HB 817

1	A bill to be entitled
2	An act relating to assisted living facilities; amending s.
3	429.28, F.S.; revising and specifying certain conditions
4	in an assisted living facility's resident bill of rights
5	for a resident's relocation or termination of residency;
6	requiring grievance procedures to be written; creating s.
7	429.285, F.S.; prohibiting resident relocation or
8	termination of residency in the absence of certain
9	specified conditions; requiring the administrator or a
10	designated employee of a facility to sign a notice of
11	relocation or termination of residency and requiring a
12	physician's signature under certain circumstances;
13	requiring a licensee to provide advance written notice to
14	the resident and other specified persons regarding
15	relocation or termination of residency; providing that the
16	notice contain certain information; providing for the
17	creation of a form to submit relocation or termination of
18	residency information and specifying information to be
19	included therein; requiring a licensee to report
20	relocation or termination of residency to the Office of
21	State Long-Term Care Ombudsman within a specified time;
22	permitting residents to seek the assistance of the local
23	long-term care ombudsman council in reviewing a notice of
24	relocation or termination of residency; providing for
25	emergency relocation and termination of residency;
26	authorizing the department to adopt rules; amending ss.
27	429.07 and 429.31, F.S.; conforming cross-references;
28	providing an effective date.
29
30	Be It Enacted by the Legislature of the State of Florida:
31
32	Section 1.  Paragraphs (k) and (l) of subsection (1),
33	subsection (2), and paragraph (b) of subsection (3) of section
34	429.28, Florida Statutes, are amended to read:
35	429.28  Resident bill of rights.-
36	(1)  No resident of a facility shall be deprived of any
37	civil or legal rights, benefits, or privileges guaranteed by
38	law, the Constitution of the State of Florida, or the
39	Constitution of the United States as a resident of a facility.
40	Every resident of a facility shall have the right to:
41	(k)  Receive at least 45 days' written notice of relocation
42	or termination of residency from the licensee as provided in s.
43	429.285, unless the relocation or termination of residency is
44	initiated by the resident or the resident's designee facility
45	unless, for medical reasons, the resident is certified by a
46	physician to require an emergency relocation for medical reasons
47	to a facility providing a more skilled level of care, or the
48	resident engages in a pattern of conduct that is harmful or
49	offensive to other residents. In the case of a resident who has
50	been adjudicated mentally incapacitated, the guardian shall be
51	given at least 45 days' written notice of a nonemergency
52	relocation or residency termination. Reasons for relocation
53	shall be set forth in writing. In order for a licensee facility
54	to terminate the residency of an individual without notice as
55	provided in this paragraph herein, the licensee facility shall
56	show good cause in a court of competent jurisdiction. Admission
57	to a facility licensed under this part may not be conditioned
58	upon a waiver of such right, and any document or provision in a
59	document that purports to waive or preclude such right is void
60	and unenforceable.
61	(l)  Present grievances and recommend changes in policies,
62	procedures, and services to the staff of the facility, governing
63	officials, or any other person without restraint, interference,
64	coercion, discrimination, or reprisal. Each licensee facility
65	shall establish a written grievance procedure to facilitate the
66	residents' exercise of this right. This right includes access to
67	ombudsman volunteers and advocates and the right to be a member
68	of, to be active in, and to associate with advocacy or special
69	interest groups.
70	(2)  The administrator of a facility shall ensure that a
71	written notice of the rights, obligations, and prohibitions set
72	forth in this part is posted in a prominent place in each
73	facility and read or explained to residents who cannot read.
74	This notice shall include the name, address, and telephone
75	numbers of the local ombudsman council and central abuse hotline
76	and, when applicable, the Advocacy Center for Persons with
77	Disabilities, Inc., and the Florida local advocacy council,
78	where complaints may be lodged. The licensee facility must
79	ensure a resident's access to a telephone to call the local
80	ombudsman council, central abuse hotline, Advocacy Center for
81	Persons with Disabilities, Inc., and the Florida local advocacy
82	council.
83	(3)
84	(b)  In order to determine whether the licensee facility is
85	adequately protecting residents' rights, the biennial survey
86	shall include private informal conversations with a sample of
87	residents and consultation with the ombudsman council in the
88	planning and service area in which the facility is located to
89	discuss residents' experiences within the facility.
90	Section 2.  Section 429.285, Florida Statutes, is created
91	to read:
92	429.285  Resident relocation or termination of residency;
93	requirements and procedures.-
94	(1)  A facility licensed under this part must permit a
95	resident to remain in the facility unless the conditions
96	specified in this subsection apply. Relocation or termination of
97	residency of a resident may occur only if:
98	(a)  The relocation or termination of residency is
99	necessary for the resident's welfare and the resident's needs
100	cannot be met in the facility;
101	(b)  The relocation or termination of residency is
102	appropriate because the resident's health has improved or
103	deteriorated to the extent that the resident no longer needs the
104	services provided by the facility and the resident's health
105	condition is documented by a physician's order, as required
106	under subsection (2);
107	(c)  The health and safety of other residents or facility
108	employees would be endangered;
109	(d)  The resident has failed, after at least 30 days'
110	written notice, to provide payment for his or her stay in the
111	facility;
112	(e)  The facility ceases to operate; or
113	(f)  There is a documented pattern of harmful or offensive
114	behavior by the resident.
115	(2)  When a relocation or termination of residency is
116	initiated by the licensee:
117	(a)  The licensee must provide at least 45 days' written
118	notice by certified mail of the proposed relocation or
119	termination of residency to the affected resident and, if known,
120	to a family member or the resident's legal guardian or
121	representative, unless, for medical reasons, the resident is
122	certified by a physician to require an emergency relocation to a
123	facility that provides a more skilled level of care.
124	(b)  The administrator who is relocating the resident or
125	terminating residency, or an individual employed by the facility
126	who is designated by the administrator to act on behalf of the
127	administration, must sign the notice of relocation or
128	termination of residency.
129	(3)  A notice indicating a medical reason for relocation or
130	termination of residency must be signed by the resident's
131	physician or include an attached written order for the
132	relocation or termination of residency signed by a physician.
133	(a)  The notice must be in writing and contain all
134	information required by department rules and state laws.
135	(b)  A copy of the notice must be signed by the resident
136	upon receipt and placed in the resident's file.
137	(c)  The department shall develop a standard form for the
138	notice to be used by all facilities licensed under this part for
139	the purpose of notifying residents of a relocation or
140	termination of residency. In addition to any other pertinent
141	information included, the form shall:
142	1.  Specify the reason allowed under state law justifying
143	the relocation or termination of the residency, with an
144	explanation to support this action.
145	2.  State the effective date of the relocation or
146	termination of residency and the location to which the resident
147	is being relocated.
148	3.  State the right and specify the means to request the
149	local long-term care ombudsman council to review the notice of
150	relocation or termination of residency.
151	(4)  A relocation or termination of residency notice
152	initiated by a licensee must be reported to the Office of State
153	Long-Term Care Ombudsman by mail, e-mail, or facsimile within 2
154	business days after a resident's receipt of a notice to relocate
155	or terminate residency. A resident may request that the local
156	long-term care ombudsman council review any notice of relocation
157	or termination of residency given to the resident.
158	(5)  In the event of an emergency relocation or termination
159	of residency, as provided under s. 429.28(1)(k), notice shall be
160	provided as soon as practicable, but no later than 2 business
161	days after the emergency relocation or termination, to the
162	resident, the resident's legal guardian or representative, and
163	the Office of State Long-Term Care Ombudsman by telephone or in
164	person. If possible, the written notice shall be given before
165	the relocation or termination of residency, as required under
166	subsection (2), no later than 5 business days after the
167	relocation or termination of residency. The resident's file must
168	include documentation indicating who was contacted, whether the
169	contact was by telephone or in person, and the date and time of
170	the contact.
171	(6)  The department may adopt rules pursuant to ss.
172	120.536(1) and 120.54 to administer this section.
173	Section 3.  Paragraphs (b) and (c) of subsection (3) of
174	section 429.07, Florida Statutes, are amended to read:
175	429.07  License required; fee.-
176	(3)  In addition to the requirements of s. 408.806, each
177	license granted by the agency must state the type of care for
178	which the license is granted. Licenses shall be issued for one
179	or more of the following categories of care: standard, extended
180	congregate care, limited nursing services, or limited mental
181	health.
182	(b)  An extended congregate care license shall be issued to
183	facilities providing, directly or through contract, services
184	beyond those authorized in paragraph (a), including acts
185	performed pursuant to part I of chapter 464 by persons licensed
186	thereunder, and supportive services defined by rule to persons
187	who otherwise would be disqualified from continued residence in
188	a facility licensed under this part.
189	1.  In order for extended congregate care services to be
190	provided in a facility licensed under this part, the agency must
191	first determine that all requirements established in law and
192	rule are met and must specifically designate, on the facility's
193	license, that such services may be provided and whether the
194	designation applies to all or part of a facility. Such
195	designation may be made at the time of initial licensure or
196	relicensure, or upon request in writing by a licensee under this
197	part and part II of chapter 408. Notification of approval or
198	denial of such request shall be made in accordance with part II
199	of chapter 408. Existing facilities qualifying to provide
200	extended congregate care services must have maintained a
201	standard license and may not have been subject to administrative
202	sanctions during the previous 2 years, or since initial
203	licensure if the facility has been licensed for less than 2
204	years, for any of the following reasons:
205	a.  A class I or class II violation;
206	b.  Three or more repeat or recurring class III violations
207	of identical or similar resident care standards as specified in
208	rule from which a pattern of noncompliance is found by the
209	agency;
210	c.  Three or more class III violations that were not
211	corrected in accordance with the corrective action plan approved
212	by the agency;
213	d.  Violation of resident care standards resulting in a
214	requirement to employ the services of a consultant pharmacist or
215	consultant dietitian;
216	e.  Denial, suspension, or revocation of a license for
217	another facility under this part in which the applicant for an
218	extended congregate care license has at least 25 percent
219	ownership interest; or
220	f.  Imposition of a moratorium pursuant to this part or
221	part II of chapter 408 or initiation of injunctive proceedings.
222	2.  Facilities that are licensed to provide extended
223	congregate care services shall maintain a written progress
224	report on each person who receives such services, which report
225	describes the type, amount, duration, scope, and outcome of
226	services that are rendered and the general status of the
227	resident's health. A registered nurse, or appropriate designee,
228	representing the agency shall visit such facilities at least
229	quarterly to monitor residents who are receiving extended
230	congregate care services and to determine if the facility is in
231	compliance with this part, part II of chapter 408, and rules
232	that relate to extended congregate care. One of these visits may
233	be in conjunction with the regular survey. The monitoring visits
234	may be provided through contractual arrangements with
235	appropriate community agencies. A registered nurse shall serve
236	as part of the team that inspects such facility. The agency may
237	waive one of the required yearly monitoring visits for a
238	facility that has been licensed for at least 24 months to
239	provide extended congregate care services, if, during the
240	inspection, the registered nurse determines that extended
241	congregate care services are being provided appropriately, and
242	if the facility has no class I or class II violations and no
243	uncorrected class III violations. Before such decision is made,
244	the agency shall consult with the long-term care ombudsman
245	council for the area in which the facility is located to
246	determine if any complaints have been made and substantiated
247	about the quality of services or care. The agency may not waive
248	one of the required yearly monitoring visits if complaints have
249	been made and substantiated.
250	3.  Facilities that are licensed to provide extended
251	congregate care services shall:
252	a.  Demonstrate the capability to meet unanticipated
253	resident service needs.
254	b.  Offer a physical environment that promotes a homelike
255	setting, provides for resident privacy, promotes resident
256	independence, and allows sufficient congregate space as defined
257	by rule.
258	c.  Have sufficient staff available, taking into account
259	the physical plant and firesafety features of the building, to
260	assist with the evacuation of residents in an emergency, as
261	necessary.
262	d.  Adopt and follow policies and procedures that maximize
263	resident independence, dignity, choice, and decisionmaking to
264	permit residents to age in place to the extent possible, so that
265	moves due to changes in functional status are minimized or
266	avoided.
267	e.  Allow residents or, if applicable, a resident's
268	representative, designee, surrogate, guardian, or attorney in
269	fact to make a variety of personal choices, participate in
270	developing service plans, and share responsibility in
271	decisionmaking.
272	f.  Implement the concept of managed risk.
273	g.  Provide, either directly or through contract, the
274	services of a person licensed pursuant to part I of chapter 464.
275	h.  In addition to the training mandated in s. 429.52,
276	provide specialized training as defined by rule for facility
277	staff.
278	4.  Facilities licensed to provide extended congregate care
279	services are exempt from the criteria for continued residency as
280	set forth in rules adopted under s. 429.41. Facilities so
281	licensed shall adopt their own requirements within guidelines
282	for continued residency set forth by rule. However, such
283	facilities may not serve residents who require 24-hour nursing
284	supervision. Facilities licensed to provide extended congregate
285	care services shall provide each resident with a written copy of
286	facility policies governing admission and retention.
287	5.  The primary purpose of extended congregate care
288	services is to allow residents, as they become more impaired,
289	the option of remaining in a familiar setting from which they
290	would otherwise be disqualified for continued residency. A
291	facility licensed to provide extended congregate care services
292	may also admit an individual who exceeds the admission criteria
293	for a facility with a standard license, if the individual is
294	determined appropriate for admission to the extended congregate
295	care facility.
296	6.  Before admission of an individual to a facility
297	licensed to provide extended congregate care services, the
298	individual must undergo a medical examination as provided in s.
299	429.26(4) and the facility must develop a preliminary service
300	plan for the individual.
301	7.  When a facility can no longer provide or arrange for
302	services in accordance with the resident's service plan and
303	needs and the facility's policy, the facility shall make
304	arrangements for relocating the person in accordance with s.
305	429.285 429.28(1)(k).
306	8.  Failure to provide extended congregate care services
307	may result in denial of extended congregate care license
308	renewal.
309	9.  No later than January 1 of each year, the department,
310	in consultation with the agency, shall prepare and submit to the
311	Governor, the President of the Senate, the Speaker of the House
312	of Representatives, and the chairs of appropriate legislative
313	committees, a report on the status of, and recommendations
314	related to, extended congregate care services. The status report
315	must include, but need not be limited to, the following
316	information:
317	a.  A description of the facilities licensed to provide
318	such services, including total number of beds licensed under
319	this part.
320	b.  The number and characteristics of residents receiving
321	such services.
322	c.  The types of services rendered that could not be
323	provided through a standard license.
324	d.  An analysis of deficiencies cited during licensure
325	inspections.
326	e.  The number of residents who required extended
327	congregate care services at admission and the source of
328	admission.
329	f.  Recommendations for statutory or regulatory changes.
330	g.  The availability of extended congregate care to state
331	clients residing in facilities licensed under this part and in
332	need of additional services, and recommendations for
333	appropriations to subsidize extended congregate care services
334	for such persons.
335	h.  Such other information as the department considers
336	appropriate.
337	(c)  A limited nursing services license shall be issued to
338	a facility that provides services beyond those authorized in
339	paragraph (a) and as specified in this paragraph.
340	1.  In order for limited nursing services to be provided in
341	a facility licensed under this part, the agency must first
342	determine that all requirements established in law and rule are
343	met and must specifically designate, on the facility's license,
344	that such services may be provided. Such designation may be made
345	at the time of initial licensure or relicensure, or upon request
346	in writing by a licensee under this part and part II of chapter
347	408. Notification of approval or denial of such request shall be
348	made in accordance with part II of chapter 408. Existing
349	facilities qualifying to provide limited nursing services shall
350	have maintained a standard license and may not have been subject
351	to administrative sanctions that affect the health, safety, and
352	welfare of residents for the previous 2 years or since initial
353	licensure if the facility has been licensed for less than 2
354	years.
355	2.  Facilities that are licensed to provide limited nursing
356	services shall maintain a written progress report on each person
357	who receives such nursing services, which report describes the
358	type, amount, duration, scope, and outcome of services that are
359	rendered and the general status of the resident's health. A
360	registered nurse representing the agency shall visit such
361	facilities at least twice a year to monitor residents who are
362	receiving limited nursing services and to determine if the
363	facility is in compliance with applicable provisions of this
364	part, part II of chapter 408, and related rules. The monitoring
365	visits may be provided through contractual arrangements with
366	appropriate community agencies. A registered nurse shall also
367	serve as part of the team that inspects such facility.
368	3.  A person who receives limited nursing services under
369	this part must meet the admission criteria established by the
370	agency for assisted living facilities. When a resident no longer
371	meets the admission criteria for a facility licensed under this
372	part, arrangements for relocating the person shall be made in
373	accordance with s. 429.285 429.28(1)(k), unless the facility is
374	licensed to provide extended congregate care services.
375	Section 4.  Subsection (1) of section 429.31, Florida
376	Statutes, is amended to read:
377	429.31  Closing of facility; notice; penalty.-
378	(1)  In addition to the requirements of part II of chapter
379	408, the facility shall inform each resident or the next of kin,
380	legal representative, or agency acting on each resident's
381	behalf, of the fact and the proposed time of discontinuance of
382	operation, following the notification requirements provided in
383	s. 429.285 429.28(1)(k). In the event a resident has no person
384	to represent him or her, the facility shall be responsible for
385	referral to an appropriate social service agency for placement.
386	Section 5.  This act shall take effect July 1, 2010.

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