HB 119

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., relating to the Drug-Free Workplace Act; deleting an
4	obsolete provision; amending s. 318.21, F.S.; revising
5	distribution of funds from civil penalties imposed for
6	traffic infractions by county courts; amending s.
7	381.0072, F.S.; limiting Department of Health food service
8	inspections in nursing homes; requiring the department to
9	coordinate inspections with the Agency for Health Care
10	Administration; repealing s. 383.325, F.S., relating to
11	confidentiality of inspection reports of licensed birth
12	center facilities; amending s. 395.002, F.S.; revising and
13	deleting definitions applicable to regulation of hospitals
14	and other licensed facilities; conforming a cross-
15	reference; amending s. 395.003, F.S.; deleting an obsolete
16	provision; conforming a cross-reference; amending s.
17	395.0193, F.S.; requiring a licensed facility to report
18	certain peer review information and final disciplinary
19	actions to the Division of Medical Quality Assurance of
20	the Department of Health rather than the Division of
21	Health Quality Assurance of the Agency for Health Care
22	Administration; amending s. 395.1023, F.S.; providing for
23	the Department of Children and Family Services rather than
24	the Department of Health to perform certain functions with
25	respect to child protection cases; requiring certain
26	hospitals to notify the Department of Children and Family
27	Services of compliance; amending s. 395.1041, F.S.,
28	relating to hospital emergency services and care; deleting
29	obsolete provisions; repealing s. 395.1046, F.S., relating
30	to complaint investigation procedures; amending s.
31	395.1055, F.S.; requiring licensed facility beds to
32	conform to standards specified by the Agency for Health
33	Care Administration, the Florida Building Code, and the
34	Florida Fire Prevention Code; amending s. 395.10972, F.S.;
35	revising a reference to the Florida Society of Healthcare
36	Risk Management to conform to the current designation;
37	amending s. 395.2050, F.S.; revising a reference to the
38	federal Health Care Financing Administration to conform to
39	the current designation; amending s. 395.3036, F.S.;
40	correcting a reference; repealing s. 395.3037, F.S.,
41	relating to redundant definitions; amending ss. 154.11,
42	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
43	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
44	F.S.; revising references to the Joint Commission on
45	Accreditation of Healthcare Organizations, the Commission
46	on Accreditation of Rehabilitation Facilities, and the
47	Council on Accreditation to conform to their current
48	designations; amending s. 395.602, F.S.; revising the
49	definition of the term "rural hospital" to delete an
50	obsolete provision; amending s. 400.021, F.S.; revising
51	the definition of the term "geriatric outpatient clinic";
52	amending s. 400.0255, F.S.; correcting an obsolete cross-
53	reference to administrative rules; amending s. 400.063,
54	F.S.; deleting an obsolete provision; amending ss. 400.071
55	and 400.0712, F.S.; revising applicability of general
56	licensure requirements under part II of ch. 408, F.S., to
57	applications for nursing home licensure; revising
58	provisions governing inactive licenses; amending s.
59	400.111, F.S.; providing for disclosure of controlling
60	interest of a nursing home facility upon request by the
61	Agency for Health Care Administration; amending s.
62	400.1183, F.S.; revising grievance record maintenance and
63	reporting requirements for nursing homes; amending s.
64	400.141, F.S.; providing criteria for the provision of
65	respite services by nursing homes; requiring a written
66	plan of care; requiring a contract for services; requiring
67	resident release to caregivers to be designated in
68	writing; providing an exemption to the application of
69	discharge planning rules; providing for residents' rights;
70	providing for use of personal medications; providing terms
71	of respite stay; providing for communication of patient
72	information; requiring a physician's order for care and
73	proof of a physical examination; providing for services
74	for respite patients and duties of facilities with respect
75	to such patients; conforming a cross-reference; requiring
76	facilities to maintain clinical records that meet
77	specified standards; providing a fine relating to an
78	admissions moratorium; deleting requirement for facilities
79	to submit certain information related to management
80	companies to the agency; deleting a requirement for
81	facilities to notify the agency of certain bankruptcy
82	filings to conform to changes made by the act; amending s.
83	400.142, F.S.; deleting language relating to agency
84	adoption of rules; amending 400.147, F.S.; revising
85	reporting requirements for licensed nursing home
86	facilities relating to adverse incidents; repealing s.
87	400.148, F.S., relating to the Medicaid "Up-or-Out"
88	Quality of Care Contract Management Program; amending s.
89	400.179, F.S.; deleting an obsolete provision; amending s.
90	400.19, F.S.; revising inspection requirements; amending
91	s. 400.23, F.S.; deleting an obsolete provision;
92	correcting a reference; directing the agency to adopt
93	rules for minimum staffing standards in nursing homes that
94	serve persons under 21 years of age; providing minimum
95	staffing standards; amending s. 400.275, F.S.; revising
96	agency duties with regard to training nursing home
97	surveyor teams; revising requirements for team members;
98	amending s. 400.484, F.S.; revising the schedule of home
99	health agency inspection violations; amending s. 400.606,
100	F.S.; revising the content requirements of the plan
101	accompanying an initial or change-of-ownership application
102	for licensure of a hospice; revising requirements relating
103	to certificates of need for certain hospice facilities;
104	amending s. 400.607, F.S.; revising grounds for agency
105	action against a hospice; amending s. 400.915, F.S.;
106	correcting an obsolete cross-reference to administrative
107	rules; amending s. 400.931, F.S.; deleting a requirement
108	that an applicant for a home medical equipment provider
109	license submit a surety bond to the agency; amending s.
110	400.932, F.S.; revising grounds for the imposition of
111	administrative penalties for certain violations by an
112	employee of a home medical equipment provider; amending s.
113	400.967, F.S.; revising the schedule of inspection
114	violations for intermediate care facilities for the
115	developmentally disabled; providing a penalty for certain
116	violations; amending s. 400.9905, F.S.; revising the
117	definitions of the terms "clinic" and "portable equipment
118	provider"; providing that part X of ch, 400, F.S., the
119	Health Care Clinic Act, does not apply to certain clinical
120	facilities, an entity owned by a corporation with a
121	specified amount of annual sales of health care services
122	under certain circumstances, or an entity owned or
123	controlled by a publicly traded entity with a specified
124	amount of annual revenues; amending s. 400.991, F.S.;
125	conforming terminology; revising application requirements
126	relating to documentation of financial ability to operate
127	a mobile clinic; amending s. 408.034, F.S.; revising
128	agency authority relating to licensing of intermediate
129	care facilities for the developmentally disabled; amending
130	s. 408.036, F.S.; deleting an exemption from certain
131	certificate-of-need review requirements for a hospice or a
132	hospice inpatient facility; amending s. 408.043, F.S.;
133	revising requirements for certain freestanding inpatient
134	hospice care facilities to obtain a certificate of need;
135	amending s. 408.061, F.S.; revising health care facility
136	data reporting requirements; amending s. 408.10, F.S.;
137	removing agency authority to investigate certain consumer
138	complaints; amending s. 408.802, F.S.; removing
139	applicability of part II of ch. 408, F.S., relating to
140	general licensure requirements, to private review agents;
141	amending s. 408.804, F.S.; providing penalties for
142	altering, defacing, or falsifying a license certificate
143	issued by the agency or displaying such an altered,
144	defaced, or falsified certificate; amending s. 408.806,
145	F.S.; revising agency responsibilities for notification of
146	licensees of impending expiration of a license; requiring
147	payment of a late fee for a license application to be
148	considered complete under certain circumstances; amending
149	s. 408.810, F.S.; revising provisions relating to
150	information required for licensure; requiring proof of
151	submission of notice to a mortgagor or landlord regarding
152	provision of services requiring licensure; requiring
153	disclosure of information by a controlling interest of
154	certain court actions relating to financial instability
155	within a specified time period; amending s. 408.813, F.S.;
156	authorizing the agency to impose fines for unclassified
157	violations of part II of ch. 408, F.S.; amending s.
158	408.815, F.S.; authorizing the agency to extend a license
159	expiration date under certain circumstances; conforming a
160	cross-reference; amending s. 408.820, F.S.; conforming a
161	cross-reference; amending s. 409.91196, F.S.; conforming a
162	cross-reference; amending s. 409.912, F.S.; revising
163	procedures for implementation of a Medicaid prescribed-
164	drug spending-control program; amending s. 409.91255,
165	F.S.; transferring administrative responsibility for the
166	application procedure for federally qualified health
167	centers from the Department of Health to the Agency for
168	Health Care Administration; requiring the Florida
169	Association of Community Health Centers, Inc., to provide
170	support and assume administrative costs for the program;
171	amending s. 429.07, F.S.; deleting the requirement for an
172	assisted living facility to obtain an additional license
173	in order to provide limited nursing services; deleting the
174	requirement for the agency to conduct quarterly monitoring
175	visits of facilities that hold a license to provide
176	extended congregate care services; deleting the
177	requirement for the department to report annually on the
178	status of and recommendations related to extended
179	congregate care; deleting the requirement for the agency
180	to conduct monitoring visits at least twice a year to
181	facilities providing limited nursing services; increasing
182	the licensure fees and the maximum fee required for the
183	standard license; increasing the licensure fees for the
184	extended congregate care license; eliminating the license
185	fee for the limited nursing services license; transferring
186	from another provision of law the requirement that a
187	biennial survey of an assisted living facility include
188	specific actions to determine whether the facility is
189	adequately protecting residents' rights; providing that
190	under specified conditions an assisted living facility
191	that has a class I or class II violation is subject to
192	periodic unannounced monitoring; requiring a registered
193	nurse to participate in certain monitoring visits;
194	amending s. 429.11, F.S.; revising licensure application
195	requirements for assisted living facilities to eliminate
196	provisional licenses; amending s. 429.12, F.S.; deleting a
197	requirement that a transferor of an assisted living
198	facility advise the transferee to submit a plan for
199	correction of certain deficiencies to the Agency for
200	Health Care Administration before ownership of the
201	facility is transferred; amending s. 429.14, F.S.;
202	removing a ground for the imposition of an administrative
203	penalty; clarifying provisions relating to a facility's
204	request for a hearing under certain circumstances;
205	authorizing the agency to provide certain information
206	relating to the licensure status of assisted living
207	facilities electronically or through the agency's Internet
208	website; amending s. 429.17, F.S.; deleting provisions
209	relating to the limited nursing services license; revising
210	agency responsibilities regarding the issuance of
211	conditional licenses; amending s. 429.19, F.S.; clarifying
212	that a monitoring fee may be assessed in addition to an
213	administrative fine; amending s. 429.23, F.S.; deleting
214	reporting requirements for assisted living facilities
215	relating to liability claims; amending s. 429.255, F.S.;
216	eliminating provisions authorizing the use of volunteers
217	to provide certain health-care-related services in
218	assisted living facilities; authorizing assisted living
219	facilities to provide limited nursing services; requiring
220	an assisted living facility to be responsible for certain
221	recordkeeping and staff to be trained to monitor residents
222	receiving certain health-care-related services; amending
223	s. 429.28, F.S.; deleting a requirement for a biennial
224	survey of an assisted living facility, to conform to
225	changes made by the act; conforming a cross-reference;
226	amending s. 429.35, F.S.; authorizing the agency to
227	provide certain information relating to the inspections of
228	assisted living facilities electronically or through the
229	agency's Internet website; amending s. 429.41, F.S.,
230	relating to rulemaking; conforming provisions to changes
231	made by the act; amending s. 429.53, F.S.; revising
232	provisions relating to consultation by the agency;
233	revising a definition; amending s. 429.54, F.S.; requiring
234	licensed assisted living facilities to electronically
235	report certain data semiannually to the agency in
236	accordance with rules adopted by the department; amending
237	s. 429.71, F.S.; revising schedule of inspection
238	violations for adult family-care homes; amending s.
239	429.911, F.S.; deleting a ground for agency action against
240	an adult day care center; amending s. 429.915, F.S.;
241	revising agency responsibilities regarding the issuance of
242	conditional licenses; amending s. 483.294, F.S.; revising
243	frequency of agency inspections of multiphasic health
244	testing centers; amending s. 626.9541, F.S.; authorizing
245	an insurer offering a group or individual health benefit
246	plan to offer a wellness program; authorizing rewards or
247	incentives; providing for verification of a member's
248	inability to participate for medical reasons; providing
249	that such rewards or incentives are not insurance
250	benefits; amending s. 633.081, F.S.; limiting State Fire
251	Marshal inspections of nursing homes to once a year;
252	providing for additional inspections based on complaints
253	and violations identified in the course of orientation or
254	training activities; amending s. 766.202, F.S.; adding
255	persons licensed under part XIV of ch. 468, F.S., to the
256	definition of "health care provider"; amending ss.
257	394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
258	conforming terminology and references to changes made by
259	the act; revising a reference; providing an effective
260	date.
261
262	Be It Enacted by the Legislature of the State of Florida:
263
264	Section 1.  Paragraphs (f) through (k) of subsection (10)
265	of section 112.045, Florida Statutes, are redesignated as
266	paragraphs (e) through (j), respectively, and present paragraph
267	(e) of subsection (10) and paragraph (e) of subsection (14) of
268	that section are amended to read:
269	112.0455  Drug-Free Workplace Act.-
270	(10)  EMPLOYER PROTECTION.-
271	(e)  Nothing in this section shall be construed to operate
272	retroactively, and nothing in this section shall abrogate the
273	right of an employer under state law to conduct drug tests prior
274	to January 1, 1990. A drug test conducted by an employer prior
275	to January 1, 1990, is not subject to this section.
276	(14)  DISCIPLINE REMEDIES.-
277	(e)  Upon resolving an appeal filed pursuant to paragraph
278	(c), and finding a violation of this section, the commission may
279	order the following relief:
280	1.  Rescind the disciplinary action, expunge related
281	records from the personnel file of the employee or job applicant
282	and reinstate the employee.
283	2.  Order compliance with paragraph (10)(f)(g).
284	3.  Award back pay and benefits.
285	4.  Award the prevailing employee or job applicant the
286	necessary costs of the appeal, reasonable attorney's fees, and
287	expert witness fees.
288	Section 2.  Paragraph (n) of subsection (1) of section
289	154.11, Florida Statutes, is amended to read:
290	154.11  Powers of board of trustees.-
291	(1)  The board of trustees of each public health trust
292	shall be deemed to exercise a public and essential governmental
293	function of both the state and the county and in furtherance
294	thereof it shall, subject to limitation by the governing body of
295	the county in which such board is located, have all of the
296	powers necessary or convenient to carry out the operation and
297	governance of designated health care facilities, including, but
298	without limiting the generality of, the foregoing:
299	(n)  To appoint originally the staff of physicians to
300	practice in any designated facility owned or operated by the
301	board and to approve the bylaws and rules to be adopted by the
302	medical staff of any designated facility owned and operated by
303	the board, such governing regulations to be in accordance with
304	the standards of the Joint Commission on the Accreditation of
305	Hospitals which provide, among other things, for the method of
306	appointing additional staff members and for the removal of staff
307	members.
308	Section 3.  Subsection (15) of section 318.21, Florida
309	Statutes, is amended to read:
310	318.21  Disposition of civil penalties by county courts.-
311	All civil penalties received by a county court pursuant to the
312	provisions of this chapter shall be distributed and paid monthly
313	as follows:
314	(15)  Of the additional fine assessed under s. 318.18(3)(e)
315	for a violation of s. 316.1893, 50 percent of the moneys
316	received from the fines shall be remitted to the Department of
317	Revenue and deposited into the Brain and Spinal Cord Injury
318	Trust Fund of Department of Health and shall be appropriated to
319	the Department of Health Agency for Health Care Administration
320	as general revenue to provide an enhanced Medicaid payment to
321	nursing homes that serve Medicaid recipients with brain and
322	spinal cord injuries that are medically complex and who are
323	technologically and respiratory dependent. The remaining 50
324	percent of the moneys received from the enhanced fine imposed
325	under s. 318.18(3)(e) shall be remitted to the Department of
326	Revenue and deposited into the Department of Health Emergency
327	Medical Services Trust Fund to provide financial support to
328	certified trauma centers in the counties where enhanced penalty
329	zones are established to ensure the availability and
330	accessibility of trauma services. Funds deposited into the
331	Emergency Medical Services Trust Fund under this subsection
332	shall be allocated as follows:
333	(a)  Fifty percent shall be allocated equally among all
334	Level I, Level II, and pediatric trauma centers in recognition
335	of readiness costs for maintaining trauma services.
336	(b)  Fifty percent shall be allocated among Level I, Level
337	II, and pediatric trauma centers based on each center's relative
338	volume of trauma cases as reported in the Department of Health
339	Trauma Registry.
340	Section 4.  Paragraph (f) is added to subsection (2) of
341	section 381.0072, Florida Statutes, to read:
342	381.0072  Food service protection.-It shall be the duty of
343	the Department of Health to adopt and enforce sanitation rules
344	consistent with law to ensure the protection of the public from
345	food-borne illness. These rules shall provide the standards and
346	requirements for the storage, preparation, serving, or display
347	of food in food service establishments as defined in this
348	section and which are not permitted or licensed under chapter
349	500 or chapter 509.
350	(2)  DUTIES.-
351	(f)  The department shall inspect food service
352	establishments in nursing homes licensed under part II of
353	chapter 400 twice each year. The department may make additional
354	inspections only in response to complaints. The department shall
355	coordinate inspections with the Agency for Health Care
356	Administration, such that the department's inspection is at
357	least 60 days after a recertification visit by the Agency for
358	Health Care Administration.
359	Section 5.  Section 383.325, Florida Statutes, is repealed.
360	Section 6.  Subsection (7) of section 394.4787, Florida
361	Statutes, is amended to read:
362	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
363	and 394.4789.-As used in this section and ss. 394.4786,
364	394.4788, and 394.4789:
365	(7)  "Specialty psychiatric hospital" means a hospital
366	licensed by the agency pursuant to s. 395.002(26)(28) and part
367	II of chapter 408 as a specialty psychiatric hospital.
368	Section 7.  Subsection (2) of section 394.741, Florida
369	Statutes, is amended to read:
370	394.741  Accreditation requirements for providers of
371	behavioral health care services.-
372	(2)  Notwithstanding any provision of law to the contrary,
373	accreditation shall be accepted by the agency and department in
374	lieu of the agency's and department's facility licensure onsite
375	review requirements and shall be accepted as a substitute for
376	the department's administrative and program monitoring
377	requirements, except as required by subsections (3) and (4),
378	for:
379	(a)  Any organization from which the department purchases
380	behavioral health care services that is accredited by the Joint
381	Commission on Accreditation of Healthcare Organizations or the
382	Council on Accreditation for Children and Family Services, or
383	has those services that are being purchased by the department
384	accredited by the Commission on Accreditation of Rehabilitation
385	Facilities CARF-the Rehabilitation Accreditation Commission.
386	(b)  Any mental health facility licensed by the agency or
387	any substance abuse component licensed by the department that is
388	accredited by the Joint Commission on Accreditation of
389	Healthcare Organizations, the Commission on Accreditation of
390	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
391	Commission, or the Council on Accreditation of Children and
392	Family Services.
393	(c)  Any network of providers from which the department or
394	the agency purchases behavioral health care services accredited
395	by the Joint Commission on Accreditation of Healthcare
396	Organizations, the Commission on Accreditation of Rehabilitation
397	Facilities CARF-the Rehabilitation Accreditation Commission, the
398	Council on Accreditation of Children and Family Services, or the
399	National Committee for Quality Assurance. A provider
400	organization, which is part of an accredited network, is
401	afforded the same rights under this part.
402	Section 8.  Present subsections (15) through (32) of
403	section 395.002, Florida Statutes, are renumbered as subsections
404	(14) through (28), respectively, and present subsections (1),
405	(14), (24), (30), and (31) and paragraph (c) of present
406	subsection (28) of that section are amended to read:
407	395.002  Definitions.-As used in this chapter:
408	(1)  "Accrediting organizations" means nationally
409	recognized or approved accrediting organizations whose standards
410	incorporate comparable licensure requirements as determined by
411	the agency the Joint Commission on Accreditation of Healthcare
412	Organizations, the American Osteopathic Association, the
413	Commission on Accreditation of Rehabilitation Facilities, and
414	the Accreditation Association for Ambulatory Health Care, Inc.
415	(14)  "Initial denial determination" means a determination
416	by a private review agent that the health care services
417	furnished or proposed to be furnished to a patient are
418	inappropriate, not medically necessary, or not reasonable.
419	(24)  "Private review agent" means any person or entity
420	which performs utilization review services for third-party
421	payors on a contractual basis for outpatient or inpatient
422	services. However, the term shall not include full-time
423	employees, personnel, or staff of health insurers, health
424	maintenance organizations, or hospitals, or wholly owned
425	subsidiaries thereof or affiliates under common ownership, when
426	performing utilization review for their respective hospitals,
427	health maintenance organizations, or insureds of the same
428	insurance group. For this purpose, health insurers, health
429	maintenance organizations, and hospitals, or wholly owned
430	subsidiaries thereof or affiliates under common ownership,
431	include such entities engaged as administrators of self-
432	insurance as defined in s. 624.031.
433	(26)(28)  "Specialty hospital" means any facility which
434	meets the provisions of subsection (12), and which regularly
435	makes available either:
436	(c)  Intensive residential treatment programs for children
437	and adolescents as defined in subsection (14) (15).
438	(30)  "Utilization review" means a system for reviewing the
439	medical necessity or appropriateness in the allocation of health
440	care resources of hospital services given or proposed to be
441	given to a patient or group of patients.
442	(31)  "Utilization review plan" means a description of the
443	policies and procedures governing utilization review activities
444	performed by a private review agent.
445	Section 9.  Paragraph (c) of subsection (1) and paragraph
446	(b) of subsection (2) of section 395.003, Florida Statutes, are
447	amended to read:
448	395.003  Licensure; denial, suspension, and revocation.-
449	(1)
450	(c)  Until July 1, 2006, additional emergency departments
451	located off the premises of licensed hospitals may not be
452	authorized by the agency.
453	(2)
454	(b)  The agency shall, at the request of a licensee that is
455	a teaching hospital as defined in s. 408.07(45), issue a single
456	license to a licensee for facilities that have been previously
457	licensed as separate premises, provided such separately licensed
458	facilities, taken together, constitute the same premises as
459	defined in s. 395.002(22)(23). Such license for the single
460	premises shall include all of the beds, services, and programs
461	that were previously included on the licenses for the separate
462	premises. The granting of a single license under this paragraph
463	shall not in any manner reduce the number of beds, services, or
464	programs operated by the licensee.
465	Section 10.  Paragraph (e) of subsection (2) and subsection
466	(4) of section 395.0193, Florida Statutes, are amended to read:
467	395.0193  Licensed facilities; peer review; disciplinary
468	powers; agency or partnership with physicians.-
469	(2)  Each licensed facility, as a condition of licensure,
470	shall provide for peer review of physicians who deliver health
471	care services at the facility. Each licensed facility shall
472	develop written, binding procedures by which such peer review
473	shall be conducted. Such procedures shall include:
474	(e)  Recording of agendas and minutes which do not contain
475	confidential material, for review by the Division of Medical
476	Quality Assurance of the department Health Quality Assurance of
477	the agency.
478	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
479	actions taken under subsection (3) shall be reported in writing
480	to the Division of Medical Quality Assurance of the department
481	Health Quality Assurance of the agency within 30 working days
482	after its initial occurrence, regardless of the pendency of
483	appeals to the governing board of the hospital. The notification
484	shall identify the disciplined practitioner, the action taken,
485	and the reason for such action. All final disciplinary actions
486	taken under subsection (3), if different from those which were
487	reported to the department agency within 30 days after the
488	initial occurrence, shall be reported within 10 working days to
489	the Division of Medical Quality Assurance of the department
490	Health Quality Assurance of the agency in writing and shall
491	specify the disciplinary action taken and the specific grounds
492	therefor. The division shall review each report and determine
493	whether it potentially involved conduct by the licensee that is
494	subject to disciplinary action, in which case s. 456.073 shall
495	apply. The reports are not subject to inspection under s.
496	119.07(1) even if the division's investigation results in a
497	finding of probable cause.
498	Section 11.  Section 395.1023, Florida Statutes, is amended
499	to read:
500	395.1023  Child abuse and neglect cases; duties.-Each
501	licensed facility shall adopt a protocol that, at a minimum,
502	requires the facility to:
503	(1)  Incorporate a facility policy that every staff member
504	has an affirmative duty to report, pursuant to chapter 39, any
505	actual or suspected case of child abuse, abandonment, or
506	neglect; and
507	(2)  In any case involving suspected child abuse,
508	abandonment, or neglect, designate, at the request of the
509	Department of Children and Family Services, a staff physician to
510	act as a liaison between the hospital and the Department of
511	Children and Family Services office which is investigating the
512	suspected abuse, abandonment, or neglect, and the child
513	protection team, as defined in s. 39.01, when the case is
514	referred to such a team.
515
516	Each general hospital and appropriate specialty hospital shall
517	comply with the provisions of this section and shall notify the
518	agency and the Department of Children and Family Services of its
519	compliance by sending a copy of its policy to the agency and the
520	Department of Children and Family Services as required by rule.
521	The failure by a general hospital or appropriate specialty
522	hospital to comply shall be punished by a fine not exceeding
523	$1,000, to be fixed, imposed, and collected by the agency. Each
524	day in violation is considered a separate offense.
525	Section 12.  Subsection (2) and paragraph (d) of subsection
526	(3) of section 395.1041, Florida Statutes, are amended to read:
527	395.1041  Access to emergency services and care.-
528	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
529	shall establish and maintain an inventory of hospitals with
530	emergency services. The inventory shall list all services within
531	the service capability of the hospital, and such services shall
532	appear on the face of the hospital license. Each hospital having
533	emergency services shall notify the agency of its service
534	capability in the manner and form prescribed by the agency. The
535	agency shall use the inventory to assist emergency medical
536	services providers and others in locating appropriate emergency
537	medical care. The inventory shall also be made available to the
538	general public. On or before August 1, 1992, the agency shall
539	request that each hospital identify the services which are
540	within its service capability. On or before November 1, 1992,
541	the agency shall notify each hospital of the service capability
542	to be included in the inventory. The hospital has 15 days from
543	the date of receipt to respond to the notice. By December 1,
544	1992, the agency shall publish a final inventory. Each hospital
545	shall reaffirm its service capability when its license is
546	renewed and shall notify the agency of the addition of a new
547	service or the termination of a service prior to a change in its
548	service capability.
549	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
550	FACILITY OR HEALTH CARE PERSONNEL.-
551	(d)1.  Every hospital shall ensure the provision of
552	services within the service capability of the hospital, at all
553	times, either directly or indirectly through an arrangement with
554	another hospital, through an arrangement with one or more
555	physicians, or as otherwise made through prior arrangements. A
556	hospital may enter into an agreement with another hospital for
557	purposes of meeting its service capability requirement, and
558	appropriate compensation or other reasonable conditions may be
559	negotiated for these backup services.
560	2.  If any arrangement requires the provision of emergency
561	medical transportation, such arrangement must be made in
562	consultation with the applicable provider and may not require
563	the emergency medical service provider to provide transportation
564	that is outside the routine service area of that provider or in
565	a manner that impairs the ability of the emergency medical
566	service provider to timely respond to prehospital emergency
567	calls.
568	3.  A hospital shall not be required to ensure service
569	capability at all times as required in subparagraph 1. if, prior
570	to the receiving of any patient needing such service capability,
571	such hospital has demonstrated to the agency that it lacks the
572	ability to ensure such capability and it has exhausted all
573	reasonable efforts to ensure such capability through backup
574	arrangements. In reviewing a hospital's demonstration of lack of
575	ability to ensure service capability, the agency shall consider
576	factors relevant to the particular case, including the
577	following:
578	a.  Number and proximity of hospitals with the same service
579	capability.
580	b.  Number, type, credentials, and privileges of
581	specialists.
582	c.  Frequency of procedures.
583	d.  Size of hospital.
584	4.  The agency shall publish proposed rules implementing a
585	reasonable exemption procedure by November 1, 1992. Subparagraph
586	1. shall become effective upon the effective date of said rules
587	or January 31, 1993, whichever is earlier. For a period not to
588	exceed 1 year from the effective date of subparagraph 1., a
589	hospital requesting an exemption shall be deemed to be exempt
590	from offering the service until the agency initially acts to
591	deny or grant the original request. The agency has 45 days after
592	from the date of receipt of the request to approve or deny the
593	request. After the first year from the effective date of
594	subparagraph 1., If the agency fails to initially act within
595	that the time period, the hospital is deemed to be exempt from
596	offering the service until the agency initially acts to deny the
597	request.
598	Section 13.  Section 395.1046, Florida Statutes, is
599	repealed.
600	Section 14.  Paragraph (e) of subsection (1) of section
601	395.1055, Florida Statutes, is amended to read:
602	395.1055  Rules and enforcement.-
603	(1)  The agency shall adopt rules pursuant to ss.
604	120.536(1) and 120.54 to implement the provisions of this part,
605	which shall include reasonable and fair minimum standards for
606	ensuring that:
607	(e)  Licensed facility beds conform to minimum space,
608	equipment, and furnishings standards as specified by the agency,
609	the Florida Building Code, and the Florida Fire Prevention Code
610	department.
611	Section 15.  Subsection (1) of section 395.10972, Florida
612	Statutes, is amended to read:
613	395.10972  Health Care Risk Manager Advisory Council.-The
614	Secretary of Health Care Administration may appoint a seven-
615	member advisory council to advise the agency on matters
616	pertaining to health care risk managers. The members of the
617	council shall serve at the pleasure of the secretary. The
618	council shall designate a chair. The council shall meet at the
619	call of the secretary or at those times as may be required by
620	rule of the agency. The members of the advisory council shall
621	receive no compensation for their services, but shall be
622	reimbursed for travel expenses as provided in s. 112.061. The
623	council shall consist of individuals representing the following
624	areas:
625	(1)  Two shall be active health care risk managers,
626	including one risk manager who is recommended by and a member of
627	the Florida Society for of Healthcare Risk Management and
628	Patient Safety.
629	Section 16.  Subsection (3) of section 395.2050, Florida
630	Statutes, is amended to read:
631	395.2050  Routine inquiry for organ and tissue donation;
632	certification for procurement activities; death records review.-
633	(3)  Each organ procurement organization designated by the
634	federal Centers for Medicare and Medicaid Services Health Care
635	Financing Administration and licensed by the state shall conduct
636	an annual death records review in the organ procurement
637	organization's affiliated donor hospitals. The organ procurement
638	organization shall enlist the services of every Florida licensed
639	tissue bank and eye bank affiliated with or providing service to
640	the donor hospital and operating in the same service area to
641	participate in the death records review.
642	Section 17.  Subsection (2) of section 395.3036, Florida
643	Statutes, is amended to read:
644	395.3036  Confidentiality of records and meetings of
645	corporations that lease public hospitals or other public health
646	care facilities.-The records of a private corporation that
647	leases a public hospital or other public health care facility
648	are confidential and exempt from the provisions of s. 119.07(1)
649	and s. 24(a), Art. I of the State Constitution, and the meetings
650	of the governing board of a private corporation are exempt from
651	s. 286.011 and s. 24(b), Art. I of the State Constitution when
652	the public lessor complies with the public finance
653	accountability provisions of s. 155.40(5) with respect to the
654	transfer of any public funds to the private lessee and when the
655	private lessee meets at least three of the five following
656	criteria:
657	(2)  The public lessor and the private lessee do not
658	commingle any of their funds in any account maintained by either
659	of them, other than the payment of the rent and administrative
660	fees or the transfer of funds pursuant to s. 155.40 subsection
661	(2).
662	Section 18.  Section 395.3037, Florida Statutes, is
663	repealed.
664	Section 19.  Subsections (1), (4), and (5) of section
665	395.3038, Florida Statutes, are amended to read:
666	395.3038  State-listed primary stroke centers and
667	comprehensive stroke centers; notification of hospitals.-
668	(1)  The agency shall make available on its website and to
669	the department a list of the name and address of each hospital
670	that meets the criteria for a primary stroke center and the name
671	and address of each hospital that meets the criteria for a
672	comprehensive stroke center. The list of primary and
673	comprehensive stroke centers shall include only those hospitals
674	that attest in an affidavit submitted to the agency that the
675	hospital meets the named criteria, or those hospitals that
676	attest in an affidavit submitted to the agency that the hospital
677	is certified as a primary or a comprehensive stroke center by
678	the Joint Commission on Accreditation of Healthcare
679	Organizations.
680	(4)  The agency shall adopt by rule criteria for a primary
681	stroke center which are substantially similar to the
682	certification standards for primary stroke centers of the Joint
683	Commission on Accreditation of Healthcare Organizations.
684	(5)  The agency shall adopt by rule criteria for a
685	comprehensive stroke center. However, if the Joint Commission on
686	Accreditation of Healthcare Organizations establishes criteria
687	for a comprehensive stroke center, the agency shall establish
688	criteria for a comprehensive stroke center which are
689	substantially similar to those criteria established by the Joint
690	Commission on Accreditation of Healthcare Organizations.
691	Section 20.  Paragraph (e) of subsection (2) of section
692	395.602, Florida Statutes, is amended to read:
693	395.602  Rural hospitals.-
694	(2)  DEFINITIONS.-As used in this part:
695	(e)  "Rural hospital" means an acute care hospital licensed
696	under this chapter, having 100 or fewer licensed beds and an
697	emergency room, which is:
698	1.  The sole provider within a county with a population
699	density of no greater than 100 persons per square mile;
700	2.  An acute care hospital, in a county with a population
701	density of no greater than 100 persons per square mile, which is
702	at least 30 minutes of travel time, on normally traveled roads
703	under normal traffic conditions, from any other acute care
704	hospital within the same county;
705	3.  A hospital supported by a tax district or subdistrict
706	whose boundaries encompass a population of 100 persons or fewer
707	per square mile;
708	4.  A hospital in a constitutional charter county with a
709	population of over 1 million persons that has imposed a local
710	option health service tax pursuant to law and in an area that
711	was directly impacted by a catastrophic event on August 24,
712	1992, for which the Governor of Florida declared a state of
713	emergency pursuant to chapter 125, and has 120 beds or less that
714	serves an agricultural community with an emergency room
715	utilization of no less than 20,000 visits and a Medicaid
716	inpatient utilization rate greater than 15 percent;
717	4.5.  A hospital with a service area that has a population
718	of 100 persons or fewer per square mile. As used in this
719	subparagraph, the term "service area" means the fewest number of
720	zip codes that account for 75 percent of the hospital's
721	discharges for the most recent 5-year period, based on
722	information available from the hospital inpatient discharge
723	database in the Florida Center for Health Information and Policy
724	Analysis at the Agency for Health Care Administration; or
725	5.6.  A hospital designated as a critical access hospital,
726	as defined in s. 408.07(15).
727
728	Population densities used in this paragraph must be based upon
729	the most recently completed United States census. A hospital
730	that received funds under s. 409.9116 for a quarter beginning no
731	later than July 1, 2002, is deemed to have been and shall
732	continue to be a rural hospital from that date through June 30,
733	2015, if the hospital continues to have 100 or fewer licensed
734	beds and an emergency room, or meets the criteria of
735	subparagraph 4. An acute care hospital that has not previously
736	been designated as a rural hospital and that meets the criteria
737	of this paragraph shall be granted such designation upon
738	application, including supporting documentation to the Agency
739	for Health Care Administration.
740	Section 21.  Subsection (8) of section 400.021, Florida
741	Statutes, is amended to read:
742	400.021  Definitions.-When used in this part, unless the
743	context otherwise requires, the term:
744	(8)  "Geriatric outpatient clinic" means a site for
745	providing outpatient health care to persons 60 years of age or
746	older, which is staffed by a registered nurse or a physician
747	assistant, or a licensed practical nurse under the direct
748	supervision of a registered nurse, advanced registered nurse
749	practitioner, or physician.
750	Section 22.  Paragraph (g) of subsection (2) of section
751	400.0239, Florida Statutes, is amended to read:
752	400.0239  Quality of Long-Term Care Facility Improvement
753	Trust Fund.-
754	(2)  Expenditures from the trust fund shall be allowable
755	for direct support of the following:
756	(g)  Other initiatives authorized by the Centers for
757	Medicare and Medicaid Services for the use of federal civil
758	monetary penalties, including projects recommended through the
759	Medicaid "Up-or-Out" Quality of Care Contract Management Program
760	pursuant to s. 400.148.
761	Section 23.  Subsection (15) of section 400.0255, Florida
762	Statutes, is amended to read
763	400.0255  Resident transfer or discharge; requirements and
764	procedures; hearings.-
765	(15)(a)  The department's Office of Appeals Hearings shall
766	conduct hearings under this section. The office shall notify the
767	facility of a resident's request for a hearing.
768	(b)  The department shall, by rule, establish procedures to
769	be used for fair hearings requested by residents. These
770	procedures shall be equivalent to the procedures used for fair
771	hearings for other Medicaid cases appearing in s. 409.285 and
772	applicable rules, chapter 10-2, part VI, Florida Administrative
773	Code. The burden of proof must be clear and convincing evidence.
774	A hearing decision must be rendered within 90 days after receipt
775	of the request for hearing.
776	(c)  If the hearing decision is favorable to the resident
777	who has been transferred or discharged, the resident must be
778	readmitted to the facility's first available bed.
779	(d)  The decision of the hearing officer shall be final.
780	Any aggrieved party may appeal the decision to the district
781	court of appeal in the appellate district where the facility is
782	located. Review procedures shall be conducted in accordance with
783	the Florida Rules of Appellate Procedure.
784	Section 24.  Subsection (2) of section 400.063, Florida
785	Statutes, is amended to read:
786	400.063  Resident protection.-
787	(2)  The agency is authorized to establish for each
788	facility, subject to intervention by the agency, a separate bank
789	account for the deposit to the credit of the agency of any
790	moneys received from the Health Care Trust Fund or any other
791	moneys received for the maintenance and care of residents in the
792	facility, and the agency is authorized to disburse moneys from
793	such account to pay obligations incurred for the purposes of
794	this section. The agency is authorized to requisition moneys
795	from the Health Care Trust Fund in advance of an actual need for
796	cash on the basis of an estimate by the agency of moneys to be
797	spent under the authority of this section. Any bank account
798	established under this section need not be approved in advance
799	of its creation as required by s. 17.58, but shall be secured by
800	depository insurance equal to or greater than the balance of
801	such account or by the pledge of collateral security in
802	conformance with criteria established in s. 18.11. The agency
803	shall notify the Chief Financial Officer of any such account so
804	established and shall make a quarterly accounting to the Chief
805	Financial Officer for all moneys deposited in such account.
806	Section 25.  Subsections (1) and (5) of section 400.071,
807	Florida Statutes, are amended to read:
808	400.071  Application for license.-
809	(1)  In addition to the requirements of part II of chapter
810	408, the application for a license shall be under oath and must
811	contain the following:
812	(a)  The location of the facility for which a license is
813	sought and an indication, as in the original application, that
814	such location conforms to the local zoning ordinances.
815	(b)  A signed affidavit disclosing any financial or
816	ownership interest that a controlling interest as defined in
817	part II of chapter 408 has held in the last 5 years in any
818	entity licensed by this state or any other state to provide
819	health or residential care which has closed voluntarily or
820	involuntarily; has filed for bankruptcy; has had a receiver
821	appointed; has had a license denied, suspended, or revoked; or
822	has had an injunction issued against it which was initiated by a
823	regulatory agency. The affidavit must disclose the reason any
824	such entity was closed, whether voluntarily or involuntarily.
825	(c)  The total number of beds and the total number of
826	Medicare and Medicaid certified beds.
827	(b)(d)  Information relating to the applicant and employees
828	which the agency requires by rule. The applicant must
829	demonstrate that sufficient numbers of qualified staff, by
830	training or experience, will be employed to properly care for
831	the type and number of residents who will reside in the
832	facility.
833	(c)(e)  Copies of any civil verdict or judgment involving
834	the applicant rendered within the 10 years preceding the
835	application, relating to medical negligence, violation of
836	residents' rights, or wrongful death. As a condition of
837	licensure, the licensee agrees to provide to the agency copies
838	of any new verdict or judgment involving the applicant, relating
839	to such matters, within 30 days after filing with the clerk of
840	the court. The information required in this paragraph shall be
841	maintained in the facility's licensure file and in an agency
842	database which is available as a public record.
843	(5)  As a condition of licensure, each facility must
844	establish and submit with its application a plan for quality
845	assurance and for conducting risk management.
846	Section 26.  Section 400.0712, Florida Statutes, is amended
847	to read:
848	400.0712  Application for inactive license.-
849	(1)  As specified in this section, the agency may issue an
850	inactive license to a nursing home facility for all or a portion
851	of its beds. Any request by a licensee that a nursing home or
852	portion of a nursing home become inactive must be submitted to
853	the agency in the approved format. The facility may not initiate
854	any suspension of services, notify residents, or initiate
855	inactivity before receiving approval from the agency; and a
856	licensee that violates this provision may not be issued an
857	inactive license.
858	(1)(2)  In addition to the powers granted under part II of
859	chapter 408, the agency may issue an inactive license for a
860	portion of the total beds to a nursing home that chooses to use
861	an unoccupied contiguous portion of the facility for an
862	alternative use to meet the needs of elderly persons through the
863	use of less restrictive, less institutional services.
864	(a)  An inactive license issued under this subsection may
865	be granted for a period not to exceed the current licensure
866	expiration date but may be renewed by the agency at the time of
867	licensure renewal.
868	(b)  A request to extend the inactive license must be
869	submitted to the agency in the approved format and approved by
870	the agency in writing.
871	(c)  Nursing homes that receive an inactive license to
872	provide alternative services shall not receive preference for
873	participation in the Assisted Living for the Elderly Medicaid
874	waiver.
875	(2)(3)  The agency shall adopt rules pursuant to ss.
876	120.536(1) and 120.54 necessary to implement this section.
877	Section 27.  Section 400.111, Florida Statutes, is amended
878	to read:
879	400.111  Disclosure of controlling interest.-In addition to
880	the requirements of part II of chapter 408, when requested by
881	the agency, the licensee shall submit a signed affidavit
882	disclosing any financial or ownership interest that a
883	controlling interest has held within the last 5 years in any
884	entity licensed by the state or any other state to provide
885	health or residential care which entity has closed voluntarily
886	or involuntarily; has filed for bankruptcy; has had a receiver
887	appointed; has had a license denied, suspended, or revoked; or
888	has had an injunction issued against it which was initiated by a
889	regulatory agency. The affidavit must disclose the reason such
890	entity was closed, whether voluntarily or involuntarily.
891	Section 28.  Subsection (2) of section 400.1183, Florida
892	Statutes, is amended to read:
893	400.1183  Resident grievance procedures.-
894	(2)  Each facility shall maintain records of all grievances
895	and shall retain a log for agency inspection of report to the
896	agency at the time of relicensure the total number of grievances
897	handled during the prior licensure period, a categorization of
898	the cases underlying the grievances, and the final disposition
899	of the grievances.
900	Section 29.  Paragraphs (o) through (w) of subsection (1)
901	of section 400.141, Florida Statutes, are redesignated as
902	paragraphs (n) through (u), respectively, and present paragraphs
903	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
904	to read:
905	400.141  Administration and management of nursing home
906	facilities.-
907	(1)  Every licensed facility shall comply with all
908	applicable standards and rules of the agency and shall:
909	(f)  Be allowed and encouraged by the agency to provide
910	other needed services under certain conditions. If the facility
911	has a standard licensure status, and has had no class I or class
912	II deficiencies during the past 2 years or has been awarded a
913	Gold Seal under the program established in s. 400.235, it may be
914	encouraged by the agency to provide services, including, but not
915	limited to, respite and adult day services, which enable
916	individuals to move in and out of the facility. A facility is
917	not subject to any additional licensure requirements for
918	providing these services, under the following conditions:.
919	1.  Respite care may be offered to persons in need of
920	short-term or temporary nursing home services. For each person
921	admitted under the respite care program, the facility licensee
922	must:
923	a.  Have a written abbreviated plan of care that, at a
924	minimum, includes nutritional requirements, medication orders,
925	physician orders, nursing assessments, and dietary preferences.
926	The nursing or physician assessments may take the place of all
927	other assessments required for full-time residents.
928	b.  Have a contract that, at a minimum, specifies the
929	services to be provided to the respite resident, including
930	charges for services, activities, equipment, emergency medical
931	services, and the administration of medications. If multiple
932	respite admissions for a single person are anticipated, the
933	original contract is valid for 1 year after the date of
934	execution.
935	c.  Ensure that each resident is released to his or her
936	caregiver or an individual designated in writing by the
937	caregiver.
938	2.  A person admitted under the respite care program is:
939	a.  Exempt from requirements in rule related to discharge
940	planning.
941	b.  Covered by the residents' rights set forth in s.
942	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
943	shall not be considered trust funds subject to the requirements
944	of s. 400.022(1)(h) until the resident has been in the facility
945	for more than 14 consecutive days.
946	c.  Allowed to use his or her personal medications for the
947	respite stay if permitted by facility policy. The facility must
948	obtain a physician's order for the medications. The caregiver
949	may provide information regarding the medications as part of the
950	nursing assessment and that information must agree with the
951	physician's order. Medications shall be released with the
952	resident upon discharge in accordance with current physician's
953	orders.
954	3.  A person receiving respite care is entitled to reside
955	in the facility for a total of 60 days within a contract year or
956	within a calendar year if the contract is for less than 12
957	months. However, each single stay may not exceed 14 days. If a
958	stay exceeds 14 consecutive days, the facility must comply with
959	all assessment and care planning requirements applicable to
960	nursing home residents.
961	4.  A person receiving respite care must reside in a
962	licensed nursing home bed.
963	5.  A prospective respite resident must provide medical
964	information from a physician, a physician assistant, or a nurse
965	practitioner and other information from the primary caregiver as
966	may be required by the facility prior to or at the time of
967	admission to receive respite care. The medical information must
968	include a physician's order for respite care and proof of a
969	physical examination by a licensed physician, physician
970	assistant, or nurse practitioner. The physician's order and
971	physical examination may be used to provide intermittent respite
972	care for up to 12 months after the date the order is written.
973	6.  The facility must assume the duties of the primary
974	caregiver. To ensure continuity of care and services, the
975	resident is entitled to retain his or her personal physician and
976	must have access to medically necessary services such as
977	physical therapy, occupational therapy, or speech therapy, as
978	needed. The facility must arrange for transportation to these
979	services if necessary. Respite care must be provided in
980	accordance with this part and rules adopted by the agency.
981	However, the agency shall, by rule, adopt modified requirements
982	for resident assessment, resident care plans, resident
983	contracts, physician orders, and other provisions, as
984	appropriate, for short-term or temporary nursing home services.
985	7.  The agency shall allow for shared programming and staff
986	in a facility which meets minimum standards and offers services
987	pursuant to this paragraph, but, if the facility is cited for
988	deficiencies in patient care, may require additional staff and
989	programs appropriate to the needs of service recipients. A
990	person who receives respite care may not be counted as a
991	resident of the facility for purposes of the facility's licensed
992	capacity unless that person receives 24-hour respite care. A
993	person receiving either respite care for 24 hours or longer or
994	adult day services must be included when calculating minimum
995	staffing for the facility. Any costs and revenues generated by a
996	nursing home facility from nonresidential programs or services
997	shall be excluded from the calculations of Medicaid per diems
998	for nursing home institutional care reimbursement.
999	(g)  If the facility has a standard license or is a Gold
1000	Seal facility, exceeds the minimum required hours of licensed
1001	nursing and certified nursing assistant direct care per resident
1002	per day, and is part of a continuing care facility licensed
1003	under chapter 651 or a retirement community that offers other
1004	services pursuant to part III of this chapter or part I or part
1005	III of chapter 429 on a single campus, be allowed to share
1006	programming and staff. At the time of inspection and in the
1007	semiannual report required pursuant to paragraph (n) (o), a
1008	continuing care facility or retirement community that uses this
1009	option must demonstrate through staffing records that minimum
1010	staffing requirements for the facility were met. Licensed nurses
1011	and certified nursing assistants who work in the nursing home
1012	facility may be used to provide services elsewhere on campus if
1013	the facility exceeds the minimum number of direct care hours
1014	required per resident per day and the total number of residents
1015	receiving direct care services from a licensed nurse or a
1016	certified nursing assistant does not cause the facility to
1017	violate the staffing ratios required under s. 400.23(3)(a).
1018	Compliance with the minimum staffing ratios shall be based on
1019	total number of residents receiving direct care services,
1020	regardless of where they reside on campus. If the facility
1021	receives a conditional license, it may not share staff until the
1022	conditional license status ends. This paragraph does not
1023	restrict the agency's authority under federal or state law to
1024	require additional staff if a facility is cited for deficiencies
1025	in care which are caused by an insufficient number of certified
1026	nursing assistants or licensed nurses. The agency may adopt
1027	rules for the documentation necessary to determine compliance
1028	with this provision.
1029	(j)  Keep full records of resident admissions and
1030	discharges; medical and general health status, including medical
1031	records, personal and social history, and identity and address
1032	of next of kin or other persons who may have responsibility for
1033	the affairs of the residents; and individual resident care plans
1034	including, but not limited to, prescribed services, service
1035	frequency and duration, and service goals. The records shall be
1036	open to inspection by the agency. The facility must maintain
1037	clinical records on each resident in accordance with accepted
1038	professional standards and practices that are complete,
1039	accurately documented, readily accessible, and systematically
1040	organized.
1041	(n)  Submit to the agency the information specified in s.
1042	400.071(1)(b) for a management company within 30 days after the
1043	effective date of the management agreement.
1044	(n)(o)1.  Submit semiannually to the agency, or more
1045	frequently if requested by the agency, information regarding
1046	facility staff-to-resident ratios, staff turnover, and staff
1047	stability, including information regarding certified nursing
1048	assistants, licensed nurses, the director of nursing, and the
1049	facility administrator. For purposes of this reporting:
1050	a.  Staff-to-resident ratios must be reported in the
1051	categories specified in s. 400.23(3)(a) and applicable rules.
1052	The ratio must be reported as an average for the most recent
1053	calendar quarter.
1054	b.  Staff turnover must be reported for the most recent 12-
1055	month period ending on the last workday of the most recent
1056	calendar quarter prior to the date the information is submitted.
1057	The turnover rate must be computed quarterly, with the annual
1058	rate being the cumulative sum of the quarterly rates. The
1059	turnover rate is the total number of terminations or separations
1060	experienced during the quarter, excluding any employee
1061	terminated during a probationary period of 3 months or less,
1062	divided by the total number of staff employed at the end of the
1063	period for which the rate is computed, and expressed as a
1064	percentage.
1065	c.  The formula for determining staff stability is the
1066	total number of employees that have been employed for more than
1067	12 months, divided by the total number of employees employed at
1068	the end of the most recent calendar quarter, and expressed as a
1069	percentage.
1070	d.  A nursing facility that has failed to comply with state
1071	minimum-staffing requirements for 2 consecutive days is
1072	prohibited from accepting new admissions until the facility has
1073	achieved the minimum-staffing requirements for a period of 6
1074	consecutive days. For the purposes of this sub-subparagraph, any
1075	person who was a resident of the facility and was absent from
1076	the facility for the purpose of receiving medical care at a
1077	separate location or was on a leave of absence is not considered
1078	a new admission. Failure to impose such an admissions moratorium
1079	is subject to a $1,000 fine constitutes a class II deficiency.
1080	2.e.  A nursing facility which does not have a conditional
1081	license may be cited for failure to comply with the standards in
1082	s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
1083	standards on 2 consecutive days or if it has failed to meet at
1084	least 97 percent of those standards on any one day.
1085	3.f.  A facility which has a conditional license must be in
1086	compliance with the standards in s. 400.23(3)(a) at all times.
1087	(r)2.  This subsection paragraph does not limit the
1088	agency's ability to impose a deficiency or take other actions if
1089	a facility does not have enough staff to meet the residents'
1090	needs.
1091	(r)  Report to the agency any filing for bankruptcy
1092	protection by the facility or its parent corporation,
1093	divestiture or spin-off of its assets, or corporate
1094	reorganization within 30 days after the completion of such
1095	activity.
1096	Section 30.  Subsection (3) of section 400.142, Florida
1097	Statutes, is amended to read:
1098	400.142  Emergency medication kits; orders not to
1099	resuscitate.-
1100	(3)  Facility staff may withhold or withdraw
1101	cardiopulmonary resuscitation if presented with an order not to
1102	resuscitate executed pursuant to s. 401.45. The agency shall
1103	adopt rules providing for the implementation of such orders.
1104	Facility staff and facilities shall not be subject to criminal
1105	prosecution or civil liability, nor be considered to have
1106	engaged in negligent or unprofessional conduct, for withholding
1107	or withdrawing cardiopulmonary resuscitation pursuant to such an
1108	order and rules adopted by the agency. The absence of an order
1109	not to resuscitate executed pursuant to s. 401.45 does not
1110	preclude a physician from withholding or withdrawing
1111	cardiopulmonary resuscitation as otherwise permitted by law.
1112	Section 31.  Subsections (11) through (15) of section
1113	400.147, Florida Statutes, are renumbered as subsections (10)
1114	through (14), respectively, and present subsection (10) is
1115	amended to read:
1116	400.147  Internal risk management and quality assurance
1117	program.-
1118	(10)  By the 10th of each month, each facility subject to
1119	this section shall report any notice received pursuant to s.
1120	400.0233(2) and each initial complaint that was filed with the
1121	clerk of the court and served on the facility during the
1122	previous month by a resident or a resident's family member,
1123	guardian, conservator, or personal legal representative. The
1124	report must include the name of the resident, the resident's
1125	date of birth and social security number, the Medicaid
1126	identification number for Medicaid-eligible persons, the date or
1127	dates of the incident leading to the claim or dates of
1128	residency, if applicable, and the type of injury or violation of
1129	rights alleged to have occurred. Each facility shall also submit
1130	a copy of the notices received pursuant to s. 400.0233(2) and
1131	complaints filed with the clerk of the court. This report is
1132	confidential as provided by law and is not discoverable or
1133	admissible in any civil or administrative action, except in such
1134	actions brought by the agency to enforce the provisions of this
1135	part.
1136	Section 32.  Section 400.148, Florida Statutes, is
1137	repealed.
1138	Section 33.  Paragraph (e) of subsection (2) of section
1139	400.179, Florida Statutes, is amended to read:
1140	400.179  Liability for Medicaid underpayments and
1141	overpayments.-
1142	(2)  Because any transfer of a nursing facility may expose
1143	the fact that Medicaid may have underpaid or overpaid the
1144	transferor, and because in most instances, any such underpayment
1145	or overpayment can only be determined following a formal field
1146	audit, the liabilities for any such underpayments or
1147	overpayments shall be as follows:
1148	(e)  For the 2009-2010 fiscal year only, the provisions of
1149	paragraph (d) shall not apply. This paragraph expires July 1,
1150	2010.
1151	Section 34.  Subsection (3) of section 400.19, Florida
1152	Statutes, is amended to read:
1153	400.19  Right of entry and inspection.-
1154	(3)  The agency shall every 15 months conduct at least one
1155	unannounced inspection to determine compliance by the licensee
1156	with statutes, and with rules promulgated under the provisions
1157	of those statutes, governing minimum standards of construction,
1158	quality and adequacy of care, and rights of residents. The
1159	survey shall be conducted every 6 months for the next 2-year
1160	period if the facility has been cited for a class I deficiency,
1161	has been cited for two or more class II deficiencies arising
1162	from separate surveys or investigations within a 60-day period,
1163	or has had three or more substantiated complaints within a 6-
1164	month period, each resulting in at least one class I or class II
1165	deficiency. In addition to any other fees or fines in this part,
1166	the agency shall assess a fine for each facility that is subject
1167	to the 6-month survey cycle. The fine for the 2-year period
1168	shall be $6,000, one-half to be paid at the completion of each
1169	survey. The agency may adjust this fine by the change in the
1170	Consumer Price Index, based on the 12 months immediately
1171	preceding the increase, to cover the cost of the additional
1172	surveys. The agency shall verify through subsequent inspection
1173	that any deficiency identified during inspection is corrected.
1174	However, the agency may verify the correction of a class III or
1175	class IV deficiency unrelated to resident rights or resident
1176	care without reinspecting the facility if adequate written
1177	documentation has been received from the facility, which
1178	provides assurance that the deficiency has been corrected. The
1179	giving or causing to be given of advance notice of such
1180	unannounced inspections by an employee of the agency to any
1181	unauthorized person shall constitute cause for suspension of not
1182	fewer than 5 working days according to the provisions of chapter
1183	110.
1184	Section 35.  Subsection (5) of section 400.23, Florida
1185	Statutes, is amended to read:
1186	400.23  Rules; evaluation and deficiencies; licensure
1187	status.-
1188	(5)(a)  The agency, in collaboration with the Division of
1189	Children's Medical Services Network of the Department of Health,
1190	must, no later than December 31, 1993, adopt rules for minimum
1191	standards of care for persons under 21 years of age who reside
1192	in nursing home facilities. The rules must include a methodology
1193	for reviewing a nursing home facility under ss. 408.031-408.045
1194	which serves only persons under 21 years of age. A facility may
1195	be exempt from these standards for specific persons between 18
1196	and 21 years of age, if the person's physician agrees that
1197	minimum standards of care based on age are not necessary.
1198	(b)  The agency, in collaboration with the Division of
1199	Children's Medical Services Network, shall adopt rules for
1200	minimum staffing requirements for nursing home facilities that
1201	serve persons under 21 years of age, which shall apply in lieu
1202	of the standards contained in subsection (3).
1203	1.  For persons under 21 years of age who require skilled
1204	care, the requirements shall include a minimum combined average
1205	of licensed nurses, respiratory therapists, respiratory care
1206	practitioners, and certified nursing assistants of 3.9 hours of
1207	direct care per resident per day for each nursing home facility.
1208	2.  For persons under 21 years of age who are fragile, the
1209	requirements shall include a minimum combined average of
1210	licensed nurses, respiratory therapists, respiratory care
1211	practitioners, and certified nursing assistants of 5 hours of
1212	direct care per resident per day for each nursing home facility.
1213	Section 36.  Subsection (1) of section 400.275, Florida
1214	Statutes, is amended to read:
1215	400.275  Agency duties.-
1216	(1)  The agency shall ensure that each newly hired nursing
1217	home surveyor, as a part of basic training, is assigned full-
1218	time to a licensed nursing home for at least 2 days within a 7-
1219	day period to observe facility operations outside of the survey
1220	process before the surveyor begins survey responsibilities. Such
1221	observations may not be the sole basis of a deficiency citation
1222	against the facility. The agency may not assign an individual to
1223	be a member of a survey team for purposes of a survey,
1224	evaluation, or consultation visit at a nursing home facility in
1225	which the surveyor was an employee within the preceding 2 5
1226	years.
1227	Section 37.  Subsection (2) of section 400.484, Florida
1228	Statutes, is amended to read:
1229	400.484  Right of inspection; violations deficiencies;
1230	fines.-
1231	(2)  The agency shall impose fines for various classes of
1232	violations deficiencies in accordance with the following
1233	schedule:
1234	(a)  Class I violations are defined in s. 408.813. A class
1235	I deficiency is any act, omission, or practice that results in a
1236	patient's death, disablement, or permanent injury, or places a
1237	patient at imminent risk of death, disablement, or permanent
1238	injury. Upon finding a class I violation deficiency, the agency
1239	shall impose an administrative fine in the amount of $15,000 for
1240	each occurrence and each day that the violation deficiency
1241	exists.
1242	(b)  Class II violations are defined in s. 408.813. A class
1243	II deficiency is any act, omission, or practice that has a
1244	direct adverse effect on the health, safety, or security of a
1245	patient. Upon finding a class II violation deficiency, the
1246	agency shall impose an administrative fine in the amount of
1247	$5,000 for each occurrence and each day that the violation
1248	deficiency exists.
1249	(c)  Class III violations are defined in s. 408.813. A
1250	class III deficiency is any act, omission, or practice that has
1251	an indirect, adverse effect on the health, safety, or security
1252	of a patient. Upon finding an uncorrected or repeated class III
1253	violation deficiency, the agency shall impose an administrative
1254	fine not to exceed $1,000 for each occurrence and each day that
1255	the uncorrected or repeated violation deficiency exists.
1256	(d)  Class IV violations are defined in s. 408.813. A class
1257	IV deficiency is any act, omission, or practice related to
1258	required reports, forms, or documents which does not have the
1259	potential of negatively affecting patients. These violations are
1260	of a type that the agency determines do not threaten the health,
1261	safety, or security of patients. Upon finding an uncorrected or
1262	repeated class IV violation deficiency, the agency shall impose
1263	an administrative fine not to exceed $500 for each occurrence
1264	and each day that the uncorrected or repeated violation
1265	deficiency exists.
1266	Section 38.  Paragraph (i) of subsection (1) and subsection
1267	(4) of section 400.606, Florida Statutes, are amended to read:
1268	400.606  License; application; renewal; conditional license
1269	or permit; certificate of need.-
1270	(1)  In addition to the requirements of part II of chapter
1271	408, the initial application and change of ownership application
1272	must be accompanied by a plan for the delivery of home,
1273	residential, and homelike inpatient hospice services to
1274	terminally ill persons and their families. Such plan must
1275	contain, but need not be limited to:
1276	(i)  The projected annual operating cost of the hospice.
1277
1278	If the applicant is an existing licensed health care provider,
1279	the application must be accompanied by a copy of the most recent
1280	profit-loss statement and, if applicable, the most recent
1281	licensure inspection report.
1282	(4)  A freestanding hospice facility that is primarily
1283	engaged in providing inpatient and related services and that is
1284	not otherwise licensed as a health care facility shall be
1285	required to obtain a certificate of need. However, a
1286	freestanding hospice facility with six or fewer beds shall not
1287	be required to comply with institutional standards such as, but
1288	not limited to, standards requiring sprinkler systems, emergency
1289	electrical systems, or special lavatory devices.
1290	Section 39.  Subsection (2) of section 400.607, Florida
1291	Statutes, is amended to read:
1292	400.607  Denial, suspension, revocation of license;
1293	emergency actions; imposition of administrative fine; grounds.-
1294	(2)  A violation of this part, part II of chapter 408, or
1295	applicable rules Any of the following actions by a licensed
1296	hospice or any of its employees shall be grounds for
1297	administrative action by the agency against a hospice.:
1298	(a)  A violation of the provisions of this part, part II of
1299	chapter 408, or applicable rules.
1300	(b)  An intentional or negligent act materially affecting
1301	the health or safety of a patient.
1302	Section 40.  Section 400.915, Florida Statutes, is amended
1303	to read:
1304	400.915  Construction and renovation; requirements.-The
1305	requirements for the construction or renovation of a PPEC center
1306	shall comply with:
1307	(1)  The provisions of chapter 553, which pertain to
1308	building construction standards, including plumbing, electrical
1309	code, glass, manufactured buildings, accessibility for the
1310	physically disabled;
1311	(2)  The provisions of s. 633.022 and applicable rules
1312	pertaining to physical minimum standards for nonresidential
1313	child care physical facilities in rule 10M-12.003, Florida
1314	Administrative Code, Child Care Standards; and
1315	(3)  The standards or rules adopted pursuant to this part
1316	and part II of chapter 408.
1317	Section 41.  Subsection (1) of section 400.925, Florida
1318	Statutes, is amended to read:
1319	400.925  Definitions.-As used in this part, the term:
1320	(1)  "Accrediting organizations" means the Joint Commission
1321	on Accreditation of Healthcare Organizations or other national
1322	accreditation agencies whose standards for accreditation are
1323	comparable to those required by this part for licensure.
1324	Section 42.  Subsections (3) through (6) of section
1325	400.931, Florida Statutes, are renumbered as subsections (2)
1326	through (5), respectively, and present subsection (2) of that
1327	section is amended to read:
1328	400.931  Application for license; fee; provisional license;
1329	temporary permit.-
1330	(2)  As an alternative to submitting proof of financial
1331	ability to operate as required in s. 408.810(8), the applicant
1332	may submit a $50,000 surety bond to the agency.
1333	Section 43.  Subsection (2) of section 400.932, Florida
1334	Statutes, is amended to read:
1335	400.932  Administrative penalties.-
1336	(2)  A violation of this part, part II of chapter 408, or
1337	applicable rules Any of the following actions by an employee of
1338	a home medical equipment provider shall be are grounds for
1339	administrative action or penalties by the agency.:
1340	(a)  Violation of this part, part II of chapter 408, or
1341	applicable rules.
1342	(b)  An intentional, reckless, or negligent act that
1343	materially affects the health or safety of a patient.
1344	Section 44.  Subsection (3) of section 400.967, Florida
1345	Statutes, is amended to read:
1346	400.967  Rules and classification of violations
1347	deficiencies.-
1348	(3)  The agency shall adopt rules to provide that, when the
1349	criteria established under this part and part II of chapter 408
1350	are not met, such violations deficiencies shall be classified
1351	according to the nature of the violation deficiency. The agency
1352	shall indicate the classification on the face of the notice of
1353	deficiencies as follows:
1354	(a)  Class I violations deficiencies are defined in s.
1355	408.813 those which the agency determines present an imminent
1356	danger to the residents or guests of the facility or a
1357	substantial probability that death or serious physical harm
1358	would result therefrom. The condition or practice constituting a
1359	class I violation must be abated or eliminated immediately,
1360	unless a fixed period of time, as determined by the agency, is
1361	required for correction. A class I violation deficiency is
1362	subject to a civil penalty in an amount not less than $5,000 and
1363	not exceeding $10,000 for each violation deficiency. A fine may
1364	be levied notwithstanding the correction of the violation
1365	deficiency.
1366	(b)  Class II violations deficiencies are defined in s.
1367	408.813 those which the agency determines have a direct or
1368	immediate relationship to the health, safety, or security of the
1369	facility residents, other than class I deficiencies. A class II
1370	violation deficiency is subject to a civil penalty in an amount
1371	not less than $1,000 and not exceeding $5,000 for each violation
1372	deficiency. A citation for a class II violation deficiency shall
1373	specify the time within which the violation deficiency must be
1374	corrected. If a class II violation deficiency is corrected
1375	within the time specified, no civil penalty shall be imposed,
1376	unless it is a repeated offense.
1377	(c)  Class III violations deficiencies are defined in s.
1378	408.813 those which the agency determines to have an indirect or
1379	potential relationship to the health, safety, or security of the
1380	facility residents, other than class I or class II deficiencies.
1381	A class III violation deficiency is subject to a civil penalty
1382	of not less than $500 and not exceeding $1,000 for each
1383	deficiency. A citation for a class III violation deficiency
1384	shall specify the time within which the violation deficiency
1385	must be corrected. If a class III violation deficiency is
1386	corrected within the time specified, no civil penalty shall be
1387	imposed, unless it is a repeated offense.
1388	(d)  Class IV violations are defined in s. 408.813. Upon
1389	finding an uncorrected or repeated class IV violation, the
1390	agency shall impose an administrative fine not to exceed $500
1391	for each occurrence and each day that the uncorrected or
1392	repeated violation exists.
1393	Section 45.  Subsections (4) and (7) of section 400.9905,
1394	Florida Statutes, are amended to read:
1395	400.9905  Definitions.-
1396	(4)  "Clinic" means an entity at which health care services
1397	are provided to individuals and which tenders charges for
1398	reimbursement for such services, including a mobile clinic and a
1399	portable health service or equipment provider. For purposes of
1400	this part, the term does not include and the licensure
1401	requirements of this part do not apply to:
1402	(a)  Entities licensed or registered by the state under
1403	chapter 395; or entities licensed or registered by the state and
1404	providing only health care services within the scope of services
1405	authorized under their respective licenses granted under ss.
1406	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1407	chapter except part X, chapter 429, chapter 463, chapter 465,
1408	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1409	chapter 651; end-stage renal disease providers authorized under
1410	42 C.F.R. part 405, subpart U; or providers certified under 42
1411	C.F.R. part 485, subpart B or subpart H; or any entity that
1412	provides neonatal or pediatric hospital-based health care
1413	services or other health care services by licensed practitioners
1414	solely within a hospital licensed under chapter 395.
1415	(b)  Entities that own, directly or indirectly, entities
1416	licensed or registered by the state pursuant to chapter 395; or
1417	entities that own, directly or indirectly, entities licensed or
1418	registered by the state and providing only health care services
1419	within the scope of services authorized pursuant to their
1420	respective licenses granted under ss. 383.30-383.335, chapter
1421	390, chapter 394, chapter 397, this chapter except part X,
1422	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1423	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1424	disease providers authorized under 42 C.F.R. part 405, subpart
1425	U; or providers certified under 42 C.F.R. part 485, subpart B or
1426	subpart H; or any entity that provides neonatal or pediatric
1427	hospital-based health care services by licensed practitioners
1428	solely within a hospital licensed under chapter 395.
1429	(c)  Entities that are owned, directly or indirectly, by an
1430	entity licensed or registered by the state pursuant to chapter
1431	395; or entities that are owned, directly or indirectly, by an
1432	entity licensed or registered by the state and providing only
1433	health care services within the scope of services authorized
1434	pursuant to their respective licenses granted under ss. 383.30-
1435	383.335, chapter 390, chapter 394, chapter 397, this chapter
1436	except part X, chapter 429, chapter 463, chapter 465, chapter
1437	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1438	651; end-stage renal disease providers authorized under 42
1439	C.F.R. part 405, subpart U; or providers certified under 42
1440	C.F.R. part 485, subpart B or subpart H; or any entity that
1441	provides neonatal or pediatric hospital-based health care
1442	services by licensed practitioners solely within a hospital
1443	under chapter 395.
1444	(d)  Entities that are under common ownership, directly or
1445	indirectly, with an entity licensed or registered by the state
1446	pursuant to chapter 395; or entities that are under common
1447	ownership, directly or indirectly, with an entity licensed or
1448	registered by the state and providing only health care services
1449	within the scope of services authorized pursuant to their
1450	respective licenses granted under ss. 383.30-383.335, chapter
1451	390, chapter 394, chapter 397, this chapter except part X,
1452	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1453	part I of chapter 483, chapter 484, or chapter 651; end-stage
1454	renal disease providers authorized under 42 C.F.R. part 405,
1455	subpart U; or providers certified under 42 C.F.R. part 485,
1456	subpart B or subpart H; or any entity that provides neonatal or
1457	pediatric hospital-based health care services by licensed
1458	practitioners solely within a hospital licensed under chapter
1459	395.
1460	(e)  An entity that is exempt from federal taxation under
1461	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1462	under 26 U.S.C. s. 409 that has a board of trustees not less
1463	than two-thirds of which are Florida-licensed health care
1464	practitioners and provides only physical therapy services under
1465	physician orders, any community college or university clinic,
1466	and any entity owned or operated by the federal or state
1467	government, including agencies, subdivisions, or municipalities
1468	thereof.
1469	(f)  A sole proprietorship, group practice, partnership, or
1470	corporation that provides health care services by physicians
1471	covered by s. 627.419, that is directly supervised by one or
1472	more of such physicians, and that is wholly owned by one or more
1473	of those physicians or by a physician and the spouse, parent,
1474	child, or sibling of that physician.
1475	(g)  A sole proprietorship, group practice, partnership, or
1476	corporation that provides health care services by licensed
1477	health care practitioners under chapter 457, chapter 458,
1478	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1479	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1480	chapter 490, chapter 491, or part I, part III, part X, part
1481	XIII, or part XIV of chapter 468, or s. 464.012, which are
1482	wholly owned by one or more licensed health care practitioners,
1483	or the licensed health care practitioners set forth in this
1484	paragraph and the spouse, parent, child, or sibling of a
1485	licensed health care practitioner, so long as one of the owners
1486	who is a licensed health care practitioner is supervising the
1487	business activities and is legally responsible for the entity's
1488	compliance with all federal and state laws. However, a health
1489	care practitioner may not supervise services beyond the scope of
1490	the practitioner's license, except that, for the purposes of
1491	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1492	provides only services authorized pursuant to s. 456.053(3)(b)
1493	may be supervised by a licensee specified in s. 456.053(3)(b).
1494	(h)  Clinical facilities affiliated with an accredited
1495	medical school at which training is provided for medical
1496	students, residents, or fellows.
1497	(i)  Entities that provide only oncology or radiation
1498	therapy services by physicians licensed under chapter 458 or
1499	chapter 459 or entities that provide oncology or radiation
1500	therapy services by physicians licensed under chapter 458 or
1501	chapter 459 which are owned by a corporation whose shares are
1502	publicly traded on a recognized stock exchange.
1503	(j)  Clinical facilities affiliated with a college of
1504	chiropractic accredited by the Council on Chiropractic Education
1505	at which training is provided for chiropractic students.
1506	(k)  Entities that provide licensed practitioners to staff
1507	emergency departments or to deliver anesthesia services in
1508	facilities licensed under chapter 395 and that derive at least
1509	90 percent of their gross annual revenues from the provision of
1510	such services. Entities claiming an exemption from licensure
1511	under this paragraph must provide documentation demonstrating
1512	compliance.
1513	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1514	perinatology clinical facilities that are a publicly traded
1515	corporation or that are wholly owned, directly or indirectly, by
1516	a publicly traded corporation. As used in this paragraph, a
1517	publicly traded corporation is a corporation that issues
1518	securities traded on an exchange registered with the United
1519	States Securities and Exchange Commission as a national
1520	securities exchange.
1521	(m)  Entities that are owned by a corporation that has $250
1522	million or more in total annual sales of health care services
1523	provided by licensed health care practitioners if one or more of
1524	the owners of the entity is a health care practitioner who is
1525	licensed in this state, is responsible for supervising the
1526	business activities of the entity, and is legally responsible
1527	for the entity's compliance with state law for purposes of this
1528	section.
1529	(n)  Entities that are owned or controlled, directly or
1530	indirectly, by a publicly traded entity with $100 million or
1531	more, in the aggregate, in total annual revenues derived from
1532	providing health care services by licensed health care
1533	practitioners that are employed or contracted by an entity
1534	described in this paragraph.
1535	(7)  "Portable health service or equipment provider" means
1536	an entity that contracts with or employs persons to provide
1537	portable health care services or equipment to multiple locations
1538	performing treatment or diagnostic testing of individuals, that
1539	bills third-party payors for those services, and that otherwise
1540	meets the definition of a clinic in subsection (4).
1541	Section 46.  Paragraph (b) of subsection (1) and paragraph
1542	(c) of subsection (4) of section 400.991, Florida Statutes, are
1543	amended to read:
1544	400.991  License requirements; background screenings;
1545	prohibitions.-
1546	(1)
1547	(b)  Each mobile clinic must obtain a separate health care
1548	clinic license and must provide to the agency, at least
1549	quarterly, its projected street location to enable the agency to
1550	locate and inspect such clinic. A portable health service or
1551	equipment provider must obtain a health care clinic license for
1552	a single administrative office and is not required to submit
1553	quarterly projected street locations.
1554	(4)  In addition to the requirements of part II of chapter
1555	408, the applicant must file with the application satisfactory
1556	proof that the clinic is in compliance with this part and
1557	applicable rules, including:
1558	(c)  Proof of financial ability to operate as required
1559	under ss. s. 408.810(8) and 408.8065. As an alternative to
1560	submitting proof of financial ability to operate as required
1561	under s. 408.810(8), the applicant may file a surety bond of at
1562	least $500,000 which guarantees that the clinic will act in full
1563	conformity with all legal requirements for operating a clinic,
1564	payable to the agency. The agency may adopt rules to specify
1565	related requirements for such surety bond.
1566	Section 47.  Paragraph (g) of subsection (1) and paragraph
1567	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1568	amended to read:
1569	400.9935  Clinic responsibilities.-
1570	(1)  Each clinic shall appoint a medical director or clinic
1571	director who shall agree in writing to accept legal
1572	responsibility for the following activities on behalf of the
1573	clinic. The medical director or the clinic director shall:
1574	(g)  Conduct systematic reviews of clinic billings to
1575	ensure that the billings are not fraudulent or unlawful. Upon
1576	discovery of an unlawful charge, the medical director or clinic
1577	director shall take immediate corrective action. If the clinic
1578	performs only the technical component of magnetic resonance
1579	imaging, static radiographs, computed tomography, or positron
1580	emission tomography, and provides the professional
1581	interpretation of such services, in a fixed facility that is
1582	accredited by the Joint Commission on Accreditation of
1583	Healthcare Organizations or the Accreditation Association for
1584	Ambulatory Health Care, and the American College of Radiology;
1585	and if, in the preceding quarter, the percentage of scans
1586	performed by that clinic which was billed to all personal injury
1587	protection insurance carriers was less than 15 percent, the
1588	chief financial officer of the clinic may, in a written
1589	acknowledgment provided to the agency, assume the responsibility
1590	for the conduct of the systematic reviews of clinic billings to
1591	ensure that the billings are not fraudulent or unlawful.
1592	(7)(a)  Each clinic engaged in magnetic resonance imaging
1593	services must be accredited by the Joint Commission on
1594	Accreditation of Healthcare Organizations, the American College
1595	of Radiology, or the Accreditation Association for Ambulatory
1596	Health Care, within 1 year after licensure. A clinic that is
1597	accredited by the American College of Radiology or is within the
1598	original 1-year period after licensure and replaces its core
1599	magnetic resonance imaging equipment shall be given 1 year after
1600	the date on which the equipment is replaced to attain
1601	accreditation. However, a clinic may request a single, 6-month
1602	extension if it provides evidence to the agency establishing
1603	that, for good cause shown, such clinic cannot be accredited
1604	within 1 year after licensure, and that such accreditation will
1605	be completed within the 6-month extension. After obtaining
1606	accreditation as required by this subsection, each such clinic
1607	must maintain accreditation as a condition of renewal of its
1608	license. A clinic that files a change of ownership application
1609	must comply with the original accreditation timeframe
1610	requirements of the transferor. The agency shall deny a change
1611	of ownership application if the clinic is not in compliance with
1612	the accreditation requirements. When a clinic adds, replaces, or
1613	modifies magnetic resonance imaging equipment and the
1614	accreditation agency requires new accreditation, the clinic must
1615	be accredited within 1 year after the date of the addition,
1616	replacement, or modification but may request a single, 6-month
1617	extension if the clinic provides evidence of good cause to the
1618	agency.
1619	Section 48.  Subsection (2) of section 408.034, Florida
1620	Statutes, is amended to read:
1621	408.034  Duties and responsibilities of agency; rules.-
1622	(2)  In the exercise of its authority to issue licenses to
1623	health care facilities and health service providers, as provided
1624	under chapters 393 and 395 and parts II, and IV, and VIII of
1625	chapter 400, the agency may not issue a license to any health
1626	care facility or health service provider that fails to receive a
1627	certificate of need or an exemption for the licensed facility or
1628	service.
1629	Section 49.  Paragraph (d) of subsection (1) of section
1630	408.036, Florida Statutes, is amended to read:
1631	408.036  Projects subject to review; exemptions.-
1632	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1633	health-care-related projects, as described in paragraphs (a)-
1634	(g), are subject to review and must file an application for a
1635	certificate of need with the agency. The agency is exclusively
1636	responsible for determining whether a health-care-related
1637	project is subject to review under ss. 408.031-408.045.
1638	(d)  The establishment of a hospice or hospice inpatient
1639	facility, except as provided in s. 408.043.
1640	Section 50.  Subsection (2) of section 408.043, Florida
1641	Statutes, is amended to read:
1642	408.043  Special provisions.-
1643	(2)  HOSPICES.-When an application is made for a
1644	certificate of need to establish or to expand a hospice, the
1645	need for such hospice shall be determined on the basis of the
1646	need for and availability of hospice services in the community.
1647	The formula on which the certificate of need is based shall
1648	discourage regional monopolies and promote competition. The
1649	inpatient hospice care component of a hospice which is a
1650	freestanding facility, or a part of a facility, which is
1651	primarily engaged in providing inpatient care and related
1652	services and is not licensed as a health care facility shall
1653	also be required to obtain a certificate of need. Provision of
1654	hospice care by any current provider of health care is a
1655	significant change in service and therefore requires a
1656	certificate of need for such services.
1657	Section 51.  Paragraph (k) of subsection (3) of section
1658	408.05, Florida Statutes, is amended to read:
1659	408.05  Florida Center for Health Information and Policy
1660	Analysis.-
1661	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1662	produce comparable and uniform health information and statistics
1663	for the development of policy recommendations, the agency shall
1664	perform the following functions:
1665	(k)  Develop, in conjunction with the State Consumer Health
1666	Information and Policy Advisory Council, and implement a long-
1667	range plan for making available health care quality measures and
1668	financial data that will allow consumers to compare health care
1669	services. The health care quality measures and financial data
1670	the agency must make available shall include, but is not limited
1671	to, pharmaceuticals, physicians, health care facilities, and
1672	health plans and managed care entities. The agency shall update
1673	the plan and report on the status of its implementation
1674	annually. The agency shall also make the plan and status report
1675	available to the public on its Internet website. As part of the
1676	plan, the agency shall identify the process and timeframes for
1677	implementation, any barriers to implementation, and
1678	recommendations of changes in the law that may be enacted by the
1679	Legislature to eliminate the barriers. As preliminary elements
1680	of the plan, the agency shall:
1681	1.  Make available patient-safety indicators, inpatient
1682	quality indicators, and performance outcome and patient charge
1683	data collected from health care facilities pursuant to s.
1684	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1685	"inpatient quality indicators" shall be as defined by the
1686	Centers for Medicare and Medicaid Services, the National Quality
1687	Forum, the Joint Commission on Accreditation of Healthcare
1688	Organizations, the Agency for Healthcare Research and Quality,
1689	the Centers for Disease Control and Prevention, or a similar
1690	national entity that establishes standards to measure the
1691	performance of health care providers, or by other states. The
1692	agency shall determine which conditions, procedures, health care
1693	quality measures, and patient charge data to disclose based upon
1694	input from the council. When determining which conditions and
1695	procedures are to be disclosed, the council and the agency shall
1696	consider variation in costs, variation in outcomes, and
1697	magnitude of variations and other relevant information. When
1698	determining which health care quality measures to disclose, the
1699	agency:
1700	a.  Shall consider such factors as volume of cases; average
1701	patient charges; average length of stay; complication rates;
1702	mortality rates; and infection rates, among others, which shall
1703	be adjusted for case mix and severity, if applicable.
1704	b.  May consider such additional measures that are adopted
1705	by the Centers for Medicare and Medicaid Studies, National
1706	Quality Forum, the Joint Commission on Accreditation of
1707	Healthcare Organizations, the Agency for Healthcare Research and
1708	Quality, Centers for Disease Control and Prevention, or a
1709	similar national entity that establishes standards to measure
1710	the performance of health care providers, or by other states.
1711
1712	When determining which patient charge data to disclose, the
1713	agency shall include such measures as the average of
1714	undiscounted charges on frequently performed procedures and
1715	preventive diagnostic procedures, the range of procedure charges
1716	from highest to lowest, average net revenue per adjusted patient
1717	day, average cost per adjusted patient day, and average cost per
1718	admission, among others.
1719	2.  Make available performance measures, benefit design,
1720	and premium cost data from health plans licensed pursuant to
1721	chapter 627 or chapter 641. The agency shall determine which
1722	health care quality measures and member and subscriber cost data
1723	to disclose, based upon input from the council. When determining
1724	which data to disclose, the agency shall consider information
1725	that may be required by either individual or group purchasers to
1726	assess the value of the product, which may include membership
1727	satisfaction, quality of care, current enrollment or membership,
1728	coverage areas, accreditation status, premium costs, plan costs,
1729	premium increases, range of benefits, copayments and
1730	deductibles, accuracy and speed of claims payment, credentials
1731	of physicians, number of providers, names of network providers,
1732	and hospitals in the network. Health plans shall make available
1733	to the agency any such data or information that is not currently
1734	reported to the agency or the office.
1735	3.  Determine the method and format for public disclosure
1736	of data reported pursuant to this paragraph. The agency shall
1737	make its determination based upon input from the State Consumer
1738	Health Information and Policy Advisory Council. At a minimum,
1739	the data shall be made available on the agency's Internet
1740	website in a manner that allows consumers to conduct an
1741	interactive search that allows them to view and compare the
1742	information for specific providers. The website must include
1743	such additional information as is determined necessary to ensure
1744	that the website enhances informed decisionmaking among
1745	consumers and health care purchasers, which shall include, at a
1746	minimum, appropriate guidance on how to use the data and an
1747	explanation of why the data may vary from provider to provider.
1748	4.  Publish on its website undiscounted charges for no
1749	fewer than 150 of the most commonly performed adult and
1750	pediatric procedures, including outpatient, inpatient,
1751	diagnostic, and preventative procedures.
1752	Section 52.  Paragraph (a) of subsection (1) of section
1753	408.061, Florida Statutes, is amended to read:
1754	408.061  Data collection; uniform systems of financial
1755	reporting; information relating to physician charges;
1756	confidential information; immunity.-
1757	(1)  The agency shall require the submission by health care
1758	facilities, health care providers, and health insurers of data
1759	necessary to carry out the agency's duties. Specifications for
1760	data to be collected under this section shall be developed by
1761	the agency with the assistance of technical advisory panels
1762	including representatives of affected entities, consumers,
1763	purchasers, and such other interested parties as may be
1764	determined by the agency.
1765	(a)  Data submitted by health care facilities, including
1766	the facilities as defined in chapter 395, shall include, but are
1767	not limited to: case-mix data, patient admission and discharge
1768	data, hospital emergency department data which shall include the
1769	number of patients treated in the emergency department of a
1770	licensed hospital reported by patient acuity level, data on
1771	hospital-acquired infections as specified by rule, data on
1772	complications as specified by rule, data on readmissions as
1773	specified by rule, with patient and provider-specific
1774	identifiers included, actual charge data by diagnostic groups,
1775	financial data, accounting data, operating expenses, expenses
1776	incurred for rendering services to patients who cannot or do not
1777	pay, interest charges, depreciation expenses based on the
1778	expected useful life of the property and equipment involved, and
1779	demographic data. The agency shall adopt nationally recognized
1780	risk adjustment methodologies or software consistent with the
1781	standards of the Agency for Healthcare Research and Quality and
1782	as selected by the agency for all data submitted as required by
1783	this section. Data may be obtained from documents such as, but
1784	not limited to: leases, contracts, debt instruments, itemized
1785	patient bills, medical record abstracts, and related diagnostic
1786	information. Reported data elements shall be reported
1787	electronically and in accordance with rule 59E-7.012, Florida
1788	Administrative Code. Data submitted shall be certified by the
1789	chief executive officer or an appropriate and duly authorized
1790	representative or employee of the licensed facility that the
1791	information submitted is true and accurate.
1792	Section 53.  Subsection (43) of section 408.07, Florida
1793	Statutes, is amended to read:
1794	408.07  Definitions.-As used in this chapter, with the
1795	exception of ss. 408.031-408.045, the term:
1796	(43)  "Rural hospital" means an acute care hospital
1797	licensed under chapter 395, having 100 or fewer licensed beds
1798	and an emergency room, and which is:
1799	(a)  The sole provider within a county with a population
1800	density of no greater than 100 persons per square mile;
1801	(b)  An acute care hospital, in a county with a population
1802	density of no greater than 100 persons per square mile, which is
1803	at least 30 minutes of travel time, on normally traveled roads
1804	under normal traffic conditions, from another acute care
1805	hospital within the same county;
1806	(c)  A hospital supported by a tax district or subdistrict
1807	whose boundaries encompass a population of 100 persons or fewer
1808	per square mile;
1809	(d)  A hospital with a service area that has a population
1810	of 100 persons or fewer per square mile. As used in this
1811	paragraph, the term "service area" means the fewest number of
1812	zip codes that account for 75 percent of the hospital's
1813	discharges for the most recent 5-year period, based on
1814	information available from the hospital inpatient discharge
1815	database in the Florida Center for Health Information and Policy
1816	Analysis at the Agency for Health Care Administration; or
1817	(e)  A critical access hospital.
1818
1819	Population densities used in this subsection must be based upon
1820	the most recently completed United States census. A hospital
1821	that received funds under s. 409.9116 for a quarter beginning no
1822	later than July 1, 2002, is deemed to have been and shall
1823	continue to be a rural hospital from that date through June 30,
1824	2015, if the hospital continues to have 100 or fewer licensed
1825	beds and an emergency room, or meets the criteria of s.
1826	395.602(2)(e)4. An acute care hospital that has not previously
1827	been designated as a rural hospital and that meets the criteria
1828	of this subsection shall be granted such designation upon
1829	application, including supporting documentation, to the Agency
1830	for Health Care Administration.
1831	Section 54.  Section 408.10, Florida Statutes, is amended
1832	to read:
1833	408.10  Consumer complaints.-The agency shall:
1834	(1)  publish and make available to the public a toll-free
1835	telephone number for the purpose of handling consumer complaints
1836	and shall serve as a liaison between consumer entities and other
1837	private entities and governmental entities for the disposition
1838	of problems identified by consumers of health care.
1839	(2)  Be empowered to investigate consumer complaints
1840	relating to problems with health care facilities' billing
1841	practices and issue reports to be made public in any cases where
1842	the agency determines the health care facility has engaged in
1843	billing practices which are unreasonable and unfair to the
1844	consumer.
1845	Section 55.  Subsections (12) through (30) of section
1846	408.802, Florida Statutes, are renumbered as subsections (11)
1847	through (29), respectively, and present subsection (11) of that
1848	section is amended to read:
1849	408.802  Applicability.-The provisions of this part apply
1850	to the provision of services that require licensure as defined
1851	in this part and to the following entities licensed, registered,
1852	or certified by the agency, as described in chapters 112, 383,
1853	390, 394, 395, 400, 429, 440, 483, and 765:
1854	(11)  Private review agents, as provided under part I of
1855	chapter 395.
1856	Section 56.  Subsection (3) is added to section 408.804,
1857	Florida Statutes, to read:
1858	408.804  License required; display.-
1859	(3)  Any person who knowingly alters, defaces, or falsifies
1860	a license certificate issued by the agency, or causes or
1861	procures any person to commit such an offense, commits a
1862	misdemeanor of the second degree, punishable as provided in s.
1863	775.082 or s 775.083. Any licensee or provider who displays an
1864	altered, defaced, or falsified license certificate is subject to
1865	the penalties set forth in s. 408.815 and an administrative fine
1866	of $1,000 for each day of illegal display.
1867	Section 57.  Paragraph (d) of subsection (2) of section
1868	408.806, Florida Statutes, is amended, present subsections (3)
1869	through (8) are renumbered as subsections (4) through (9),
1870	respectively, and a new subsection (3) is added to that section,
1871	to read:
1872	408.806  License application process.-
1873	(2)
1874	(d)  The agency shall notify the licensee by mail or
1875	electronically at least 90 days before the expiration of a
1876	license that a renewal license is necessary to continue
1877	operation. The licensee's failure to timely file submit a
1878	renewal application and license application fee with the agency
1879	shall result in a $50 per day late fee charged to the licensee
1880	by the agency; however, the aggregate amount of the late fee may
1881	not exceed 50 percent of the licensure fee or $500, whichever is
1882	less. The agency shall provide a courtesy notice to the licensee
1883	by United States mail, electronically, or by any other manner at
1884	its address of record or mailing address, if provided, at least
1885	90 days prior to the expiration of a license informing the
1886	licensee of the expiration of the license. If the agency does
1887	not provide the courtesy notice or the licensee does not receive
1888	the courtesy notice, the licensee continues to be legally
1889	obligated to timely file the renewal application and license
1890	application fee with the agency and is not excused from the
1891	payment of a late fee. If an application is received after the
1892	required filing date and exhibits a hand-canceled postmark
1893	obtained from a United States post office dated on or before the
1894	required filing date, no fine will be levied.
1895	(3)  Payment of the late fee is required to consider any
1896	late application complete, and failure to pay the late fee is
1897	considered an omission from the application.
1898	Section 58.  Subsections (6) and (9) of section 408.810,
1899	Florida Statutes, are amended to read:
1900	408.810  Minimum licensure requirements.-In addition to the
1901	licensure requirements specified in this part, authorizing
1902	statutes, and applicable rules, each applicant and licensee must
1903	comply with the requirements of this section in order to obtain
1904	and maintain a license.
1905	(6)(a)  An applicant must provide the agency with proof of
1906	the applicant's legal right to occupy the property before a
1907	license may be issued. Proof may include, but need not be
1908	limited to, copies of warranty deeds, lease or rental
1909	agreements, contracts for deeds, quitclaim deeds, or other such
1910	documentation.
1911	(b)  In the event the property is encumbered by a mortgage
1912	or is leased, an applicant must provide the agency with proof
1913	that the mortgagor or landlord has been provided written notice
1914	of the applicant's intent as mortgagee or tenant to provide
1915	services that require licensure and instruct the mortgagor or
1916	landlord to serve the agency by certified mail with copies of
1917	any foreclosure or eviction actions initiated by the mortgagor
1918	or landlord against the applicant.
1919	(9)  A controlling interest may not withhold from the
1920	agency any evidence of financial instability, including, but not
1921	limited to, checks returned due to insufficient funds,
1922	delinquent accounts, nonpayment of withholding taxes, unpaid
1923	utility expenses, nonpayment for essential services, or adverse
1924	court action concerning the financial viability of the provider
1925	or any other provider licensed under this part that is under the
1926	control of the controlling interest. A controlling interest
1927	shall notify the agency within 10 days after a court action to
1928	initiate bankruptcy, foreclosure, or eviction proceedings
1929	concerning the provider, in which the controlling interest is a
1930	petitioner or defendant. Any person who violates this subsection
1931	commits a misdemeanor of the second degree, punishable as
1932	provided in s. 775.082 or s. 775.083. Each day of continuing
1933	violation is a separate offense.
1934	Section 59.  Subsection (3) is added to section 408.813,
1935	Florida Statutes, to read:
1936	408.813  Administrative fines; violations.-As a penalty for
1937	any violation of this part, authorizing statutes, or applicable
1938	rules, the agency may impose an administrative fine.
1939	(3)  The agency may impose an administrative fine for a
1940	violation that does not qualify as a class I, class II, class
1941	III, or class IV violation. Unless otherwise specified by law,
1942	the amount of the fine shall not exceed $500 for each violation.
1943	Unclassified violations may include:
1944	(a)  Violating any term or condition of a license.
1945	(b)  Violating any provision of this part, authorizing
1946	statutes, or applicable rules.
1947	(c)  Exceeding licensed capacity.
1948	(d)  Providing services beyond the scope of the license.
1949	(e)  Violating a moratorium imposed pursuant to s. 408.814.
1950	Section 60.  Subsection (2) of section 408.815, Florida
1951	Statutes, is amended, and subsection (5) is added to that
1952	section, to read:
1953	408.815  License or application denial; revocation.-
1954	(2)  If a licensee lawfully continues to operate while a
1955	denial or revocation is pending in litigation, the licensee must
1956	continue to meet all other requirements of this part,
1957	authorizing statutes, and applicable rules and must file
1958	subsequent renewal applications for licensure and pay all
1959	licensure fees. The provisions of ss. 120.60(1) and 408.806(4)
1960	(3)(c) shall not apply to renewal applications filed during the
1961	time period in which the litigation of the denial or revocation
1962	is pending until that litigation is final.
1963	(5)  In order to ensure the health, safety, and welfare of
1964	clients when a license has been denied, revoked, or is set to
1965	terminate, the agency may extend the license expiration date for
1966	a period of up to 30 days for the sole purpose of allowing the
1967	safe and orderly discharge of clients. The agency may impose
1968	conditions on the extension, including, but not limited to,
1969	prohibiting or limiting admissions, expedited discharge
1970	planning, required status reports, and mandatory monitoring by
1971	the agency or third parties. When imposing these conditions, the
1972	agency shall take into consideration the nature and number of
1973	clients, the availability and location of acceptable alternative
1974	placements, and the ability of the licensee to continue
1975	providing care to the clients. The agency may terminate the
1976	extension or modify the conditions at any time. This authority
1977	is in addition to any other authority granted to the agency
1978	under chapter 120, this part, and authorizing statutes but
1979	creates no right or entitlement to an extension of a license
1980	expiration date.
1981	Section 61.  Subsection (11) of section 408.820, Florida
1982	Statutes, is amended to read:
1983	408.820  Exemptions.-Except as prescribed in authorizing
1984	statutes, the following exemptions shall apply to specified
1985	requirements of this part:
1986	(11)  Health care risk managers, as provided under part I
1987	of chapter 395, are exempt from ss. 408.806(8)(7), 408.810(4)-
1988	(10), and 408.811.
1989	Section 62.  Subsection (1) of section 409.91196, Florida
1990	Statutes, is amended to read:
1991	409.91196  Supplemental rebate agreements; public records
1992	and public meetings exemption.-
1993	(1)  The rebate amount, percent of rebate, manufacturer's
1994	pricing, and supplemental rebate, and other trade secrets as
1995	defined in s. 688.002 that the agency has identified for use in
1996	negotiations, held by the Agency for Health Care Administration
1997	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
1998	119.07(1) and s. 24(a), Art. I of the State Constitution.
1999	Section 63.  Paragraph (a) of subsection (39) of section
2000	409.912, Florida Statutes, is amended to read:
2001	409.912  Cost-effective purchasing of health care.-The
2002	agency shall purchase goods and services for Medicaid recipients
2003	in the most cost-effective manner consistent with the delivery
2004	of quality medical care. To ensure that medical services are
2005	effectively utilized, the agency may, in any case, require a
2006	confirmation or second physician's opinion of the correct
2007	diagnosis for purposes of authorizing future services under the
2008	Medicaid program. This section does not restrict access to
2009	emergency services or poststabilization care services as defined
2010	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2011	shall be rendered in a manner approved by the agency. The agency
2012	shall maximize the use of prepaid per capita and prepaid
2013	aggregate fixed-sum basis services when appropriate and other
2014	alternative service delivery and reimbursement methodologies,
2015	including competitive bidding pursuant to s. 287.057, designed
2016	to facilitate the cost-effective purchase of a case-managed
2017	continuum of care. The agency shall also require providers to
2018	minimize the exposure of recipients to the need for acute
2019	inpatient, custodial, and other institutional care and the
2020	inappropriate or unnecessary use of high-cost services. The
2021	agency shall contract with a vendor to monitor and evaluate the
2022	clinical practice patterns of providers in order to identify
2023	trends that are outside the normal practice patterns of a
2024	provider's professional peers or the national guidelines of a
2025	provider's professional association. The vendor must be able to
2026	provide information and counseling to a provider whose practice
2027	patterns are outside the norms, in consultation with the agency,
2028	to improve patient care and reduce inappropriate utilization.
2029	The agency may mandate prior authorization, drug therapy
2030	management, or disease management participation for certain
2031	populations of Medicaid beneficiaries, certain drug classes, or
2032	particular drugs to prevent fraud, abuse, overuse, and possible
2033	dangerous drug interactions. The Pharmaceutical and Therapeutics
2034	Committee shall make recommendations to the agency on drugs for
2035	which prior authorization is required. The agency shall inform
2036	the Pharmaceutical and Therapeutics Committee of its decisions
2037	regarding drugs subject to prior authorization. The agency is
2038	authorized to limit the entities it contracts with or enrolls as
2039	Medicaid providers by developing a provider network through
2040	provider credentialing. The agency may competitively bid single-
2041	source-provider contracts if procurement of goods or services
2042	results in demonstrated cost savings to the state without
2043	limiting access to care. The agency may limit its network based
2044	on the assessment of beneficiary access to care, provider
2045	availability, provider quality standards, time and distance
2046	standards for access to care, the cultural competence of the
2047	provider network, demographic characteristics of Medicaid
2048	beneficiaries, practice and provider-to-beneficiary standards,
2049	appointment wait times, beneficiary use of services, provider
2050	turnover, provider profiling, provider licensure history,
2051	previous program integrity investigations and findings, peer
2052	review, provider Medicaid policy and billing compliance records,
2053	clinical and medical record audits, and other factors. Providers
2054	shall not be entitled to enrollment in the Medicaid provider
2055	network. The agency shall determine instances in which allowing
2056	Medicaid beneficiaries to purchase durable medical equipment and
2057	other goods is less expensive to the Medicaid program than long-
2058	term rental of the equipment or goods. The agency may establish
2059	rules to facilitate purchases in lieu of long-term rentals in
2060	order to protect against fraud and abuse in the Medicaid program
2061	as defined in s. 409.913. The agency may seek federal waivers
2062	necessary to administer these policies.
2063	(39)(a)  The agency shall implement a Medicaid prescribed-
2064	drug spending-control program that includes the following
2065	components:
2066	1.  A Medicaid preferred drug list, which shall be a
2067	listing of cost-effective therapeutic options recommended by the
2068	Medicaid Pharmacy and Therapeutics Committee established
2069	pursuant to s. 409.91195 and adopted by the agency for each
2070	therapeutic class on the preferred drug list. At the discretion
2071	of the committee, and when feasible, the preferred drug list
2072	should include at least two products in a therapeutic class. The
2073	agency may post the preferred drug list and updates to the
2074	preferred drug list on an Internet website without following the
2075	rulemaking procedures of chapter 120. Antiretroviral agents are
2076	excluded from the preferred drug list. The agency shall also
2077	limit the amount of a prescribed drug dispensed to no more than
2078	a 34-day supply unless the drug products' smallest marketed
2079	package is greater than a 34-day supply, or the drug is
2080	determined by the agency to be a maintenance drug in which case
2081	a 100-day maximum supply may be authorized. The agency is
2082	authorized to seek any federal waivers necessary to implement
2083	these cost-control programs and to continue participation in the
2084	federal Medicaid rebate program, or alternatively to negotiate
2085	state-only manufacturer rebates. The agency may adopt rules to
2086	implement this subparagraph. The agency shall continue to
2087	provide unlimited contraceptive drugs and items. The agency must
2088	establish procedures to ensure that:
2089	a.  There is a response to a request for prior consultation
2090	by telephone or other telecommunication device within 24 hours
2091	after receipt of a request for prior consultation; and
2092	b.  A 72-hour supply of the drug prescribed is provided in
2093	an emergency or when the agency does not provide a response
2094	within 24 hours as required by sub-subparagraph a.
2095	2.  Reimbursement to pharmacies for Medicaid prescribed
2096	drugs shall be set at the lesser of: the average wholesale price
2097	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2098	plus 4.75 percent, the federal upper limit (FUL), the state
2099	maximum allowable cost (SMAC), or the usual and customary (UAC)
2100	charge billed by the provider.
2101	3.  For a prescribed drug billed as a 340B prescribed
2102	medication, the claim must meet the requirements of the Deficit
2103	Reduction Act of 2005 and the federal 340B program, contain a
2104	national drug code, and be billed at the actual acquisition cost
2105	or payment shall be denied.
2106	4.3.  The agency shall develop and implement a process for
2107	managing the drug therapies of Medicaid recipients who are using
2108	significant numbers of prescribed drugs each month. The
2109	management process may include, but is not limited to,
2110	comprehensive, physician-directed medical-record reviews, claims
2111	analyses, and case evaluations to determine the medical
2112	necessity and appropriateness of a patient's treatment plan and
2113	drug therapies. The agency may contract with a private
2114	organization to provide drug-program-management services. The
2115	Medicaid drug benefit management program shall include
2116	initiatives to manage drug therapies for HIV/AIDS patients,
2117	patients using 20 or more unique prescriptions in a 180-day
2118	period, and the top 1,000 patients in annual spending. The
2119	agency shall enroll any Medicaid recipient in the drug benefit
2120	management program if he or she meets the specifications of this
2121	provision and is not enrolled in a Medicaid health maintenance
2122	organization.
2123	5.4.  The agency may limit the size of its pharmacy network
2124	based on need, competitive bidding, price negotiations,
2125	credentialing, or similar criteria. The agency shall give
2126	special consideration to rural areas in determining the size and
2127	location of pharmacies included in the Medicaid pharmacy
2128	network. A pharmacy credentialing process may include criteria
2129	such as a pharmacy's full-service status, location, size,
2130	patient educational programs, patient consultation, disease
2131	management services, and other characteristics. The agency may
2132	impose a moratorium on Medicaid pharmacy enrollment when it is
2133	determined that it has a sufficient number of Medicaid-
2134	participating providers. The agency must allow dispensing
2135	practitioners to participate as a part of the Medicaid pharmacy
2136	network regardless of the practitioner's proximity to any other
2137	entity that is dispensing prescription drugs under the Medicaid
2138	program. A dispensing practitioner must meet all credentialing
2139	requirements applicable to his or her practice, as determined by
2140	the agency.
2141	6.5.  The agency shall develop and implement a program that
2142	requires Medicaid practitioners who prescribe drugs to use a
2143	counterfeit-proof prescription pad for Medicaid prescriptions.
2144	The agency shall require the use of standardized counterfeit-
2145	proof prescription pads by Medicaid-participating prescribers or
2146	prescribers who write prescriptions for Medicaid recipients. The
2147	agency may implement the program in targeted geographic areas or
2148	statewide.
2149	7.6.  The agency may enter into arrangements that require
2150	manufacturers of generic drugs prescribed to Medicaid recipients
2151	to provide rebates of at least 15.1 percent of the average
2152	manufacturer price for the manufacturer's generic products.
2153	These arrangements shall require that if a generic-drug
2154	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2155	at a level below 15.1 percent, the manufacturer must provide a
2156	supplemental rebate to the state in an amount necessary to
2157	achieve a 15.1-percent rebate level.
2158	8.7.  The agency may establish a preferred drug list as
2159	described in this subsection, and, pursuant to the establishment
2160	of such preferred drug list, it is authorized to negotiate
2161	supplemental rebates from manufacturers that are in addition to
2162	those required by Title XIX of the Social Security Act and at no
2163	less than 14 percent of the average manufacturer price as
2164	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2165	the federal or supplemental rebate, or both, equals or exceeds
2166	29 percent. There is no upper limit on the supplemental rebates
2167	the agency may negotiate. The agency may determine that specific
2168	products, brand-name or generic, are competitive at lower rebate
2169	percentages. Agreement to pay the minimum supplemental rebate
2170	percentage will guarantee a manufacturer that the Medicaid
2171	Pharmaceutical and Therapeutics Committee will consider a
2172	product for inclusion on the preferred drug list. However, a
2173	pharmaceutical manufacturer is not guaranteed placement on the
2174	preferred drug list by simply paying the minimum supplemental
2175	rebate. Agency decisions will be made on the clinical efficacy
2176	of a drug and recommendations of the Medicaid Pharmaceutical and
2177	Therapeutics Committee, as well as the price of competing
2178	products minus federal and state rebates. The agency is
2179	authorized to contract with an outside agency or contractor to
2180	conduct negotiations for supplemental rebates. For the purposes
2181	of this section, the term "supplemental rebates" means cash
2182	rebates. Effective July 1, 2004, value-added programs as a
2183	substitution for supplemental rebates are prohibited. The agency
2184	is authorized to seek any federal waivers to implement this
2185	initiative.
2186	9.8.  The Agency for Health Care Administration shall
2187	expand home delivery of pharmacy products. To assist Medicaid
2188	patients in securing their prescriptions and reduce program
2189	costs, the agency shall expand its current mail-order-pharmacy
2190	diabetes-supply program to include all generic and brand-name
2191	drugs used by Medicaid patients with diabetes. Medicaid
2192	recipients in the current program may obtain nondiabetes drugs
2193	on a voluntary basis. This initiative is limited to the
2194	geographic area covered by the current contract. The agency may
2195	seek and implement any federal waivers necessary to implement
2196	this subparagraph.
2197	10.9.  The agency shall limit to one dose per month any
2198	drug prescribed to treat erectile dysfunction.
2199	11.10.a.  The agency may implement a Medicaid behavioral
2200	drug management system. The agency may contract with a vendor
2201	that has experience in operating behavioral drug management
2202	systems to implement this program. The agency is authorized to
2203	seek federal waivers to implement this program.
2204	b.  The agency, in conjunction with the Department of
2205	Children and Family Services, may implement the Medicaid
2206	behavioral drug management system that is designed to improve
2207	the quality of care and behavioral health prescribing practices
2208	based on best practice guidelines, improve patient adherence to
2209	medication plans, reduce clinical risk, and lower prescribed
2210	drug costs and the rate of inappropriate spending on Medicaid
2211	behavioral drugs. The program may include the following
2212	elements:
2213	(I)  Provide for the development and adoption of best
2214	practice guidelines for behavioral health-related drugs such as
2215	antipsychotics, antidepressants, and medications for treating
2216	bipolar disorders and other behavioral conditions; translate
2217	them into practice; review behavioral health prescribers and
2218	compare their prescribing patterns to a number of indicators
2219	that are based on national standards; and determine deviations
2220	from best practice guidelines.
2221	(II)  Implement processes for providing feedback to and
2222	educating prescribers using best practice educational materials
2223	and peer-to-peer consultation.
2224	(III)  Assess Medicaid beneficiaries who are outliers in
2225	their use of behavioral health drugs with regard to the numbers
2226	and types of drugs taken, drug dosages, combination drug
2227	therapies, and other indicators of improper use of behavioral
2228	health drugs.
2229	(IV)  Alert prescribers to patients who fail to refill
2230	prescriptions in a timely fashion, are prescribed multiple same-
2231	class behavioral health drugs, and may have other potential
2232	medication problems.
2233	(V)  Track spending trends for behavioral health drugs and
2234	deviation from best practice guidelines.
2235	(VI)  Use educational and technological approaches to
2236	promote best practices, educate consumers, and train prescribers
2237	in the use of practice guidelines.
2238	(VII)  Disseminate electronic and published materials.
2239	(VIII)  Hold statewide and regional conferences.
2240	(IX)  Implement a disease management program with a model
2241	quality-based medication component for severely mentally ill
2242	individuals and emotionally disturbed children who are high
2243	users of care.
2244	12.11.a.  The agency shall implement a Medicaid
2245	prescription drug management system. The agency may contract
2246	with a vendor that has experience in operating prescription drug
2247	management systems in order to implement this system. Any
2248	management system that is implemented in accordance with this
2249	subparagraph must rely on cooperation between physicians and
2250	pharmacists to determine appropriate practice patterns and
2251	clinical guidelines to improve the prescribing, dispensing, and
2252	use of drugs in the Medicaid program. The agency may seek
2253	federal waivers to implement this program.
2254	b.  The drug management system must be designed to improve
2255	the quality of care and prescribing practices based on best
2256	practice guidelines, improve patient adherence to medication
2257	plans, reduce clinical risk, and lower prescribed drug costs and
2258	the rate of inappropriate spending on Medicaid prescription
2259	drugs. The program must:
2260	(I)  Provide for the development and adoption of best
2261	practice guidelines for the prescribing and use of drugs in the
2262	Medicaid program, including translating best practice guidelines
2263	into practice; reviewing prescriber patterns and comparing them
2264	to indicators that are based on national standards and practice
2265	patterns of clinical peers in their community, statewide, and
2266	nationally; and determine deviations from best practice
2267	guidelines.
2268	(II)  Implement processes for providing feedback to and
2269	educating prescribers using best practice educational materials
2270	and peer-to-peer consultation.
2271	(III)  Assess Medicaid recipients who are outliers in their
2272	use of a single or multiple prescription drugs with regard to
2273	the numbers and types of drugs taken, drug dosages, combination
2274	drug therapies, and other indicators of improper use of
2275	prescription drugs.
2276	(IV)  Alert prescribers to patients who fail to refill
2277	prescriptions in a timely fashion, are prescribed multiple drugs
2278	that may be redundant or contraindicated, or may have other
2279	potential medication problems.
2280	(V)  Track spending trends for prescription drugs and
2281	deviation from best practice guidelines.
2282	(VI)  Use educational and technological approaches to
2283	promote best practices, educate consumers, and train prescribers
2284	in the use of practice guidelines.
2285	(VII)  Disseminate electronic and published materials.
2286	(VIII)  Hold statewide and regional conferences.
2287	(IX)  Implement disease management programs in cooperation
2288	with physicians and pharmacists, along with a model quality-
2289	based medication component for individuals having chronic
2290	medical conditions.
2291	13.12.  The agency is authorized to contract for drug
2292	rebate administration, including, but not limited to,
2293	calculating rebate amounts, invoicing manufacturers, negotiating
2294	disputes with manufacturers, and maintaining a database of
2295	rebate collections.
2296	14.13.  The agency may specify the preferred daily dosing
2297	form or strength for the purpose of promoting best practices
2298	with regard to the prescribing of certain drugs as specified in
2299	the General Appropriations Act and ensuring cost-effective
2300	prescribing practices.
2301	15.14.  The agency may require prior authorization for
2302	Medicaid-covered prescribed drugs. The agency may, but is not
2303	required to, prior-authorize the use of a product:
2304	a.  For an indication not approved in labeling;
2305	b.  To comply with certain clinical guidelines; or
2306	c.  If the product has the potential for overuse, misuse,
2307	or abuse.
2308
2309	The agency may require the prescribing professional to provide
2310	information about the rationale and supporting medical evidence
2311	for the use of a drug. The agency may post prior authorization
2312	criteria and protocol and updates to the list of drugs that are
2313	subject to prior authorization on an Internet website without
2314	amending its rule or engaging in additional rulemaking.
2315	16.15.  The agency, in conjunction with the Pharmaceutical
2316	and Therapeutics Committee, may require age-related prior
2317	authorizations for certain prescribed drugs. The agency may
2318	preauthorize the use of a drug for a recipient who may not meet
2319	the age requirement or may exceed the length of therapy for use
2320	of this product as recommended by the manufacturer and approved
2321	by the Food and Drug Administration. Prior authorization may
2322	require the prescribing professional to provide information
2323	about the rationale and supporting medical evidence for the use
2324	of a drug.
2325	17.16.  The agency shall implement a step-therapy prior
2326	authorization approval process for medications excluded from the
2327	preferred drug list. Medications listed on the preferred drug
2328	list must be used within the previous 12 months prior to the
2329	alternative medications that are not listed. The step-therapy
2330	prior authorization may require the prescriber to use the
2331	medications of a similar drug class or for a similar medical
2332	indication unless contraindicated in the Food and Drug
2333	Administration labeling. The trial period between the specified
2334	steps may vary according to the medical indication. The step-
2335	therapy approval process shall be developed in accordance with
2336	the committee as stated in s. 409.91195(7) and (8). A drug
2337	product may be approved without meeting the step-therapy prior
2338	authorization criteria if the prescribing physician provides the
2339	agency with additional written medical or clinical documentation
2340	that the product is medically necessary because:
2341	a.  There is not a drug on the preferred drug list to treat
2342	the disease or medical condition which is an acceptable clinical
2343	alternative;
2344	b.  The alternatives have been ineffective in the treatment
2345	of the beneficiary's disease; or
2346	c.  Based on historic evidence and known characteristics of
2347	the patient and the drug, the drug is likely to be ineffective,
2348	or the number of doses have been ineffective.
2349
2350	The agency shall work with the physician to determine the best
2351	alternative for the patient. The agency may adopt rules waiving
2352	the requirements for written clinical documentation for specific
2353	drugs in limited clinical situations.
2354	18.17.  The agency shall implement a return and reuse
2355	program for drugs dispensed by pharmacies to institutional
2356	recipients, which includes payment of a $5 restocking fee for
2357	the implementation and operation of the program. The return and
2358	reuse program shall be implemented electronically and in a
2359	manner that promotes efficiency. The program must permit a
2360	pharmacy to exclude drugs from the program if it is not
2361	practical or cost-effective for the drug to be included and must
2362	provide for the return to inventory of drugs that cannot be
2363	credited or returned in a cost-effective manner. The agency
2364	shall determine if the program has reduced the amount of
2365	Medicaid prescription drugs which are destroyed on an annual
2366	basis and if there are additional ways to ensure more
2367	prescription drugs are not destroyed which could safely be
2368	reused. The agency's conclusion and recommendations shall be
2369	reported to the Legislature by December 1, 2005.
2370	Section 64.  Section 409.91255, Florida Statutes, is
2371	amended to read:
2372	409.91255  Federally qualified health center access
2373	program.-
2374	(1)  SHORT TITLE.-This section may be cited as the
2375	"Community Health Center Access Program Act."
2376	(2)  LEGISLATIVE FINDINGS AND INTENT.-
2377	(a)  The Legislature finds that, despite significant
2378	investments in health care programs, nearly 6 more than 2
2379	million low-income Floridians, primarily the working poor and
2380	minority populations, continue to lack access to basic health
2381	care services. Further, the Legislature recognizes that
2382	federally qualified health centers have a proven record of
2383	providing cost-effective, comprehensive primary and preventive
2384	health care and are uniquely qualified to address the lack of
2385	adequate health care services for the uninsured.
2386	(b)  It is the intent of the Legislature to recognize the
2387	significance of increased federal investments in federally
2388	qualified health centers and to leverage that investment through
2389	the creation of a program to provide for the expansion of the
2390	primary and preventive health care services offered by federally
2391	qualified health centers. Further, such a program will support
2392	the coordination of federal, state, and local resources to
2393	assist such health centers in developing an expanded community-
2394	based primary care delivery system.
2395	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.-The
2396	agency shall administer Department of Health shall develop a
2397	program for the expansion of federally qualified health centers
2398	for the purpose of providing comprehensive primary and
2399	preventive health care and urgent care services that may reduce
2400	the morbidity, mortality, and cost of care among the uninsured
2401	population of the state. The program shall provide for
2402	distribution of financial assistance to federally qualified
2403	health centers that apply and demonstrate a need for such
2404	assistance in order to sustain or expand the delivery of primary
2405	and preventive health care services. In selecting centers to
2406	receive this financial assistance, the program:
2407	(a)  Shall give preference to communities that have few or
2408	no community-based primary care services or in which the current
2409	services are unable to meet the community's needs. To assist in
2410	the assessment and identification of areas of critical need, the
2411	Florida Association of Community Health Centers, Inc., shall
2412	develop, every 5 years, beginning January 1, 2012, a federally
2413	qualified health center based statewide assessment and strategic
2414	plan.
2415	(b)  Shall require that primary care services be provided
2416	to the medically indigent using a sliding fee schedule based on
2417	income.
2418	(c)  Shall promote allow innovative and creative uses of
2419	federal, state, and local health care resources.
2420	(d)  Shall require that the funds provided be used to pay
2421	for operating costs of a projected expansion in patient
2422	caseloads or services or for capital improvement projects.
2423	Capital improvement projects may include renovations to existing
2424	facilities or construction of new facilities, provided that an
2425	expansion in patient caseloads or services to a new patient
2426	population will occur as a result of the capital expenditures.
2427	The agency department shall include in its standard contract
2428	document a requirement that any state funds provided for the
2429	purchase of or improvements to real property are contingent upon
2430	the contractor granting to the state a security interest in the
2431	property at least to the amount of the state funds provided for
2432	at least 5 years from the date of purchase or the completion of
2433	the improvements or as further required by law. The contract
2434	must include a provision that, as a condition of receipt of
2435	state funding for this purpose, the contractor agrees that, if
2436	it disposes of the property before the agency's department's
2437	interest is vacated, the contractor will refund the
2438	proportionate share of the state's initial investment, as
2439	adjusted by depreciation.
2440	(e)  Shall May require in-kind support from other sources.
2441	(f)  Shall promote May encourage coordination among
2442	federally qualified health centers, other private sector
2443	providers, and publicly supported programs.
2444	(g)  Shall promote allow the development of community
2445	emergency room diversion programs in conjunction with local
2446	resources, providing extended hours of operation to urgent care
2447	patients. Diversion programs shall include case management for
2448	emergency room followup care.
2449	(4)  EVALUATION OF APPLICATIONS.-A review panel shall be
2450	established, consisting of four persons appointed by the
2451	Secretary of Health Care Administration State Surgeon General
2452	and three persons appointed by the chief executive officer of
2453	the Florida Association of Community Health Centers, Inc., to
2454	review all applications for financial assistance under the
2455	program. Applicants shall specify in the application whether the
2456	program funds will be used for the expansion of patient
2457	caseloads or services or for capital improvement projects to
2458	expand and improve patient facilities. The panel shall use the
2459	following elements in reviewing application proposals and shall
2460	determine the relative weight for scoring and evaluating these
2461	elements:
2462	(a)  The target population to be served.
2463	(b)  The health benefits to be provided.
2464	(c)  The methods that will be used to measure cost-
2465	effectiveness.
2466	(d)  How patient satisfaction will be measured.
2467	(e)  The proposed internal quality assurance process.
2468	(f)  Projected health status outcomes.
2469	(g)  How data will be collected to measure cost-
2470	effectiveness, health status outcomes, and overall achievement
2471	of the goals of the proposal.
2472	(h)  All resources, including cash, in-kind, voluntary, or
2473	other resources that will be dedicated to the proposal.
2474	(5)  ADMINISTRATION AND TECHNICAL ASSISTANCE.-The agency
2475	shall Department of Health may contract with the Florida
2476	Association of Community Health Centers, Inc., to develop and
2477	coordinate administer the program and provide technical
2478	assistance to the federally qualified health centers selected to
2479	receive financial assistance. The contracted entity shall be
2480	responsible for program support and assume all costs related to
2481	administration of this program.
2482	Section 65.  Subsections (3) and (4) of section 429.07,
2483	Florida Statutes, are amended, and subsections (6) and (7) are
2484	added to that section, to read:
2485	429.07  License required; fee; inspections.-
2486	(3)  In addition to the requirements of s. 408.806, each
2487	license granted by the agency must state the type of care for
2488	which the license is granted. Licenses shall be issued for one
2489	or more of the following categories of care: standard, extended
2490	congregate care, limited nursing services, or limited mental
2491	health.
2492	(a)  A standard license shall be issued to a facility
2493	facilities providing one or more of the personal services
2494	identified in s. 429.02. Such licensee facilities may also
2495	employ or contract with a person licensed under part I of
2496	chapter 464 to administer medications and perform other tasks as
2497	specified in s. 429.255.
2498	(b)  An extended congregate care license shall be issued to
2499	a licensee facilities providing, directly or through contract,
2500	services beyond those authorized in paragraph (a), including
2501	services performed by persons licensed under part I of chapter
2502	464 and supportive services, as defined by rule, to persons who
2503	would otherwise be disqualified from continued residence in a
2504	facility licensed under this part.
2505	1.  In order for extended congregate care services to be
2506	provided, the agency must first determine that all requirements
2507	established in law and rule are met and must specifically
2508	designate, on the facility's license, that such services may be
2509	provided and whether the designation applies to all or part of
2510	the facility. Such designation may be made at the time of
2511	initial licensure or relicensure, or upon request in writing by
2512	a licensee under this part and part II of chapter 408. The
2513	notification of approval or the denial of the request shall be
2514	made in accordance with part II of chapter 408. An existing
2515	licensee facilities qualifying to provide extended congregate
2516	care services must have maintained a standard license and may
2517	not have been subject to administrative sanctions during the
2518	previous 2 years, or since initial licensure if the facility has
2519	been licensed for less than 2 years, for any of the following
2520	reasons:
2521	a.  A class I or class II violation;
2522	b.  Three or more repeat or recurring class III violations
2523	of identical or similar resident care standards from which a
2524	pattern of noncompliance is found by the agency;
2525	c.  Three or more class III violations that were not
2526	corrected in accordance with the corrective action plan approved
2527	by the agency;
2528	d.  Violation of resident care standards which results in
2529	requiring the facility to employ the services of a consultant
2530	pharmacist or consultant dietitian;
2531	e.  Denial, suspension, or revocation of a license for
2532	another facility licensed under this part in which the applicant
2533	for an extended congregate care license has at least 25 percent
2534	ownership interest; or
2535	f.  Imposition of a moratorium pursuant to this part or
2536	part II of chapter 408 or initiation of injunctive proceedings.
2537	2.  A facility that is licensed to provide extended
2538	congregate care services shall maintain a written progress
2539	report for on each person who receives services which describes
2540	the type, amount, duration, scope, and outcome of services that
2541	are rendered and the general status of the resident's health. A
2542	registered nurse, or appropriate designee, representing the
2543	agency shall visit the facility at least quarterly to monitor
2544	residents who are receiving extended congregate care services
2545	and to determine if the facility is in compliance with this
2546	part, part II of chapter 408, and relevant rules. One of the
2547	visits may be in conjunction with the regular survey. The
2548	monitoring visits may be provided through contractual
2549	arrangements with appropriate community agencies. A registered
2550	nurse shall serve as part of the team that inspects the
2551	facility. The agency may waive one of the required yearly
2552	monitoring visits for a facility that has been licensed for at
2553	least 24 months to provide extended congregate care services,
2554	if, during the inspection, the registered nurse determines that
2555	extended congregate care services are being provided
2556	appropriately, and if the facility has no class I or class II
2557	violations and no uncorrected class III violations. The agency
2558	must first consult with the long-term care ombudsman council for
2559	the area in which the facility is located to determine if any
2560	complaints have been made and substantiated about the quality of
2561	services or care. The agency may not waive one of the required
2562	yearly monitoring visits if complaints have been made and
2563	substantiated.
2564	3.  A facility that is licensed to provide extended
2565	congregate care services must:
2566	a.  Demonstrate the capability to meet unanticipated
2567	resident service needs.
2568	b.  Offer a physical environment that promotes a homelike
2569	setting, provides for resident privacy, promotes resident
2570	independence, and allows sufficient congregate space as defined
2571	by rule.
2572	c.  Have sufficient staff available, taking into account
2573	the physical plant and firesafety features of the building, to
2574	assist with the evacuation of residents in an emergency.
2575	d.  Adopt and follow policies and procedures that maximize
2576	resident independence, dignity, choice, and decisionmaking to
2577	permit residents to age in place, so that moves due to changes
2578	in functional status are minimized or avoided.
2579	e.  Allow residents or, if applicable, a resident's
2580	representative, designee, surrogate, guardian, or attorney in
2581	fact to make a variety of personal choices, participate in
2582	developing service plans, and share responsibility in
2583	decisionmaking.
2584	f.  Implement the concept of managed risk.
2585	g.  Provide, directly or through contract, the services of
2586	a person licensed under part I of chapter 464.
2587	h.  In addition to the training mandated in s. 429.52,
2588	provide specialized training as defined by rule for facility
2589	staff.
2590	4.  A facility that is licensed to provide extended
2591	congregate care services is exempt from the criteria for
2592	continued residency set forth in rules adopted under s. 429.41.
2593	A licensed facility must adopt its own requirements within
2594	guidelines for continued residency set forth by rule. However,
2595	the facility may not serve residents who require 24-hour nursing
2596	supervision. A licensed facility that provides extended
2597	congregate care services must also provide each resident with a
2598	written copy of facility policies governing admission and
2599	retention.
2600	5.  The primary purpose of extended congregate care
2601	services is to allow residents, as they become more impaired,
2602	the option of remaining in a familiar setting from which they
2603	would otherwise be disqualified for continued residency. A
2604	facility licensed to provide extended congregate care services
2605	may also admit an individual who exceeds the admission criteria
2606	for a facility with a standard license, if the individual is
2607	determined appropriate for admission to the extended congregate
2608	care facility.
2609	6.  Before the admission of an individual to a facility
2610	licensed to provide extended congregate care services, the
2611	individual must undergo a medical examination as provided in s.
2612	429.26(4) and the facility must develop a preliminary service
2613	plan for the individual.
2614	7.  When a licensee facility can no longer provide or
2615	arrange for services in accordance with the resident's service
2616	plan and needs and the licensee's facility's policy, the
2617	licensee facility shall make arrangements for relocating the
2618	person in accordance with s. 429.28(1)(k).
2619	8.  Failure to provide extended congregate care services
2620	may result in denial of extended congregate care license
2621	renewal.
2622	(c)  A limited nursing services license shall be issued to
2623	a facility that provides services beyond those authorized in
2624	paragraph (a) and as specified in this paragraph.
2625	1.  In order for limited nursing services to be provided in
2626	a facility licensed under this part, the agency must first
2627	determine that all requirements established in law and rule are
2628	met and must specifically designate, on the facility's license,
2629	that such services may be provided. Such designation may be made
2630	at the time of initial licensure or relicensure, or upon request
2631	in writing by a licensee under this part and part II of chapter
2632	408. Notification of approval or denial of such request shall be
2633	made in accordance with part II of chapter 408. Existing
2634	facilities qualifying to provide limited nursing services shall
2635	have maintained a standard license and may not have been subject
2636	to administrative sanctions that affect the health, safety, and
2637	welfare of residents for the previous 2 years or since initial
2638	licensure if the facility has been licensed for less than 2
2639	years.
2640	2.  Facilities that are licensed to provide limited nursing
2641	services shall maintain a written progress report on each person
2642	who receives such nursing services, which report describes the
2643	type, amount, duration, scope, and outcome of services that are
2644	rendered and the general status of the resident's health. A
2645	registered nurse representing the agency shall visit such
2646	facilities at least twice a year to monitor residents who are
2647	receiving limited nursing services and to determine if the
2648	facility is in compliance with applicable provisions of this
2649	part, part II of chapter 408, and related rules. The monitoring
2650	visits may be provided through contractual arrangements with
2651	appropriate community agencies. A registered nurse shall also
2652	serve as part of the team that inspects such facility.
2653	3.  A person who receives limited nursing services under
2654	this part must meet the admission criteria established by the
2655	agency for assisted living facilities. When a resident no longer
2656	meets the admission criteria for a facility licensed under this
2657	part, arrangements for relocating the person shall be made in
2658	accordance with s. 429.28(1)(k), unless the facility is licensed
2659	to provide extended congregate care services.
2660	(4)  In accordance with s. 408.805, an applicant or
2661	licensee shall pay a fee for each license application submitted
2662	under this part, part II of chapter 408, and applicable rules.
2663	The amount of the fee shall be established by rule.
2664	(a)  The biennial license fee required of a facility is
2665	$356 $300 per license, with an additional fee of $67.50 $50 per
2666	resident based on the total licensed resident capacity of the
2667	facility, except that no additional fee will be assessed for
2668	beds designated for recipients of optional state supplementation
2669	payments provided for in s. 409.212. The total fee may not
2670	exceed $18,000 $10,000.
2671	(b)  In addition to the total fee assessed under paragraph
2672	(a), the agency shall require facilities that are licensed to
2673	provide extended congregate care services under this part to pay
2674	an additional fee per licensed facility. The amount of the
2675	biennial fee shall be $501 $400 per license, with an additional
2676	fee of $10 per resident based on the total licensed resident
2677	capacity of the facility.
2678	(c)  In addition to the total fee assessed under paragraph
2679	(a), the agency shall require facilities that are licensed to
2680	provide limited nursing services under this part to pay an
2681	additional fee per licensed facility. The amount of the biennial
2682	fee shall be $250 per license, with an additional fee of $10 per
2683	resident based on the total licensed resident capacity of the
2684	facility.
2685	(6)  In order to determine whether the facility is
2686	adequately protecting residents' rights as provided in s.
2687	429.28, the agency shall conduct a biennial survey, which shall
2688	include private informal conversations with a sample of
2689	residents and consultation with the ombudsman council in the
2690	planning and service area in which the facility is located to
2691	discuss residents' experiences within the facility.
2692	(7)  An assisted living facility that has been cited within
2693	the previous 24-month period for a class I or class II
2694	violation, regardless of the status of any enforcement or
2695	disciplinary action, is subject to periodic unannounced
2696	monitoring to determine if the facility is in compliance with
2697	this part, part II of chapter 408, and applicable rules.
2698	Monitoring may occur through a desk review or an onsite
2699	assessment. If the class I or class II violation relates to
2700	providing or failing to provide nursing care, a registered nurse
2701	must participate in at least two onsite monitoring visits within
2702	a 12-month period.
2703	Section 66.  Subsection (7) of section 429.11, Florida
2704	Statutes, is renumbered as subsection (6), and present
2705	subsection (6) of that section is amended to read:
2706	429.11  Initial application for license; provisional
2707	license.-
2708	(6)  In addition to the license categories available in s.
2709	408.808, a provisional license may be issued to an applicant
2710	making initial application for licensure or making application
2711	for a change of ownership. A provisional license shall be
2712	limited in duration to a specific period of time not to exceed 6
2713	months, as determined by the agency.
2714	Section 67.  Section 429.12, Florida Statutes, is amended
2715	to read:
2716	429.12  Sale or transfer of ownership of a facility.-It is
2717	the intent of the Legislature to protect the rights of the
2718	residents of an assisted living facility when the facility is
2719	sold or the ownership thereof is transferred. Therefore, in
2720	addition to the requirements of part II of chapter 408, whenever
2721	a facility is sold or the ownership thereof is transferred,
2722	including leasing,:
2723	(1)  the transferee shall notify the residents, in writing,
2724	of the change of ownership within 7 days after receipt of the
2725	new license.
2726	(2)  The transferor of a facility the license of which is
2727	denied pending an administrative hearing shall, as a part of the
2728	written change-of-ownership contract, advise the transferee that
2729	a plan of correction must be submitted by the transferee and
2730	approved by the agency at least 7 days before the change of
2731	ownership and that failure to correct the condition which
2732	resulted in the moratorium pursuant to part II of chapter 408 or
2733	denial of licensure is grounds for denial of the transferee's
2734	license.
2735	Section 68.  Paragraphs (b) through (l) of subsection (1)
2736	of section 429.14, Florida Statutes, are redesignated as
2737	paragraphs (a) through (k), respectively, and present paragraph
2738	(a) of subsection (1) and subsections (5) and (6) of that
2739	section are amended to read:
2740	429.14  Administrative penalties.-
2741	(1)  In addition to the requirements of part II of chapter
2742	408, the agency may deny, revoke, and suspend any license issued
2743	under this part and impose an administrative fine in the manner
2744	provided in chapter 120 against a licensee for a violation of
2745	any provision of this part, part II of chapter 408, or
2746	applicable rules, or for any of the following actions by a
2747	licensee, for the actions of any person subject to level 2
2748	background screening under s. 408.809, or for the actions of any
2749	facility employee:
2750	(a)  An intentional or negligent act seriously affecting
2751	the health, safety, or welfare of a resident of the facility.
2752	(5)  An action taken by the agency to suspend, deny, or
2753	revoke a facility's license under this part or part II of
2754	chapter 408, in which the agency claims that the facility owner
2755	or an employee of the facility has threatened the health,
2756	safety, or welfare of a resident of the facility shall be heard
2757	by the Division of Administrative Hearings of the Department of
2758	Management Services within 120 days after receipt of the
2759	facility's request for a hearing, unless that time limitation is
2760	waived by both parties. The administrative law judge must render
2761	a decision within 30 days after receipt of a proposed
2762	recommended order.
2763	(6)  The agency shall provide to the Division of Hotels and
2764	Restaurants of the Department of Business and Professional
2765	Regulation, on a monthly basis, a list of those assisted living
2766	facilities that have had their licenses denied, suspended, or
2767	revoked or that are involved in an appellate proceeding pursuant
2768	to s. 120.60 related to the denial, suspension, or revocation of
2769	a license. This information may be provided electronically or
2770	through the agency's Internet website.
2771	Section 69.  Subsections (1), (4), and (5) of section
2772	429.17, Florida Statutes, are amended to read:
2773	429.17  Expiration of license; renewal; conditional
2774	license.-
2775	(1)  Limited nursing, Extended congregate care, and limited
2776	mental health licenses shall expire at the same time as the
2777	facility's standard license, regardless of when issued.
2778	(4)  In addition to the license categories available in s.
2779	408.808, a conditional license may be issued to an applicant for
2780	license renewal if the applicant fails to meet all standards and
2781	requirements for licensure. A conditional license issued under
2782	this subsection shall be limited in duration to a specific
2783	period of time not to exceed 6 months, as determined by the
2784	agency, and shall be accompanied by an agency-approved plan of
2785	correction.
2786	(5)  When an extended congregate care or limited nursing
2787	license is requested during a facility's biennial license
2788	period, the fee shall be prorated in order to permit the
2789	additional license to expire at the end of the biennial license
2790	period. The fee shall be calculated as of the date the
2791	additional license application is received by the agency.
2792	Section 70.  Subsection (7) of section 429.19, Florida
2793	Statutes, is amended to read:
2794	429.19  Violations; imposition of administrative fines;
2795	grounds.-
2796	(7)  In addition to any administrative fines imposed, the
2797	agency may assess a survey or monitoring fee, equal to the
2798	lesser of one half of the facility's biennial license and bed
2799	fee or $500, to cover the cost of conducting initial complaint
2800	investigations that result in the finding of a violation that
2801	was the subject of the complaint or to monitor the health,
2802	safety, or security of residents under s. 429.07(7) monitoring
2803	visits conducted under s. 429.28(3)(c) to verify the correction
2804	of the violations.
2805	Section 71.  Subsections (6) through (10) of section
2806	429.23, Florida Statutes, are renumbered as subsections (5)
2807	through (9), respectively, and present subsection (5) of that
2808	section is amended to read:
2809	429.23  Internal risk management and quality assurance
2810	program; adverse incidents and reporting requirements.-
2811	(5)  Each facility shall report monthly to the agency any
2812	liability claim filed against it. The report must include the
2813	name of the resident, the dates of the incident leading to the
2814	claim, if applicable, and the type of injury or violation of
2815	rights alleged to have occurred. This report is not discoverable
2816	in any civil or administrative action, except in such actions
2817	brought by the agency to enforce the provisions of this part.
2818	Section 72.  Paragraph (a) of subsection (1) and subsection
2819	(2) of section 429.255, Florida Statutes, are amended to read:
2820	429.255  Use of personnel; emergency care.-
2821	(1)(a)  Persons under contract to the facility or, facility
2822	staff, or volunteers, who are licensed according to part I of
2823	chapter 464, or those persons exempt under s. 464.022(1), and
2824	others as defined by rule, may administer medications to
2825	residents, take residents' vital signs, manage individual weekly
2826	pill organizers for residents who self-administer medication,
2827	give prepackaged enemas ordered by a physician, observe
2828	residents, document observations on the appropriate resident's
2829	record, report observations to the resident's physician, and
2830	contract or allow residents or a resident's representative,
2831	designee, surrogate, guardian, or attorney in fact to contract
2832	with a third party, provided residents meet the criteria for
2833	appropriate placement as defined in s. 429.26. Persons under
2834	contract to the facility or facility staff who are licensed
2835	according to part I of chapter 464 may provide limited nursing
2836	services. Nursing assistants certified pursuant to part II of
2837	chapter 464 may take residents' vital signs as directed by a
2838	licensed nurse or physician. The facility is responsible for
2839	maintaining documentation of services provided under this
2840	paragraph as required by rule and ensuring that staff are
2841	adequately trained to monitor residents receiving these
2842	services.
2843	(2)  In facilities licensed to provide extended congregate
2844	care, persons under contract to the facility or, facility staff,
2845	or volunteers, who are licensed according to part I of chapter
2846	464, or those persons exempt under s. 464.022(1), or those
2847	persons certified as nursing assistants pursuant to part II of
2848	chapter 464, may also perform all duties within the scope of
2849	their license or certification, as approved by the facility
2850	administrator and pursuant to this part.
2851	Section 73.  Subsections (4), (5), (6), and (7) of section
2852	429.28, Florida Statutes, are renumbered as subsections (3),
2853	(4), (5), and (6), respectively, and present subsections (3) and
2854	(6) of that section are amended to read:
2855	429.28  Resident bill of rights.-
2856	(3)(a)  The agency shall conduct a survey to determine
2857	general compliance with facility standards and compliance with
2858	residents' rights as a prerequisite to initial licensure or
2859	licensure renewal.
2860	(b)  In order to determine whether the facility is
2861	adequately protecting residents' rights, the biennial survey
2862	shall include private informal conversations with a sample of
2863	residents and consultation with the ombudsman council in the
2864	planning and service area in which the facility is located to
2865	discuss residents' experiences within the facility.
2866	(c)  During any calendar year in which no survey is
2867	conducted, the agency shall conduct at least one monitoring
2868	visit of each facility cited in the previous year for a class I
2869	or class II violation, or more than three uncorrected class III
2870	violations.
2871	(d)  The agency may conduct periodic followup inspections
2872	as necessary to monitor the compliance of facilities with a
2873	history of any class I, class II, or class III violations that
2874	threaten the health, safety, or security of residents.
2875	(e)  The agency may conduct complaint investigations as
2876	warranted to investigate any allegations of noncompliance with
2877	requirements required under this part or rules adopted under
2878	this part.
2879	(5)(6)  Any facility which terminates the residency of an
2880	individual who participated in activities specified in
2881	subsection (4) (5) shall show good cause in a court of competent
2882	jurisdiction.
2883	Section 74.  Subsection (2) of section 429.35, Florida
2884	Statutes, is amended to read:
2885	429.35  Maintenance of records; reports.-
2886	(2)  Within 60 days after the date of the biennial
2887	inspection visit required under s. 408.811 or within 30 days
2888	after the date of any interim visit, the agency shall forward
2889	the results of the inspection to the local ombudsman council in
2890	whose planning and service area, as defined in part II of
2891	chapter 400, the facility is located; to at least one public
2892	library or, in the absence of a public library, the county seat
2893	in the county in which the inspected assisted living facility is
2894	located; and, when appropriate, to the district Adult Services
2895	and Mental Health Program Offices. This information may be
2896	provided electronically or through the agency's Internet
2897	website.
2898	Section 75.  Paragraphs (i) and (j) of subsection (1) of
2899	section 429.41, Florida Statutes, are amended to read:
2900	429.41  Rules establishing standards.-
2901	(1)  It is the intent of the Legislature that rules
2902	published and enforced pursuant to this section shall include
2903	criteria by which a reasonable and consistent quality of
2904	resident care and quality of life may be ensured and the results
2905	of such resident care may be demonstrated. Such rules shall also
2906	ensure a safe and sanitary environment that is residential and
2907	noninstitutional in design or nature. It is further intended
2908	that reasonable efforts be made to accommodate the needs and
2909	preferences of residents to enhance the quality of life in a
2910	facility. The agency, in consultation with the department, may
2911	adopt rules to administer the requirements of part II of chapter
2912	408. In order to provide safe and sanitary facilities and the
2913	highest quality of resident care accommodating the needs and
2914	preferences of residents, the department, in consultation with
2915	the agency, the Department of Children and Family Services, and
2916	the Department of Health, shall adopt rules, policies, and
2917	procedures to administer this part, which must include
2918	reasonable and fair minimum standards in relation to:
2919	(i)  Facilities holding an a limited nursing, extended
2920	congregate care, or limited mental health license.
2921	(j)  The establishment of specific criteria to define
2922	appropriateness of resident admission and continued residency in
2923	a facility holding a standard, limited nursing, extended
2924	congregate care, and limited mental health license.
2925	Section 76.  Subsections (1) and (2) of section 429.53,
2926	Florida Statutes, are amended to read:
2927	429.53  Consultation by the agency.-
2928	(1)  The area offices of licensure and certification of the
2929	agency shall provide consultation to the following upon request:
2930	(a)  A licensee of a facility.
2931	(b)  A person interested in obtaining a license to operate
2932	a facility under this part.
2933	(2)  As used in this section, "consultation" includes:
2934	(a)  An explanation of the requirements of this part and
2935	rules adopted pursuant thereto;
2936	(b)  An explanation of the license application and renewal
2937	procedures; and
2938	(c)  The provision of a checklist of general local and
2939	state approvals required prior to constructing or developing a
2940	facility and a listing of the types of agencies responsible for
2941	such approvals;
2942	(d)  An explanation of benefits and financial assistance
2943	available to a recipient of supplemental security income
2944	residing in a facility;
2945	(c)(e)  Any other information which the agency deems
2946	necessary to promote compliance with the requirements of this
2947	part; and
2948	(f)  A preconstruction review of a facility to ensure
2949	compliance with agency rules and this part.
2950	Section 77.  Subsections (1) and (2) of section 429.54,
2951	Florida Statutes, are renumbered as subsections (2) and (3),
2952	respectively, and a new subsection (1) is added to that section
2953	to read:
2954	429.54  Collection of information; local subsidy.-
2955	(1)  A facility that is licensed under this part must
2956	report electronically to the agency semiannually data related to
2957	the facility, including, but not limited to, the total number of
2958	residents, the number of residents who are receiving limited
2959	mental health services, the number of residents who are
2960	receiving extended congregate care services, the number of
2961	residents who are receiving limited nursing services, and
2962	professional staffing employed by or under contract with the
2963	licensee to provide resident services. The department, in
2964	consultation with the agency, shall adopt rules to administer
2965	this subsection.
2966	Section 78.  Subsections (1) and (5) of section 429.71,
2967	Florida Statutes, are amended to read:
2968	429.71  Classification of violations deficiencies;
2969	administrative fines.-
2970	(1)  In addition to the requirements of part II of chapter
2971	408 and in addition to any other liability or penalty provided
2972	by law, the agency may impose an administrative fine on a
2973	provider according to the following classification:
2974	(a)  Class I violations are defined in s. 408.813 those
2975	conditions or practices related to the operation and maintenance
2976	of an adult family-care home or to the care of residents which
2977	the agency determines present an imminent danger to the
2978	residents or guests of the facility or a substantial probability
2979	that death or serious physical or emotional harm would result
2980	therefrom. The condition or practice that constitutes a class I
2981	violation must be abated or eliminated within 24 hours, unless a
2982	fixed period, as determined by the agency, is required for
2983	correction. A class I violation deficiency is subject to an
2984	administrative fine in an amount not less than $500 and not
2985	exceeding $1,000 for each violation. A fine may be levied
2986	notwithstanding the correction of the deficiency.
2987	(b)  Class II violations are defined in s. 408.813 those
2988	conditions or practices related to the operation and maintenance
2989	of an adult family-care home or to the care of residents which
2990	the agency determines directly threaten the physical or
2991	emotional health, safety, or security of the residents, other
2992	than class I violations. A class II violation is subject to an
2993	administrative fine in an amount not less than $250 and not
2994	exceeding $500 for each violation. A citation for a class II
2995	violation must specify the time within which the violation is
2996	required to be corrected. If a class II violation is corrected
2997	within the time specified, no civil penalty shall be imposed,
2998	unless it is a repeated offense.
2999	(c)  Class III violations are defined in s. 408.813 those
3000	conditions or practices related to the operation and maintenance
3001	of an adult family-care home or to the care of residents which
3002	the agency determines indirectly or potentially threaten the
3003	physical or emotional health, safety, or security of residents,
3004	other than class I or class II violations. A class III violation
3005	is subject to an administrative fine in an amount not less than
3006	$100 and not exceeding $250 for each violation. A citation for a
3007	class III violation shall specify the time within which the
3008	violation is required to be corrected. If a class III violation
3009	is corrected within the time specified, no civil penalty shall
3010	be imposed, unless it is a repeated violation offense.
3011	(d)  Class IV violations are defined in s. 408.813 those
3012	conditions or occurrences related to the operation and
3013	maintenance of an adult family-care home, or related to the
3014	required reports, forms, or documents, which do not have the
3015	potential of negatively affecting the residents. A provider that
3016	does not correct A class IV violation within the time limit
3017	specified by the agency is subject to an administrative fine in
3018	an amount not less than $50 and not exceeding $100 for each
3019	violation. Any class IV violation that is corrected during the
3020	time the agency survey is conducted will be identified as an
3021	agency finding and not as a violation, unless it is a repeat
3022	violation.
3023	(5)  As an alternative to or in conjunction with an
3024	administrative action against a provider, the agency may request
3025	a plan of corrective action that demonstrates a good faith
3026	effort to remedy each violation by a specific date, subject to
3027	the approval of the agency.
3028	Section 79.  Paragraphs (b) through (e) of subsection (2)
3029	of section 429.911, Florida Statutes, are redesignated as
3030	paragraphs (a) through (d), respectively, and present paragraph
3031	(a) of that subsection is amended to read:
3032	429.911  Denial, suspension, revocation of license;
3033	emergency action; administrative fines; investigations and
3034	inspections.-
3035	(2)  Each of the following actions by the owner of an adult
3036	day care center or by its operator or employee is a ground for
3037	action by the agency against the owner of the center or its
3038	operator or employee:
3039	(a)  An intentional or negligent act materially affecting
3040	the health or safety of center participants.
3041	Section 80.  Section 429.915, Florida Statutes, is amended
3042	to read:
3043	429.915  Conditional license.-In addition to the license
3044	categories available in part II of chapter 408, the agency may
3045	issue a conditional license to an applicant for license renewal
3046	or change of ownership if the applicant fails to meet all
3047	standards and requirements for licensure. A conditional license
3048	issued under this subsection must be limited to a specific
3049	period not exceeding 6 months, as determined by the agency, and
3050	must be accompanied by an approved plan of correction.
3051	Section 81.  Paragraphs (b) and (g) of subsection (3) of
3052	section 430.80, Florida Statutes, are amended to read:
3053	430.80  Implementation of a teaching nursing home pilot
3054	project.-
3055	(3)  To be designated as a teaching nursing home, a nursing
3056	home licensee must, at a minimum:
3057	(b)  Participate in a nationally recognized accreditation
3058	program and hold a valid accreditation, such as the
3059	accreditation awarded by the Joint Commission on Accreditation
3060	of Healthcare Organizations, or, at the time of initial
3061	designation, possess a Gold Seal Award as conferred by the state
3062	on its licensed nursing home;
3063	(g)  Maintain insurance coverage pursuant to s.
3064	400.141(1)(q)(s) or proof of financial responsibility in a
3065	minimum amount of $750,000. Such proof of financial
3066	responsibility may include:
3067	1.  Maintaining an escrow account consisting of cash or
3068	assets eligible for deposit in accordance with s. 625.52; or
3069	2.  Obtaining and maintaining pursuant to chapter 675 an
3070	unexpired, irrevocable, nontransferable and nonassignable letter
3071	of credit issued by any bank or savings association organized
3072	and existing under the laws of this state or any bank or savings
3073	association organized under the laws of the United States that
3074	has its principal place of business in this state or has a
3075	branch office which is authorized to receive deposits in this
3076	state. The letter of credit shall be used to satisfy the
3077	obligation of the facility to the claimant upon presentment of a
3078	final judgment indicating liability and awarding damages to be
3079	paid by the facility or upon presentment of a settlement
3080	agreement signed by all parties to the agreement when such final
3081	judgment or settlement is a result of a liability claim against
3082	the facility.
3083	Section 82.  Paragraph (a) of subsection (2) of section
3084	440.13, Florida Statutes, is amended to read:
3085	440.13  Medical services and supplies; penalty for
3086	violations; limitations.-
3087	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3088	(a)  Subject to the limitations specified elsewhere in this
3089	chapter, the employer shall furnish to the employee such
3090	medically necessary remedial treatment, care, and attendance for
3091	such period as the nature of the injury or the process of
3092	recovery may require, which is in accordance with established
3093	practice parameters and protocols of treatment as provided for
3094	in this chapter, including medicines, medical supplies, durable
3095	medical equipment, orthoses, prostheses, and other medically
3096	necessary apparatus. Remedial treatment, care, and attendance,
3097	including work-hardening programs or pain-management programs
3098	accredited by the Commission on Accreditation of Rehabilitation
3099	Facilities or the Joint Commission on the Accreditation of
3100	Health Organizations or pain-management programs affiliated with
3101	medical schools, shall be considered as covered treatment only
3102	when such care is given based on a referral by a physician as
3103	defined in this chapter. Medically necessary treatment, care,
3104	and attendance does not include chiropractic services in excess
3105	of 24 treatments or rendered 12 weeks beyond the date of the
3106	initial chiropractic treatment, whichever comes first, unless
3107	the carrier authorizes additional treatment or the employee is
3108	catastrophically injured.
3109
3110	Failure of the carrier to timely comply with this subsection
3111	shall be a violation of this chapter and the carrier shall be
3112	subject to penalties as provided for in s. 440.525.
3113	Section 83.  Section 483.294, Florida Statutes, is amended
3114	to read:
3115	483.294  Inspection of centers.-In accordance with s.
3116	408.811, the agency shall biennially, at least once annually,
3117	inspect the premises and operations of all centers subject to
3118	licensure under this part.
3119	Section 84.  Subsection (4) is added to section 626.9541,
3120	Florida Statutes, to read:
3121	626.9541  Unfair methods of competition and unfair or
3122	deceptive acts or practices defined; alternative rates of
3123	payment; wellness programs.-
3124	(4)  WELLNESS PROGRAMS.-An insurer issuing a group or
3125	individual health benefit plan may offer a voluntary wellness or
3126	health-improvement program that allows for rewards or
3127	incentives, including, but not limited to, merchandise, gift
3128	cards, debit cards, premium discounts or rebates, contributions
3129	towards a member's health savings account, modifications to
3130	copayment, deductible, or coinsurance amounts, or any
3131	combination of these incentives, to encourage or reward
3132	participation in the program. The health plan member may be
3133	required to provide verification, such as a statement from his
3134	or her physician, that a medical condition makes it unreasonably
3135	difficult or medically inadvisable for the individual to
3136	participate in the wellness program. Any reward or incentive
3137	established under this subsection is not an insurance benefit
3138	and does not violate this section. This subsection does not
3139	prohibit an insurer from offering incentives or rewards to
3140	members for adherence to wellness or health improvement programs
3141	if otherwise allowed by state or federal law. Notwithstanding
3142	any provision of this subsection, no insurer, nor its agent, may
3143	use any incentive authorized by this subsection for the purpose
3144	of redirecting patients from one health care insurance plan to
3145	another.
3146	Section 85.  Subsection (1) of section 627.645, Florida
3147	Statutes, is amended to read:
3148	627.645  Denial of health insurance claims restricted.-
3149	(1)  No claim for payment under a health insurance policy
3150	or self-insured program of health benefits for treatment, care,
3151	or services in a licensed hospital which is accredited by the
3152	Joint Commission on the Accreditation of Hospitals, the American
3153	Osteopathic Association, or the Commission on the Accreditation
3154	of Rehabilitative Facilities shall be denied because such
3155	hospital lacks major surgical facilities and is primarily of a
3156	rehabilitative nature, if such rehabilitation is specifically
3157	for treatment of physical disability.
3158	Section 86.  Paragraph (c) of subsection (2) of section
3159	627.668, Florida Statutes, is amended to read:
3160	627.668  Optional coverage for mental and nervous disorders
3161	required; exception.-
3162	(2)  Under group policies or contracts, inpatient hospital
3163	benefits, partial hospitalization benefits, and outpatient
3164	benefits consisting of durational limits, dollar amounts,
3165	deductibles, and coinsurance factors shall not be less favorable
3166	than for physical illness generally, except that:
3167	(c)  Partial hospitalization benefits shall be provided
3168	under the direction of a licensed physician. For purposes of
3169	this part, the term "partial hospitalization services" is
3170	defined as those services offered by a program accredited by the
3171	Joint Commission on Accreditation of Hospitals (JCAH) or in
3172	compliance with equivalent standards. Alcohol rehabilitation
3173	programs accredited by the Joint Commission on Accreditation of
3174	Hospitals or approved by the state and licensed drug abuse
3175	rehabilitation programs shall also be qualified providers under
3176	this section. In any benefit year, if partial hospitalization
3177	services or a combination of inpatient and partial
3178	hospitalization are utilized, the total benefits paid for all
3179	such services shall not exceed the cost of 30 days of inpatient
3180	hospitalization for psychiatric services, including physician
3181	fees, which prevail in the community in which the partial
3182	hospitalization services are rendered. If partial
3183	hospitalization services benefits are provided beyond the limits
3184	set forth in this paragraph, the durational limits, dollar
3185	amounts, and coinsurance factors thereof need not be the same as
3186	those applicable to physical illness generally.
3187	Section 87.  Subsection (3) of section 627.669, Florida
3188	Statutes, is amended to read:
3189	627.669  Optional coverage required for substance abuse
3190	impaired persons; exception.-
3191	(3)  The benefits provided under this section shall be
3192	applicable only if treatment is provided by, or under the
3193	supervision of, or is prescribed by, a licensed physician or
3194	licensed psychologist and if services are provided in a program
3195	accredited by the Joint Commission on Accreditation of Hospitals
3196	or approved by the state.
3197	Section 88.  Paragraph (a) of subsection (1) of section
3198	627.736, Florida Statutes, is amended to read:
3199	627.736  Required personal injury protection benefits;
3200	exclusions; priority; claims.-
3201	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3202	with the security requirements of s. 627.733 shall provide
3203	personal injury protection to the named insured, relatives
3204	residing in the same household, persons operating the insured
3205	motor vehicle, passengers in such motor vehicle, and other
3206	persons struck by such motor vehicle and suffering bodily injury
3207	while not an occupant of a self-propelled vehicle, subject to
3208	the provisions of subsection (2) and paragraph (4)(e), to a
3209	limit of $10,000 for loss sustained by any such person as a
3210	result of bodily injury, sickness, disease, or death arising out
3211	of the ownership, maintenance, or use of a motor vehicle as
3212	follows:
3213	(a)  Medical benefits.-Eighty percent of all reasonable
3214	expenses for medically necessary medical, surgical, X-ray,
3215	dental, and rehabilitative services, including prosthetic
3216	devices, and medically necessary ambulance, hospital, and
3217	nursing services. However, the medical benefits shall provide
3218	reimbursement only for such services and care that are lawfully
3219	provided, supervised, ordered, or prescribed by a physician
3220	licensed under chapter 458 or chapter 459, a dentist licensed
3221	under chapter 466, or a chiropractic physician licensed under
3222	chapter 460 or that are provided by any of the following persons
3223	or entities:
3224	1.  A hospital or ambulatory surgical center licensed under
3225	chapter 395.
3226	2.  A person or entity licensed under ss. 401.2101-401.45
3227	that provides emergency transportation and treatment.
3228	3.  An entity wholly owned by one or more physicians
3229	licensed under chapter 458 or chapter 459, chiropractic
3230	physicians licensed under chapter 460, or dentists licensed
3231	under chapter 466 or by such practitioner or practitioners and
3232	the spouse, parent, child, or sibling of that practitioner or
3233	those practitioners.
3234	4.  An entity wholly owned, directly or indirectly, by a
3235	hospital or hospitals.
3236	5.  A health care clinic licensed under ss. 400.990-400.995
3237	that is:
3238	a.  Accredited by the Joint Commission on Accreditation of
3239	Healthcare Organizations, the American Osteopathic Association,
3240	the Commission on Accreditation of Rehabilitation Facilities, or
3241	the Accreditation Association for Ambulatory Health Care, Inc.;
3242	or
3243	b.  A health care clinic that:
3244	(I)  Has a medical director licensed under chapter 458,
3245	chapter 459, or chapter 460;
3246	(II)  Has been continuously licensed for more than 3 years
3247	or is a publicly traded corporation that issues securities
3248	traded on an exchange registered with the United States
3249	Securities and Exchange Commission as a national securities
3250	exchange; and
3251	(III)  Provides at least four of the following medical
3252	specialties:
3253	(A)  General medicine.
3254	(B)  Radiography.
3255	(C)  Orthopedic medicine.
3256	(D)  Physical medicine.
3257	(E)  Physical therapy.
3258	(F)  Physical rehabilitation.
3259	(G)  Prescribing or dispensing outpatient prescription
3260	medication.
3261	(H)  Laboratory services.
3262
3263	The Financial Services Commission shall adopt by rule the form
3264	that must be used by an insurer and a health care provider
3265	specified in subparagraph 3., subparagraph 4., or subparagraph
3266	5. to document that the health care provider meets the criteria
3267	of this paragraph, which rule must include a requirement for a
3268	sworn statement or affidavit.
3269
3270	Only insurers writing motor vehicle liability insurance in this
3271	state may provide the required benefits of this section, and no
3272	such insurer shall require the purchase of any other motor
3273	vehicle coverage other than the purchase of property damage
3274	liability coverage as required by s. 627.7275 as a condition for
3275	providing such required benefits. Insurers may not require that
3276	property damage liability insurance in an amount greater than
3277	$10,000 be purchased in conjunction with personal injury
3278	protection. Such insurers shall make benefits and required
3279	property damage liability insurance coverage available through
3280	normal marketing channels. Any insurer writing motor vehicle
3281	liability insurance in this state who fails to comply with such
3282	availability requirement as a general business practice shall be
3283	deemed to have violated part IX of chapter 626, and such
3284	violation shall constitute an unfair method of competition or an
3285	unfair or deceptive act or practice involving the business of
3286	insurance; and any such insurer committing such violation shall
3287	be subject to the penalties afforded in such part, as well as
3288	those which may be afforded elsewhere in the insurance code.
3289	Section 89.  Section 633.081, Florida Statutes, is amended
3290	to read:
3291	633.081  Inspection of buildings and equipment; orders;
3292	firesafety inspection training requirements; certification;
3293	disciplinary action.-The State Fire Marshal and her or his
3294	agents shall, at any reasonable hour, when the State Fire
3295	Marshal has reasonable cause to believe that a violation of this
3296	chapter or s. 509.215, or a rule promulgated thereunder, or a
3297	minimum firesafety code adopted by a local authority, may exist,
3298	inspect any and all buildings and structures which are subject
3299	to the requirements of this chapter or s. 509.215 and rules
3300	promulgated thereunder. The authority to inspect shall extend to
3301	all equipment, vehicles, and chemicals which are located within
3302	the premises of any such building or structure. The State Fire
3303	Marshal and her or his agents shall inspect nursing homes
3304	licensed under part II of chapter 400 only once every calendar
3305	year and upon receiving a complaint forming the basis of a
3306	reasonable cause to believe that a violation of this chapter or
3307	s. 509.215, or a rule promulgated thereunder, or a minimum
3308	firesafety code adopted by a local authority may exist and upon
3309	identifying such a violation in the course of conducting
3310	orientation or training activities within a nursing home.
3311	(1)  Each county, municipality, and special district that
3312	has firesafety enforcement responsibilities shall employ or
3313	contract with a firesafety inspector. Except as provided in s.
3314	633.082(2), the firesafety inspector must conduct all firesafety
3315	inspections that are required by law. The governing body of a
3316	county, municipality, or special district that has firesafety
3317	enforcement responsibilities may provide a schedule of fees to
3318	pay only the costs of inspections conducted pursuant to this
3319	subsection and related administrative expenses. Two or more
3320	counties, municipalities, or special districts that have
3321	firesafety enforcement responsibilities may jointly employ or
3322	contract with a firesafety inspector.
3323	(2)  Except as provided in s. 633.082(2), every firesafety
3324	inspection conducted pursuant to state or local firesafety
3325	requirements shall be by a person certified as having met the
3326	inspection training requirements set by the State Fire Marshal.
3327	Such person shall:
3328	(a)  Be a high school graduate or the equivalent as
3329	determined by the department;
3330	(b)  Not have been found guilty of, or having pleaded
3331	guilty or nolo contendere to, a felony or a crime punishable by
3332	imprisonment of 1 year or more under the law of the United
3333	States, or of any state thereof, which involves moral turpitude,
3334	without regard to whether a judgment of conviction has been
3335	entered by the court having jurisdiction of such cases;
3336	(c)  Have her or his fingerprints on file with the
3337	department or with an agency designated by the department;
3338	(d)  Have good moral character as determined by the
3339	department;
3340	(e)  Be at least 18 years of age;
3341	(f)  Have satisfactorily completed the firesafety inspector
3342	certification examination as prescribed by the department; and
3343	(g)1.  Have satisfactorily completed, as determined by the
3344	department, a firesafety inspector training program of not less
3345	than 200 hours established by the department and administered by
3346	agencies and institutions approved by the department for the
3347	purpose of providing basic certification training for firesafety
3348	inspectors; or
3349	2.  Have received in another state training which is
3350	determined by the department to be at least equivalent to that
3351	required by the department for approved firesafety inspector
3352	education and training programs in this state.
3353	(3)  Each special state firesafety inspection which is
3354	required by law and is conducted by or on behalf of an agency of
3355	the state must be performed by an individual who has met the
3356	provision of subsection (2), except that the duration of the
3357	training program shall not exceed 120 hours of specific training
3358	for the type of property that such special state firesafety
3359	inspectors are assigned to inspect.
3360	(4)  A firefighter certified pursuant to s. 633.35 may
3361	conduct firesafety inspections, under the supervision of a
3362	certified firesafety inspector, while on duty as a member of a
3363	fire department company conducting inservice firesafety
3364	inspections without being certified as a firesafety inspector,
3365	if such firefighter has satisfactorily completed an inservice
3366	fire department company inspector training program of at least
3367	24 hours' duration as provided by rule of the department.
3368	(5)  Every firesafety inspector or special state firesafety
3369	inspector certificate is valid for a period of 3 years from the
3370	date of issuance. Renewal of certification shall be subject to
3371	the affected person's completing proper application for renewal
3372	and meeting all of the requirements for renewal as established
3373	under this chapter or by rule promulgated thereunder, which
3374	shall include completion of at least 40 hours during the
3375	preceding 3-year period of continuing education as required by
3376	the rule of the department or, in lieu thereof, successful
3377	passage of an examination as established by the department.
3378	(6)  The State Fire Marshal may deny, refuse to renew,
3379	suspend, or revoke the certificate of a firesafety inspector or
3380	special state firesafety inspector if it finds that any of the
3381	following grounds exist:
3382	(a)  Any cause for which issuance of a certificate could
3383	have been refused had it then existed and been known to the
3384	State Fire Marshal.
3385	(b)  Violation of this chapter or any rule or order of the
3386	State Fire Marshal.
3387	(c)  Falsification of records relating to the certificate.
3388	(d)  Having been found guilty of or having pleaded guilty
3389	or nolo contendere to a felony, whether or not a judgment of
3390	conviction has been entered.
3391	(e)  Failure to meet any of the renewal requirements.
3392	(f)  Having been convicted of a crime in any jurisdiction
3393	which directly relates to the practice of fire code inspection,
3394	plan review, or administration.
3395	(g)  Making or filing a report or record that the
3396	certificateholder knows to be false, or knowingly inducing
3397	another to file a false report or record, or knowingly failing
3398	to file a report or record required by state or local law, or
3399	knowingly impeding or obstructing such filing, or knowingly
3400	inducing another person to impede or obstruct such filing.
3401	(h)  Failing to properly enforce applicable fire codes or
3402	permit requirements within this state which the
3403	certificateholder knows are applicable by committing willful
3404	misconduct, gross negligence, gross misconduct, repeated
3405	negligence, or negligence resulting in a significant danger to
3406	life or property.
3407	(i)  Accepting labor, services, or materials at no charge
3408	or at a noncompetitive rate from any person who performs work
3409	that is under the enforcement authority of the certificateholder
3410	and who is not an immediate family member of the
3411	certificateholder. For the purpose of this paragraph, the term
3412	"immediate family member" means a spouse, child, parent,
3413	sibling, grandparent, aunt, uncle, or first cousin of the person
3414	or the person's spouse or any person who resides in the primary
3415	residence of the certificateholder.
3416	(7)  The Division of State Fire Marshal and the Florida
3417	Building Code Administrators and Inspectors Board, established
3418	pursuant to s. 468.605, shall enter into a reciprocity agreement
3419	to facilitate joint recognition of continuing education
3420	recertification hours for certificateholders licensed under s.
3421	468.609 and firesafety inspectors certified under subsection
3422	(2).
3423	(8)  The State Fire Marshal shall develop by rule an
3424	advanced training and certification program for firesafety
3425	inspectors having fire code management responsibilities. The
3426	program must be consistent with the appropriate provisions of
3427	NFPA 1037, or similar standards adopted by the division, and
3428	establish minimum training, education, and experience levels for
3429	firesafety inspectors having fire code management
3430	responsibilities.
3431	(9)  The department shall provide by rule for the
3432	certification of firesafety inspectors.
3433	Section 90.  Subsection (12) of section 641.495, Florida
3434	Statutes, is amended to read:
3435	641.495  Requirements for issuance and maintenance of
3436	certificate.-
3437	(12)  The provisions of part I of chapter 395 do not apply
3438	to a health maintenance organization that, on or before January
3439	1, 1991, provides not more than 10 outpatient holding beds for
3440	short-term and hospice-type patients in an ambulatory care
3441	facility for its members, provided that such health maintenance
3442	organization maintains current accreditation by the Joint
3443	Commission on Accreditation of Health Care Organizations, the
3444	Accreditation Association for Ambulatory Health Care, or the
3445	National Committee for Quality Assurance.
3446	Section 91.  Subsection (13) of section 651.118, Florida
3447	Statutes, is amended to read:
3448	651.118  Agency for Health Care Administration;
3449	certificates of need; sheltered beds; community beds.-
3450	(13)  Residents, as defined in this chapter, are not
3451	considered new admissions for the purpose of s.
3452	400.141(1)(n)(o)1.d.
3453	Section 92.  Subsection (2) of section 766.1015, Florida
3454	Statutes, is amended to read:
3455	766.1015  Civil immunity for members of or consultants to
3456	certain boards, committees, or other entities.-
3457	(2)  Such committee, board, group, commission, or other
3458	entity must be established in accordance with state law or in
3459	accordance with requirements of the Joint Commission on
3460	Accreditation of Healthcare Organizations, established and duly
3461	constituted by one or more public or licensed private hospitals
3462	or behavioral health agencies, or established by a governmental
3463	agency. To be protected by this section, the act, decision,
3464	omission, or utterance may not be made or done in bad faith or
3465	with malicious intent.
3466	Section 93.  Subsection (4) of section 766.202, Florida
3467	Statutes, is amended to read:
3468	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3469	766.201-766.212, the term:
3470	(4)  "Health care provider" means any hospital, ambulatory
3471	surgical center, or mobile surgical facility as defined and
3472	licensed under chapter 395; a birth center licensed under
3473	chapter 383; any person licensed under chapter 458, chapter 459,
3474	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3475	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3476	or chapter 486; a clinical lab licensed under chapter 483; a
3477	health maintenance organization certificated under part I of
3478	chapter 641; a blood bank; a plasma center; an industrial
3479	clinic; a renal dialysis facility; or a professional association
3480	partnership, corporation, joint venture, or other association
3481	for professional activity by health care providers.
3482	Section 94.  This act shall take effect July 1, 2011.

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