facility for all or a portion
1197 of its beds. Any request by a licensee that a nursing home or
1198 portion of a nursing home become inactive must be submitted to
1199 the agency in the approved format. The facility may not initiate
1200 any suspension of services, notify residents, or initiate
1201 inactivity before receiving approval from the agency; and a
1202 licensee that violates this provision may not be issued an
1203 inactive license.
1204 (1)(2) In addition to the authority granted in part II of
1205 chapter 408, the agency may issue an inactive license to a
1206 nursing home that chooses to use an unoccupied contiguous
1207 portion of the facility for an alternative use to meet the needs
1208 of elderly persons through the use of less restrictive, less
1209 institutional services.
1210 (a) An inactive license issued under this subsection may be
1211 granted for a period not to exceed the current licensure
1212 expiration date but may be renewed by the agency at the time of
1213 licensure renewal.
1214 (b) A request to extend the inactive license must be
1215 submitted to the agency in the approved format and approved by
1216 the agency in writing.
1217 (c) Nursing homes that receive an inactive license to
1218 provide alternative services shall not receive preference for
1219 participation in the Assisted Living for the Elderly Medicaid
1220 waiver.
1221 (2)(3) The agency shall adopt rules pursuant to ss.
1222 120.536(1) and 120.54 necessary to administer implement this
1223 section.
1224 Section 27. Section 400.111, Florida Statutes, is amended
1225 to read:
1226 400.111 Disclosure of controlling interest.—In addition to
1227 the requirements of part II of chapter 408, when requested by
1228 the agency, the licensee shall submit a signed affidavit
1229 disclosing any financial or ownership interest that a
1230 controlling interest has held within the last 5 years in any
1231 entity licensed by the state or any other state to provide
1232 health or residential care if that which entity has closed
1233 voluntarily or involuntarily; has filed for bankruptcy; has had
1234 a receiver appointed; has had a license denied, suspended, or
1235 revoked; or has had an injunction issued against it which was
1236 initiated by a regulatory agency. The affidavit must disclose
1237 the reason such entity was closed, whether voluntarily or
1238 involuntarily.
1239 Section 28. Section 400.1183, Florida Statutes, is amended
1240 to read:
1241 400.1183 Resident grievance procedures.—
1242 (1) Every nursing home must have a grievance procedure
1243 available to its residents and their families. The grievance
1244 procedure must include:
1245 (a) An explanation of how to pursue redress of a grievance.
1246 (b) The names, job titles, and telephone numbers of the
1247 employees responsible for implementing the facility’s grievance
1248 procedure. The list must include the address and the toll-free
1249 telephone numbers of the ombudsman and the agency.
1250 (c) A simple description of the process through which a
1251 resident may, at any time, contact the toll-free telephone
1252 hotline of the ombudsman or the agency to report the unresolved
1253 grievance.
1254 (d) A procedure for providing assistance to residents who
1255 cannot prepare a written grievance without help.
1256 (2) Each facility shall maintain records of all grievances
1257 for agency inspection and shall report to the agency at the time
1258 of relicensure the total number of grievances handled during the
1259 prior licensure period, a categorization of the cases underlying
1260 the grievances, and the final disposition of the grievances.
1261 (3) Each facility must respond to the grievance within a
1262 reasonable time after its submission.
1263 (4) The agency may investigate any grievance at any time.
1264 Section 29. Section 400.141, Florida Statutes, is amended
1265 to read:
1266 400.141 Administration and management of nursing home
1267 facilities.—
1268 (1) Every licensed facility shall comply with all
1269 applicable standards and rules of the agency and shall:
1270 (a) Be under the administrative direction and charge of a
1271 licensed administrator.
1272 (b) Appoint a medical director licensed pursuant to chapter
1273 458 or chapter 459. The agency may establish by rule more
1274 specific criteria for the appointment of a medical director.
1275 (c) Have available the regular, consultative, and emergency
1276 services of physicians licensed by the state.
1277 (d) Provide for resident use of a community pharmacy as
1278 specified in s. 400.022(1)(q). Any other law to the contrary
1279 notwithstanding, a registered pharmacist licensed in Florida,
1280 that is under contract with a facility licensed under this
1281 chapter or chapter 429, shall repackage a nursing facility
1282 resident’s bulk prescription medication that which has been
1283 packaged by another pharmacist licensed in any state in the
1284 United States into a unit dose system compatible with the system
1285 used by the nursing facility, if the pharmacist is requested to
1286 offer such service. In order to be eligible for the repackaging,
1287 a resident or the resident’s spouse must receive prescription
1288 medication benefits provided through a former employer as part
1289 of his or her retirement benefits, a qualified pension plan as
1290 specified in s. 4972 of the Internal Revenue Code, a federal
1291 retirement program as specified under 5 C.F.R. s. 831, or a
1292 long-term care policy as defined in s. 627.9404(1). A pharmacist
1293 who correctly repackages and relabels the medication and the
1294 nursing facility that which correctly administers such
1295 repackaged medication under this paragraph may not be held
1296 liable in any civil or administrative action arising from the
1297 repackaging. In order to be eligible for the repackaging, a
1298 nursing facility resident for whom the medication is to be
1299 repackaged shall sign an informed consent form provided by the
1300 facility which includes an explanation of the repackaging
1301 process and which notifies the resident of the immunities from
1302 liability provided in this paragraph. A pharmacist who
1303 repackages and relabels prescription medications, as authorized
1304 under this paragraph, may charge a reasonable fee for costs
1305 resulting from the implementation of this provision.
1306 (e) Provide for the access of the facility residents to
1307 dental and other health-related services, recreational services,
1308 rehabilitative services, and social work services appropriate to
1309 their needs and conditions and not directly furnished by the
1310 licensee. When a geriatric outpatient nurse clinic is conducted
1311 in accordance with rules adopted by the agency, outpatients
1312 attending such clinic shall not be counted as part of the
1313 general resident population of the nursing home facility, nor
1314 shall the nursing staff of the geriatric outpatient clinic be
1315 counted as part of the nursing staff of the facility, until the
1316 outpatient clinic load exceeds 15 a day.
1317 (f) Be allowed and encouraged by the agency to provide
1318 other needed services under certain conditions. If the facility
1319 has a standard licensure status, and has had no class I or class
1320 II violations deficiencies during the past 2 years or has been
1321 awarded a Gold Seal under the program established in s. 400.235,
1322 it may be encouraged by the agency to provide services,
1323 including, but not limited to, respite and adult day services
1324 that, which enable individuals to move in and out of the
1325 facility. A facility is not subject to any additional licensure
1326 requirements for providing these services. Respite care may be
1327 offered to persons in need of short-term or temporary nursing
1328 home services. Respite care must be provided in accordance with
1329 this part and rules adopted by the agency. However, the agency
1330 shall, by rule, adopt modified requirements for resident
1331 assessment, resident care plans, resident contracts, physician
1332 orders, and other provisions, as appropriate, for short-term or
1333 temporary nursing home services. The agency shall allow for
1334 shared programming and staff in a facility that which meets
1335 minimum standards and offers services pursuant to this
1336 paragraph, but, if the facility is cited for deficiencies in
1337 patient care, may require additional staff and programs
1338 appropriate to the needs of service recipients. A person who
1339 receives respite care may not be counted as a resident of the
1340 facility for purposes of the facility’s licensed capacity unless
1341 that person receives 24-hour respite care. A person receiving
1342 either respite care for 24 hours or longer or adult day services
1343 must be included when calculating minimum staffing for the
1344 facility. Any costs and revenues generated by a nursing home
1345 facility from nonresidential programs or services shall be
1346 excluded from the calculations of Medicaid per diems for nursing
1347 home institutional care reimbursement.
1348 (g) If the facility has a standard license or is a Gold
1349 Seal facility, exceeds the minimum required hours of licensed
1350 nursing and certified nursing assistant direct care per resident
1351 per day, and is part of a continuing care facility licensed
1352 under chapter 651 or a retirement community that offers other
1353 services pursuant to part III of this chapter or part I or part
1354 III of chapter 429 on a single campus, be allowed to share
1355 programming and staff. At the time of inspection and in the
1356 semiannual report required pursuant to paragraph (o), a
1357 continuing care facility or retirement community that uses this
1358 option must demonstrate through staffing records that minimum
1359 staffing requirements for the facility were met. Licensed nurses
1360 and certified nursing assistants who work in the nursing home
1361 facility may be used to provide services elsewhere on campus if
1362 the facility exceeds the minimum number of direct care hours
1363 required per resident per day and the total number of residents
1364 receiving direct care services from a licensed nurse or a
1365 certified nursing assistant does not cause the facility to
1366 violate the staffing ratios required under s. 400.23(3)(a).
1367 Compliance with the minimum staffing ratios shall be based on
1368 total number of residents receiving direct care services,
1369 regardless of where they reside on campus. If the facility
1370 receives a conditional license, it may not share staff until the
1371 conditional license status ends. This paragraph does not
1372 restrict the agency’s authority under federal or state law to
1373 require additional staff if a facility is cited for deficiencies
1374 in care which are caused by an insufficient number of certified
1375 nursing assistants or licensed nurses. The agency may adopt
1376 rules for the documentation necessary to determine compliance
1377 with this provision.
1378 (h) Maintain the facility premises and equipment and
1379 conduct its operations in a safe and sanitary manner.
1380 (i) If the licensee furnishes food service, provide a
1381 wholesome and nourishing diet sufficient to meet generally
1382 accepted standards of proper nutrition for its residents and
1383 provide such therapeutic diets as may be prescribed by attending
1384 physicians. In making rules to implement this paragraph, the
1385 agency shall be guided by standards recommended by nationally
1386 recognized professional groups and associations with knowledge
1387 of dietetics.
1388 (j) Keep full records of resident admissions and
1389 discharges; medical and general health status, including medical
1390 records, personal and social history, and identity and address
1391 of next of kin or other persons who may have responsibility for
1392 the affairs of the residents; and individual resident care plans
1393 including, but not limited to, prescribed services, service
1394 frequency and duration, and service goals. The records shall be
1395 open to inspection by the agency.
1396 (k) Keep such fiscal records of its operations and
1397 conditions as may be necessary to provide information pursuant
1398 to this part.
1399 (l) Furnish copies of personnel records for employees
1400 affiliated with such facility, to any other facility licensed by
1401 this state requesting this information pursuant to this part.
1402 Such information contained in the records may include, but is
1403 not limited to, disciplinary matters and any reason for
1404 termination. Any facility releasing such records pursuant to
1405 this part shall be considered to be acting in good faith and may
1406 not be held liable for information contained in such records,
1407 absent a showing that the facility maliciously falsified such
1408 records.
1409 (m) Publicly display a poster provided by the agency
1410 containing the names, addresses, and telephone numbers for the
1411 state’s abuse hotline, the State Long-Term Care Ombudsman, the
1412 Agency for Health Care Administration consumer hotline, the
1413 Advocacy Center for Persons with Disabilities, the Florida
1414 Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1415 with a clear description of the assistance to be expected from
1416 each.
1417 (n) Submit to the agency the information specified in s.
1418 400.071(1)(b) for a management company within 30 days after the
1419 effective date of the management agreement.
1420 (n)(o)1. Submit semiannually to the agency, or more
1421 frequently if requested by the agency, information regarding
1422 facility staff-to-resident ratios, staff turnover, and staff
1423 stability, including information regarding certified nursing
1424 assistants, licensed nurses, the director of nursing, and the
1425 facility administrator. For purposes of this reporting:
1426 a. Staff-to-resident ratios must be reported in the
1427 categories specified in s. 400.23(3)(a) and applicable rules.
1428 The ratio must be reported as an average for the most recent
1429 calendar quarter.
1430 b. Staff turnover must be reported for the most recent 12
1431 month period ending on the last workday of the most recent
1432 calendar quarter prior to the date the information is submitted.
1433 The turnover rate must be computed quarterly, with the annual
1434 rate being the cumulative sum of the quarterly rates. The
1435 turnover rate is the total number of terminations or separations
1436 experienced during the quarter, excluding any employee
1437 terminated during a probationary period of 3 months or less,
1438 divided by the total number of staff employed at the end of the
1439 period for which the rate is computed, and expressed as a
1440 percentage.
1441 c. The formula for determining staff stability is the total
1442 number of employees who that have been employed for more than 12
1443 months, divided by the total number of employees employed at the
1444 end of the most recent calendar quarter, and expressed as a
1445 percentage.
1446 d. A nursing facility that has failed to comply with state
1447 minimum-staffing requirements for 2 consecutive days is
1448 prohibited from accepting new admissions until the facility has
1449 achieved the minimum-staffing requirements for a period of 6
1450 consecutive days. For the purposes of this sub-subparagraph, any
1451 person who was a resident of the facility and was absent from
1452 the facility for the purpose of receiving medical care at a
1453 separate location or was on a leave of absence is not considered
1454 a new admission. Failure to impose such an admissions moratorium
1455 constitutes a class II violation, and the agency shall fine the
1456 nursing facility $1,000 for such violation deficiency.
1457 e. A nursing facility that which does not have a
1458 conditional license may be cited for failure to comply with the
1459 standards in s. 400.23(3)(a)1.a. only if it has failed to meet
1460 those standards on 2 consecutive days or if it has failed to
1461 meet at least 97 percent of those standards on any one day.
1462 f. A facility that which has a conditional license must be
1463 in compliance with the standards in s. 400.23(3)(a) at all
1464 times.
1465 2. This paragraph does not limit the agency’s ability to
1466 impose a deficiency or take other actions if a facility does not
1467 have enough staff to meet the residents’ needs.
1468 (o)(p) Notify a licensed physician when a resident exhibits
1469 signs of dementia or cognitive impairment or has a change of
1470 condition in order to rule out the presence of an underlying
1471 physiological condition that may be contributing to such
1472 dementia or impairment. The notification must occur within 30
1473 days after the acknowledgment of such signs by facility staff.
1474 If an underlying condition is determined to exist, the facility
1475 shall arrange, with the appropriate health care provider, the
1476 necessary care and services to treat the condition.
1477 (p)(q) If the facility implements a dining and hospitality
1478 attendant program, ensure that the program is developed and
1479 implemented under the supervision of the facility director of
1480 nursing. A licensed nurse, licensed speech or occupational
1481 therapist, or a registered dietitian must conduct training of
1482 dining and hospitality attendants. A person employed by a
1483 facility as a dining and hospitality attendant must perform
1484 tasks under the direct supervision of a licensed nurse.
1485 (r) Report to the agency any filing for bankruptcy
1486 protection by the facility or its parent corporation,
1487 divestiture or spin-off of its assets, or corporate
1488 reorganization within 30 days after the completion of such
1489 activity.
1490 (q)(s) Maintain general and professional liability
1491 insurance coverage that is in force at all times. In lieu of
1492 general and professional liability insurance coverage, a state
1493 designated teaching nursing home and its affiliated assisted
1494 living facilities created under s. 430.80 may demonstrate proof
1495 of financial responsibility as provided in s. 430.80(3)(h).
1496 (r)(t) Maintain in the medical record for each resident a
1497 daily chart of certified nursing assistant services provided to
1498 the resident. The certified nursing assistant who is caring for
1499 the resident must complete this record by the end of his or her
1500 shift. This record must indicate assistance with activities of
1501 daily living, assistance with eating, and assistance with
1502 drinking, and must record each offering of nutrition and
1503 hydration for those residents whose plan of care or assessment
1504 indicates a risk for malnutrition or dehydration.
1505 (s)(u) Before November 30 of each year, subject to the
1506 availability of an adequate supply of the necessary vaccine,
1507 provide for immunizations against influenza viruses to all its
1508 consenting residents in accordance with the recommendations of
1509 the United States Centers for Disease Control and Prevention,
1510 subject to exemptions for medical contraindications and
1511 religious or personal beliefs. Subject to these exemptions, any
1512 consenting person who becomes a resident of the facility after
1513 November 30 but before March 31 of the following year must be
1514 immunized within 5 working days after becoming a resident.
1515 Immunization shall not be provided to any resident who provides
1516 documentation that he or she has been immunized as required by
1517 this paragraph. This paragraph does not prohibit a resident from
1518 receiving the immunization from his or her personal physician if
1519 he or she so chooses. A resident who chooses to receive the
1520 immunization from his or her personal physician shall provide
1521 proof of immunization to the facility. The agency may adopt and
1522 enforce any rules necessary to comply with or administer
1523 implement this paragraph subsection.
1524 (t)(v) Assess all residents for eligibility for
1525 pneumococcal polysaccharide vaccination (PPV) and vaccinate
1526 residents when indicated within 60 days after the effective date
1527 of this act in accordance with the recommendations of the United
1528 States Centers for Disease Control and Prevention, subject to
1529 exemptions for medical contraindications and religious or
1530 personal beliefs. Residents admitted after the effective date of
1531 this act shall be assessed within 5 working days of admission
1532 and, when indicated, vaccinated within 60 days in accordance
1533 with the recommendations of the United States Centers for
1534 Disease Control and Prevention, subject to exemptions for
1535 medical contraindications and religious or personal beliefs.
1536 Immunization shall not be provided to any resident who provides
1537 documentation that he or she has been immunized as required by
1538 this paragraph. This paragraph does not prohibit a resident from
1539 receiving the immunization from his or her personal physician if
1540 he or she so chooses. A resident who chooses to receive the
1541 immunization from his or her personal physician shall provide
1542 proof of immunization to the facility. The agency may adopt and
1543 enforce any rules necessary to comply with or administer
1544 implement this paragraph.
1545 (u)(w) Annually encourage and promote to its employees the
1546 benefits associated with immunizations against influenza viruses
1547 in accordance with the recommendations of the United States
1548 Centers for Disease Control and Prevention. The agency may adopt
1549 and enforce any rules necessary to comply with or administer
1550 implement this paragraph.
1551 (2) Facilities that have been awarded a Gold Seal under the
1552 program established in s. 400.235 may develop a plan to provide
1553 certified nursing assistant training as prescribed by federal
1554 regulations and state rules and may apply to the agency for
1555 approval of their program.
1556 Section 30. Subsection (3) of section 400.142, Florida
1557 Statutes, is amended to read:
1558 400.142 Emergency medication kits; orders not to
1559 resuscitate.—
1560 (3) Facility staff may withhold or withdraw cardiopulmonary
1561 resuscitation if presented with an order not to resuscitate
1562 executed pursuant to s. 401.45. The agency shall adopt rules
1563 providing for the implementation of such orders. Facility staff
1564 and facilities are shall not be subject to criminal prosecution
1565 or civil liability, nor be considered to have engaged in
1566 negligent or unprofessional conduct, for withholding or
1567 withdrawing cardiopulmonary resuscitation pursuant to such an
1568 order and rules adopted by the agency. The absence of an order
1569 not to resuscitate executed pursuant to s. 401.45 does not
1570 preclude a physician from withholding or withdrawing
1571 cardiopulmonary resuscitation as otherwise permitted by law.
1572 Section 31. Subsection (10) of section 400.147, Florida
1573 Statutes, is repealed.
1574 Section 32. Section 400.148, Florida Statutes, is repealed.
1575 Section 33. Subsection (3) of section 400.19, Florida
1576 Statutes, is amended to read:
1577 400.19 Right of entry and inspection.—
1578 (3) The agency shall every 15 months conduct at least one
1579 unannounced inspection to determine compliance by the licensee
1580 with statutes, and with rules adopted promulgated under the
1581 provisions of those statutes, governing minimum standards of
1582 construction, quality and adequacy of care, and rights of
1583 residents. The survey shall be conducted every 6 months for the
1584 next 2-year period if the facility has been cited for a class I
1585 deficiency, has been cited for two or more class II violations
1586 deficiencies arising from separate surveys or investigations
1587 within a 60-day period, or has had three or more substantiated
1588 complaints within a 6-month period, each resulting in at least
1589 one class I or class II deficiency. In addition to any other
1590 fees or fines in this part, the agency shall assess a fine for
1591 each facility that is subject to the 6-month survey cycle. The
1592 fine for the 2-year period shall be $6,000, one-half to be paid
1593 at the completion of each survey. The agency may adjust this
1594 fine by the change in the Consumer Price Index, based on the 12
1595 months immediately preceding the increase, to cover the cost of
1596 the additional surveys. The agency shall verify through
1597 subsequent inspection that any deficiency identified during
1598 inspection is corrected. However, the agency may verify the
1599 correction of a class III or class IV violation deficiency
1600 unrelated to resident rights or resident care without
1601 reinspecting the facility if adequate written documentation has
1602 been received from the facility, which provides assurance that
1603 the deficiency has been corrected. The giving or causing to be
1604 given of advance notice of such unannounced inspections by an
1605 employee of the agency to any unauthorized person shall
1606 constitute cause for suspension of not fewer than 5 working days
1607 according to the provisions of chapter 110.
1608 Section 34. Section 400.195, Florida Statutes, is repealed.
1609 Section 35. Subsection (5) of section 400.23, Florida
1610 Statutes, is amended to read:
1611 400.23 Rules; evaluation and deficiencies; licensure
1612 status.—
1613 (5) The agency, in collaboration with the Division of
1614 Children’s Medical Services Network of the Department of Health,
1615 must, no later than December 31, 1993, adopt rules for minimum
1616 standards of care for persons under 21 years of age who reside
1617 in nursing home facilities. The rules must include a methodology
1618 for reviewing a nursing home facility under ss. 408.031-408.045
1619 which serves only persons under 21 years of age. A facility may
1620 be exempt from these standards for specific persons between 18
1621 and 21 years of age, if the person’s physician agrees that
1622 minimum standards of care based on age are not necessary.
1623 Section 36. Subsection (1) of section 400.275, Florida
1624 Statutes, is amended to read:
1625 400.275 Agency duties.—
1626 (1) The agency shall ensure that each newly hired nursing
1627 home surveyor, as a part of basic training, is assigned full
1628 time to a licensed nursing home for at least 2 days within a 7
1629 day period to observe facility operations outside of the survey
1630 process before the surveyor begins survey responsibilities. Such
1631 observations may not be the sole basis of a deficiency citation
1632 against the facility. The agency may not assign an individual to
1633 be a member of a survey team for purposes of a survey,
1634 evaluation, or consultation visit at a nursing home facility in
1635 which the surveyor was an employee within the preceding 5 years.
1636 Section 37. Section 400.484, Florida Statutes, is amended
1637 to read:
1638 400.484 Right of inspection; violations deficiencies;
1639 fines.—
1640 (1) In addition to the requirements of s. 408.811, the
1641 agency may make such inspections and investigations as are
1642 necessary in order to determine the state of compliance with
1643 this part, part II of chapter 408, and applicable rules.
1644 (2) The agency shall impose fines for various classes of
1645 violations deficiencies in accordance with the following
1646 schedule:
1647 (a) A class I violation is defined in s. 408.813. A class I
1648 deficiency is any act, omission, or practice that results in a
1649 patient’s death, disablement, or permanent injury, or places a
1650 patient at imminent risk of death, disablement, or permanent
1651 injury. Upon finding a class I violation deficiency, the agency
1652 shall impose an administrative fine in the amount of $15,000 for
1653 each occurrence and each day that the violation deficiency
1654 exists.
1655 (b) A class II violation is defined in s. 408.813. A class
1656 II deficiency is any act, omission, or practice that has a
1657 direct adverse effect on the health, safety, or security of a
1658 patient. Upon finding a class II violation deficiency, the
1659 agency shall impose an administrative fine in the amount of
1660 $5,000 for each occurrence and each day that the violation
1661 deficiency exists.
1662 (c) A class III violation is defined in s. 408.813. A class
1663 III deficiency is any act, omission, or practice that has an
1664 indirect, adverse effect on the health, safety, or security of a
1665 patient. Upon finding an uncorrected or repeated class III
1666 violation deficiency, the agency shall impose an administrative
1667 fine not to exceed $1,000 for each occurrence and each day that
1668 the uncorrected or repeated violation deficiency exists.
1669 (d) A class IV violation is defined in s. 408.813. A class
1670 IV deficiency is any act, omission, or practice related to
1671 required reports, forms, or documents which does not have the
1672 potential of negatively affecting patients. These violations are
1673 of a type that the agency determines do not threaten the health,
1674 safety, or security of patients. Upon finding an uncorrected or
1675 repeated class IV violation deficiency, the agency shall impose
1676 an administrative fine not to exceed $500 for each occurrence
1677 and each day that the uncorrected or repeated violation
1678 deficiency exists.
1679 (3) In addition to any other penalties imposed pursuant to
1680 this section or part, the agency may assess costs related to an
1681 investigation that results in a successful prosecution,
1682 excluding costs associated with an attorney’s time.
1683 Section 38. Subsections (1) and (4) of section 400.606,
1684 Florida Statutes, are amended to read:
1685 400.606 License; application; renewal; conditional license
1686 or permit; certificate of need.—
1687 (1) In addition to the requirements of part II of chapter
1688 408, the initial application and change of ownership application
1689 must be accompanied by a plan for the delivery of home,
1690 residential, and homelike inpatient hospice services to
1691 terminally ill persons and their families. Such plan must
1692 contain, but need not be limited to:
1693 (a) The estimated average number of terminally ill persons
1694 to be served monthly.
1695 (b) The geographic area in which hospice services will be
1696 available.
1697 (c) A listing of services that which are or will be
1698 provided, either directly by the applicant or through
1699 contractual arrangements with existing providers.
1700 (d) Provisions for the implementation of hospice home care
1701 within 3 months after licensure.
1702 (e) Provisions for the implementation of hospice homelike
1703 inpatient care within 12 months after licensure.
1704 (f) The number and disciplines of professional staff to be
1705 employed.
1706 (g) The name and qualifications of any existing or
1707 potential contractee.
1708 (h) A plan for attracting and training volunteers.
1709 (i) The projected annual operating cost of the hospice.
1710
1711 If the applicant is an existing licensed health care provider,
1712 the application must be accompanied by a copy of the most recent
1713 profit-loss statement and, if applicable, the most recent
1714 licensure inspection report.
1715 (4) A freestanding hospice facility that is primarily
1716 engaged in providing inpatient and related services and that is
1717 not otherwise licensed as a health care facility shall be
1718 required to obtain a certificate of need. However, a
1719 freestanding hospice facility with six or fewer beds shall not
1720 be required to comply with institutional standards such as, but
1721 not limited to, standards requiring sprinkler systems, emergency
1722 electrical systems, or special lavatory devices.
1723 Section 39. Subsection (2) of section 400.607, Florida
1724 Statutes, is amended to read:
1725 400.607 Denial, suspension, revocation of license;
1726 emergency actions; imposition of administrative fine; grounds.—
1727 (2) A violation of the provisions of this part, part II of
1728 chapter 408, or applicable rules Any of the following actions by
1729 a licensed hospice or any of its employees shall be grounds for
1730 administrative action by the agency against a hospice.:
1731 (a) A violation of the provisions of this part, part II of
1732 chapter 408, or applicable rules.
1733 (b) An intentional or negligent act materially affecting
1734 the health or safety of a patient.
1735 Section 40. Section 400.915, Florida Statutes, is amended
1736 to read:
1737 400.915 Construction and renovation; requirements.—The
1738 requirements for the construction or renovation of a PPEC center
1739 shall comply with:
1740 (1) The provisions of chapter 553, which pertain to
1741 building construction standards, including plumbing, electrical
1742 code, glass, manufactured buildings, accessibility for the
1743 physically disabled;
1744 (2) The provisions of s. 633.022 and applicable rules
1745 pertaining to physical minimum standards for nonresidential
1746 child care physical facilities in rule 10M-12.003, Florida
1747 Administrative Code, Child Care Standards; and
1748 (3) The standards or rules adopted pursuant to this part
1749 and part II of chapter 408.
1750 Section 41. Subsection (1) of section 400.925, Florida
1751 Statutes, is amended to read:
1752 400.925 Definitions.—As used in this part, the term:
1753 (1) “Accrediting organizations” means the Joint Commission
1754 on Accreditation of Healthcare Organizations or other national
1755 accreditation agencies whose standards for accreditation are
1756 comparable to those required by this part for licensure.
1757 Section 42. Section 400.931, Florida Statutes, is amended
1758 to read:
1759 400.931 Application for license; fee; provisional license;
1760 temporary permit.—
1761 (1) In addition to the requirements of part II of chapter
1762 408, the applicant must file with the application satisfactory
1763 proof that the home medical equipment provider is in compliance
1764 with this part and applicable rules, including:
1765 (a) A report, by category, of the equipment to be provided,
1766 indicating those offered either directly by the applicant or
1767 through contractual arrangements with existing providers.
1768 Categories of equipment include:
1769 1. Respiratory modalities.
1770 2. Ambulation aids.
1771 3. Mobility aids.
1772 4. Sickroom setup.
1773 5. Disposables.
1774 (b) A report, by category, of the services to be provided,
1775 indicating those offered either directly by the applicant or
1776 through contractual arrangements with existing providers.
1777 Categories of services include:
1778 1. Intake.
1779 2. Equipment selection.
1780 3. Delivery.
1781 4. Setup and installation.
1782 5. Patient training.
1783 6. Ongoing service and maintenance.
1784 7. Retrieval.
1785 (c) A listing of those with whom the applicant contracts,
1786 both the providers the applicant uses to provide equipment or
1787 services to its consumers and the providers for whom the
1788 applicant provides services or equipment.
1789 (2) As an alternative to submitting proof of financial
1790 ability to operate as required in s. 408.810(8), the applicant
1791 may submit a $50,000 surety bond to the agency.
1792 (2)(3) As specified in part II of chapter 408, the home
1793 medical equipment provider must also obtain and maintain
1794 professional and commercial liability insurance. Proof of
1795 liability insurance, as defined in s. 624.605, must be submitted
1796 with the application. The agency shall set the required amounts
1797 of liability insurance by rule, but the required amount must not
1798 be less than $250,000 per claim. In the case of contracted
1799 services, it is required that the contractor must have liability
1800 insurance not less than $250,000 per claim.
1801 (3)(4) When a change of the general manager of a home
1802 medical equipment provider occurs, the licensee must notify the
1803 agency of the change within 45 days.
1804 (4)(5) In accordance with s. 408.805, an applicant or a
1805 licensee shall pay a fee for each license application submitted
1806 under this part, part II of chapter 408, and applicable rules.
1807 The amount of the fee shall be established by rule and may not
1808 exceed $300 per biennium. The agency shall set the fees in an
1809 amount that is sufficient to cover its costs in carrying out its
1810 responsibilities under this part. However, state, county, or
1811 municipal governments applying for licenses under this part are
1812 exempt from the payment of license fees.
1813 (5)(6) An applicant for initial licensure, renewal, or
1814 change of ownership shall also pay an inspection fee not to
1815 exceed $400, which shall be paid by all applicants except those
1816 not subject to licensure inspection by the agency as described
1817 in s. 400.933.
1818 Section 43. Subsection (2) of section 400.932, Florida
1819 Statutes, is amended to read:
1820 400.932 Administrative penalties.—
1821 (2) A violation of this part, part II of chapter 408, or
1822 applicable rules Any of the following actions by an employee of
1823 a home medical equipment provider is are grounds for
1824 administrative action or penalties by the agency.:
1825 (a) Violation of this part, part II of chapter 408, or
1826 applicable rules.
1827 (b) An intentional, reckless, or negligent act that
1828 materially affects the health or safety of a patient.
1829 Section 44. Subsection (2) of section 400.933, Florida
1830 Statutes, is amended to read:
1831 400.933 Licensure inspections and investigations.—
1832 (2) The agency shall accept, in lieu of its own periodic
1833 inspections for licensure, submission of the following:
1834 (a) The survey or inspection of an accrediting
1835 organization, provided the accreditation of the licensed home
1836 medical equipment provider is not conditional or provisional and
1837 provided the licensed home medical equipment provider authorizes
1838 release of, and the agency receives the report of, the
1839 accrediting organization; or
1840 (b) A copy of a valid medical oxygen retail establishment
1841 permit issued by the Department of Health, pursuant to chapter
1842 499.
1843 Section 45. Subsection (2) of section 400.953, Florida
1844 Statutes, is amended to read:
1845 400.953 Background screening of home medical equipment
1846 provider personnel.—The agency shall require employment
1847 screening as provided in chapter 435, using the level 1
1848 standards for screening set forth in that chapter, for home
1849 medical equipment provider personnel.
1850 (2) The general manager of each home medical equipment
1851 provider must sign an affidavit annually, under penalty of
1852 perjury, stating that all home medical equipment provider
1853 personnel hired on or after July 1, 1999, who enter the home of
1854 a patient in the capacity of their employment have been screened
1855 and that its remaining personnel have worked for the home
1856 medical equipment provider continuously since before July 1,
1857 1999. This attestation must be submitted in accordance with s.
1858 408.809(6).
1859 Section 46. Section 400.967, Florida Statutes, is amended
1860 to read:
1861 400.967 Rules and classification of violations
1862 deficiencies.—
1863 (1) It is the intent of the Legislature that rules adopted
1864 and enforced under this part and part II of chapter 408 include
1865 criteria by which a reasonable and consistent quality of
1866 resident care may be ensured, the results of such resident care
1867 can be demonstrated, and safe and sanitary facilities can be
1868 provided.
1869 (2) Pursuant to the intention of the Legislature, the
1870 agency, in consultation with the Agency for Persons with
1871 Disabilities and the Department of Elderly Affairs, shall adopt
1872 and enforce rules to administer this part and part II of chapter
1873 408, which shall include reasonable and fair criteria governing:
1874 (a) The location and construction of the facility;
1875 including fire and life safety, plumbing, heating, cooling,
1876 lighting, ventilation, and other housing conditions that will
1877 ensure the health, safety, and comfort of residents. The agency
1878 shall establish standards for facilities and equipment to
1879 increase the extent to which new facilities and a new wing or
1880 floor added to an existing facility after July 1, 2000, are
1881 structurally capable of serving as shelters only for residents,
1882 staff, and families of residents and staff, and equipped to be
1883 self-supporting during and immediately following disasters. The
1884 Agency for Health Care Administration shall work with facilities
1885 licensed under this part and report to the Governor and the
1886 Legislature by April 1, 2000, its recommendations for cost
1887 effective renovation standards to be applied to existing
1888 facilities. In making such rules, the agency shall be guided by
1889 criteria recommended by nationally recognized, reputable
1890 professional groups and associations having knowledge concerning
1891 such subject matters. The agency shall update or revise such
1892 criteria as the need arises. All facilities must comply with
1893 those lifesafety code requirements and building code standards
1894 applicable at the time of approval of their construction plans.
1895 The agency may require alterations to a building if it
1896 determines that an existing condition constitutes a distinct
1897 hazard to life, health, or safety. The agency shall adopt fair
1898 and reasonable rules setting forth conditions under which
1899 existing facilities undergoing additions, alterations,
1900 conversions, renovations, or repairs are required to comply with
1901 the most recent updated or revised standards.
1902 (b) The number and qualifications of all personnel,
1903 including management, medical nursing, and other personnel,
1904 having responsibility for any part of the care given to
1905 residents.
1906 (c) All sanitary conditions within the facility and its
1907 surroundings, including water supply, sewage disposal, food
1908 handling, and general hygiene, which will ensure the health and
1909 comfort of residents.
1910 (d) The equipment essential to the health and welfare of
1911 the residents.
1912 (e) A uniform accounting system.
1913 (f) The care, treatment, and maintenance of residents and
1914 measurement of the quality and adequacy thereof.
1915 (g) The preparation and annual update of a comprehensive
1916 emergency management plan. The agency shall adopt rules
1917 establishing minimum criteria for the plan after consultation
1918 with the Department of Community Affairs. At a minimum, the
1919 rules must provide for plan components that address emergency
1920 evacuation transportation; adequate sheltering arrangements;
1921 postdisaster activities, including emergency power, food, and
1922 water; postdisaster transportation; supplies; staffing;
1923 emergency equipment; individual identification of residents and
1924 transfer of records; and responding to family inquiries. The
1925 comprehensive emergency management plan is subject to review and
1926 approval by the local emergency management agency. During its
1927 review, the local emergency management agency shall ensure that
1928 the following agencies, at a minimum, are given the opportunity
1929 to review the plan: the Department of Elderly Affairs, the
1930 Agency for Persons with Disabilities, the Agency for Health Care
1931 Administration, and the Department of Community Affairs. Also,
1932 appropriate volunteer organizations must be given the
1933 opportunity to review the plan. The local emergency management
1934 agency shall complete its review within 60 days and either
1935 approve the plan or advise the facility of necessary revisions.
1936 (h) The use of restraint and seclusion. Such rules must be
1937 consistent with recognized best practices; prohibit inherently
1938 dangerous restraint or seclusion procedures; establish
1939 limitations on the use and duration of restraint and seclusion;
1940 establish measures to ensure the safety of clients and staff
1941 during an incident of restraint or seclusion; establish
1942 procedures for staff to follow before, during, and after
1943 incidents of restraint or seclusion, including individualized
1944 plans for the use of restraints or seclusion in emergency
1945 situations; establish professional qualifications of and
1946 training for staff who may order or be engaged in the use of
1947 restraint or seclusion; establish requirements for facility data
1948 collection and reporting relating to the use of restraint and
1949 seclusion; and establish procedures relating to the
1950 documentation of the use of restraint or seclusion in the
1951 client’s facility or program record.
1952 (3) The agency shall adopt rules to provide that, when the
1953 criteria established under this part and part II of chapter 408
1954 are not met, such violations deficiencies shall be classified
1955 according to the nature of the violation deficiency. The agency
1956 shall indicate the classification on the face of the notice of
1957 violations deficiencies as follows:
1958 (a) Class I violations deficiencies are defined in s.
1959 408.813. those which the agency determines present an imminent
1960 danger to the residents or guests of the facility or a
1961 substantial probability that death or serious physical harm
1962 would result therefrom. The condition or practice constituting a
1963 class I violation must be abated or eliminated immediately,
1964 unless a fixed period of time, as determined by the agency, is
1965 required for correction. A class I violation deficiency is
1966 subject to a civil penalty in an amount not less than $5,000 and
1967 not exceeding $10,000 for each violation deficiency. A fine may
1968 be levied notwithstanding the correction of the violation
1969 deficiency.
1970 (b) Class II violations deficiencies are defined in s.
1971 408.813. those which the agency determines have a direct or
1972 immediate relationship to the health, safety, or security of the
1973 facility residents, other than class I deficiencies. A class II
1974 violation deficiency is subject to a civil penalty in an amount
1975 not less than $1,000 and not exceeding $5,000 for each
1976 deficiency. A citation for a class II violation deficiency shall
1977 specify the time within which the violation deficiency must be
1978 corrected. If a class II violation deficiency is corrected
1979 within the time specified, no civil penalty shall be imposed,
1980 unless it is a repeated offense.
1981 (c) Class III violations deficiencies are defined in s.
1982 408.813. those which the agency determines to have an indirect
1983 or potential relationship to the health, safety, or security of
1984 the facility residents, other than class I or class II
1985 deficiencies. A class III violation deficiency is subject to a
1986 civil penalty of not less than $500 and not exceeding $1,000 for
1987 each violation deficiency. A citation for a class III violation
1988 deficiency shall specify the time within which the violation
1989 deficiency must be corrected. If a class III violation
1990 deficiency is corrected within the time specified, no civil
1991 penalty shall be imposed, unless it is a repeated offense.
1992 (d) Class IV violations are defined in s. 408.813.
1993 (4) The agency shall approve or disapprove the plans and
1994 specifications within 60 days after receipt of the final plans
1995 and specifications. The agency may be granted one 15-day
1996 extension for the review period, if the secretary of the agency
1997 so approves. If the agency fails to act within the specified
1998 time, it is deemed to have approved the plans and
1999 specifications. When the agency disapproves plans and
2000 specifications, it must set forth in writing the reasons for
2001 disapproval. Conferences and consultations may be provided as
2002 necessary.
2003 (5) The agency may charge an initial fee of $2,000 for
2004 review of plans and construction on all projects, no part of
2005 which is refundable. The agency may also collect a fee, not to
2006 exceed 1 percent of the estimated construction cost or the
2007 actual cost of review, whichever is less, for the portion of the
2008 review that which encompasses initial review through the initial
2009 revised construction document review. The agency may collect its
2010 actual costs on all subsequent portions of the review and
2011 construction inspections. Initial fee payment must accompany the
2012 initial submission of plans and specifications. Any subsequent
2013 payment that is due is payable upon receipt of the invoice from
2014 the agency. Notwithstanding any other provision of law, all
2015 money received by the agency under this section shall be deemed
2016 to be trust funds, to be held and applied solely for the
2017 operations required under this section.
2018 Section 47. Subsections (4) and (7) of section 400.9905,
2019 Florida Statutes, are amended to read:
2020 400.9905 Definitions.—
2021 (4) “Clinic” means an entity where at which health care
2022 services are provided to individuals and which tenders charges
2023 for reimbursement for such services, including a mobile clinic
2024 and a portable service or equipment provider. For purposes of
2025 this part, the term does not include and the licensure
2026 requirements of this part do not apply to:
2027 (a) Entities licensed or registered by the state under
2028 chapter 395; or entities licensed or registered by the state and
2029 providing only health care services within the scope of services
2030 authorized under their respective licenses granted under ss.
2031 383.30-383.335, chapter 390, chapter 394, chapter 397, this
2032 chapter except part X, chapter 429, chapter 463, chapter 465,
2033 chapter 466, chapter 478, part I of chapter 483, chapter 484, or
2034 chapter 651; end-stage renal disease providers authorized under
2035 42 C.F.R. part 405, subpart U; or providers certified under 42
2036 C.F.R. part 485, subpart B or subpart H; or any entity that
2037 provides neonatal or pediatric hospital-based health care
2038 services or other health care services by licensed practitioners
2039 solely within a hospital licensed under chapter 395.
2040 (b) Entities that own, directly or indirectly, entities
2041 licensed or registered by the state pursuant to chapter 395; or
2042 entities that own, directly or indirectly, entities licensed or
2043 registered by the state and providing only health care services
2044 within the scope of services authorized pursuant to their
2045 respective licenses granted under ss. 383.30-383.335, chapter
2046 390, chapter 394, chapter 397, this chapter except part X,
2047 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
2048 part I of chapter 483, chapter 484, chapter 651; end-stage renal
2049 disease providers authorized under 42 C.F.R. part 405, subpart
2050 U; or providers certified under 42 C.F.R. part 485, subpart B or
2051 subpart H; or any entity that provides neonatal or pediatric
2052 hospital-based health care services by licensed practitioners
2053 solely within a hospital licensed under chapter 395.
2054 (c) Entities that are owned, directly or indirectly, by an
2055 entity licensed or registered by the state pursuant to chapter
2056 395; or entities that are owned, directly or indirectly, by an
2057 entity licensed or registered by the state and providing only
2058 health care services within the scope of services authorized
2059 pursuant to their respective licenses granted under ss. 383.30
2060 383.335, chapter 390, chapter 394, chapter 397, this chapter
2061 except part X, chapter 429, chapter 463, chapter 465, chapter
2062 466, chapter 478, part I of chapter 483, chapter 484, or chapter
2063 651; end-stage renal disease providers authorized under 42
2064 C.F.R. part 405, subpart U; or providers certified under 42
2065 C.F.R. part 485, subpart B or subpart H; or any entity that
2066 provides neonatal or pediatric hospital-based health care
2067 services by licensed practitioners solely within a hospital
2068 under chapter 395.
2069 (d) Entities that are under common ownership, directly or
2070 indirectly, with an entity licensed or registered by the state
2071 pursuant to chapter 395; or entities that are under common
2072 ownership, directly or indirectly, with an entity licensed or
2073 registered by the state and providing only health care services
2074 within the scope of services authorized pursuant to their
2075 respective licenses granted under ss. 383.30-383.335, chapter
2076 390, chapter 394, chapter 397, this chapter except part X,
2077 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
2078 part I of chapter 483, chapter 484, or chapter 651; end-stage
2079 renal disease providers authorized under 42 C.F.R. part 405,
2080 subpart U; or providers certified under 42 C.F.R. part 485,
2081 subpart B or subpart H; or any entity that provides neonatal or
2082 pediatric hospital-based health care services by licensed
2083 practitioners solely within a hospital licensed under chapter
2084 395.
2085 (e) An entity that is exempt from federal taxation under 26
2086 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
2087 under 26 U.S.C. s. 409 that has a board of trustees not less
2088 than two-thirds of which are Florida-licensed health care
2089 practitioners and provides only physical therapy services under
2090 physician orders, any community college or university clinic,
2091 and any entity owned or operated by the federal or state
2092 government, including agencies, subdivisions, or municipalities
2093 thereof.
2094 (f) A sole proprietorship, group practice, partnership, or
2095 corporation that provides health care services by physicians
2096 covered by s. 627.419, that is directly supervised by one or
2097 more of such physicians, and that is wholly owned by one or more
2098 of those physicians or by a physician and the spouse, parent,
2099 child, or sibling of that physician.
2100 (g) A sole proprietorship, group practice, partnership, or
2101 corporation that provides health care services by licensed
2102 health care practitioners under chapter 457, chapter 458,
2103 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
2104 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
2105 chapter 490, chapter 491, or part I, part III, part X, part
2106 XIII, or part XIV of chapter 468, or s. 464.012, which are
2107 wholly owned by one or more licensed health care practitioners,
2108 or the licensed health care practitioners set forth in this
2109 paragraph and the spouse, parent, child, or sibling of a
2110 licensed health care practitioner, so long as one of the owners
2111 who is a licensed health care practitioner is supervising the
2112 business activities and is legally responsible for the entity’s
2113 compliance with all federal and state laws. However, a health
2114 care practitioner may not supervise services beyond the scope of
2115 the practitioner’s license, except that, for the purposes of
2116 this part, a clinic owned by a licensee in s. 456.053(3)(b) that
2117 provides only services authorized pursuant to s. 456.053(3)(b)
2118 may be supervised by a licensee specified in s. 456.053(3)(b).
2119 (h) Clinical facilities affiliated with an accredited
2120 medical school at which training is provided for medical
2121 students, residents, or fellows.
2122 (i) Entities that provide only oncology or radiation
2123 therapy services by physicians licensed under chapter 458 or
2124 chapter 459 or entities that provide oncology or radiation
2125 therapy services by physicians licensed under chapter 458 or
2126 chapter 459 which are owned by a corporation whose shares are
2127 publicly traded on a recognized stock exchange.
2128 (j) Clinical facilities affiliated with a college of
2129 chiropractic accredited by the Council on Chiropractic Education
2130 at which training is provided for chiropractic students.
2131 (k) Entities that provide licensed practitioners to staff
2132 emergency departments or to deliver anesthesia services in
2133 facilities licensed under chapter 395 and that derive at least
2134 90 percent of their gross annual revenues from the provision of
2135 such services. Entities claiming an exemption from licensure
2136 under this paragraph must provide documentation demonstrating
2137 compliance.
2138 (l) Orthotic, or prosthetic, pediatric cardiology, or
2139 perinatology clinical facilities that are a publicly traded
2140 corporation or that are wholly owned, directly or indirectly, by
2141 a publicly traded corporation. As used in this paragraph, a
2142 publicly traded corporation is a corporation that issues
2143 securities traded on an exchange registered with the United
2144 States Securities and Exchange Commission as a national
2145 securities exchange.
2146 (7) “Portable service or equipment provider” means an
2147 entity that contracts with or employs persons to provide
2148 portable health care services or equipment to multiple locations
2149 which performing treatment or diagnostic testing of individuals,
2150 that bills third-party payors for those services, and which that
2151 otherwise meets the definition of a clinic in subsection (4).
2152 Section 48. Subsections (1) and (4) of section 400.991,
2153 Florida Statutes, are amended to read:
2154 400.991 License requirements; background screenings;
2155 prohibitions.—
2156 (1)(a) The requirements of part II of chapter 408 apply to
2157 the provision of services that require licensure pursuant to
2158 this part and part II of chapter 408 and to entities licensed by
2159 or applying for such licensure from the agency pursuant to this
2160 part. A license issued by the agency is required in order to
2161 operate a clinic in this state. Each clinic location shall be
2162 licensed separately regardless of whether the clinic is operated
2163 under the same business name or management as another clinic.
2164 (b) Each mobile clinic must obtain a separate health care
2165 clinic license and must provide to the agency, at least
2166 quarterly, its projected street location to enable the agency to
2167 locate and inspect such clinic. A portable service or equipment
2168 provider must obtain a health care clinic license for a single
2169 administrative office and is not required to submit quarterly
2170 projected street locations.
2171 (4) In addition to the requirements of part II of chapter
2172 408, the applicant must file with the application satisfactory
2173 proof that the clinic is in compliance with this part and
2174 applicable rules, including:
2175 (a) A listing of services to be provided either directly by
2176 the applicant or through contractual arrangements with existing
2177 providers;
2178 (b) The number and discipline of each professional staff
2179 member to be employed; and
2180 (c) Proof of financial ability to operate as required under
2181 ss. 408.8065 and s. 408.810(8). As an alternative to submitting
2182 proof of financial ability to operate as required under s.
2183 408.810(8), the applicant may file a surety bond of at least
2184 $500,000 which guarantees that the clinic will act in full
2185 conformity with all legal requirements for operating a clinic,
2186 payable to the agency. The agency may adopt rules to specify
2187 related requirements for such surety bond.
2188 Section 49. Paragraph (g) of subsection (1) and paragraph
2189 (a) of subsection (7) of section 400.9935, Florida Statutes, are
2190 amended to read:
2191 400.9935 Clinic responsibilities.—
2192 (1) Each clinic shall appoint a medical director or clinic
2193 director who shall agree in writing to accept legal
2194 responsibility for the following activities on behalf of the
2195 clinic. The medical director or the clinic director shall:
2196 (g) Conduct systematic reviews of clinic billings to ensure
2197 that the billings are not fraudulent or unlawful. Upon discovery
2198 of an unlawful charge, the medical director or clinic director
2199 shall take immediate corrective action. If the clinic performs
2200 only the technical component of magnetic resonance imaging,
2201 static radiographs, computed tomography, or positron emission
2202 tomography, and provides the professional interpretation of such
2203 services, in a fixed facility that is accredited by the Joint
2204 Commission on Accreditation of Healthcare Organizations or the
2205 Accreditation Association for Ambulatory Health Care, and the
2206 American College of Radiology; and if, in the preceding quarter,
2207 the percentage of scans performed by that clinic which was
2208 billed to all personal injury protection insurance carriers was
2209 less than 15 percent, the chief financial officer of the clinic
2210 may, in a written acknowledgment provided to the agency, assume
2211 the responsibility for the conduct of the systematic reviews of
2212 clinic billings to ensure that the billings are not fraudulent
2213 or unlawful.
2214 (7)(a) Each clinic engaged in magnetic resonance imaging
2215 services must be accredited by the Joint Commission on
2216 Accreditation of Healthcare Organizations, the American College
2217 of Radiology, or the Accreditation Association for Ambulatory
2218 Health Care, within 1 year after licensure. A clinic that is
2219 accredited by the American College of Radiology or is within the
2220 original 1-year period after licensure and replaces its core
2221 magnetic resonance imaging equipment shall be given 1 year after
2222 the date on which the equipment is replaced to attain
2223 accreditation. However, a clinic may request a single, 6-month
2224 extension if it provides evidence to the agency establishing
2225 that, for good cause shown, such clinic cannot be accredited
2226 within 1 year after licensure, and that such accreditation will
2227 be completed within the 6-month extension. After obtaining
2228 accreditation as required by this subsection, each such clinic
2229 must maintain accreditation as a condition of renewal of its
2230 license. A clinic that files a change of ownership application
2231 must comply with the original accreditation timeframe
2232 requirements of the transferor. The agency shall deny a change
2233 of ownership application if the clinic is not in compliance with
2234 the accreditation requirements. When a clinic adds, replaces, or
2235 modifies magnetic resonance imaging equipment and the
2236 accreditation agency requires new accreditation, the clinic must
2237 be accredited within 1 year after the date of the addition,
2238 replacement, or modification but may request a single, 6-month
2239 extension if the clinic provides evidence of good cause to the
2240 agency.
2241 Section 50. Subsection (2) of section 408.034, Florida
2242 Statutes, is amended to read:
2243 408.034 Duties and responsibilities of agency; rules.—
2244 (2) In the exercise of its authority to issue licenses to
2245 health care facilities and health service providers, as provided
2246 under chapters 393 and 395 and parts II, and IV, and VIII of
2247 chapter 400, the agency may not issue a license to any health
2248 care facility or health service provider that fails to receive a
2249 certificate of need or an exemption for the licensed facility or
2250 service.
2251 Section 51. Paragraph (d) of subsection (1) of section
2252 408.036, Florida Statutes, is amended to read:
2253 408.036 Projects subject to review; exemptions.—
2254 (1) APPLICABILITY.—Unless exempt under subsection (3), all
2255 health-care-related projects, as described in paragraphs (a)
2256 (g), are subject to review and must file an application for a
2257 certificate of need with the agency. The agency is exclusively
2258 responsible for determining whether a health-care-related
2259 project is subject to review under ss. 408.031-408.045.
2260 (d) The establishment of a hospice or hospice inpatient
2261 facility, except as provided in s. 408.043.
2262 Section 52. Subsection (2) of section 408.043, Florida
2263 Statutes, is amended to read:
2264 408.043 Special provisions.—
2265 (2) HOSPICES.—When an application is made for a certificate
2266 of need to establish or to expand a hospice, the need for such
2267 hospice shall be determined on the basis of the need for and
2268 availability of hospice services in the community. The formula
2269 on which the certificate of need is based shall discourage
2270 regional monopolies and promote competition. The inpatient
2271 hospice care component of a hospice that which is a freestanding
2272 facility, or a part of a facility, which is primarily engaged in
2273 providing inpatient care and related services and is not
2274 licensed as a health care facility shall also be required to
2275 obtain a certificate of need. Provision of hospice care by any
2276 current provider of health care is a significant change in
2277 service and therefore requires a certificate of need for such
2278 services.
2279 Section 53. Paragraph (k) of subsection (3) of section
2280 408.05, Florida Statutes, is amended to read:
2281 408.05 Florida Center for Health Information and Policy
2282 Analysis.—
2283 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
2284 produce comparable and uniform health information and statistics
2285 for the development of policy recommendations, the agency shall
2286 perform the following functions:
2287 (k) Develop, in conjunction with the State Consumer Health
2288 Information and Policy Advisory Council, and implement a long
2289 range plan for making available health care quality measures and
2290 financial data that will allow consumers to compare health care
2291 services. The health care quality measures and financial data
2292 the agency must make available shall include, but is not limited
2293 to, pharmaceuticals, physicians, health care facilities, and
2294 health plans and managed care entities. The agency shall submit
2295 the initial plan to the Governor, the President of the Senate,
2296 and the Speaker of the House of Representatives by January 1,
2297 2006, and shall update the plan and report on the status of its
2298 implementation annually thereafter. The agency shall also make
2299 the plan and status report available to the public on its
2300 Internet website. As part of the plan, the agency shall identify
2301 the process and timeframes for implementation, any barriers to
2302 implementation, and recommendations of changes in the law that
2303 may be enacted by the Legislature to eliminate the barriers. As
2304 preliminary elements of the plan, the agency shall:
2305 1. Make available patient-safety indicators, inpatient
2306 quality indicators, and performance outcome and patient charge
2307 data collected from health care facilities pursuant to s.
2308 408.061(1)(a) and (2). The terms “patient-safety indicators” and
2309 “inpatient quality indicators” shall be as defined by the
2310 Centers for Medicare and Medicaid Services, the National Quality
2311 Forum, the Joint Commission on Accreditation of Healthcare
2312 Organizations, the Agency for Healthcare Research and Quality,
2313 the Centers for Disease Control and Prevention, or a similar
2314 national entity that establishes standards to measure the
2315 performance of health care providers, or by other states. The
2316 agency shall determine which conditions, procedures, health care
2317 quality measures, and patient charge data to disclose based upon
2318 input from the council. When determining which conditions and
2319 procedures are to be disclosed, the council and the agency shall
2320 consider variation in costs, variation in outcomes, and
2321 magnitude of variations and other relevant information. When
2322 determining which health care quality measures to disclose, the
2323 agency:
2324 a. Shall consider such factors as volume of cases; average
2325 patient charges; average length of stay; complication rates;
2326 mortality rates; and infection rates, among others, which shall
2327 be adjusted for case mix and severity, if applicable.
2328 b. May consider such additional measures that are adopted
2329 by the Centers for Medicare and Medicaid Studies, National
2330 Quality Forum, the Joint Commission on Accreditation of
2331 Healthcare Organizations, the Agency for Healthcare Research and
2332 Quality, Centers for Disease Control and Prevention, or a
2333 similar national entity that establishes standards to measure
2334 the performance of health care providers, or by other states.
2335
2336 When determining which patient charge data to disclose, the
2337 agency shall include such measures as the average of
2338 undiscounted charges on frequently performed procedures and
2339 preventive diagnostic procedures, the range of procedure charges
2340 from highest to lowest, average net revenue per adjusted patient
2341 day, average cost per adjusted patient day, and average cost per
2342 admission, among others.
2343 2. Make available performance measures, benefit design, and
2344 premium cost data from health plans licensed pursuant to chapter
2345 627 or chapter 641. The agency shall determine which health care
2346 quality measures and member and subscriber cost data to
2347 disclose, based upon input from the council. When determining
2348 which data to disclose, the agency shall consider information
2349 that may be required by either individual or group purchasers to
2350 assess the value of the product, which may include membership
2351 satisfaction, quality of care, current enrollment or membership,
2352 coverage areas, accreditation status, premium costs, plan costs,
2353 premium increases, range of benefits, copayments and
2354 deductibles, accuracy and speed of claims payment, credentials
2355 of physicians, number of providers, names of network providers,
2356 and hospitals in the network. Health plans shall make available
2357 to the agency any such data or information that is not currently
2358 reported to the agency or the office.
2359 3. Determine the method and format for public disclosure of
2360 data reported pursuant to this paragraph. The agency shall make
2361 its determination based upon input from the State Consumer
2362 Health Information and Policy Advisory Council. At a minimum,
2363 the data shall be made available on the agency’s Internet
2364 website in a manner that allows consumers to conduct an
2365 interactive search that allows them to view and compare the
2366 information for specific providers. The website must include
2367 such additional information as is determined necessary to ensure
2368 that the website enhances informed decisionmaking among
2369 consumers and health care purchasers, which shall include, at a
2370 minimum, appropriate guidance on how to use the data and an
2371 explanation of why the data may vary from provider to provider.
2372 The data specified in subparagraph 1. shall be released no later
2373 than January 1, 2006, for the reporting of infection rates, and
2374 no later than October 1, 2005, for mortality rates and
2375 complication rates. The data specified in subparagraph 2. shall
2376 be released no later than October 1, 2006.
2377 4. Publish on its website undiscounted charges for no fewer
2378 than 150 of the most commonly performed adult and pediatric
2379 procedures, including outpatient, inpatient, diagnostic, and
2380 preventative procedures.
2381 Section 54. Paragraph (a) of subsection (1) of section
2382 408.061, Florida Statutes, is amended to read:
2383 408.061 Data collection; uniform systems of financial
2384 reporting; information relating to physician charges;
2385 confidential information; immunity.—
2386 (1) The agency shall require the submission by health care
2387 facilities, health care providers, and health insurers of data
2388 necessary to carry out the agency’s duties. Specifications for
2389 data to be collected under this section shall be developed by
2390 the agency with the assistance of technical advisory panels
2391 including representatives of affected entities, consumers,
2392 purchasers, and such other interested parties as may be
2393 determined by the agency.
2394 (a) Data submitted by health care facilities, including the
2395 facilities as defined in chapter 395, shall include, but are not
2396 limited to: case-mix data, patient admission and discharge data,
2397 hospital emergency department data that which shall include the
2398 number of patients treated in the emergency department of a
2399 licensed hospital reported by patient acuity level, data on
2400 hospital-acquired infections as specified by rule, data on
2401 complications as specified by rule, data on readmissions as
2402 specified by rule, with patient and provider-specific
2403 identifiers included, actual charge data by diagnostic groups,
2404 financial data, accounting data, operating expenses, expenses
2405 incurred for rendering services to patients who cannot or do not
2406 pay, interest charges, depreciation expenses based on the
2407 expected useful life of the property and equipment involved, and
2408 demographic data. The agency shall adopt nationally recognized
2409 risk adjustment methodologies or software consistent with the
2410 standards of the Agency for Healthcare Research and Quality and
2411 as selected by the agency for all data submitted as required by
2412 this section. Data may be obtained from documents such as, but
2413 not limited to: leases, contracts, debt instruments, itemized
2414 patient bills, medical record abstracts, and related diagnostic
2415 information. Reported data elements shall be reported
2416 electronically and in accordance with rule 59E-7.012, Florida
2417 Administrative Code. Data submitted shall be certified by the
2418 chief executive officer or an appropriate and duly authorized
2419 representative or employee of the licensed facility that the
2420 information submitted is true and accurate.
2421 Section 55. Subsection (1) of section 408.10, Florida
2422 Statutes, is amended to read:
2423 408.10 Consumer complaints.—The agency shall:
2424 (1) Publish and make available to the public a toll-free
2425 telephone number for the purpose of handling consumer complaints
2426 and shall serve as a liaison between consumer entities and other
2427 private entities and governmental entities for the disposition
2428 of problems identified by consumers of health care. The agency
2429 may provide staffing for this toll-free number through agency
2430 staff or other arrangements.
2431 Section 56. Subsection (11) of section 408.802, Florida
2432 Statutes, is repealed.
2433 Section 57. Effective October 1, 2010, subsection (3) is
2434 added to section 408.804, Florida Statutes, to read:
2435 408.804 License required; display.—
2436 (3) A person who knowingly alters, defaces, or falsifies
2437 any license certificate issued by the agency, or causes or
2438 procures another person to commit such an offense, commits a
2439 misdemeanor of the second degree, punishable as provided in s.
2440 775.082 or s. 775.083. Any licensee or provider who displays an
2441 altered, defaced, or falsified license certificate is subject to
2442 the penalties set forth in s. 408.815 and an administrative fine
2443 of $1,000 for each day of illegal display.
2444 Section 58. Paragraph (d) of subsection (2) of section
2445 408.806, Florida Statutes, is amended to read:
2446 408.806 License application process.—
2447 (2)
2448 (d) The agency shall notify the licensee by mail or
2449 electronically at least 90 days before the expiration of a
2450 license that a renewal license is necessary to continue
2451 operation. The failure of the licensee to timely submit a
2452 renewal application and license application fee with the agency
2453 shall result in a $50 per day late fee charged to the licensee
2454 by the agency; however, the aggregate amount of the late fee may
2455 not exceed 50 percent of the licensure fee or $500, whichever is
2456 less. The agency shall provide a courtesy notice to the licensee
2457 by United States mail, electronically, or by any other manner at
2458 its address of record at least 90 days before the expiration of
2459 a license informing the licensee of the expiration of the
2460 license. Any failure of the agency to provide the courtesy
2461 notice or any failure of the licensee to receive the courtesy
2462 notice does not excuse the licensee from the legal obligation to
2463 timely file the renewal application and license application fee
2464 with the agency and does not mitigate the late fee. Payment of
2465 the late fee is required in order for any late application to be
2466 complete, and failure to pay the late fee is an omission from
2467 the application. If an application is received after the
2468 required filing date and exhibits a hand-canceled postmark
2469 obtained from a United States post office dated on or before the
2470 required filing date, no fine will be levied.
2471 Section 59. Subsections (6) and (9) of section 408.810,
2472 Florida Statutes, are amended to read:
2473 408.810 Minimum licensure requirements.—In addition to the
2474 licensure requirements specified in this part, authorizing
2475 statutes, and applicable rules, each applicant and licensee must
2476 comply with the requirements of this section in order to obtain
2477 and maintain a license.
2478 (6)(a) An applicant must provide the agency with proof of
2479 the applicant’s legal right to occupy the property before a
2480 license may be issued. Proof may include, but need not be
2481 limited to, copies of warranty deeds, lease or rental
2482 agreements, contracts for deeds, quitclaim deeds, or other such
2483 documentation.
2484 (b) If the property is encumbered by a mortgage or is
2485 leased, an applicant must provide the agency with proof that the
2486 mortgagor or landlord has received written notice of the
2487 applicant’s intent, as mortgagee or tenant, to provide services
2488 that require licensure and with instructions that the agency
2489 must be served by certified mail with copies of any actions
2490 initiated by the mortgagor or landlord against the applicant.
2491 (9) A controlling interest may not withhold from the agency
2492 any evidence of financial instability, including, but not
2493 limited to, checks returned due to insufficient funds,
2494 delinquent accounts, nonpayment of withholding taxes, unpaid
2495 utility expenses, nonpayment for essential services, or adverse
2496 court action concerning the financial viability of the provider
2497 or any other provider licensed under this part which that is
2498 under the control of the controlling interest. A controlling
2499 interest shall notify the agency within 10 days after a court
2500 action, including, but not limited to, the initiation of
2501 bankruptcy proceedings, foreclosure, or eviction proceedings in
2502 which the controlling interest is a petitioner or defendant. Any
2503 person who violates this subsection commits a misdemeanor of the
2504 second degree, punishable as provided in s. 775.082 or s.
2505 775.083. Each day of continuing violation is a separate offense.
2506 Section 60. Paragraph (e) is added to subsection (2) of
2507 section 408.813, Florida Statutes, to read:
2508 408.813 Administrative fines; violations.—As a penalty for
2509 any violation of this part, authorizing statutes, or applicable
2510 rules, the agency may impose an administrative fine.
2511 (2) Violations of this part, authorizing statutes, or
2512 applicable rules shall be classified according to the nature of
2513 the violation and the gravity of its probable effect on clients.
2514 The scope of a violation may be cited as an isolated, patterned,
2515 or widespread deficiency. An isolated deficiency is a deficiency
2516 affecting one or a very limited number of clients, or involving
2517 one or a very limited number of staff, or a situation that
2518 occurred only occasionally or in a very limited number of
2519 locations. A patterned deficiency is a deficiency in which more
2520 than a very limited number of clients are affected, or more than
2521 a very limited number of staff are involved, or the situation
2522 has occurred in several locations, or the same client or clients
2523 have been affected by repeated occurrences of the same deficient
2524 practice but the effect of the deficient practice is not found
2525 to be pervasive throughout the provider. A widespread deficiency
2526 is a deficiency in which the problems causing the deficiency are
2527 pervasive in the provider or represent systemic failure that has
2528 affected or has the potential to affect a large portion of the
2529 provider’s clients. This subsection does not affect the
2530 legislative determination of the amount of a fine imposed under
2531 authorizing statutes. Violations shall be classified on the
2532 written notice as follows:
2533 (e) The agency may impose an administrative fine for
2534 violations that do not qualify as class I, class II, class III,
2535 or class IV violations. The amount of the fine may not exceed
2536 $500 for each violation. Unclassified violations may include:
2537 1. Violating any term or condition of a license.
2538 2. Violating any provision of this part, authorizing
2539 statutes, or applicable rules.
2540 3. Exceeding licensed capacity without authorization.
2541 4. Providing services beyond the scope of the license.
2542 5. Violating a moratorium.
2543 Section 61. Subsection (5) is added to section 408.815,
2544 Florida Statutes, to read:
2545 408.815 License or application denial; revocation.—
2546 (5) In order to ensure the health, safety, and welfare of
2547 clients when a license has been denied or revoked or is set to
2548 terminate, the agency may extend the license expiration date for
2549 up to 60 days after denial, revocation, or termination for the
2550 sole purpose of allowing the safe and orderly discharge of
2551 clients. The agency may impose conditions on the extension,
2552 including, but not limited to, prohibiting or limiting
2553 admissions, expediting discharge planning, submitting required
2554 status reports, and mandatory monitoring by the agency or third
2555 parties. The agency may terminate the extension or modify the
2556 conditions at any time at its discretion. Upon the discharge of
2557 the final client, the extension shall immediately terminate and
2558 the provider shall cease operation and promptly surrender its
2559 license certificate to the agency. During the extension, the
2560 provider must continue to meet all other requirements of this
2561 part, authorizing statutes, and applicable rules. This authority
2562 is in addition to any other authority granted to the agency
2563 under chapter 120, this part, and the authorizing statutes, but
2564 does not create any right or entitlement to an extension of a
2565 license expiration date.
2566 Section 62. Paragraph (d) is added to subsection (13) of
2567 section 409.906, Florida Statutes, to read:
2568 409.906 Optional Medicaid services.—Subject to specific
2569 appropriations, the agency may make payments for services which
2570 are optional to the state under Title XIX of the Social Security
2571 Act and are furnished by Medicaid providers to recipients who
2572 are determined to be eligible on the dates on which the services
2573 were provided. Any optional service that is provided shall be
2574 provided only when medically necessary and in accordance with
2575 state and federal law. Optional services rendered by providers
2576 in mobile units to Medicaid recipients may be restricted or
2577 prohibited by the agency. Nothing in this section shall be
2578 construed to prevent or limit the agency from adjusting fees,
2579 reimbursement rates, lengths of stay, number of visits, or
2580 number of services, or making any other adjustments necessary to
2581 comply with the availability of moneys and any limitations or
2582 directions provided for in the General Appropriations Act or
2583 chapter 216. If necessary to safeguard the state’s systems of
2584 providing services to elderly and disabled persons and subject
2585 to the notice and review provisions of s. 216.177, the Governor
2586 may direct the Agency for Health Care Administration to amend
2587 the Medicaid state plan to delete the optional Medicaid service
2588 known as “Intermediate Care Facilities for the Developmentally
2589 Disabled.” Optional services may include:
2590 (13) HOME AND COMMUNITY-BASED SERVICES.—
2591 (d) The agency, in consultation with the Department of
2592 Elderly Affairs, shall phase out the adult day health care
2593 waiver program and transfer existing waiver enrollees to other
2594 appropriate home and community-based service programs. Effective
2595 July 1, 2010, the adult day health care waiver program shall
2596 cease to enroll new members. Existing enrollees in the adult day
2597 health care program shall receive counseling regarding available
2598 options and shall be offered an alternative home and community
2599 based services program based on eligibility and personal choice.
2600 Each enrollee in the waiver program shall continue to receive
2601 home and community-based services without interruption in the
2602 enrollee’s program of choice. The providers of the adult day
2603 health care waiver program, in consultation with resource
2604 centers for the aged, shall assist in the transition of
2605 enrollees and cease provision of adult day health care waiver
2606 services by December 31, 2010. The agency may seek federal
2607 waiver approval to administer this change.
2608 Section 63. Paragraph (k) of subsection (4) of section
2609 409.221, Florida Statutes, is repealed.
2610 Section 64. Paragraphs (e), (f), and (g) of subsection (15)
2611 of section 409.912, Florida Statutes, are repealed.
2612 Section 65. Section 429.07, Florida Statutes, is amended to
2613 read:
2614 429.07 License required; fee; and inspections.—
2615 (1) The requirements of part II of chapter 408 apply to the
2616 provision of services that require licensure pursuant to this
2617 part and part II of chapter 408 and to entities licensed by or
2618 applying for such licensure from the agency pursuant to this
2619 part. A license issued by the agency is required in order to
2620 operate an assisted living facility in this state.
2621 (2) Separate licenses shall be required for facilities
2622 maintained in separate premises, even though operated under the
2623 same management. A separate license shall not be required for
2624 separate buildings on the same grounds.
2625 (3) In addition to the requirements of s. 408.806, each
2626 license granted by the agency must state the type of care for
2627 which the license is granted. Licenses shall be issued for one
2628 or more of the following categories of care: standard, extended
2629 congregate care, limited nursing services, or limited mental
2630 health.
2631 (a) A standard license shall be issued to a facility that
2632 provides facilities providing one or more of the personal
2633 services identified in s. 429.02. Such licensee facilities may
2634 also employ or contract with a person licensed under part I of
2635 chapter 464 to administer medications and perform other tasks as
2636 specified in s. 429.255.
2637 (b) An extended congregate care license shall be issued to
2638 a licensee that provides facilities providing, directly or
2639 through contract, services beyond those authorized in paragraph
2640 (a), including acts performed pursuant to part I of chapter 464
2641 by persons licensed thereunder, and supportive services defined
2642 by rule to persons who otherwise would be disqualified from
2643 continued residence in a facility licensed under this part.
2644 1. In order for extended congregate care services to be
2645 provided in a facility licensed under this part, the agency must
2646 first determine that all requirements established in law and
2647 rule are met and must specifically designate, on the facility’s
2648 license, that such services may be provided and whether the
2649 designation applies to all or part of a facility. Such
2650 designation may be made at the time of initial licensure or
2651 relicensure, or upon request in writing by a licensee under this
2652 part and part II of chapter 408. Notification of approval or
2653 denial of such request shall be made in accordance with part II
2654 of chapter 408. An existing licensee facilities qualifying to
2655 provide extended congregate care services must have maintained a
2656 standard license and may not have been subject to administrative
2657 sanctions during the previous 2 years, or since initial
2658 licensure if the facility has been licensed for less than 2
2659 years, for any of the following reasons:
2660 a. A class I or class II violation;
2661 b. Three or more repeat or recurring class III violations
2662 of identical or similar resident care standards as specified in
2663 rule from which a pattern of noncompliance is found by the
2664 agency;
2665 c. Three or more class III violations that were not
2666 corrected in accordance with the corrective action plan approved
2667 by the agency;
2668 d. Violation of resident care standards resulting in a
2669 requirement to employ the services of a consultant pharmacist or
2670 consultant dietitian;
2671 e. Denial, suspension, or revocation of a license for
2672 another facility under this part in which the applicant for an
2673 extended congregate care license has at least 25 percent
2674 ownership interest; or
2675 f. Imposition of a moratorium pursuant to this part or part
2676 II of chapter 408 or initiation of injunctive proceedings.
2677 2. A licensee Facilities that is are licensed to provide
2678 extended congregate care services shall maintain a written
2679 progress report for on each person who receives such services,
2680 and the which report must describe describes the type, amount,
2681 duration, scope, and outcome of services that are rendered and
2682 the general status of the resident’s health. A registered nurse,
2683 or appropriate designee, representing the agency shall visit
2684 such facilities at least quarterly to monitor residents who are
2685 receiving extended congregate care services and to determine if
2686 the facility is in compliance with this part, part II of chapter
2687 408, and rules that relate to extended congregate care. One of
2688 these visits may be in conjunction with the regular survey. The
2689 monitoring visits may be provided through contractual
2690 arrangements with appropriate community agencies. A registered
2691 nurse shall serve as part of the team that inspects such
2692 facility. The agency may waive one of the required yearly
2693 monitoring visits for a facility that has been licensed for at
2694 least 24 months to provide extended congregate care services,
2695 if, during the inspection, the registered nurse determines that
2696 extended congregate care services are being provided
2697 appropriately, and if the facility has no class I or class II
2698 violations and no uncorrected class III violations. Before such
2699 decision is made, the agency shall consult with the long-term
2700 care ombudsman council for the area in which the facility is
2701 located to determine if any complaints have been made and
2702 substantiated about the quality of services or care. The agency
2703 may not waive one of the required yearly monitoring visits if
2704 complaints have been made and substantiated.
2705 3. Licensees Facilities that are licensed to provide
2706 extended congregate care services shall:
2707 a. Demonstrate the capability to meet unanticipated
2708 resident service needs.
2709 b. Offer a physical environment that promotes a homelike
2710 setting, provides for resident privacy, promotes resident
2711 independence, and allows sufficient congregate space as defined
2712 by rule.
2713 c. Have sufficient staff available, taking into account the
2714 physical plant and firesafety features of the building, to
2715 assist with the evacuation of residents in an emergency, as
2716 necessary.
2717 d. Adopt and follow policies and procedures that maximize
2718 resident independence, dignity, choice, and decisionmaking to
2719 permit residents to age in place to the extent possible, so that
2720 moves due to changes in functional status are minimized or
2721 avoided.
2722 e. Allow residents or, if applicable, a resident’s
2723 representative, designee, surrogate, guardian, or attorney in
2724 fact to make a variety of personal choices, participate in
2725 developing service plans, and share responsibility in
2726 decisionmaking.
2727 f. Implement the concept of managed risk.
2728 g. Provide, either directly or through contract, the
2729 services of a person licensed pursuant to part I of chapter 464.
2730 h. In addition to the training mandated in s. 429.52,
2731 provide specialized training as defined by rule for facility
2732 staff.
2733 4. Licensees Facilities licensed to provide extended
2734 congregate care services are exempt from the criteria for
2735 continued residency as set forth in rules adopted under s.
2736 429.41. Licensees Facilities so licensed shall adopt their own
2737 requirements within guidelines for continued residency set forth
2738 by rule. However, such licensees facilities may not serve
2739 residents who require 24-hour nursing supervision. Licensees
2740 Facilities licensed to provide extended congregate care services
2741 shall provide each resident with a written copy of facility
2742 policies governing admission and retention.
2743 5. The primary purpose of extended congregate care services
2744 is to allow residents, as they become more impaired, the option
2745 of remaining in a familiar setting from which they would
2746 otherwise be disqualified for continued residency. A licensee
2747 facility licensed to provide extended congregate care services
2748 may also admit an individual who exceeds the admission criteria
2749 for a facility with a standard license, if the individual is
2750 determined appropriate for admission to the extended congregate
2751 care facility.
2752 6. Before admission of an individual to a facility licensed
2753 to provide extended congregate care services, the individual
2754 must undergo a medical examination as provided in s. 429.26(4)
2755 and the facility must develop a preliminary service plan for the
2756 individual.
2757 7. When a licensee facility can no longer provide or
2758 arrange for services in accordance with the resident’s service
2759 plan and needs and the licensee facility’s policy, the licensee
2760 facility shall make arrangements for relocating the person in
2761 accordance with s. 429.28(1)(k).
2762 8. Failure to provide extended congregate care services may
2763 result in denial of extended congregate care license renewal.
2764 9. No later than January 1 of each year, the department, in
2765 consultation with the agency, shall prepare and submit to the
2766 Governor, the President of the Senate, the Speaker of the House
2767 of Representatives, and the chairs of appropriate legislative
2768 committees, a report on the status of, and recommendations
2769 related to, extended congregate care services. The status report
2770 must include, but need not be limited to, the following
2771 information:
2772 a. A description of the facilities licensed to provide such
2773 services, including total number of beds licensed under this
2774 part.
2775 b. The number and characteristics of residents receiving
2776 such services.
2777 c. The types of services rendered that could not be
2778 provided through a standard license.
2779 d. An analysis of deficiencies cited during licensure
2780 inspections.
2781 e. The number of residents who required extended congregate
2782 care services at admission and the source of admission.
2783 f. Recommendations for statutory or regulatory changes.
2784 g. The availability of extended congregate care to state
2785 clients residing in facilities licensed under this part and in
2786 need of additional services, and recommendations for
2787 appropriations to subsidize extended congregate care services
2788 for such persons.
2789 h. Such other information as the department considers
2790 appropriate.
2791 (c) A limited nursing services license shall be issued to a
2792 facility that provides services beyond those authorized in
2793 paragraph (a) and as specified in this paragraph.
2794 1. In order for limited nursing services to be provided in
2795 a facility licensed under this part, the agency must first
2796 determine that all requirements established in law and rule are
2797 met and must specifically designate, on the facility’s license,
2798 that such services may be provided. Such designation may be made
2799 at the time of initial licensure or relicensure, or upon request
2800 in writing by a licensee under this part and part II of chapter
2801 408. Notification of approval or denial of such request shall be
2802 made in accordance with part II of chapter 408. Existing
2803 facilities qualifying to provide limited nursing services shall
2804 have maintained a standard license and may not have been subject
2805 to administrative sanctions that affect the health, safety, and
2806 welfare of residents for the previous 2 years or since initial
2807 licensure if the facility has been licensed for less than 2
2808 years.
2809 2. Facilities that are licensed to provide limited nursing
2810 services shall maintain a written progress report on each person
2811 who receives such nursing services, which report describes the
2812 type, amount, duration, scope, and outcome of services that are
2813 rendered and the general status of the resident’s health. A
2814 registered nurse representing the agency shall visit such
2815 facilities at least twice a year to monitor residents who are
2816 receiving limited nursing services and to determine if the
2817 facility is in compliance with applicable provisions of this
2818 part, part II of chapter 408, and related rules. The monitoring
2819 visits may be provided through contractual arrangements with
2820 appropriate community agencies. A registered nurse shall also
2821 serve as part of the team that inspects such facility.
2822 3. A person who receives limited nursing services under
2823 this part must meet the admission criteria established by the
2824 agency for assisted living facilities. When a resident no longer
2825 meets the admission criteria for a facility licensed under this
2826 part, arrangements for relocating the person shall be made in
2827 accordance with s. 429.28(1)(k), unless the facility is licensed
2828 to provide extended congregate care services.
2829 (4) In accordance with s. 408.805, an applicant or licensee
2830 shall pay a fee for each license application submitted under
2831 this part, part II of chapter 408, and applicable rules. The
2832 amount of the fee shall be established by rule.
2833 (a) The biennial license fee required of a facility is $356
2834 $300 per license, with an additional fee of $67.50 $50 per
2835 resident based on the total licensed resident capacity of the
2836 facility, except that no additional fee will be assessed for
2837 beds designated for recipients of optional state supplementation
2838 payments provided for in s. 409.212. The total fee may not
2839 exceed $18,500 $10,000.
2840 (b) In addition to the total fee assessed under paragraph
2841 (a), the agency shall require facilities that are licensed to
2842 provide extended congregate care services under this part to pay
2843 an additional fee per licensed facility. The amount of the
2844 biennial fee shall be $501 $400 per license, with an additional
2845 fee of $10 per resident based on the total licensed resident
2846 capacity of the facility.
2847 (c) In addition to the total fee assessed under paragraph
2848 (a), the agency shall require facilities that are licensed to
2849 provide limited nursing services under this part to pay an
2850 additional fee per licensed facility. The amount of the biennial
2851 fee shall be $250 per license, with an additional fee of $10 per
2852 resident based on the total licensed resident capacity of the
2853 facility.
2854 (5) Counties or municipalities applying for licenses under
2855 this part are exempt from the payment of license fees.
2856 (6) In order to determine whether the licensee is
2857 adequately protecting residents’ rights as provided in s.
2858 429.28, the biennial survey must include private, informal
2859 conversations with a sample of the residents and consultation
2860 with the ombudsman council in the planning and service area in
2861 which the facility is located to discuss residents’ experiences
2862 within the facility.
2863 (7) An assisted living facility that has been cited within
2864 the previous 24-month period for a class I violation or a class
2865 II violation, regardless of the status of any enforcement or
2866 disciplinary action, is subject to periodic unannounced
2867 monitoring to determine if the facility is in compliance with
2868 this part, part II of chapter 408, and applicable rules.
2869 Monitoring may occur through a desk review or onsite. If a cited
2870 violation relates to providing or failing to provide nursing
2871 care, a registered nurse must participate in at least two onsite
2872 monitoring visits within a 12-month period.
2873 Section 66. Section 429.11, Florida Statutes, is amended to
2874 read:
2875 429.11 Initial application for license; provisional
2876 license.—
2877 (1) Each applicant for licensure must comply with all
2878 provisions of part II of chapter 408 and must:
2879 (a) Identify all other homes or facilities, including the
2880 addresses and the license or licenses under which they operate,
2881 if applicable, which are currently operated by the applicant or
2882 administrator and which provide housing, meals, and personal
2883 services to residents.
2884 (b) Provide the location of the facility for which a
2885 license is sought and documentation, signed by the appropriate
2886 local government official, which states that the applicant has
2887 met local zoning requirements.
2888 (c) Provide the name, address, date of birth, social
2889 security number, education, and experience of the administrator,
2890 if different from the applicant.
2891 (2) The applicant shall provide proof of liability
2892 insurance as defined in s. 624.605.
2893 (3) If the applicant is a community residential home, the
2894 applicant must provide proof that it has met the requirements
2895 specified in chapter 419.
2896 (4) The applicant must furnish proof that the facility has
2897 received a satisfactory firesafety inspection. The local
2898 authority having jurisdiction or the State Fire Marshal must
2899 conduct the inspection within 30 days after written request by
2900 the applicant.
2901 (5) The applicant must furnish documentation of a
2902 satisfactory sanitation inspection of the facility by the county
2903 health department.
2904 (6) In addition to the license categories available in s.
2905 408.808, a provisional license may be issued to an applicant
2906 making initial application for licensure or making application
2907 for a change of ownership. A provisional license shall be
2908 limited in duration to a specific period of time not to exceed 6
2909 months, as determined by the agency.
2910 (6)(7) A county or municipality may not issue an
2911 occupational license that is being obtained for the purpose of
2912 operating a facility regulated under this part without first
2913 ascertaining that the applicant has been licensed to operate
2914 such facility at the specified location or locations by the
2915 agency. The agency shall furnish to local agencies responsible
2916 for issuing occupational licenses sufficient instruction for
2917 making such determinations.
2918 Section 67. Subsection (2) of section 429.12, Florida
2919 Statutes, is repealed.
2920 Section 68. Subsections (5) and (6) of section 429.14,
2921 Florida Statutes, are amended to read:
2922 429.14 Administrative penalties.—
2923 (5) An action taken by the agency to suspend, deny, or
2924 revoke a facility’s license under this part or part II of
2925 chapter 408, in which the agency claims that the facility owner
2926 or an employee of the facility has threatened the health,
2927 safety, or welfare of a resident of the facility shall be heard
2928 by the Division of Administrative Hearings of the Department of
2929 Management Services within 120 days after receipt of the
2930 facility’s request for a hearing, unless that time limitation is
2931 waived by both parties. The administrative law judge must render
2932 a decision within 30 days after receipt of a proposed
2933 recommended order.
2934 (6) The agency shall provide to the Division of Hotels and
2935 Restaurants of the Department of Business and Professional
2936 Regulation, on a monthly basis, a list of those assisted living
2937 facilities that have had their licenses denied, suspended, or
2938 revoked or that are involved in an appellate proceeding pursuant
2939 to s. 120.60 related to the denial, suspension, or revocation of
2940 a license. This information may be provided electronically or
2941 through the agency’s Internet website.
2942 Section 69. Subsections (1), (4), and (5) of section
2943 429.17, Florida Statutes, are amended to read:
2944 429.17 Expiration of license; renewal; conditional
2945 license.—
2946 (1) Limited nursing, Extended congregate care, and limited
2947 mental health licenses shall expire at the same time as the
2948 facility’s standard license, regardless of when issued.
2949 (4) In addition to the license categories available in s.
2950 408.808, a conditional license may be issued to an applicant for
2951 license renewal if the applicant fails to meet all standards and
2952 requirements for licensure. A conditional license issued under
2953 this subsection shall be limited in duration to a specific
2954 period of time not to exceed 6 months, as determined by the
2955 agency, and shall be accompanied by an agency-approved plan of
2956 correction.
2957 (5) When an extended congregate care or limited nursing
2958 license is requested during a facility’s biennial license
2959 period, the fee shall be prorated in order to permit the
2960 additional license to expire at the end of the biennial license
2961 period. The fee shall be calculated as of the date the
2962 additional license application is received by the agency.
2963 Section 70. Subsection (7) of section 429.19, Florida
2964 Statutes, is amended to read:
2965 429.19 Violations; imposition of administrative fines;
2966 grounds.—
2967 (7) In addition to any administrative fines imposed, the
2968 agency may assess a survey or monitoring fee, equal to the
2969 lesser of one half of the facility’s biennial license and bed
2970 fee or $500, to cover the cost of conducting initial complaint
2971 investigations that result in the finding of a violation that
2972 was the subject of the complaint or monitoring visits conducted
2973 under s. 429.28(3)(c) to verify the correction of the
2974 violations, or to monitor the health, safety, or security of
2975 residents under s. 429.07(7).
2976 Section 71. Subsection (5) of section 429.23, Florida
2977 Statutes, is repealed.
2978 Section 72. Section 429.255, Florida Statutes, is amended
2979 to read:
2980 429.255 Use of personnel; emergency care.—
2981 (1)(a) Persons under contract to the facility or, facility
2982 staff, or volunteers, who are licensed according to part I of
2983 chapter 464, or those persons exempt under s. 464.022(1), and
2984 others as defined by rule, may administer medications to
2985 residents, take residents’ vital signs, manage individual weekly
2986 pill organizers for residents who self-administer medication,
2987 give prepackaged enemas ordered by a physician, observe
2988 residents, document observations on the appropriate resident’s
2989 record, report observations to the resident’s physician, and
2990 contract or allow residents or a resident’s representative,
2991 designee, surrogate, guardian, or attorney in fact to contract
2992 with a third party, provided residents meet the criteria for
2993 appropriate placement as defined in s. 429.26. Persons under
2994 contract to the facility or facility staff who are licensed
2995 according to part I of chapter 464 may provide limited nursing
2996 services. Nursing assistants certified pursuant to part II of
2997 chapter 464 may take residents’ vital signs as directed by a
2998 licensed nurse or physician. The licensee is responsible for
2999 maintaining documentation of services provided under this
3000 paragraph as required by rule and ensuring that staff are
3001 adequately trained to monitor residents receiving these
3002 services.
3003 (b) All staff in facilities licensed under this part shall
3004 exercise their professional responsibility to observe residents,
3005 to document observations on the appropriate resident’s record,
3006 and to report the observations to the resident’s physician.
3007 However, the owner or administrator of the facility shall be
3008 responsible for determining that the resident receiving services
3009 is appropriate for residence in the facility.
3010 (c) In an emergency situation, licensed personnel may carry
3011 out their professional duties pursuant to part I of chapter 464
3012 until emergency medical personnel assume responsibility for
3013 care.
3014 (2) In facilities licensed to provide extended congregate
3015 care, persons under contract to the facility or, facility staff,
3016 or volunteers, who are licensed according to part I of chapter
3017 464, or those persons exempt under s. 464.022(1), or those
3018 persons certified as nursing assistants pursuant to part II of
3019 chapter 464, may also perform all duties within the scope of
3020 their license or certification, as approved by the facility
3021 administrator and pursuant to this part.
3022 (3) Facility staff may withhold or withdraw cardiopulmonary
3023 resuscitation if presented with an order not to resuscitate
3024 executed pursuant to s. 401.45. The department shall adopt rules
3025 providing for the implementation of such orders. Facility staff
3026 and facilities shall not be subject to criminal prosecution or
3027 civil liability, nor be considered to have engaged in negligent
3028 or unprofessional conduct, for withholding or withdrawing
3029 cardiopulmonary resuscitation pursuant to such an order and
3030 rules adopted by the department. The absence of an order to
3031 resuscitate executed pursuant to s. 401.45 does not preclude a
3032 physician from withholding or withdrawing cardiopulmonary
3033 resuscitation as otherwise permitted by law.
3034 Section 73. Subsection (3) of section 429.28, Florida
3035 Statutes, is repealed.
3036 Section 74. Subsection (2) of section 429.35, Florida
3037 Statutes, is amended to read:
3038 429.35 Maintenance of records; reports.—
3039 (2) Within 60 days after the date of the biennial
3040 inspection visit required under s. 408.811 or within 30 days
3041 after the date of any interim visit, the agency shall forward
3042 the results of the inspection to the local ombudsman council in
3043 whose planning and service area, as defined in part II of
3044 chapter 400, the facility is located; to at least one public
3045 library or, in the absence of a public library, the county seat
3046 in the county in which the inspected assisted living facility is
3047 located; and, when appropriate, to the district Adult Services
3048 and Mental Health Program Offices. This information may be
3049 provided electronically or through the agency’s Internet site.
3050 Section 75. Paragraphs (i) and (j) of subsection (1) of
3051 section 429.41, Florida Statutes, are amended to read:
3052 429.41 Rules establishing standards.—
3053 (1) It is the intent of the Legislature that rules
3054 published and enforced pursuant to this section shall include
3055 criteria by which a reasonable and consistent quality of
3056 resident care and quality of life may be ensured and the results
3057 of such resident care may be demonstrated. Such rules shall also
3058 ensure a safe and sanitary environment that is residential and
3059 noninstitutional in design or nature. It is further intended
3060 that reasonable efforts be made to accommodate the needs and
3061 preferences of residents to enhance the quality of life in a
3062 facility. The agency, in consultation with the department, may
3063 adopt rules to administer the requirements of part II of chapter
3064 408. In order to provide safe and sanitary facilities and the
3065 highest quality of resident care accommodating the needs and
3066 preferences of residents, the department, in consultation with
3067 the agency, the Department of Children and Family Services, and
3068 the Department of Health, shall adopt rules, policies, and
3069 procedures to administer this part, which must include
3070 reasonable and fair minimum standards in relation to:
3071 (i) Facilities holding an a limited nursing, extended
3072 congregate care, or limited mental health license.
3073 (j) The establishment of specific criteria to define
3074 appropriateness of resident admission and continued residency in
3075 a facility holding a standard, limited nursing, extended
3076 congregate care, and limited mental health license.
3077 Section 76. Section 429.53, Florida Statutes, is amended to
3078 read:
3079 429.53 Consultation by the agency.—
3080 (1) The area offices of licensure and certification of the
3081 agency shall provide consultation to the following upon request:
3082 (a) A licensee of a facility.
3083 (b) A person interested in obtaining a license to operate a
3084 facility under this part.
3085 (2) As used in this section, “consultation” includes:
3086 (a) An explanation of the requirements of this part and
3087 rules adopted pursuant thereto;
3088 (b) An explanation of the license application and renewal
3089 procedures; and
3090 (c) The provision of a checklist of general local and state
3091 approvals required prior to constructing or developing a
3092 facility and a listing of the types of agencies responsible for
3093 such approvals;
3094 (d) An explanation of benefits and financial assistance
3095 available to a recipient of supplemental security income
3096 residing in a facility;
3097 (c)(e) Any other information which the agency deems
3098 necessary to promote compliance with the requirements of this
3099 part; and
3100 (f) A preconstruction review of a facility to ensure
3101 compliance with agency rules and this part.
3102 (3) The agency may charge a fee commensurate with the cost
3103 of providing consultation under this section.
3104 Section 77. Section 429.54, Florida Statutes, is amended to
3105 read:
3106 429.54 Collection of information; local subsidy.—
3107 (1) Facilities that are licensed under this part must
3108 report electronically to the agency semiannually, or more
3109 frequently as determined by rule, data related to the facility,
3110 including, but not limited to: the total number of residents,
3111 the number of residents who are receiving limited mental health
3112 services, the number of residents who are receiving extended
3113 congregate care services, the number of residents who are
3114 receiving limited nursing services, funding sources of the
3115 residents, and professional staffing employed by or under
3116 contract with the licensee to provide resident services. The
3117 department, in consultation with the agency, shall adopt rules
3118 to administer this subsection.
3119 (2)(1) To enable the department to collect the information
3120 requested by the Legislature regarding the actual cost of
3121 providing room, board, and personal care in facilities, the
3122 department is authorized to conduct field visits and audits of
3123 facilities as may be necessary. The owners of randomly sampled
3124 facilities shall submit such reports, audits, and accountings of
3125 cost as the department may require by rule; provided that such
3126 reports, audits, and accountings shall be the minimum necessary
3127 to implement the provisions of this section. Any facility
3128 selected to participate in the study shall cooperate with the
3129 department by providing cost of operation information to
3130 interviewers.
3131 (3)(2) Local governments or organizations may contribute to
3132 the cost of care of local facility residents by further
3133 subsidizing the rate of state-authorized payment to such
3134 facilities. Implementation of local subsidy shall require
3135 departmental approval and shall not result in reductions in the
3136 state supplement.
3137 Section 78. Subsections (2) and (11) of section 429.65,
3138 Florida Statutes, are amended to read:
3139 429.65 Definitions.—As used in this part, the term:
3140 (2) “Adult family-care home” means a full-time, family-type
3141 living arrangement, in a private home, under which up to two
3142 individuals a person who reside in the home and own or rent owns
3143 or rents the home provide provides room, board, and personal
3144 care, on a 24-hour basis, for no more than five disabled adults
3145 or frail elders who are not relatives. The following family-type
3146 living arrangements are not required to be licensed as an adult
3147 family-care home:
3148 (a) An arrangement whereby the person who resides in the
3149 home and owns or rents the home provides room, board, and
3150 personal services for not more than two adults who do not
3151 receive optional state supplementation under s. 409.212. The
3152 person who provides the housing, meals, and personal care must
3153 own or rent the home and reside therein.
3154 (b) An arrangement whereby the person who owns or rents the
3155 home provides room, board, and personal services only to his or
3156 her relatives.
3157 (c) An establishment that is licensed as an assisted living
3158 facility under this chapter.
3159 (11) “Provider” means up to two individuals a person who
3160 are is licensed to operate an adult family-care home.
3161 Section 79. Section 429.71, Florida Statutes, is amended to
3162 read:
3163 429.71 Classification of violations deficiencies;
3164 administrative fines.—
3165 (1) In addition to the requirements of part II of chapter
3166 408 and in addition to any other liability or penalty provided
3167 by law, the agency may impose an administrative fine on a
3168 provider according to the following classification:
3169 (a) Class I violations are defined in s. 408.813. those
3170 conditions or practices related to the operation and maintenance
3171 of an adult family-care home or to the care of residents which
3172 the agency determines present an imminent danger to the
3173 residents or guests of the facility or a substantial probability
3174 that death or serious physical or emotional harm would result
3175 therefrom. The condition or practice that constitutes a class I
3176 violation must be abated or eliminated within 24 hours, unless a
3177 fixed period, as determined by the agency, is required for
3178 correction. A class I violation deficiency is subject to an
3179 administrative fine in an amount not less than $500 and not
3180 exceeding $1,000 for each violation. A fine may be levied
3181 notwithstanding the correction of the violation deficiency.
3182 (b) Class II violations are defined in s. 408.813. those
3183 conditions or practices related to the operation and maintenance
3184 of an adult family-care home or to the care of residents which
3185 the agency determines directly threaten the physical or
3186 emotional health, safety, or security of the residents, other
3187 than class I violations. A class II violation is subject to an
3188 administrative fine in an amount not less than $250 and not
3189 exceeding $500 for each violation. A citation for a class II
3190 violation must specify the time within which the violation is
3191 required to be corrected. If a class II violation is corrected
3192 within the time specified, no civil penalty shall be imposed,
3193 unless it is a repeated offense.
3194 (c) Class III violations are defined in s. 408.813. those
3195 conditions or practices related to the operation and maintenance
3196 of an adult family-care home or to the care of residents which
3197 the agency determines indirectly or potentially threaten the
3198 physical or emotional health, safety, or security of residents,
3199 other than class I or class II violations. A class III violation
3200 is subject to an administrative fine in an amount not less than
3201 $100 and not exceeding $250 for each violation. A citation for a
3202 class III violation shall specify the time within which the
3203 violation is required to be corrected. If a class III violation
3204 is corrected within the time specified, no civil penalty shall
3205 be imposed, unless it is a repeated offense.
3206 (d) Class IV violations are defined in s. 408.813. those
3207 conditions or occurrences related to the operation and
3208 maintenance of an adult family-care home, or related to the
3209 required reports, forms, or documents, which do not have the
3210 potential of negatively affecting the residents. A provider that
3211 does not correct A class IV violation within the time limit
3212 specified by the agency is subject to an administrative fine in
3213 an amount not less than $50 and not exceeding $100 for each
3214 violation. Any class IV violation that is corrected during the
3215 time the agency survey is conducted will be identified as an
3216 agency finding and not as a violation.
3217 (2) The agency may impose an administrative fine for
3218 violations that which do not qualify as class I, class II, class
3219 III, or class IV violations. The amount of the fine may shall
3220 not exceed $250 for each violation or $2,000 in the aggregate.
3221 Unclassified violations may include:
3222 (a) Violating any term or condition of a license.
3223 (b) Violating any provision of this part, part II of
3224 chapter 408, or applicable rules.
3225 (c) Failure to follow the criteria and procedures provided
3226 under part I of chapter 394 relating to the transportation,
3227 voluntary admission, and involuntary examination of adult
3228 family-care home residents.
3229 (d) Exceeding licensed capacity.
3230 (e) Providing services beyond the scope of the license.
3231 (f) Violating a moratorium.
3232 (3) Each day during which a violation occurs constitutes a
3233 separate offense.
3234 (4) In determining whether a penalty is to be imposed, and
3235 in fixing the amount of any penalty to be imposed, the agency
3236 must consider:
3237 (a) The gravity of the violation.
3238 (b) Actions taken by the provider to correct a violation.
3239 (c) Any previous violation by the provider.
3240 (d) The financial benefit to the provider of committing or
3241 continuing the violation.
3242 (5) As an alternative to or in conjunction with an
3243 administrative action against a provider, the agency may request
3244 a plan of corrective action that demonstrates a good faith
3245 effort to remedy each violation by a specific date, subject to
3246 the approval of the agency.
3247 (5)(6) The department shall set forth, by rule, notice
3248 requirements and procedures for correction of deficiencies.
3249 Section 80. Subsection (5) of section 429.901, Florida
3250 Statutes, is repealed.
3251 Section 81. Paragraph (a) of subsection (2) of section
3252 429.911, Florida Statutes is repealed.
3253 Section 82. Section 429.915, Florida Statutes, is amended
3254 to read:
3255 429.915 Conditional license.—In addition to the license
3256 categories available in part II of chapter 408, the agency may
3257 issue a conditional license to an applicant for license renewal
3258 or change of ownership if the applicant fails to meet all
3259 standards and requirements for licensure. A conditional license
3260 issued under this subsection must be limited to a specific
3261 period not exceeding 6 months, as determined by the agency, and
3262 must be accompanied by an approved plan of correction.
3263 Section 83. Subsection (3) of section 430.80, Florida
3264 Statutes, is amended to read:
3265 430.80 Implementation of a teaching nursing home pilot
3266 project.—
3267 (3) To be designated as a teaching nursing home, a nursing
3268 home licensee must, at a minimum:
3269 (a) Provide a comprehensive program of integrated senior
3270 services that include institutional services and community-based
3271 services;
3272 (b) Participate in a nationally recognized accreditation
3273 program and hold a valid accreditation, such as the
3274 accreditation awarded by the Joint Commission on Accreditation
3275 of Healthcare Organizations;
3276 (c) Have been in business in this state for a minimum of 10
3277 consecutive years;
3278 (d) Demonstrate an active program in multidisciplinary
3279 education and research that relates to gerontology;
3280 (e) Have a formalized contractual relationship with at
3281 least one accredited health profession education program located
3282 in this state;
3283 (f) Have a formalized contractual relationship with an
3284 accredited hospital that is designated by law as a teaching
3285 hospital; and
3286 (g) Have senior staff members who hold formal faculty
3287 appointments at universities, which must include at least one
3288 accredited health profession education program.
3289 (h) Maintain insurance coverage pursuant to s.
3290 400.141(1)(q) s. 400.141(1)(s) or proof of financial
3291 responsibility in a minimum amount of $750,000. Such proof of
3292 financial responsibility may include:
3293 1. Maintaining an escrow account consisting of cash or
3294 assets eligible for deposit in accordance with s. 625.52; or
3295 2. Obtaining and maintaining pursuant to chapter 675 an
3296 unexpired, irrevocable, nontransferable and nonassignable letter
3297 of credit issued by any bank or savings association organized
3298 and existing under the laws of this state or any bank or savings
3299 association organized under the laws of the United States which
3300 that has its principal place of business in this state or which
3301 has a branch office that which is authorized to receive deposits
3302 in this state. The letter of credit shall be used to satisfy the
3303 obligation of the facility to the claimant upon presentment of a
3304 final judgment indicating liability and awarding damages to be
3305 paid by the facility or upon presentment of a settlement
3306 agreement signed by all parties to the agreement when such final
3307 judgment or settlement is a result of a liability claim against
3308 the facility.
3309 Section 84. Paragraph (a) of subsection (2) of section
3310 440.13, Florida Statutes, is amended to read:
3311 440.13 Medical services and supplies; penalty for
3312 violations; limitations.—
3313 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3314 (a) Subject to the limitations specified elsewhere in this
3315 chapter, the employer shall furnish to the employee such
3316 medically necessary remedial treatment, care, and attendance for
3317 such period as the nature of the injury or the process of
3318 recovery may require, which is in accordance with established
3319 practice parameters and protocols of treatment as provided for
3320 in this chapter, including medicines, medical supplies, durable
3321 medical equipment, orthoses, prostheses, and other medically
3322 necessary apparatus. Remedial treatment, care, and attendance,
3323 including work-hardening programs or pain-management programs
3324 accredited by the Commission on Accreditation of Rehabilitation
3325 Facilities or Joint Commission on the Accreditation of Health
3326 Organizations or pain-management programs affiliated with
3327 medical schools, shall be considered as covered treatment only
3328 when such care is given based on a referral by a physician as
3329 defined in this chapter. Medically necessary treatment, care,
3330 and attendance does not include chiropractic services in excess
3331 of 24 treatments or rendered 12 weeks beyond the date of the
3332 initial chiropractic treatment, whichever comes first, unless
3333 the carrier authorizes additional treatment or the employee is
3334 catastrophically injured.
3335
3336 Failure of the carrier to timely comply with this subsection
3337 shall be a violation of this chapter and the carrier shall be
3338 subject to penalties as provided for in s. 440.525.
3339 Section 85. Subsection (11) is added to section 483.201,
3340 Florida Statutes, to read:
3341 483.201 Grounds for disciplinary action against clinical
3342 laboratories.—In addition to the requirements of part II of
3343 chapter 408, the following acts constitute grounds for which a
3344 disciplinary action specified in s. 483.221 may be taken against
3345 a clinical laboratory:
3346 (11) A blood establishment that collects blood or blood
3347 components from volunteer donors failing to disclose information
3348 concerning its activities as required by s. 381.06014. Each day
3349 of violation constitutes a separate violation and each separate
3350 violation is subject to a separate fine. If multiple licensed
3351 establishments operated by a single business entity fail to meet
3352 such disclosure requirements, the agency may assess fines
3353 against only one of the business entity’s clinical laboratory
3354 licenses. The total administrative fine may not exceed $10,000
3355 for each annual reporting period.
3356 Section 86. Section 483.294, Florida Statutes, is amended
3357 to read:
3358 483.294 Inspection of centers.—In accordance with s.
3359 408.811, the agency shall biennially, at least once annually,
3360 inspect the premises and operations of all centers subject to
3361 licensure under this part.
3362 Section 87. Subsection (23) of section 499.003, Florida
3363 Statutes, is amended to read
3364 499.003 Definitions of terms used in this part.—As used in
3365 this part, the term:
3366 (23) “Health care entity” means a closed pharmacy or any
3367 person, organization, or business entity that provides
3368 diagnostic, medical, surgical, or dental treatment or care, or
3369 chronic or rehabilitative care, but does not include any
3370 wholesale distributor or retail pharmacy licensed under state
3371 law to deal in prescription drugs. However, a blood
3372 establishment may be a health care entity and engage in the
3373 wholesale distribution of prescription drugs under s.
3374 499.01(2)(g)1.c.
3375 Section 88. Subsection (21) of section 499.005, Florida
3376 Statutes, is amended to read:
3377 499.005 Prohibited acts.—It is unlawful for a person to
3378 perform or cause the performance of any of the following acts in
3379 this state:
3380 (21) The wholesale distribution of any prescription drug
3381 that was:
3382 (a) Purchased by a public or private hospital or other
3383 health care entity, except as authorized in s. 499.01(2)(g)1.c.;
3384 or
3385 (b) Donated or supplied at a reduced price to a charitable
3386 organization.
3387 Section 89. Paragraphs (a) and (g) of subsection (2) of
3388 section 499.01, Florida Statutes, are amended to read:
3389 499.01 Permits.—
3390 (2) The following permits are established:
3391 (a) Prescription drug manufacturer permit.—A prescription
3392 drug manufacturer permit is required for any person that is a
3393 manufacturer of a prescription drug and that manufactures or
3394 distributes such prescription drugs in this state.
3395 1. A person that operates an establishment permitted as a
3396 prescription drug manufacturer may engage in wholesale
3397 distribution of prescription drugs manufactured at that
3398 establishment and must comply with all of the provisions of this
3399 part, except s. 499.01212, and the rules adopted under this
3400 part, except s. 499.01212, that apply to a wholesale
3401 distributor.
3402 2. A prescription drug manufacturer must comply with all
3403 appropriate state and federal good manufacturing practices.
3404 3. A blood establishment as defined in s. 381.06014,
3405 operating in a manner consistent with the provisions of Title 21
3406 C.F.R. Parts 211 and 600-640, and manufacturing only the
3407 prescription drugs described in s. 499.003(53)(d) is not
3408 required to be permitted as a prescription drug manufacturer
3409 under this paragraph or register products under s. 499.015.
3410 (g) Restricted prescription drug distributor permit.—
3411 1. A restricted prescription drug distributor permit is
3412 required for:
3413 a. Any person that engages in the distribution of a
3414 prescription drug, which distribution is not considered
3415 “wholesale distribution” under s. 499.003(53)(a).
3416 b.1. Any A person who engages in the receipt or
3417 distribution of a prescription drug in this state for the
3418 purpose of processing its return or its destruction must obtain
3419 a permit as a restricted prescription drug distributor if such
3420 person is not the person initiating the return, the prescription
3421 drug wholesale supplier of the person initiating the return, or
3422 the manufacturer of the drug.
3423 c. A blood establishment located in this state which
3424 collects blood and blood components only from volunteer donors
3425 as defined in s. 381.06014 or pursuant to an authorized
3426 practitioner’s order for medical treatment or therapy and
3427 engages in the wholesale distribution of a prescription drug not
3428 described in s. 499.003(53)(d) to a health care entity. The
3429 health care entity receiving a prescription drug distributed
3430 under this sub-subparagraph must be licensed as a closed
3431 pharmacy or provide health care services at that establishment.
3432 The blood establishment must operate in accordance with s.
3433 381.06014 and may distribute only:
3434 (I) Prescription drugs indicated for a bleeding or clotting
3435 disorder or anemia;
3436 (II) Blood-collection containers approved under s. 505 of
3437 the federal act;
3438 (III) Drugs that are blood derivatives, or a recombinant or
3439 synthetic form of a blood derivative; or
3440 (IV) Prescription drugs identified in rules adopted by the
3441 department which are essential to services performed or provided
3442 by blood establishments and authorized for distribution by blood
3443 establishments under federal law,
3444
3445 as long as all of the health care services provided by the blood
3446 establishment are related to its activities as a registered
3447 blood establishment or the health care services consist of
3448 collecting, processing, storing, or administering human
3449 hematopoietic stem cells or progenitor cells or performing
3450 diagnostic testing of specimens if such specimens are tested
3451 together with specimens undergoing routine donor testing.
3452 2. Storage, handling, and recordkeeping of these
3453 distributions by a person permitted as a restricted prescription
3454 drug distributor must comply with the requirements for wholesale
3455 distributors under s. 499.0121, but not those set forth in s.
3456 499.01212 if the distribution occurs pursuant to sub
3457 subparagraph 1.a. or sub-subparagraph 1.b.
3458 3. A person who applies for a permit as a restricted
3459 prescription drug distributor, or for the renewal of such a
3460 permit, must provide to the department the information required
3461 under s. 499.012.
3462 4. The department may adopt rules regarding the
3463 distribution of prescription drugs by hospitals, health care
3464 entities, charitable organizations, or other persons not
3465 involved in wholesale distribution, and blood establishments,
3466 which rules are necessary for the protection of the public
3467 health, safety, and welfare. The department may adopt rules
3468 related to the transportation, storage, and recordkeeping of
3469 prescription drugs which are essential to services performed or
3470 provided by a blood establishment, including requirements for
3471 the use of prescription drugs in mobile blood-collection
3472 vehicles.
3473 Section 90. Subsection (1) of section 627.645, Florida
3474 Statutes, is amended to read:
3475 627.645 Denial of health insurance claims restricted.—
3476 (1) A No claim for payment under a health insurance policy
3477 or self-insured program of health benefits for treatment, care,
3478 or services in a licensed hospital that which is accredited by
3479 the Joint Commission on the Accreditation of Hospitals, the
3480 American Osteopathic Association, or the Commission on the
3481 Accreditation of Rehabilitative Facilities may not shall be
3482 denied because the such hospital lacks major surgical facilities
3483 and is primarily of a rehabilitative nature, if such
3484 rehabilitation is specifically for treatment of physical
3485 disability.
3486 Section 91. Paragraph (c) of subsection (2) of section
3487 627.668, Florida Statutes, is amended to read:
3488 627.668 Optional coverage for mental and nervous disorders
3489 required; exception.—
3490 (2) Under group policies or contracts, inpatient hospital
3491 benefits, partial hospitalization benefits, and outpatient
3492 benefits consisting of durational limits, dollar amounts,
3493 deductibles, and coinsurance factors shall not be less favorable
3494 than for physical illness generally, except that:
3495 (c) Partial hospitalization benefits shall be provided
3496 under the direction of a licensed physician. For purposes of
3497 this part, the term “partial hospitalization services” is
3498 defined as those services offered by a program accredited by the
3499 Joint Commission on Accreditation of Hospitals (JCAH) or in
3500 compliance with equivalent standards. Alcohol rehabilitation
3501 programs accredited by the Joint Commission on Accreditation of
3502 Hospitals or approved by the state and licensed drug abuse
3503 rehabilitation programs shall also be qualified providers under
3504 this section. In any benefit year, if partial hospitalization
3505 services or a combination of inpatient and partial
3506 hospitalization are utilized, the total benefits paid for all
3507 such services shall not exceed the cost of 30 days of inpatient
3508 hospitalization for psychiatric services, including physician
3509 fees, which prevail in the community in which the partial
3510 hospitalization services are rendered. If partial
3511 hospitalization services benefits are provided beyond the limits
3512 set forth in this paragraph, the durational limits, dollar
3513 amounts, and coinsurance factors thereof need not be the same as
3514 those applicable to physical illness generally.
3515 Section 92. Subsection (3) of section 627.669, Florida
3516 Statutes, is amended to read:
3517 627.669 Optional coverage required for substance abuse
3518 impaired persons; exception.—
3519 (3) The benefits provided under this section shall be
3520 applicable only if treatment is provided by, or under the
3521 supervision of, or is prescribed by, a licensed physician or
3522 licensed psychologist and if services are provided in a program
3523 accredited by the Joint Commission on Accreditation of Hospitals
3524 or approved by the state.
3525 Section 93. Subsection (1) of section 627.736, Florida
3526 Statutes, is amended to read:
3527 627.736 Required personal injury protection benefits;
3528 exclusions; priority; claims.—
3529 (1) REQUIRED BENEFITS.—Every insurance policy complying
3530 with the security requirements of s. 627.733 shall provide
3531 personal injury protection to the named insured, relatives
3532 residing in the same household, persons operating the insured
3533 motor vehicle, passengers in such motor vehicle, and other
3534 persons struck by such motor vehicle and suffering bodily injury
3535 while not an occupant of a self-propelled vehicle, subject to
3536 the provisions of subsection (2) and paragraph (4)(e), to a
3537 limit of $10,000 for loss sustained by any such person as a
3538 result of bodily injury, sickness, disease, or death arising out
3539 of the ownership, maintenance, or use of a motor vehicle as
3540 follows:
3541 (a) Medical benefits.—Eighty percent of all reasonable
3542 expenses for medically necessary medical, surgical, X-ray,
3543 dental, and rehabilitative services, including prosthetic
3544 devices, and medically necessary ambulance, hospital, and
3545 nursing services. However, the medical benefits shall provide
3546 reimbursement only for such services and care that are lawfully
3547 provided, supervised, ordered, or prescribed by a physician
3548 licensed under chapter 458 or chapter 459, a dentist licensed
3549 under chapter 466, or a chiropractic physician licensed under
3550 chapter 460 or that are provided by any of the following persons
3551 or entities:
3552 1. A hospital or ambulatory surgical center licensed under
3553 chapter 395.
3554 2. A person or entity licensed under ss. 401.2101-401.45
3555 which that provides emergency transportation and treatment.
3556 3. An entity wholly owned by one or more physicians
3557 licensed under chapter 458 or chapter 459, chiropractic
3558 physicians licensed under chapter 460, or dentists licensed
3559 under chapter 466 or by such practitioner or practitioners and
3560 the spouse, parent, child, or sibling of that practitioner or
3561 those practitioners.
3562 4. An entity wholly owned, directly or indirectly, by a
3563 hospital or hospitals.
3564 5. A health care clinic licensed under ss. 400.990-400.995
3565 which that is:
3566 a. Accredited by the Joint Commission on Accreditation of
3567 Healthcare Organizations, the American Osteopathic Association,
3568 the Commission on Accreditation of Rehabilitation Facilities, or
3569 the Accreditation Association for Ambulatory Health Care, Inc.;
3570 or
3571 b. A health care clinic that:
3572 (I) Has a medical director licensed under chapter 458,
3573 chapter 459, or chapter 460;
3574 (II) Has been continuously licensed for more than 3 years
3575 or is a publicly traded corporation that issues securities
3576 traded on an exchange registered with the United States
3577 Securities and Exchange Commission as a national securities
3578 exchange; and
3579 (III) Provides at least four of the following medical
3580 specialties:
3581 (A) General medicine.
3582 (B) Radiography.
3583 (C) Orthopedic medicine.
3584 (D) Physical medicine.
3585 (E) Physical therapy.
3586 (F) Physical rehabilitation.
3587 (G) Prescribing or dispensing outpatient prescription
3588 medication.
3589 (H) Laboratory services.
3590
3591 The Financial Services Commission shall adopt by rule the form
3592 that must be used by an insurer and a health care provider
3593 specified in subparagraph 3., subparagraph 4., or subparagraph
3594 5. to document that the health care provider meets the criteria
3595 of this paragraph. This, which rule must include a requirement
3596 for a sworn statement or affidavit.
3597 (b) Disability benefits.—Sixty percent of any loss of gross
3598 income and loss of earning capacity per individual from
3599 inability to work proximately caused by the injury sustained by
3600 the injured person, plus all expenses reasonably incurred in
3601 obtaining from others ordinary and necessary services in lieu of
3602 those that, but for the injury, the injured person would have
3603 performed without income for the benefit of his or her
3604 household. All disability benefits payable under this provision
3605 shall be paid not less than every 2 weeks.
3606 (c) Death benefits.—Death benefits equal to the lesser of
3607 $5,000 or the remainder of unused personal injury protection
3608 benefits per individual. The insurer may pay such benefits to
3609 the executor or administrator of the deceased, to any of the
3610 deceased’s relatives by blood or legal adoption or connection by
3611 marriage, or to any person appearing to the insurer to be
3612 equitably entitled thereto.
3613
3614 Only insurers writing motor vehicle liability insurance in this
3615 state may provide the required benefits of this section, and no
3616 such insurer shall require the purchase of any other motor
3617 vehicle coverage other than the purchase of property damage
3618 liability coverage as required by s. 627.7275 as a condition for
3619 providing such required benefits. Insurers may not require that
3620 property damage liability insurance in an amount greater than
3621 $10,000 be purchased in conjunction with personal injury
3622 protection. Such insurers shall make benefits and required
3623 property damage liability insurance coverage available through
3624 normal marketing channels. Any insurer writing motor vehicle
3625 liability insurance in this state who fails to comply with such
3626 availability requirement as a general business practice shall be
3627 deemed to have violated part IX of chapter 626, and such
3628 violation shall constitute an unfair method of competition or an
3629 unfair or deceptive act or practice involving the business of
3630 insurance; and any such insurer committing such violation shall
3631 be subject to the penalties afforded in such part, as well as
3632 those which may be afforded elsewhere in the insurance code.
3633 Section 94. Subsection (12) of section 641.495, Florida
3634 Statutes, is amended to read:
3635 641.495 Requirements for issuance and maintenance of
3636 certificate.—
3637 (12) The provisions of part I of chapter 395 do not apply
3638 to a health maintenance organization that, on or before January
3639 1, 1991, provides not more than 10 outpatient holding beds for
3640 short-term and hospice-type patients in an ambulatory care
3641 facility for its members, provided that such health maintenance
3642 organization maintains current accreditation by the Joint
3643 Commission on Accreditation of Health Care Organizations, the
3644 Accreditation Association for Ambulatory Health Care, or the
3645 National Committee for Quality Assurance.
3646 Section 95. Subsection (2) of section 766.1015, Florida
3647 Statutes, is amended to read:
3648 766.1015 Civil immunity for members of or consultants to
3649 certain boards, committees, or other entities.—
3650 (2) Such committee, board, group, commission, or other
3651 entity must be established in accordance with state law or in
3652 accordance with requirements of the Joint Commission on
3653 Accreditation of Healthcare Organizations, established and duly
3654 constituted by one or more public or licensed private hospitals
3655 or behavioral health agencies, or established by a governmental
3656 agency. To be protected by this section, the act, decision,
3657 omission, or utterance may not be made or done in bad faith or
3658 with malicious intent.
3659 Section 96. Except as otherwise expressly provided in this
3660 act, this act shall take effect July 1, 2010.