CS/HB 119

1	A bill to be entitled
2	An act relating to health care; amending s. 83.42, F.S.,
3	establishing that s. 400.0255, F.S., provides exclusive
4	procedures for resident transfer and discharge; amending
5	s. 112.0455, F.S., relating to the Drug-Free Workplace
6	Act; deleting an obsolete provision; deleting a
7	requirement that a laboratory that conducts drug tests
8	submit certain reports to the Agency for Health Care
9	Administration; amending s. 318.21, F.S.; revising
10	distribution of funds from civil penalties imposed for
11	traffic infractions by county courts; repealing s.
12	383.325, F.S., relating to confidentiality of inspection
13	reports of licensed birth center facilities; amending s.
14	395.002, F.S.; revising and deleting definitions
15	applicable to regulation of hospitals and other licensed
16	facilities; conforming a cross-reference; amending s.
17	395.003, F.S.; deleting an obsolete provision; conforming
18	a cross-reference; amending s. 395.0161, F.S.; deleting a
19	provision requiring licensure inspection fees for
20	hospitals, ambulatory surgical centers, and mobile
21	surgical facilities to be paid at the time of the
22	inspection; amending s. 395.0193, F.S.; requiring a
23	licensed facility to report certain peer review
24	information and final disciplinary actions to the Division
25	of Medical Quality Assurance of the Department of Health
26	rather than the Division of Health Quality Assurance of
27	the Agency for Health Care Administration; amending s.
28	395.1023, F.S.; providing for the Department of Children
29	and Family Services rather than the Department of Health
30	to perform certain functions with respect to child
31	protection cases; requiring certain hospitals to notify
32	the Department of Children and Family Services of
33	compliance; amending s. 395.1041, F.S., relating to
34	hospital emergency services and care; deleting obsolete
35	provisions; repealing s. 395.1046, F.S., relating to
36	complaint investigation procedures; amending s. 395.1055,
37	F.S.; requiring licensed facility beds to conform to
38	standards specified by the Agency for Health Care
39	Administration, the Florida Building Code, and the Florida
40	Fire Prevention Code; amending s. 395.10972, F.S.;
41	revising a reference to the Florida Society of Healthcare
42	Risk Management to conform to the current designation;
43	amending s. 395.2050, F.S.; revising a reference to the
44	federal Health Care Financing Administration to conform to
45	the current designation; amending s. 395.3036, F.S.;
46	correcting a reference; repealing s. 395.3037, F.S.,
47	relating to redundant definitions; amending ss. 154.11,
48	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
49	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
50	F.S.; revising references to the Joint Commission on
51	Accreditation of Healthcare Organizations, the Commission
52	on Accreditation of Rehabilitation Facilities, and the
53	Council on Accreditation to conform to their current
54	designations; amending s. 395.602, F.S.; revising the
55	definition of the term "rural hospital" to delete an
56	obsolete provision; amending s. 400.021, F.S.; revising
57	the definition of the term "geriatric outpatient clinic"
58	to include additional staff; revising the term "resident
59	care plan"; removing a provision that requires certain
60	signatures on the plan; amending s. 400.0255, F.S.;
61	correcting an obsolete cross-reference to administrative
62	rules; amending s. 400.063, F.S.; deleting an obsolete
63	provision; amending ss. 400.071 and 400.0712, F.S.;
64	revising applicability of general licensure requirements
65	under part II of ch. 408, F.S., the Health Care Licensing
66	Procedures Act, to applications for nursing home
67	licensure; revising provisions governing inactive
68	licenses; amending s. 400.111, F.S.; providing for
69	disclosure of controlling interest of a nursing home
70	facility upon request by the Agency for Health Care
71	Administration; amending s. 400.1183, F.S.; revising
72	grievance record maintenance and reporting requirements
73	for nursing homes; amending s. 400.141, F.S.; providing
74	criteria for the provision of respite services by nursing
75	homes; requiring a written plan of care; requiring a
76	contract for services; requiring resident release to
77	caregivers to be designated in writing; providing an
78	exemption to the application of discharge planning rules;
79	providing for residents' rights; providing for use of
80	personal medications; providing terms of respite stay;
81	providing for communication of patient information;
82	requiring a physician's order for care and proof of a
83	physical examination; providing for services for respite
84	patients and duties of facilities with respect to such
85	patients; conforming a cross-reference; requiring
86	facilities to maintain clinical records that meet
87	specified standards; providing a fine relating to an
88	admissions moratorium; deleting requirement for facilities
89	to submit certain information related to management
90	companies to the agency; deleting a requirement for
91	facilities to notify the agency of certain bankruptcy
92	filings to conform to changes made by the act; providing a
93	limit on fees charged by a facility for copies of patient
94	records; amending s. 400.142, F.S.; deleting language
95	relating to agency adoption of rules; repealing s.
96	400.145, F.S., relating to records of care and treatment
97	of residents; repealing ss. 400.0234 and 429.294, F.S.,
98	relating to availability of facility records for
99	investigation of resident's rights violations and
100	defenses; amending 400.147, F.S.; revising reporting
101	requirements for licensed nursing home facilities relating
102	to adverse incidents; repealing s. 400.148, F.S., relating
103	to the Medicaid "Up-or-Out" Quality of Care Contract
104	Management Program; amending s. 400.179, F.S.; deleting an
105	obsolete provision; amending s. 400.19, F.S.; revising
106	inspection requirements; amending s. 400.23, F.S.;
107	deleting an obsolete provision; correcting a reference;
108	directing the agency to adopt rules for minimum staffing
109	standards in nursing homes that serve persons under 21
110	years of age; providing minimum staffing standards;
111	amending s. 400.275, F.S.; revising agency duties with
112	regard to training nursing home surveyor teams; revising
113	requirements for team members; amending s. 400.484, F.S.;
114	revising the schedule of home health agency inspection
115	violations; amending s. 400.506, F.S.; deleting language
116	relating to exemptions from penalties imposed on nurse
117	registries if a nurse registry does not bill the Florida
118	Medicaid Program; providing criteria for an administrator
119	to manage a nurse registry; amending s. 400.509, F.S.;
120	revising the service providers exempt from licensure
121	registration to include organizations that provide
122	companion services only for persons with developmental
123	disabilities; amending s. 400.606, F.S.; revising the
124	content requirements of the plan accompanying an initial
125	or change-of-ownership application for licensure of a
126	hospice; revising requirements relating to certificates of
127	need for certain hospice facilities; amending s. 400.607,
128	F.S.; revising grounds for agency action against a
129	hospice; amending s. 400.915, F.S.; correcting an obsolete
130	cross-reference to administrative rules; amending s.
131	400.931, F.S.; deleting a requirement that an applicant
132	for a home medical equipment provider license submit a
133	surety bond to the agency; requiring applicants to submit
134	documentation of accreditation within a specified period
135	of time; amending s. 400.932, F.S.; revising grounds for
136	the imposition of administrative penalties for certain
137	violations by an employee of a home medical equipment
138	provider; amending s. 400.967, F.S.; revising the schedule
139	of inspection violations for intermediate care facilities
140	for the developmentally disabled; providing a penalty for
141	certain violations; amending s. 400.9905, F.S.; revising
142	the definitions of the terms "clinic" and "portable
143	equipment provider"; providing that part X of ch. 400,
144	F.S., the Health Care Clinic Act, does not apply to
145	certain clinical facilities, an entity owned by a
146	corporation with a specified amount of annual sales of
147	health care services under certain circumstances, or an
148	entity owned or controlled by a publicly traded entity
149	with a specified amount of annual revenues; amending s.
150	400.991, F.S.; conforming terminology; revising
151	application requirements relating to documentation of
152	financial ability to operate a mobile clinic; amending s.
153	408.033, F.S.; permitting fees assessed on certain health
154	care facilities to be collected prospectively at the time
155	of licensure renewal and prorated for the licensure
156	period; amending s. 408.034, F.S.; revising agency
157	authority relating to licensing of intermediate care
158	facilities for the developmentally disabled; amending s.
159	408.036, F.S.; deleting an exemption from certain
160	certificate-of-need review requirements for a hospice or a
161	hospice inpatient facility; deleting a requirement that
162	the agency submit a report regarding requests for
163	exemption; amending s. 408.037, F.S.; revising
164	certificate-of-need requirements for general hospital
165	applicants to evaluate the applicant's parent corporation
166	if audited financial statements of the applicant do not
167	exist; amending s. 408.043, F.S.; revising requirements
168	for certain freestanding inpatient hospice care facilities
169	to obtain a certificate of need; amending s. 408.061,
170	F.S.; revising health care facility data reporting
171	requirements; amending s. 408.10, F.S.; removing agency
172	authority to investigate certain consumer complaints;
173	amending s. 408.802, F.S.; removing applicability of part
174	II of ch. 408, F.S., relating to general licensure
175	requirements, to private review agents; amending s.
176	408.804, F.S.; providing penalties for altering, defacing,
177	or falsifying a license certificate issued by the agency
178	or displaying such an altered, defaced, or falsified
179	certificate; amending s. 408.806, F.S.; revising agency
180	responsibilities for notification of licensees of
181	impending expiration of a license; requiring payment of a
182	late fee for a license application to be considered
183	complete under certain circumstances; amending s.
184	408.8065, F.S.; requiring home health agencies, home
185	medical equipment providers, and health care clinics to
186	submit projected financial statements; amending s.
187	408.809, F.S., relating to background screening of
188	specified employees of health care providers; revising
189	provisions for required rescreening; removing provisions
190	authorizing the agency to adopt rules establishing a
191	rescreening schedule; establishing a rescreening schedule;
192	amending s. 408.810, F.S.; requiring disclosure of
193	information by a controlling interest of certain court
194	actions relating to financial instability within a
195	specified time period; amending s. 408.813, F.S.;
196	authorizing the agency to impose fines for unclassified
197	violations of part II of ch. 408, F.S.; amending s.
198	408.815, F.S.; authorizing the agency to extend a license
199	expiration date under certain circumstances; amending s.
200	409.91196, F.S.; conforming a cross-reference; amending s.
201	409.912, F.S.; revising procedures for implementation of a
202	Medicaid prescribed-drug spending-control program;
203	amending s. 429.07, F.S.; deleting the requirement for an
204	assisted living facility to obtain an additional license
205	in order to provide limited nursing services; deleting the
206	requirement for the agency to conduct quarterly monitoring
207	visits of facilities that hold a license to provide
208	extended congregate care services; deleting the
209	requirement for the department to report annually on the
210	status of and recommendations related to extended
211	congregate care; deleting the requirement for the agency
212	to conduct monitoring visits at least twice a year to
213	facilities providing limited nursing services; increasing
214	the per resident licensure fees required for the standard
215	license; eliminating the license fee for the limited
216	nursing services license; transferring from another
217	provision of law the requirement that the standard survey
218	of an assisted living facility include specific actions to
219	determine whether the facility is adequately protecting
220	residents' rights; providing that under specified
221	conditions an assisted living facility that has a class I
222	or class II violation is subject to periodic unannounced
223	monitoring; requiring a registered nurse to participate in
224	certain monitoring visits; amending s. 429.11, F.S.;
225	revising licensure application requirements for assisted
226	living facilities to eliminate provisional licenses;
227	amending s. 429.12, F.S.; deleting a requirement that a
228	transferor of an assisted living facility advise the
229	transferee to submit a plan for correction of certain
230	deficiencies to the Agency for Health Care Administration
231	before ownership of the facility is transferred; amending
232	s. 429.14, F.S.; clarifying provisions relating to a
233	facility's request for a hearing under certain
234	circumstances; amending s. 429.17, F.S.; deleting
235	provisions relating to the limited nursing services
236	license; revising agency responsibilities regarding the
237	issuance of conditional licenses; amending s. 429.23,
238	F.S.; deleting reporting requirements for assisted living
239	facilities relating to liability claims; amending s.
240	429.255, F.S.; eliminating provisions authorizing the use
241	of volunteers to provide certain health-care-related
242	services in assisted living facilities; authorizing
243	assisted living facilities to provide limited nursing
244	services; requiring an assisted living facility to be
245	responsible for certain recordkeeping and staff to be
246	trained to monitor residents receiving certain health-
247	care-related services; amending s. 429.28, F.S.; deleting
248	a requirement for a biennial survey of an assisted living
249	facility, to conform to changes made by the act;
250	conforming a cross-reference; amending s. 429.41, F.S.,
251	relating to rulemaking; conforming provisions to changes
252	made by the act; deleting the requirement for the
253	Department of Elderly Affairs to submit a copy of proposed
254	rules to the Legislature; amending s. 429.53, F.S.;
255	revising provisions relating to consultation by the
256	agency; revising a definition; amending s. 429.71, F.S.;
257	revising schedule of inspection violations for adult
258	family-care homes; amending s. 429.915, F.S.; revising
259	agency responsibilities regarding the issuance of
260	conditional licenses; amending s. 440.102, F.S.; deleting
261	the requirement for laboratories to submit a monthly
262	report to the agency with statistical information
263	regarding the testing of employees and job applicants;
264	amending s. 483.035, F.S.; requiring certain clinical
265	laboratories operated by one or more practitioners
266	licensed under part I of ch. 464, F.S., the Nurse Practice
267	Act, to be licensed under part I of ch. 483, F.S., the
268	Florida Clinical Laboratory Law; amending s. 483.051,
269	F.S.; establishing qualifications necessary for clinical
270	laboratory licensure; amending s. 483.294, F.S.; revising
271	frequency of agency inspections of multiphasic health
272	testing centers; amending s. 626.9541, F.S.; authorizing
273	an insurer offering a group or individual health benefit
274	plan to offer a wellness program; authorizing rewards or
275	incentives; providing for verification of a member's
276	inability to participate for medical reasons; providing
277	that such rewards or incentives are not insurance
278	benefits; amending s. 633.081, F.S.; limiting State Fire
279	Marshal inspections of nursing homes to once a year;
280	providing for additional inspections based on complaints
281	and violations identified in the course of orientation or
282	training activities; amending s. 766.202, F.S.; adding
283	persons licensed under part XIV of ch. 468, F.S., relating
284	to orthotics, prosthetics, and pedorthics, to the
285	definition of "health care provider"; amending ss.
286	394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
287	conforming terminology and references to changes made by
288	the act; revising a reference; providing an effective
289	date.
290
291	Be It Enacted by the Legislature of the State of Florida:
292
293	Section 1.  Subsection (1) of section 83.42, Florida
294	Statutes, is amended to read:
295	83.42  Exclusions from application of part.-This part does
296	not apply to:
297	(1)  Residency or detention in a facility, whether public
298	or private, when residence or detention is incidental to the
299	provision of medical, geriatric, educational, counseling,
300	religious, or similar services. For residents of a facility
301	licensed under part II of chapter 400, the provisions of s.
302	400.0255 are the exclusive procedures for all transfers and
303	discharges.
304	Section 2.  Paragraphs (f) through (k) of subsection (10)
305	of section 112.0455, Florida Statutes, are redesignated as
306	paragraphs (e) through (j), respectively, paragraph (e) of
307	subsection (12) is redesignated as paragraph (d), and present
308	paragraph (e) of subsection (10), present paragraph (d) of
309	subsection (12), and paragraph (e) of subsection (14) of that
310	section are amended to read:
311	112.0455  Drug-Free Workplace Act.-
312	(10)  EMPLOYER PROTECTION.-
313	(e)  Nothing in this section shall be construed to operate
314	retroactively, and nothing in this section shall abrogate the
315	right of an employer under state law to conduct drug tests prior
316	to January 1, 1990. A drug test conducted by an employer prior
317	to January 1, 1990, is not subject to this section.
318	(12)  DRUG-TESTING STANDARDS; LABORATORIES.-
319	(d)  The laboratory shall submit to the Agency for Health
320	Care Administration a monthly report with statistical
321	information regarding the testing of employees and job
322	applicants. The reports shall include information on the methods
323	of analyses conducted, the drugs tested for, the number of
324	positive and negative results for both initial and confirmation
325	tests, and any other information deemed appropriate by the
326	Agency for Health Care Administration. No monthly report shall
327	identify specific employees or job applicants.
328	(14)  DISCIPLINE REMEDIES.-
329	(e)  Upon resolving an appeal filed pursuant to paragraph
330	(c), and finding a violation of this section, the commission may
331	order the following relief:
332	1.  Rescind the disciplinary action, expunge related
333	records from the personnel file of the employee or job applicant
334	and reinstate the employee.
335	2.  Order compliance with paragraph (10)(f)(g).
336	3.  Award back pay and benefits.
337	4.  Award the prevailing employee or job applicant the
338	necessary costs of the appeal, reasonable attorney's fees, and
339	expert witness fees.
340	Section 3.  Paragraph (n) of subsection (1) of section
341	154.11, Florida Statutes, is amended to read:
342	154.11  Powers of board of trustees.-
343	(1)  The board of trustees of each public health trust
344	shall be deemed to exercise a public and essential governmental
345	function of both the state and the county and in furtherance
346	thereof it shall, subject to limitation by the governing body of
347	the county in which such board is located, have all of the
348	powers necessary or convenient to carry out the operation and
349	governance of designated health care facilities, including, but
350	without limiting the generality of, the foregoing:
351	(n)  To appoint originally the staff of physicians to
352	practice in any designated facility owned or operated by the
353	board and to approve the bylaws and rules to be adopted by the
354	medical staff of any designated facility owned and operated by
355	the board, such governing regulations to be in accordance with
356	the standards of the Joint Commission on the Accreditation of
357	Hospitals which provide, among other things, for the method of
358	appointing additional staff members and for the removal of staff
359	members.
360	Section 4.  Subsection (15) of section 318.21, Florida
361	Statutes, is amended to read:
362	318.21  Disposition of civil penalties by county courts.-
363	All civil penalties received by a county court pursuant to the
364	provisions of this chapter shall be distributed and paid monthly
365	as follows:
366	(15)  Of the additional fine assessed under s. 318.18(3)(e)
367	for a violation of s. 316.1893, 50 percent of the moneys
368	received from the fines shall be remitted to the Department of
369	Revenue and deposited into the Brain and Spinal Cord Injury
370	Trust Fund of Department of Health and shall be appropriated to
371	the Department of Health Agency for Health Care Administration
372	as general revenue to provide an enhanced Medicaid payment to
373	nursing homes that serve Medicaid recipients with brain and
374	spinal cord injuries that are medically complex and who are
375	technologically and respiratory dependent. The remaining 50
376	percent of the moneys received from the enhanced fine imposed
377	under s. 318.18(3)(e) shall be remitted to the Department of
378	Revenue and deposited into the Department of Health Emergency
379	Medical Services Trust Fund to provide financial support to
380	certified trauma centers in the counties where enhanced penalty
381	zones are established to ensure the availability and
382	accessibility of trauma services. Funds deposited into the
383	Emergency Medical Services Trust Fund under this subsection
384	shall be allocated as follows:
385	(a)  Fifty percent shall be allocated equally among all
386	Level I, Level II, and pediatric trauma centers in recognition
387	of readiness costs for maintaining trauma services.
388	(b)  Fifty percent shall be allocated among Level I, Level
389	II, and pediatric trauma centers based on each center's relative
390	volume of trauma cases as reported in the Department of Health
391	Trauma Registry.
392	Section 5.  Section 383.325, Florida Statutes, is repealed.
393	Section 6.  Subsection (7) of section 394.4787, Florida
394	Statutes, is amended to read:
395	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
396	and 394.4789.-As used in this section and ss. 394.4786,
397	394.4788, and 394.4789:
398	(7)  "Specialty psychiatric hospital" means a hospital
399	licensed by the agency pursuant to s. 395.002(26)(28) and part
400	II of chapter 408 as a specialty psychiatric hospital.
401	Section 7.  Subsection (2) of section 394.741, Florida
402	Statutes, is amended to read:
403	394.741  Accreditation requirements for providers of
404	behavioral health care services.-
405	(2)  Notwithstanding any provision of law to the contrary,
406	accreditation shall be accepted by the agency and department in
407	lieu of the agency's and department's facility licensure onsite
408	review requirements and shall be accepted as a substitute for
409	the department's administrative and program monitoring
410	requirements, except as required by subsections (3) and (4),
411	for:
412	(a)  Any organization from which the department purchases
413	behavioral health care services that is accredited by the Joint
414	Commission on Accreditation of Healthcare Organizations or the
415	Council on Accreditation for Children and Family Services, or
416	has those services that are being purchased by the department
417	accredited by the Commission on Accreditation of Rehabilitation
418	Facilities CARF-the Rehabilitation Accreditation Commission.
419	(b)  Any mental health facility licensed by the agency or
420	any substance abuse component licensed by the department that is
421	accredited by the Joint Commission on Accreditation of
422	Healthcare Organizations, the Commission on Accreditation of
423	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
424	Commission, or the Council on Accreditation of Children and
425	Family Services.
426	(c)  Any network of providers from which the department or
427	the agency purchases behavioral health care services accredited
428	by the Joint Commission on Accreditation of Healthcare
429	Organizations, the Commission on Accreditation of Rehabilitation
430	Facilities CARF-the Rehabilitation Accreditation Commission, the
431	Council on Accreditation of Children and Family Services, or the
432	National Committee for Quality Assurance. A provider
433	organization, which is part of an accredited network, is
434	afforded the same rights under this part.
435	Section 8.  Present subsections (15) through (32) of
436	section 395.002, Florida Statutes, are renumbered as subsections
437	(14) through (28), respectively, and present subsections (1),
438	(14), (24), (30), and (31) and paragraph (c) of present
439	subsection (28) of that section are amended to read:
440	395.002  Definitions.-As used in this chapter:
441	(1)  "Accrediting organizations" means nationally
442	recognized or approved accrediting organizations whose standards
443	incorporate comparable licensure requirements as determined by
444	the agency the Joint Commission on Accreditation of Healthcare
445	Organizations, the American Osteopathic Association, the
446	Commission on Accreditation of Rehabilitation Facilities, and
447	the Accreditation Association for Ambulatory Health Care, Inc.
448	(14)  "Initial denial determination" means a determination
449	by a private review agent that the health care services
450	furnished or proposed to be furnished to a patient are
451	inappropriate, not medically necessary, or not reasonable.
452	(24)  "Private review agent" means any person or entity
453	which performs utilization review services for third-party
454	payors on a contractual basis for outpatient or inpatient
455	services. However, the term shall not include full-time
456	employees, personnel, or staff of health insurers, health
457	maintenance organizations, or hospitals, or wholly owned
458	subsidiaries thereof or affiliates under common ownership, when
459	performing utilization review for their respective hospitals,
460	health maintenance organizations, or insureds of the same
461	insurance group. For this purpose, health insurers, health
462	maintenance organizations, and hospitals, or wholly owned
463	subsidiaries thereof or affiliates under common ownership,
464	include such entities engaged as administrators of self-
465	insurance as defined in s. 624.031.
466	(26)(28)  "Specialty hospital" means any facility which
467	meets the provisions of subsection (12), and which regularly
468	makes available either:
469	(c)  Intensive residential treatment programs for children
470	and adolescents as defined in subsection (14) (15).
471	(30)  "Utilization review" means a system for reviewing the
472	medical necessity or appropriateness in the allocation of health
473	care resources of hospital services given or proposed to be
474	given to a patient or group of patients.
475	(31)  "Utilization review plan" means a description of the
476	policies and procedures governing utilization review activities
477	performed by a private review agent.
478	Section 9.  Paragraph (c) of subsection (1) and paragraph
479	(b) of subsection (2) of section 395.003, Florida Statutes, are
480	amended to read:
481	395.003  Licensure; denial, suspension, and revocation.-
482	(1)
483	(c)  Until July 1, 2006, additional emergency departments
484	located off the premises of licensed hospitals may not be
485	authorized by the agency.
486	(2)
487	(b)  The agency shall, at the request of a licensee that is
488	a teaching hospital as defined in s. 408.07(45), issue a single
489	license to a licensee for facilities that have been previously
490	licensed as separate premises, provided such separately licensed
491	facilities, taken together, constitute the same premises as
492	defined in s. 395.002(22)(23). Such license for the single
493	premises shall include all of the beds, services, and programs
494	that were previously included on the licenses for the separate
495	premises. The granting of a single license under this paragraph
496	shall not in any manner reduce the number of beds, services, or
497	programs operated by the licensee.
498	Section 10.  Subsection (3) of section 395.0161, Florida
499	Statutes, is amended to read:
500	395.0161  Licensure inspection.-
501	(3)  In accordance with s. 408.805, an applicant or
502	licensee shall pay a fee for each license application submitted
503	under this part, part II of chapter 408, and applicable rules.
504	With the exception of state-operated licensed facilities, each
505	facility licensed under this part shall pay to the agency, at
506	the time of inspection, the following fees:
507	(a)  Inspection for licensure.-A fee shall be paid which is
508	not less than $8 per hospital bed, nor more than $12 per
509	hospital bed, except that the minimum fee shall be $400 per
510	facility.
511	(b)  Inspection for lifesafety only.-A fee shall be paid
512	which is not less than 75 cents per hospital bed, nor more than
513	$1.50 per hospital bed, except that the minimum fee shall be $40
514	per facility.
515	Section 11.  Paragraph (e) of subsection (2) and subsection
516	(4) of section 395.0193, Florida Statutes, are amended to read:
517	395.0193  Licensed facilities; peer review; disciplinary
518	powers; agency or partnership with physicians.-
519	(2)  Each licensed facility, as a condition of licensure,
520	shall provide for peer review of physicians who deliver health
521	care services at the facility. Each licensed facility shall
522	develop written, binding procedures by which such peer review
523	shall be conducted. Such procedures shall include:
524	(e)  Recording of agendas and minutes which do not contain
525	confidential material, for review by the Division of Medical
526	Quality Assurance of the department Health Quality Assurance of
527	the agency.
528	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
529	actions taken under subsection (3) shall be reported in writing
530	to the Division of Medical Quality Assurance of the department
531	Health Quality Assurance of the agency within 30 working days
532	after its initial occurrence, regardless of the pendency of
533	appeals to the governing board of the hospital. The notification
534	shall identify the disciplined practitioner, the action taken,
535	and the reason for such action. All final disciplinary actions
536	taken under subsection (3), if different from those which were
537	reported to the department agency within 30 days after the
538	initial occurrence, shall be reported within 10 working days to
539	the Division of Medical Quality Assurance of the department
540	Health Quality Assurance of the agency in writing and shall
541	specify the disciplinary action taken and the specific grounds
542	therefor. The division shall review each report and determine
543	whether it potentially involved conduct by the licensee that is
544	subject to disciplinary action, in which case s. 456.073 shall
545	apply. The reports are not subject to inspection under s.
546	119.07(1) even if the division's investigation results in a
547	finding of probable cause.
548	Section 12.  Section 395.1023, Florida Statutes, is amended
549	to read:
550	395.1023  Child abuse and neglect cases; duties.-Each
551	licensed facility shall adopt a protocol that, at a minimum,
552	requires the facility to:
553	(1)  Incorporate a facility policy that every staff member
554	has an affirmative duty to report, pursuant to chapter 39, any
555	actual or suspected case of child abuse, abandonment, or
556	neglect; and
557	(2)  In any case involving suspected child abuse,
558	abandonment, or neglect, designate, at the request of the
559	Department of Children and Family Services, a staff physician to
560	act as a liaison between the hospital and the Department of
561	Children and Family Services office which is investigating the
562	suspected abuse, abandonment, or neglect, and the child
563	protection team, as defined in s. 39.01, when the case is
564	referred to such a team.
565
566	Each general hospital and appropriate specialty hospital shall
567	comply with the provisions of this section and shall notify the
568	agency and the Department of Children and Family Services of its
569	compliance by sending a copy of its policy to the agency and the
570	Department of Children and Family Services as required by rule.
571	The failure by a general hospital or appropriate specialty
572	hospital to comply shall be punished by a fine not exceeding
573	$1,000, to be fixed, imposed, and collected by the agency. Each
574	day in violation is considered a separate offense.
575	Section 13.  Subsection (2) and paragraph (d) of subsection
576	(3) of section 395.1041, Florida Statutes, are amended to read:
577	395.1041  Access to emergency services and care.-
578	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
579	shall establish and maintain an inventory of hospitals with
580	emergency services. The inventory shall list all services within
581	the service capability of the hospital, and such services shall
582	appear on the face of the hospital license. Each hospital having
583	emergency services shall notify the agency of its service
584	capability in the manner and form prescribed by the agency. The
585	agency shall use the inventory to assist emergency medical
586	services providers and others in locating appropriate emergency
587	medical care. The inventory shall also be made available to the
588	general public. On or before August 1, 1992, the agency shall
589	request that each hospital identify the services which are
590	within its service capability. On or before November 1, 1992,
591	the agency shall notify each hospital of the service capability
592	to be included in the inventory. The hospital has 15 days from
593	the date of receipt to respond to the notice. By December 1,
594	1992, the agency shall publish a final inventory. Each hospital
595	shall reaffirm its service capability when its license is
596	renewed and shall notify the agency of the addition of a new
597	service or the termination of a service prior to a change in its
598	service capability.
599	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
600	FACILITY OR HEALTH CARE PERSONNEL.-
601	(d)1.  Every hospital shall ensure the provision of
602	services within the service capability of the hospital, at all
603	times, either directly or indirectly through an arrangement with
604	another hospital, through an arrangement with one or more
605	physicians, or as otherwise made through prior arrangements. A
606	hospital may enter into an agreement with another hospital for
607	purposes of meeting its service capability requirement, and
608	appropriate compensation or other reasonable conditions may be
609	negotiated for these backup services.
610	2.  If any arrangement requires the provision of emergency
611	medical transportation, such arrangement must be made in
612	consultation with the applicable provider and may not require
613	the emergency medical service provider to provide transportation
614	that is outside the routine service area of that provider or in
615	a manner that impairs the ability of the emergency medical
616	service provider to timely respond to prehospital emergency
617	calls.
618	3.  A hospital shall not be required to ensure service
619	capability at all times as required in subparagraph 1. if, prior
620	to the receiving of any patient needing such service capability,
621	such hospital has demonstrated to the agency that it lacks the
622	ability to ensure such capability and it has exhausted all
623	reasonable efforts to ensure such capability through backup
624	arrangements. In reviewing a hospital's demonstration of lack of
625	ability to ensure service capability, the agency shall consider
626	factors relevant to the particular case, including the
627	following:
628	a.  Number and proximity of hospitals with the same service
629	capability.
630	b.  Number, type, credentials, and privileges of
631	specialists.
632	c.  Frequency of procedures.
633	d.  Size of hospital.
634	4.  The agency shall publish proposed rules implementing a
635	reasonable exemption procedure by November 1, 1992. Subparagraph
636	1. shall become effective upon the effective date of said rules
637	or January 31, 1993, whichever is earlier. For a period not to
638	exceed 1 year from the effective date of subparagraph 1., a
639	hospital requesting an exemption shall be deemed to be exempt
640	from offering the service until the agency initially acts to
641	deny or grant the original request. The agency has 45 days after
642	from the date of receipt of the request to approve or deny the
643	request. After the first year from the effective date of
644	subparagraph 1., If the agency fails to initially act within
645	that the time period, the hospital is deemed to be exempt from
646	offering the service until the agency initially acts to deny the
647	request.
648	Section 14.  Section 395.1046, Florida Statutes, is
649	repealed.
650	Section 15.  Paragraph (e) of subsection (1) of section
651	395.1055, Florida Statutes, is amended to read:
652	395.1055  Rules and enforcement.-
653	(1)  The agency shall adopt rules pursuant to ss.
654	120.536(1) and 120.54 to implement the provisions of this part,
655	which shall include reasonable and fair minimum standards for
656	ensuring that:
657	(e)  Licensed facility beds conform to minimum space,
658	equipment, and furnishings standards as specified by the agency,
659	the Florida Building Code, and the Florida Fire Prevention Code
660	department.
661	Section 16.  Subsection (1) of section 395.10972, Florida
662	Statutes, is amended to read:
663	395.10972  Health Care Risk Manager Advisory Council.-The
664	Secretary of Health Care Administration may appoint a seven-
665	member advisory council to advise the agency on matters
666	pertaining to health care risk managers. The members of the
667	council shall serve at the pleasure of the secretary. The
668	council shall designate a chair. The council shall meet at the
669	call of the secretary or at those times as may be required by
670	rule of the agency. The members of the advisory council shall
671	receive no compensation for their services, but shall be
672	reimbursed for travel expenses as provided in s. 112.061. The
673	council shall consist of individuals representing the following
674	areas:
675	(1)  Two shall be active health care risk managers,
676	including one risk manager who is recommended by and a member of
677	the Florida Society for of Healthcare Risk Management and
678	Patient Safety.
679	Section 17.  Subsection (3) of section 395.2050, Florida
680	Statutes, is amended to read:
681	395.2050  Routine inquiry for organ and tissue donation;
682	certification for procurement activities; death records review.-
683	(3)  Each organ procurement organization designated by the
684	federal Centers for Medicare and Medicaid Services Health Care
685	Financing Administration and licensed by the state shall conduct
686	an annual death records review in the organ procurement
687	organization's affiliated donor hospitals. The organ procurement
688	organization shall enlist the services of every Florida licensed
689	tissue bank and eye bank affiliated with or providing service to
690	the donor hospital and operating in the same service area to
691	participate in the death records review.
692	Section 18.  Subsection (2) of section 395.3036, Florida
693	Statutes, is amended to read:
694	395.3036  Confidentiality of records and meetings of
695	corporations that lease public hospitals or other public health
696	care facilities.-The records of a private corporation that
697	leases a public hospital or other public health care facility
698	are confidential and exempt from the provisions of s. 119.07(1)
699	and s. 24(a), Art. I of the State Constitution, and the meetings
700	of the governing board of a private corporation are exempt from
701	s. 286.011 and s. 24(b), Art. I of the State Constitution when
702	the public lessor complies with the public finance
703	accountability provisions of s. 155.40(5) with respect to the
704	transfer of any public funds to the private lessee and when the
705	private lessee meets at least three of the five following
706	criteria:
707	(2)  The public lessor and the private lessee do not
708	commingle any of their funds in any account maintained by either
709	of them, other than the payment of the rent and administrative
710	fees or the transfer of funds pursuant to s. 155.40 subsection
711	(2).
712	Section 19.  Section 395.3037, Florida Statutes, is
713	repealed.
714	Section 20.  Subsections (1), (4), and (5) of section
715	395.3038, Florida Statutes, are amended to read:
716	395.3038  State-listed primary stroke centers and
717	comprehensive stroke centers; notification of hospitals.-
718	(1)  The agency shall make available on its website and to
719	the department a list of the name and address of each hospital
720	that meets the criteria for a primary stroke center and the name
721	and address of each hospital that meets the criteria for a
722	comprehensive stroke center. The list of primary and
723	comprehensive stroke centers shall include only those hospitals
724	that attest in an affidavit submitted to the agency that the
725	hospital meets the named criteria, or those hospitals that
726	attest in an affidavit submitted to the agency that the hospital
727	is certified as a primary or a comprehensive stroke center by
728	the Joint Commission on Accreditation of Healthcare
729	Organizations.
730	(4)  The agency shall adopt by rule criteria for a primary
731	stroke center which are substantially similar to the
732	certification standards for primary stroke centers of the Joint
733	Commission on Accreditation of Healthcare Organizations.
734	(5)  The agency shall adopt by rule criteria for a
735	comprehensive stroke center. However, if the Joint Commission on
736	Accreditation of Healthcare Organizations establishes criteria
737	for a comprehensive stroke center, the agency shall establish
738	criteria for a comprehensive stroke center which are
739	substantially similar to those criteria established by the Joint
740	Commission on Accreditation of Healthcare Organizations.
741	Section 21.  Paragraph (e) of subsection (2) of section
742	395.602, Florida Statutes, is amended to read:
743	395.602  Rural hospitals.-
744	(2)  DEFINITIONS.-As used in this part:
745	(e)  "Rural hospital" means an acute care hospital licensed
746	under this chapter, having 100 or fewer licensed beds and an
747	emergency room, which is:
748	1.  The sole provider within a county with a population
749	density of no greater than 100 persons per square mile;
750	2.  An acute care hospital, in a county with a population
751	density of no greater than 100 persons per square mile, which is
752	at least 30 minutes of travel time, on normally traveled roads
753	under normal traffic conditions, from any other acute care
754	hospital within the same county;
755	3.  A hospital supported by a tax district or subdistrict
756	whose boundaries encompass a population of 100 persons or fewer
757	per square mile;
758	4.  A hospital in a constitutional charter county with a
759	population of over 1 million persons that has imposed a local
760	option health service tax pursuant to law and in an area that
761	was directly impacted by a catastrophic event on August 24,
762	1992, for which the Governor of Florida declared a state of
763	emergency pursuant to chapter 125, and has 120 beds or less that
764	serves an agricultural community with an emergency room
765	utilization of no less than 20,000 visits and a Medicaid
766	inpatient utilization rate greater than 15 percent;
767	4.5.  A hospital with a service area that has a population
768	of 100 persons or fewer per square mile. As used in this
769	subparagraph, the term "service area" means the fewest number of
770	zip codes that account for 75 percent of the hospital's
771	discharges for the most recent 5-year period, based on
772	information available from the hospital inpatient discharge
773	database in the Florida Center for Health Information and Policy
774	Analysis at the Agency for Health Care Administration; or
775	5.6.  A hospital designated as a critical access hospital,
776	as defined in s. 408.07(15).
777
778	Population densities used in this paragraph must be based upon
779	the most recently completed United States census. A hospital
780	that received funds under s. 409.9116 for a quarter beginning no
781	later than July 1, 2002, is deemed to have been and shall
782	continue to be a rural hospital from that date through June 30,
783	2015, if the hospital continues to have 100 or fewer licensed
784	beds and an emergency room, or meets the criteria of
785	subparagraph 4. An acute care hospital that has not previously
786	been designated as a rural hospital and that meets the criteria
787	of this paragraph shall be granted such designation upon
788	application, including supporting documentation to the Agency
789	for Health Care Administration.
790	Section 22.  Subsections (8) and (16) of section 400.021,
791	Florida Statutes, are amended to read:
792	400.021  Definitions.-When used in this part, unless the
793	context otherwise requires, the term:
794	(8)  "Geriatric outpatient clinic" means a site for
795	providing outpatient health care to persons 60 years of age or
796	older, which is staffed by a registered nurse or a physician
797	assistant, or a licensed practical nurse under the direct
798	supervision of a registered nurse, advanced registered nurse
799	practitioner, or physician.
800	(16)  "Resident care plan" means a written plan developed,
801	maintained, and reviewed not less than quarterly by a registered
802	nurse, with participation from other facility staff and the
803	resident or his or her designee or legal representative, which
804	includes a comprehensive assessment of the needs of an
805	individual resident; the type and frequency of services required
806	to provide the necessary care for the resident to attain or
807	maintain the highest practicable physical, mental, and
808	psychosocial well-being; a listing of services provided within
809	or outside the facility to meet those needs; and an explanation
810	of service goals. The resident care plan must be signed by the
811	director of nursing or another registered nurse employed by the
812	facility to whom institutional responsibilities have been
813	delegated and by the resident, the resident's designee, or the
814	resident's legal representative. The facility may not use an
815	agency or temporary registered nurse to satisfy the foregoing
816	requirement and must document the institutional responsibilities
817	that have been delegated to the registered nurse.
818	Section 23.  Paragraph (g) of subsection (2) of section
819	400.0239, Florida Statutes, is amended to read:
820	400.0239  Quality of Long-Term Care Facility Improvement
821	Trust Fund.-
822	(2)  Expenditures from the trust fund shall be allowable
823	for direct support of the following:
824	(g)  Other initiatives authorized by the Centers for
825	Medicare and Medicaid Services for the use of federal civil
826	monetary penalties, including projects recommended through the
827	Medicaid "Up-or-Out" Quality of Care Contract Management Program
828	pursuant to s. 400.148.
829	Section 24.  Subsection (15) of section 400.0255, Florida
830	Statutes, is amended to read
831	400.0255  Resident transfer or discharge; requirements and
832	procedures; hearings.-
833	(15)(a)  The department's Office of Appeals Hearings shall
834	conduct hearings under this section. The office shall notify the
835	facility of a resident's request for a hearing.
836	(b)  The department shall, by rule, establish procedures to
837	be used for fair hearings requested by residents. These
838	procedures shall be equivalent to the procedures used for fair
839	hearings for other Medicaid cases appearing in s. 409.285 and
840	applicable rules, chapter 10-2, part VI, Florida Administrative
841	Code. The burden of proof must be clear and convincing evidence.
842	A hearing decision must be rendered within 90 days after receipt
843	of the request for hearing.
844	(c)  If the hearing decision is favorable to the resident
845	who has been transferred or discharged, the resident must be
846	readmitted to the facility's first available bed.
847	(d)  The decision of the hearing officer shall be final.
848	Any aggrieved party may appeal the decision to the district
849	court of appeal in the appellate district where the facility is
850	located. Review procedures shall be conducted in accordance with
851	the Florida Rules of Appellate Procedure.
852	Section 25.  Subsection (2) of section 400.063, Florida
853	Statutes, is amended to read:
854	400.063  Resident protection.-
855	(2)  The agency is authorized to establish for each
856	facility, subject to intervention by the agency, a separate bank
857	account for the deposit to the credit of the agency of any
858	moneys received from the Health Care Trust Fund or any other
859	moneys received for the maintenance and care of residents in the
860	facility, and the agency is authorized to disburse moneys from
861	such account to pay obligations incurred for the purposes of
862	this section. The agency is authorized to requisition moneys
863	from the Health Care Trust Fund in advance of an actual need for
864	cash on the basis of an estimate by the agency of moneys to be
865	spent under the authority of this section. Any bank account
866	established under this section need not be approved in advance
867	of its creation as required by s. 17.58, but shall be secured by
868	depository insurance equal to or greater than the balance of
869	such account or by the pledge of collateral security in
870	conformance with criteria established in s. 18.11. The agency
871	shall notify the Chief Financial Officer of any such account so
872	established and shall make a quarterly accounting to the Chief
873	Financial Officer for all moneys deposited in such account.
874	Section 26.  Subsections (1) and (5) of section 400.071,
875	Florida Statutes, are amended to read:
876	400.071  Application for license.-
877	(1)  In addition to the requirements of part II of chapter
878	408, the application for a license shall be under oath and must
879	contain the following:
880	(a)  The location of the facility for which a license is
881	sought and an indication, as in the original application, that
882	such location conforms to the local zoning ordinances.
883	(b)  A signed affidavit disclosing any financial or
884	ownership interest that a controlling interest as defined in
885	part II of chapter 408 has held in the last 5 years in any
886	entity licensed by this state or any other state to provide
887	health or residential care which has closed voluntarily or
888	involuntarily; has filed for bankruptcy; has had a receiver
889	appointed; has had a license denied, suspended, or revoked; or
890	has had an injunction issued against it which was initiated by a
891	regulatory agency. The affidavit must disclose the reason any
892	such entity was closed, whether voluntarily or involuntarily.
893	(c)  The total number of beds and the total number of
894	Medicare and Medicaid certified beds.
895	(b)(d)  Information relating to the applicant and employees
896	which the agency requires by rule. The applicant must
897	demonstrate that sufficient numbers of qualified staff, by
898	training or experience, will be employed to properly care for
899	the type and number of residents who will reside in the
900	facility.
901	(e)  Copies of any civil verdict or judgment involving the
902	applicant rendered within the 10 years preceding the
903	application, relating to medical negligence, violation of
904	residents' rights, or wrongful death. As a condition of
905	licensure, the licensee agrees to provide to the agency copies
906	of any new verdict or judgment involving the applicant, relating
907	to such matters, within 30 days after filing with the clerk of
908	the court. The information required in this paragraph shall be
909	maintained in the facility's licensure file and in an agency
910	database which is available as a public record.
911	(5)  As a condition of licensure, each facility must
912	establish and submit with its application a plan for quality
913	assurance and for conducting risk management.
914	Section 27.  Section 400.0712, Florida Statutes, is amended
915	to read:
916	400.0712  Application for inactive license.-
917	(1)  As specified in this section, the agency may issue an
918	inactive license to a nursing home facility for all or a portion
919	of its beds. Any request by a licensee that a nursing home or
920	portion of a nursing home become inactive must be submitted to
921	the agency in the approved format. The facility may not initiate
922	any suspension of services, notify residents, or initiate
923	inactivity before receiving approval from the agency; and a
924	licensee that violates this provision may not be issued an
925	inactive license.
926	(1)(2)  In addition to the powers granted under part II of
927	chapter 408, the agency may issue an inactive license for a
928	portion of the total beds to a nursing home that chooses to use
929	an unoccupied contiguous portion of the facility for an
930	alternative use to meet the needs of elderly persons through the
931	use of less restrictive, less institutional services.
932	(a)  An inactive license issued under this subsection may
933	be granted for a period not to exceed the current licensure
934	expiration date but may be renewed by the agency at the time of
935	licensure renewal.
936	(b)  A request to extend the inactive license must be
937	submitted to the agency in the approved format and approved by
938	the agency in writing.
939	(c)  Nursing homes that receive an inactive license to
940	provide alternative services shall not receive preference for
941	participation in the Assisted Living for the Elderly Medicaid
942	waiver.
943	(2)(3)  The agency shall adopt rules pursuant to ss.
944	120.536(1) and 120.54 necessary to implement this section.
945	Section 28.  Section 400.111, Florida Statutes, is amended
946	to read:
947	400.111  Disclosure of controlling interest.-In addition to
948	the requirements of part II of chapter 408, when requested by
949	the agency, the licensee shall submit a signed affidavit
950	disclosing any financial or ownership interest that a
951	controlling interest has held within the last 5 years in any
952	entity licensed by the state or any other state to provide
953	health or residential care which entity has closed voluntarily
954	or involuntarily; has filed for bankruptcy; has had a receiver
955	appointed; has had a license denied, suspended, or revoked; or
956	has had an injunction issued against it which was initiated by a
957	regulatory agency. The affidavit must disclose the reason such
958	entity was closed, whether voluntarily or involuntarily.
959	Section 29.  Subsection (2) of section 400.1183, Florida
960	Statutes, is amended to read:
961	400.1183  Resident grievance procedures.-
962	(2)  Each facility shall maintain records of all grievances
963	and shall retain a log for agency inspection of report to the
964	agency at the time of relicensure the total number of grievances
965	handled during the prior licensure period, a categorization of
966	the cases underlying the grievances, and the final disposition
967	of the grievances.
968	Section 30.  Section 400.141, Florida Statutes, is amended
969	to read:
970	400.141  Administration and management of nursing home
971	facilities.-
972	(1)  Every licensed facility shall comply with all
973	applicable standards and rules of the agency and shall:
974	(a)  Be under the administrative direction and charge of a
975	licensed administrator.
976	(b)  Appoint a medical director licensed pursuant to
977	chapter 458 or chapter 459. The agency may establish by rule
978	more specific criteria for the appointment of a medical
979	director.
980	(c)  Have available the regular, consultative, and
981	emergency services of physicians licensed by the state.
982	(d)  Provide for resident use of a community pharmacy as
983	specified in s. 400.022(1)(q). Any other law to the contrary
984	notwithstanding, a registered pharmacist licensed in Florida,
985	that is under contract with a facility licensed under this
986	chapter or chapter 429, shall repackage a nursing facility
987	resident's bulk prescription medication which has been packaged
988	by another pharmacist licensed in any state in the United States
989	into a unit dose system compatible with the system used by the
990	nursing facility, if the pharmacist is requested to offer such
991	service. In order to be eligible for the repackaging, a resident
992	or the resident's spouse must receive prescription medication
993	benefits provided through a former employer as part of his or
994	her retirement benefits, a qualified pension plan as specified
995	in s. 4972 of the Internal Revenue Code, a federal retirement
996	program as specified under 5 C.F.R. s. 831, or a long-term care
997	policy as defined in s. 627.9404(1). A pharmacist who correctly
998	repackages and relabels the medication and the nursing facility
999	which correctly administers such repackaged medication under
1000	this paragraph may not be held liable in any civil or
1001	administrative action arising from the repackaging. In order to
1002	be eligible for the repackaging, a nursing facility resident for
1003	whom the medication is to be repackaged shall sign an informed
1004	consent form provided by the facility which includes an
1005	explanation of the repackaging process and which notifies the
1006	resident of the immunities from liability provided in this
1007	paragraph. A pharmacist who repackages and relabels prescription
1008	medications, as authorized under this paragraph, may charge a
1009	reasonable fee for costs resulting from the implementation of
1010	this provision.
1011	(e)  Provide for the access of the facility residents to
1012	dental and other health-related services, recreational services,
1013	rehabilitative services, and social work services appropriate to
1014	their needs and conditions and not directly furnished by the
1015	licensee. When a geriatric outpatient nurse clinic is conducted
1016	in accordance with rules adopted by the agency, outpatients
1017	attending such clinic shall not be counted as part of the
1018	general resident population of the nursing home facility, nor
1019	shall the nursing staff of the geriatric outpatient clinic be
1020	counted as part of the nursing staff of the facility, until the
1021	outpatient clinic load exceeds 15 a day.
1022	(f)  Be allowed and encouraged by the agency to provide
1023	other needed services under certain conditions. If the facility
1024	has a standard licensure status, and has had no class I or class
1025	II deficiencies during the past 2 years or has been awarded a
1026	Gold Seal under the program established in s. 400.235, it may be
1027	encouraged by the agency to provide services, including, but not
1028	limited to, respite and adult day services, which enable
1029	individuals to move in and out of the facility. A facility is
1030	not subject to any additional licensure requirements for
1031	providing these services, under the following conditions:.
1032	1.  Respite care may be offered to persons in need of
1033	short-term or temporary nursing home services. For each person
1034	admitted under the respite care program, the facility licensee
1035	must:
1036	a.  Have a written abbreviated plan of care that, at a
1037	minimum, includes nutritional requirements, medication orders,
1038	physician orders, nursing assessments, and dietary preferences.
1039	The nursing or physician assessments may take the place of all
1040	other assessments required for full-time residents.
1041	b.  Have a contract that, at a minimum, specifies the
1042	services to be provided to the respite resident, including
1043	charges for services, activities, equipment, emergency medical
1044	services, and the administration of medications. If multiple
1045	respite admissions for a single person are anticipated, the
1046	original contract is valid for 1 year after the date of
1047	execution.
1048	c.  Ensure that each resident is released to his or her
1049	caregiver or an individual designated in writing by the
1050	caregiver.
1051	2.  A person admitted under the respite care program is:
1052	a.  Exempt from requirements in rule related to discharge
1053	planning.
1054	b.  Covered by the residents' rights set forth in s.
1055	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
1056	shall not be considered trust funds subject to the requirements
1057	of s. 400.022(1)(h) until the resident has been in the facility
1058	for more than 14 consecutive days.
1059	c.  Allowed to use his or her personal medications for the
1060	respite stay if permitted by facility policy. The facility must
1061	obtain a physician's order for the medications. The caregiver
1062	may provide information regarding the medications as part of the
1063	nursing assessment and that information must agree with the
1064	physician's order. Medications shall be released with the
1065	resident upon discharge in accordance with current physician's
1066	orders.
1067	3.  A person receiving respite care is entitled to reside
1068	in the facility for a total of 60 days within a contract year or
1069	within a calendar year if the contract is for less than 12
1070	months. However, each single stay may not exceed 14 days. If a
1071	stay exceeds 14 consecutive days, the facility must comply with
1072	all assessment and care planning requirements applicable to
1073	nursing home residents.
1074	4.  A person receiving respite care must reside in a
1075	licensed nursing home bed.
1076	5.  A prospective respite resident must provide medical
1077	information from a physician, physician assistant, or nurse
1078	practitioner and other information from the primary caregiver as
1079	may be required by the facility before or at the time of
1080	admission to receive respite care. The medical information must
1081	include a physician's order for respite care and proof of a
1082	physical examination by a licensed physician, physician
1083	assistant, or nurse practitioner. The physician's order and
1084	physical examination may be used to provide intermittent respite
1085	care for up to 12 months after the date the order is written.
1086	6.  The facility must assume the duties of the primary
1087	caregiver. To ensure continuity of care and services, the
1088	resident is entitled to retain his or her personal physician and
1089	must have access to medically necessary services such as
1090	physical therapy, occupational therapy, or speech therapy, as
1091	needed. The facility must arrange for transportation to these
1092	services if necessary. Respite care must be provided in
1093	accordance with this part and rules adopted by the agency.
1094	However, the agency shall, by rule, adopt modified requirements
1095	for resident assessment, resident care plans, resident
1096	contracts, physician orders, and other provisions, as
1097	appropriate, for short-term or temporary nursing home services.
1098	7.  The agency shall allow for shared programming and staff
1099	in a facility which meets minimum standards and offers services
1100	pursuant to this paragraph, but, if the facility is cited for
1101	deficiencies in patient care, may require additional staff and
1102	programs appropriate to the needs of service recipients. A
1103	person who receives respite care may not be counted as a
1104	resident of the facility for purposes of the facility's licensed
1105	capacity unless that person receives 24-hour respite care. A
1106	person receiving either respite care for 24 hours or longer or
1107	adult day services must be included when calculating minimum
1108	staffing for the facility. Any costs and revenues generated by a
1109	nursing home facility from nonresidential programs or services
1110	shall be excluded from the calculations of Medicaid per diems
1111	for nursing home institutional care reimbursement.
1112	(g)  If the facility has a standard license or is a Gold
1113	Seal facility, exceeds the minimum required hours of licensed
1114	nursing and certified nursing assistant direct care per resident
1115	per day, and is part of a continuing care facility licensed
1116	under chapter 651 or a retirement community that offers other
1117	services pursuant to part III of this chapter or part I or part
1118	III of chapter 429 on a single campus, be allowed to share
1119	programming and staff. At the time of inspection and in the
1120	semiannual report required pursuant to paragraph (o), a
1121	continuing care facility or retirement community that uses this
1122	option must demonstrate through staffing records that minimum
1123	staffing requirements for the facility were met. Licensed nurses
1124	and certified nursing assistants who work in the nursing home
1125	facility may be used to provide services elsewhere on campus if
1126	the facility exceeds the minimum number of direct care hours
1127	required per resident per day and the total number of residents
1128	receiving direct care services from a licensed nurse or a
1129	certified nursing assistant does not cause the facility to
1130	violate the staffing ratios required under s. 400.23(3)(a).
1131	Compliance with the minimum staffing ratios shall be based on
1132	total number of residents receiving direct care services,
1133	regardless of where they reside on campus. If the facility
1134	receives a conditional license, it may not share staff until the
1135	conditional license status ends. This paragraph does not
1136	restrict the agency's authority under federal or state law to
1137	require additional staff if a facility is cited for deficiencies
1138	in care which are caused by an insufficient number of certified
1139	nursing assistants or licensed nurses. The agency may adopt
1140	rules for the documentation necessary to determine compliance
1141	with this provision.
1142	(h)  Maintain the facility premises and equipment and
1143	conduct its operations in a safe and sanitary manner.
1144	(i)  If the licensee furnishes food service, provide a
1145	wholesome and nourishing diet sufficient to meet generally
1146	accepted standards of proper nutrition for its residents and
1147	provide such therapeutic diets as may be prescribed by attending
1148	physicians. In making rules to implement this paragraph, the
1149	agency shall be guided by standards recommended by nationally
1150	recognized professional groups and associations with knowledge
1151	of dietetics.
1152	(j)  Keep full records of resident admissions and
1153	discharges; medical and general health status, including medical
1154	records, personal and social history, and identity and address
1155	of next of kin or other persons who may have responsibility for
1156	the affairs of the residents; and individual resident care plans
1157	including, but not limited to, prescribed services, service
1158	frequency and duration, and service goals. The records shall be
1159	open to inspection by the agency. The facility must maintain
1160	clinical records on each resident in accordance with accepted
1161	professional standards and practices that are complete,
1162	accurately documented, readily accessible, and systematically
1163	organized.
1164	(k)  Keep such fiscal records of its operations and
1165	conditions as may be necessary to provide information pursuant
1166	to this part.
1167	(l)  Furnish copies of personnel records for employees
1168	affiliated with such facility, to any other facility licensed by
1169	this state requesting this information pursuant to this part.
1170	Such information contained in the records may include, but is
1171	not limited to, disciplinary matters and any reason for
1172	termination. Any facility releasing such records pursuant to
1173	this part shall be considered to be acting in good faith and may
1174	not be held liable for information contained in such records,
1175	absent a showing that the facility maliciously falsified such
1176	records.
1177	(m)  Publicly display a poster provided by the agency
1178	containing the names, addresses, and telephone numbers for the
1179	state's abuse hotline, the State Long-Term Care Ombudsman, the
1180	Agency for Health Care Administration consumer hotline, the
1181	Advocacy Center for Persons with Disabilities, the Florida
1182	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1183	with a clear description of the assistance to be expected from
1184	each.
1185	(n)  Submit to the agency the information specified in s.
1186	400.071(1)(b) for a management company within 30 days after the
1187	effective date of the management agreement.
1188	(n)(o)1.  Submit semiannually to the agency, or more
1189	frequently if requested by the agency, information regarding
1190	facility staff-to-resident ratios, staff turnover, and staff
1191	stability, including information regarding certified nursing
1192	assistants, licensed nurses, the director of nursing, and the
1193	facility administrator. For purposes of this reporting:
1194	a.  Staff-to-resident ratios must be reported in the
1195	categories specified in s. 400.23(3)(a) and applicable rules.
1196	The ratio must be reported as an average for the most recent
1197	calendar quarter.
1198	b.  Staff turnover must be reported for the most recent 12-
1199	month period ending on the last workday of the most recent
1200	calendar quarter prior to the date the information is submitted.
1201	The turnover rate must be computed quarterly, with the annual
1202	rate being the cumulative sum of the quarterly rates. The
1203	turnover rate is the total number of terminations or separations
1204	experienced during the quarter, excluding any employee
1205	terminated during a probationary period of 3 months or less,
1206	divided by the total number of staff employed at the end of the
1207	period for which the rate is computed, and expressed as a
1208	percentage.
1209	c.  The formula for determining staff stability is the
1210	total number of employees that have been employed for more than
1211	12 months, divided by the total number of employees employed at
1212	the end of the most recent calendar quarter, and expressed as a
1213	percentage.
1214	d.  A nursing facility that has failed to comply with state
1215	minimum-staffing requirements for 2 consecutive days is
1216	prohibited from accepting new admissions until the facility has
1217	achieved the minimum-staffing requirements for a period of 6
1218	consecutive days. For the purposes of this sub-subparagraph, any
1219	person who was a resident of the facility and was absent from
1220	the facility for the purpose of receiving medical care at a
1221	separate location or was on a leave of absence is not considered
1222	a new admission. Failure to impose such an admissions moratorium
1223	is subject to a $1,000 fine constitutes a class II deficiency.
1224	2.e.  A nursing facility which does not have a conditional
1225	license may be cited for failure to comply with the standards in
1226	s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
1227	standards on 2 consecutive days or if it has failed to meet at
1228	least 97 percent of those standards on any one day.
1229	3.f.  A facility which has a conditional license must be in
1230	compliance with the standards in s. 400.23(3)(a) at all times.
1231	2.  This paragraph does not limit the agency's ability to
1232	impose a deficiency or take other actions if a facility does not
1233	have enough staff to meet the residents' needs.
1234	(o)(p)  Notify a licensed physician when a resident
1235	exhibits signs of dementia or cognitive impairment or has a
1236	change of condition in order to rule out the presence of an
1237	underlying physiological condition that may be contributing to
1238	such dementia or impairment. The notification must occur within
1239	30 days after the acknowledgment of such signs by facility
1240	staff. If an underlying condition is determined to exist, the
1241	facility shall arrange, with the appropriate health care
1242	provider, the necessary care and services to treat the
1243	condition.
1244	(p)(q)  If the facility implements a dining and hospitality
1245	attendant program, ensure that the program is developed and
1246	implemented under the supervision of the facility director of
1247	nursing. A licensed nurse, licensed speech or occupational
1248	therapist, or a registered dietitian must conduct training of
1249	dining and hospitality attendants. A person employed by a
1250	facility as a dining and hospitality attendant must perform
1251	tasks under the direct supervision of a licensed nurse.
1252	(r)  Report to the agency any filing for bankruptcy
1253	protection by the facility or its parent corporation,
1254	divestiture or spin-off of its assets, or corporate
1255	reorganization within 30 days after the completion of such
1256	activity.
1257	(q)(s)  Maintain general and professional liability
1258	insurance coverage that is in force at all times. In lieu of
1259	general and professional liability insurance coverage, a state-
1260	designated teaching nursing home and its affiliated assisted
1261	living facilities created under s. 430.80 may demonstrate proof
1262	of financial responsibility as provided in s. 430.80(3)(g).
1263	(r)(t)  Maintain in the medical record for each resident a
1264	daily chart of certified nursing assistant services provided to
1265	the resident. The certified nursing assistant who is caring for
1266	the resident must complete this record by the end of his or her
1267	shift. This record must indicate assistance with activities of
1268	daily living, assistance with eating, and assistance with
1269	drinking, and must record each offering of nutrition and
1270	hydration for those residents whose plan of care or assessment
1271	indicates a risk for malnutrition or dehydration.
1272	(s)(u)  Before November 30 of each year, subject to the
1273	availability of an adequate supply of the necessary vaccine,
1274	provide for immunizations against influenza viruses to all its
1275	consenting residents in accordance with the recommendations of
1276	the United States Centers for Disease Control and Prevention,
1277	subject to exemptions for medical contraindications and
1278	religious or personal beliefs. Subject to these exemptions, any
1279	consenting person who becomes a resident of the facility after
1280	November 30 but before March 31 of the following year must be
1281	immunized within 5 working days after becoming a resident.
1282	Immunization shall not be provided to any resident who provides
1283	documentation that he or she has been immunized as required by
1284	this paragraph. This paragraph does not prohibit a resident from
1285	receiving the immunization from his or her personal physician if
1286	he or she so chooses. A resident who chooses to receive the
1287	immunization from his or her personal physician shall provide
1288	proof of immunization to the facility. The agency may adopt and
1289	enforce any rules necessary to comply with or implement this
1290	paragraph.
1291	(t)(v)  Assess all residents for eligibility for
1292	pneumococcal polysaccharide vaccination (PPV) and vaccinate
1293	residents when indicated within 60 days after the effective date
1294	of this act in accordance with the recommendations of the United
1295	States Centers for Disease Control and Prevention, subject to
1296	exemptions for medical contraindications and religious or
1297	personal beliefs. Residents admitted after the effective date of
1298	this act shall be assessed within 5 working days of admission
1299	and, when indicated, vaccinated within 60 days in accordance
1300	with the recommendations of the United States Centers for
1301	Disease Control and Prevention, subject to exemptions for
1302	medical contraindications and religious or personal beliefs.
1303	Immunization shall not be provided to any resident who provides
1304	documentation that he or she has been immunized as required by
1305	this paragraph. This paragraph does not prohibit a resident from
1306	receiving the immunization from his or her personal physician if
1307	he or she so chooses. A resident who chooses to receive the
1308	immunization from his or her personal physician shall provide
1309	proof of immunization to the facility. The agency may adopt and
1310	enforce any rules necessary to comply with or implement this
1311	paragraph.
1312	(u)(w)  Annually encourage and promote to its employees the
1313	benefits associated with immunizations against influenza viruses
1314	in accordance with the recommendations of the United States
1315	Centers for Disease Control and Prevention. The agency may adopt
1316	and enforce any rules necessary to comply with or implement this
1317	paragraph.
1318
1319	This subsection does not limit the agency's ability to impose a
1320	deficiency or take other actions if a facility does not have
1321	enough staff to meet the residents' needs.
1322	(2)  Facilities that have been awarded a Gold Seal under
1323	the program established in s. 400.235 may develop a plan to
1324	provide certified nursing assistant training as prescribed by
1325	federal regulations and state rules and may apply to the agency
1326	for approval of their program.
1327	(3)  A facility may charge a reasonable fee for the copying
1328	of resident records. The fee may not exceed $1 per page for the
1329	first 25 pages and 25 cents per page for each page in excess of
1330	25 pages.
1331	Section 31.  Subsection (3) of section 400.142, Florida
1332	Statutes, is amended to read:
1333	400.142  Emergency medication kits; orders not to
1334	resuscitate.-
1335	(3)  Facility staff may withhold or withdraw
1336	cardiopulmonary resuscitation if presented with an order not to
1337	resuscitate executed pursuant to s. 401.45. The agency shall
1338	adopt rules providing for the implementation of such orders.
1339	Facility staff and facilities shall not be subject to criminal
1340	prosecution or civil liability, nor be considered to have
1341	engaged in negligent or unprofessional conduct, for withholding
1342	or withdrawing cardiopulmonary resuscitation pursuant to such an
1343	order and rules adopted by the agency. The absence of an order
1344	not to resuscitate executed pursuant to s. 401.45 does not
1345	preclude a physician from withholding or withdrawing
1346	cardiopulmonary resuscitation as otherwise permitted by law.
1347	Section 32.  Sections 400.0234, 400.145, and 429.294,
1348	Florida Statutes, are repealed.
1349	Section 33.  Subsection (9) and subsections (11) through
1350	(15) of section 400.147, Florida Statutes, are renumbered as
1351	subsections (8) through (13), respectively, and present
1352	subsections (7), (8), and (10) of that section are amended to
1353	read:
1354	400.147  Internal risk management and quality assurance
1355	program.-
1356	(7)  The facility shall initiate an investigation and shall
1357	notify the agency within 1 business day after the risk manager
1358	or his or her designee has received a report pursuant to
1359	paragraph (1)(d). Each facility shall complete the investigation
1360	and submit a report to the agency within 15 calendar days after
1361	an incident is determined to be an adverse incident. The
1362	notification must be made in writing and be provided
1363	electronically, by facsimile device or overnight mail delivery.
1364	The agency shall develop a form for reporting this information
1365	and the notification must include the name of the risk manager
1366	of the facility, information regarding the identity of the
1367	affected resident, the type of adverse incident, the initiation
1368	of an investigation by the facility, and whether the events
1369	causing or resulting in the adverse incident represent a
1370	potential risk to any other resident. The notification is
1371	confidential as provided by law and is not discoverable or
1372	admissible in any civil or administrative action, except in
1373	disciplinary proceedings by the agency or the appropriate
1374	regulatory board. The agency may investigate, as it deems
1375	appropriate, any such incident and prescribe measures that must
1376	or may be taken in response to the incident. The agency shall
1377	review each report incident and determine whether it potentially
1378	involved conduct by the health care professional who is subject
1379	to disciplinary action, in which case the provisions of s.
1380	456.073 shall apply.
1381	(8)(a)  Each facility shall complete the investigation and
1382	submit an adverse incident report to the agency for each adverse
1383	incident within 15 calendar days after its occurrence. If, after
1384	a complete investigation, the risk manager determines that the
1385	incident was not an adverse incident as defined in subsection
1386	(5), the facility shall include this information in the report.
1387	The agency shall develop a form for reporting this information.
1388	(b)  The information reported to the agency pursuant to
1389	paragraph (a) which relates to persons licensed under chapter
1390	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1391	by the agency. The agency shall determine whether any of the
1392	incidents potentially involved conduct by a health care
1393	professional who is subject to disciplinary action, in which
1394	case the provisions of s. 456.073 shall apply.
1395	(c)  The report submitted to the agency must also contain
1396	the name of the risk manager of the facility.
1397	(d)  The adverse incident report is confidential as
1398	provided by law and is not discoverable or admissible in any
1399	civil or administrative action, except in disciplinary
1400	proceedings by the agency or the appropriate regulatory board.
1401	(10)  By the 10th of each month, each facility subject to
1402	this section shall report any notice received pursuant to s.
1403	400.0233(2) and each initial complaint that was filed with the
1404	clerk of the court and served on the facility during the
1405	previous month by a resident or a resident's family member,
1406	guardian, conservator, or personal legal representative. The
1407	report must include the name of the resident, the resident's
1408	date of birth and social security number, the Medicaid
1409	identification number for Medicaid-eligible persons, the date or
1410	dates of the incident leading to the claim or dates of
1411	residency, if applicable, and the type of injury or violation of
1412	rights alleged to have occurred. Each facility shall also submit
1413	a copy of the notices received pursuant to s. 400.0233(2) and
1414	complaints filed with the clerk of the court. This report is
1415	confidential as provided by law and is not discoverable or
1416	admissible in any civil or administrative action, except in such
1417	actions brought by the agency to enforce the provisions of this
1418	part.
1419	Section 34.  Section 400.148, Florida Statutes, is
1420	repealed.
1421	Section 35.  Paragraph (e) of subsection (2) of section
1422	400.179, Florida Statutes, is amended to read:
1423	400.179  Liability for Medicaid underpayments and
1424	overpayments.-
1425	(2)  Because any transfer of a nursing facility may expose
1426	the fact that Medicaid may have underpaid or overpaid the
1427	transferor, and because in most instances, any such underpayment
1428	or overpayment can only be determined following a formal field
1429	audit, the liabilities for any such underpayments or
1430	overpayments shall be as follows:
1431	(e)  For the 2009-2010 fiscal year only, the provisions of
1432	paragraph (d) shall not apply. This paragraph expires July 1,
1433	2010.
1434	Section 36.  Subsection (3) of section 400.19, Florida
1435	Statutes, is amended to read:
1436	400.19  Right of entry and inspection.-
1437	(3)  The agency shall every 15 months conduct at least one
1438	unannounced inspection to determine compliance by the licensee
1439	with statutes, and with rules promulgated under the provisions
1440	of those statutes, governing minimum standards of construction,
1441	quality and adequacy of care, and rights of residents. The
1442	survey shall be conducted every 6 months for the next 2-year
1443	period if the facility has been cited for a class I deficiency,
1444	has been cited for two or more class II deficiencies arising
1445	from separate surveys or investigations within a 60-day period,
1446	or has had three or more substantiated complaints within a 6-
1447	month period, each resulting in at least one class I or class II
1448	deficiency. In addition to any other fees or fines in this part,
1449	the agency shall assess a fine for each facility that is subject
1450	to the 6-month survey cycle. The fine for the 2-year period
1451	shall be $6,000, one-half to be paid at the completion of each
1452	survey. The agency may adjust this fine by the change in the
1453	Consumer Price Index, based on the 12 months immediately
1454	preceding the increase, to cover the cost of the additional
1455	surveys. The agency shall verify through subsequent inspection
1456	that any deficiency identified during inspection is corrected.
1457	However, the agency may verify the correction of a class III or
1458	class IV deficiency unrelated to resident rights or resident
1459	care without reinspecting the facility if adequate written
1460	documentation has been received from the facility, which
1461	provides assurance that the deficiency has been corrected. The
1462	giving or causing to be given of advance notice of such
1463	unannounced inspections by an employee of the agency to any
1464	unauthorized person shall constitute cause for suspension of not
1465	fewer than 5 working days according to the provisions of chapter
1466	110.
1467	Section 37.  Subsection (5) of section 400.23, Florida
1468	Statutes, is amended to read:
1469	400.23  Rules; evaluation and deficiencies; licensure
1470	status.-
1471	(5)(a)  The agency, in collaboration with the Division of
1472	Children's Medical Services Network of the Department of Health,
1473	must, no later than December 31, 1993, adopt rules for minimum
1474	standards of care for persons under 21 years of age who reside
1475	in nursing home facilities. The rules must include a methodology
1476	for reviewing a nursing home facility under ss. 408.031-408.045
1477	which serves only persons under 21 years of age. A facility may
1478	be exempt from these standards for specific persons between 18
1479	and 21 years of age, if the person's physician agrees that
1480	minimum standards of care based on age are not necessary.
1481	(b)  The agency, in collaboration with the Division of
1482	Children's Medical Services Network, shall adopt rules for
1483	minimum staffing requirements for nursing home facilities that
1484	serve persons under 21 years of age, which shall apply in lieu
1485	of the standards contained in subsection (3).
1486	1.  For persons under 21 years of age who require skilled
1487	care, the requirements shall include a minimum combined average
1488	of licensed nurses, respiratory therapists, respiratory care
1489	practitioners, and certified nursing assistants of 3.9 hours of
1490	direct care per resident per day for each nursing home facility.
1491	2.  For persons under 21 years of age who are fragile, the
1492	requirements shall include a minimum combined average of
1493	licensed nurses, respiratory therapists, respiratory care
1494	practitioners, and certified nursing assistants of 5 hours of
1495	direct care per resident per day for each nursing home facility.
1496	Section 38.  Subsection (1) of section 400.275, Florida
1497	Statutes, is amended to read:
1498	400.275  Agency duties.-
1499	(1)  The agency shall ensure that each newly hired nursing
1500	home surveyor, as a part of basic training, is assigned full-
1501	time to a licensed nursing home for at least 2 days within a 7-
1502	day period to observe facility operations outside of the survey
1503	process before the surveyor begins survey responsibilities. Such
1504	observations may not be the sole basis of a deficiency citation
1505	against the facility. The agency may not assign an individual to
1506	be a member of a survey team for purposes of a survey,
1507	evaluation, or consultation visit at a nursing home facility in
1508	which the surveyor was an employee within the preceding 2 5
1509	years.
1510	Section 39.  Subsection (2) of section 400.484, Florida
1511	Statutes, is amended to read:
1512	400.484  Right of inspection; violations deficiencies;
1513	fines.-
1514	(2)  The agency shall impose fines for various classes of
1515	violations deficiencies in accordance with the following
1516	schedule:
1517	(a)  Class I violations are defined in s. 408.813. A class
1518	I deficiency is any act, omission, or practice that results in a
1519	patient's death, disablement, or permanent injury, or places a
1520	patient at imminent risk of death, disablement, or permanent
1521	injury. Upon finding a class I violation deficiency, the agency
1522	shall impose an administrative fine in the amount of $15,000 for
1523	each occurrence and each day that the violation deficiency
1524	exists.
1525	(b)  Class II violations are defined in s. 408.813. A class
1526	II deficiency is any act, omission, or practice that has a
1527	direct adverse effect on the health, safety, or security of a
1528	patient. Upon finding a class II violation deficiency, the
1529	agency shall impose an administrative fine in the amount of
1530	$5,000 for each occurrence and each day that the violation
1531	deficiency exists.
1532	(c)  Class III violations are defined in s. 408.813. A
1533	class III deficiency is any act, omission, or practice that has
1534	an indirect, adverse effect on the health, safety, or security
1535	of a patient. Upon finding an uncorrected or repeated class III
1536	violation deficiency, the agency shall impose an administrative
1537	fine not to exceed $1,000 for each occurrence and each day that
1538	the uncorrected or repeated violation deficiency exists.
1539	(d)  Class IV violations are defined in s. 408.813. A class
1540	IV deficiency is any act, omission, or practice related to
1541	required reports, forms, or documents which does not have the
1542	potential of negatively affecting patients. These violations are
1543	of a type that the agency determines do not threaten the health,
1544	safety, or security of patients. Upon finding an uncorrected or
1545	repeated class IV violation deficiency, the agency shall impose
1546	an administrative fine not to exceed $500 for each occurrence
1547	and each day that the uncorrected or repeated violation
1548	deficiency exists.
1549	Section 40.  Subsections (16) and (17) of section 400.506,
1550	Florida Statutes, are renumbered as subsections (17) and (18),
1551	respectively, paragraph (a) of subsection (15) is amended, and a
1552	new subsection (16) is added to that section, to read:
1553	400.506  Licensure of nurse registries; requirements;
1554	penalties.-
1555	(15)(a)  The agency may deny, suspend, or revoke the
1556	license of a nurse registry and shall impose a fine of $5,000
1557	against a nurse registry that:
1558	1.  Provides services to residents in an assisted living
1559	facility for which the nurse registry does not receive fair
1560	market value remuneration.
1561	2.  Provides staffing to an assisted living facility for
1562	which the nurse registry does not receive fair market value
1563	remuneration.
1564	3.  Fails to provide the agency, upon request, with copies
1565	of all contracts with assisted living facilities which were
1566	executed within the last 5 years.
1567	4.  Gives remuneration to a case manager, discharge
1568	planner, facility-based staff member, or third-party vendor who
1569	is involved in the discharge planning process of a facility
1570	licensed under chapter 395 or this chapter and from whom the
1571	nurse registry receives referrals. A nurse registry is exempt
1572	from this subparagraph if it does not bill the Florida Medicaid
1573	program or the Medicare program or share a controlling interest
1574	with any entity licensed, registered, or certified under part II
1575	of chapter 408 that bills the Florida Medicaid program or the
1576	Medicare program.
1577	5.  Gives remuneration to a physician, a member of the
1578	physician's office staff, or an immediate family member of the
1579	physician, and the nurse registry received a patient referral in
1580	the last 12 months from that physician or the physician's office
1581	staff. A nurse registry is exempt from this subparagraph if it
1582	does not bill the Florida Medicaid program or the Medicare
1583	program or share a controlling interest with any entity
1584	licensed, registered, or certified under part II of chapter 408
1585	that bills the Florida Medicaid program or the Medicare program.
1586	(16)  An administrator may manage only one nurse registry,
1587	except that an administrator may manage up to five registries if
1588	all five registries have identical controlling interests as
1589	defined in s. 408.803 and are located within one agency
1590	geographic service area or within an immediately contiguous
1591	county. An administrator shall designate, in writing, for each
1592	licensed entity, a qualified alternate administrator to serve
1593	during the administrator's absence.
1594	Section 41.  Subsection (1) of section 400.509, Florida
1595	Statutes, is amended to read:
1596	400.509  Registration of particular service providers
1597	exempt from licensure; certificate of registration; regulation
1598	of registrants.-
1599	(1)  Any organization that provides companion services or
1600	homemaker services and does not provide a home health service to
1601	a person is exempt from licensure under this part. However, any
1602	organization that provides companion services or homemaker
1603	services must register with the agency. An organization under
1604	contract with the Agency for Persons with Disabilities that
1605	provides companion services only for persons with a
1606	developmental disability, as defined in s. 393.063, are exempt
1607	from registration.
1608	Section 42.  Paragraph (i) of subsection (1) and subsection
1609	(4) of section 400.606, Florida Statutes, are amended to read:
1610	400.606  License; application; renewal; conditional license
1611	or permit; certificate of need.-
1612	(1)  In addition to the requirements of part II of chapter
1613	408, the initial application and change of ownership application
1614	must be accompanied by a plan for the delivery of home,
1615	residential, and homelike inpatient hospice services to
1616	terminally ill persons and their families. Such plan must
1617	contain, but need not be limited to:
1618	(i)  The projected annual operating cost of the hospice.
1619	If the applicant is an existing licensed health care provider,
1620	the application must be accompanied by a copy of the most recent
1621	profit-loss statement and, if applicable, the most recent
1622	licensure inspection report.
1623	(4)  A freestanding hospice facility that is primarily
1624	engaged in providing inpatient and related services and that is
1625	not otherwise licensed as a health care facility shall be
1626	required to obtain a certificate of need. However, a
1627	freestanding hospice facility with six or fewer beds shall not
1628	be required to comply with institutional standards such as, but
1629	not limited to, standards requiring sprinkler systems, emergency
1630	electrical systems, or special lavatory devices.
1631	Section 43.  Subsection (2) of section 400.607, Florida
1632	Statutes, is amended to read:
1633	400.607  Denial, suspension, revocation of license;
1634	emergency actions; imposition of administrative fine; grounds.-
1635	(2)  A violation of this part, part II of chapter 408, or
1636	applicable rules Any of the following actions by a licensed
1637	hospice or any of its employees shall be grounds for
1638	administrative action by the agency against a hospice.:
1639	(a)  A violation of the provisions of this part, part II of
1640	chapter 408, or applicable rules.
1641	(b)  An intentional or negligent act materially affecting
1642	the health or safety of a patient.
1643	Section 44.  Section 400.915, Florida Statutes, is amended
1644	to read:
1645	400.915  Construction and renovation; requirements.-The
1646	requirements for the construction or renovation of a PPEC center
1647	shall comply with:
1648	(1)  The provisions of chapter 553, which pertain to
1649	building construction standards, including plumbing, electrical
1650	code, glass, manufactured buildings, accessibility for the
1651	physically disabled;
1652	(2)  The provisions of s. 633.022 and applicable rules
1653	pertaining to physical minimum standards for nonresidential
1654	child care physical facilities in rule 10M-12.003, Florida
1655	Administrative Code, Child Care Standards; and
1656	(3)  The standards or rules adopted pursuant to this part
1657	and part II of chapter 408.
1658	Section 45.  Subsection (1) of section 400.925, Florida
1659	Statutes, is amended to read:
1660	400.925  Definitions.-As used in this part, the term:
1661	(1)  "Accrediting organizations" means the Joint Commission
1662	on Accreditation of Healthcare Organizations or other national
1663	accreditation agencies whose standards for accreditation are
1664	comparable to those required by this part for licensure.
1665	Section 46.  Subsection (2) of section 400.931, Florida
1666	Statutes, is amended to read:
1667	400.931  Application for license; fee; provisional license;
1668	temporary permit.-
1669	(2)  An applicant for initial licensure, change of
1670	ownership, or renewal to operate a licensed home medical
1671	equipment provider at a location outside the state must submit
1672	documentation of accreditation or an application for
1673	accreditation from an accrediting organization that is
1674	recognized by the agency. An applicant that has applied for
1675	accreditation must provide proof of accreditation that is not
1676	conditional or provisional within 120 days after the date the
1677	agency receives the application for licensure or the application
1678	shall be withdrawn from further consideration. Such
1679	accreditation must be maintained by the home medical equipment
1680	provider to maintain licensure. As an alternative to submitting
1681	proof of financial ability to operate as required in s.
1682	408.810(8), the applicant may submit a $50,000 surety bond to
1683	the agency.
1684	Section 47.  Subsection (2) of section 400.932, Florida
1685	Statutes, is amended to read:
1686	400.932  Administrative penalties.-
1687	(2)  A violation of this part, part II of chapter 408, or
1688	applicable rules Any of the following actions by an employee of
1689	a home medical equipment provider shall be are grounds for
1690	administrative action or penalties by the agency.:
1691	(a)  Violation of this part, part II of chapter 408, or
1692	applicable rules.
1693	(b)  An intentional, reckless, or negligent act that
1694	materially affects the health or safety of a patient.
1695	Section 48.  Subsection (3) of section 400.967, Florida
1696	Statutes, is amended to read:
1697	400.967  Rules and classification of violations
1698	deficiencies.-
1699	(3)  The agency shall adopt rules to provide that, when the
1700	criteria established under this part and part II of chapter 408
1701	are not met, such violations deficiencies shall be classified
1702	according to the nature of the violation deficiency. The agency
1703	shall indicate the classification on the face of the notice of
1704	deficiencies as follows:
1705	(a)  Class I violations deficiencies are defined in s.
1706	408.813 those which the agency determines present an imminent
1707	danger to the residents or guests of the facility or a
1708	substantial probability that death or serious physical harm
1709	would result therefrom. The condition or practice constituting a
1710	class I violation must be abated or eliminated immediately,
1711	unless a fixed period of time, as determined by the agency, is
1712	required for correction. A class I violation deficiency is
1713	subject to a civil penalty in an amount not less than $5,000 and
1714	not exceeding $10,000 for each violation deficiency. A fine may
1715	be levied notwithstanding the correction of the violation
1716	deficiency.
1717	(b)  Class II violations deficiencies are defined in s.
1718	408.813 those which the agency determines have a direct or
1719	immediate relationship to the health, safety, or security of the
1720	facility residents, other than class I deficiencies. A class II
1721	violation deficiency is subject to a civil penalty in an amount
1722	not less than $1,000 and not exceeding $5,000 for each violation
1723	deficiency. A citation for a class II violation deficiency shall
1724	specify the time within which the violation deficiency must be
1725	corrected. If a class II violation deficiency is corrected
1726	within the time specified, no civil penalty shall be imposed,
1727	unless it is a repeated offense.
1728	(c)  Class III violations deficiencies are defined in s.
1729	408.813 those which the agency determines to have an indirect or
1730	potential relationship to the health, safety, or security of the
1731	facility residents, other than class I or class II deficiencies.
1732	A class III violation deficiency is subject to a civil penalty
1733	of not less than $500 and not exceeding $1,000 for each
1734	deficiency. A citation for a class III violation deficiency
1735	shall specify the time within which the violation deficiency
1736	must be corrected. If a class III violation deficiency is
1737	corrected within the time specified, no civil penalty shall be
1738	imposed, unless it is a repeated offense.
1739	(d)  Class IV violations are defined in s. 408.813. Upon
1740	finding an uncorrected or repeated class IV violation, the
1741	agency shall impose an administrative fine not to exceed $500
1742	for each occurrence and each day that the uncorrected or
1743	repeated violation exists.
1744	Section 49.  Subsections (4) and (7) of section 400.9905,
1745	Florida Statutes, are amended to read:
1746	400.9905  Definitions.-
1747	(4)  "Clinic" means an entity at which health care services
1748	are provided to individuals and which tenders charges for
1749	reimbursement for such services, including a mobile clinic and a
1750	portable health service or equipment provider. For purposes of
1751	this part, the term does not include and the licensure
1752	requirements of this part do not apply to:
1753	(a)  Entities licensed or registered by the state under
1754	chapter 395; or entities licensed or registered by the state and
1755	providing only health care services within the scope of services
1756	authorized under their respective licenses granted under ss.
1757	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1758	chapter except part X, chapter 429, chapter 463, chapter 465,
1759	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1760	chapter 651; end-stage renal disease providers authorized under
1761	42 C.F.R. part 405, subpart U; or providers certified under 42
1762	C.F.R. part 485, subpart B or subpart H; or any entity that
1763	provides neonatal or pediatric hospital-based health care
1764	services or other health care services by licensed practitioners
1765	solely within a hospital licensed under chapter 395.
1766	(b)  Entities that own, directly or indirectly, entities
1767	licensed or registered by the state pursuant to chapter 395; or
1768	entities that own, directly or indirectly, entities licensed or
1769	registered by the state and providing only health care services
1770	within the scope of services authorized pursuant to their
1771	respective licenses granted under ss. 383.30-383.335, chapter
1772	390, chapter 394, chapter 397, this chapter except part X,
1773	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1774	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1775	disease providers authorized under 42 C.F.R. part 405, subpart
1776	U; or providers certified under 42 C.F.R. part 485, subpart B or
1777	subpart H; or any entity that provides neonatal or pediatric
1778	hospital-based health care services by licensed practitioners
1779	solely within a hospital licensed under chapter 395.
1780	(c)  Entities that are owned, directly or indirectly, by an
1781	entity licensed or registered by the state pursuant to chapter
1782	395; or entities that are owned, directly or indirectly, by an
1783	entity licensed or registered by the state and providing only
1784	health care services within the scope of services authorized
1785	pursuant to their respective licenses granted under ss. 383.30-
1786	383.335, chapter 390, chapter 394, chapter 397, this chapter
1787	except part X, chapter 429, chapter 463, chapter 465, chapter
1788	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1789	651; end-stage renal disease providers authorized under 42
1790	C.F.R. part 405, subpart U; or providers certified under 42
1791	C.F.R. part 485, subpart B or subpart H; or any entity that
1792	provides neonatal or pediatric hospital-based health care
1793	services by licensed practitioners solely within a hospital
1794	under chapter 395.
1795	(d)  Entities that are under common ownership, directly or
1796	indirectly, with an entity licensed or registered by the state
1797	pursuant to chapter 395; or entities that are under common
1798	ownership, directly or indirectly, with an entity licensed or
1799	registered by the state and providing only health care services
1800	within the scope of services authorized pursuant to their
1801	respective licenses granted under ss. 383.30-383.335, chapter
1802	390, chapter 394, chapter 397, this chapter except part X,
1803	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1804	part I of chapter 483, chapter 484, or chapter 651; end-stage
1805	renal disease providers authorized under 42 C.F.R. part 405,
1806	subpart U; or providers certified under 42 C.F.R. part 485,
1807	subpart B or subpart H; or any entity that provides neonatal or
1808	pediatric hospital-based health care services by licensed
1809	practitioners solely within a hospital licensed under chapter
1810	395.
1811	(e)  An entity that is exempt from federal taxation under
1812	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1813	under 26 U.S.C. s. 409 that has a board of trustees not less
1814	than two-thirds of which are Florida-licensed health care
1815	practitioners and provides only physical therapy services under
1816	physician orders, any community college or university clinic,
1817	and any entity owned or operated by the federal or state
1818	government, including agencies, subdivisions, or municipalities
1819	thereof.
1820	(f)  A sole proprietorship, group practice, partnership, or
1821	corporation that provides health care services by physicians
1822	covered by s. 627.419, that is directly supervised by one or
1823	more of such physicians, and that is wholly owned by one or more
1824	of those physicians or by a physician and the spouse, parent,
1825	child, or sibling of that physician.
1826	(g)  A sole proprietorship, group practice, partnership, or
1827	corporation that provides health care services by licensed
1828	health care practitioners under chapter 457, chapter 458,
1829	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1830	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1831	chapter 490, chapter 491, or part I, part III, part X, part
1832	XIII, or part XIV of chapter 468, or s. 464.012, which are
1833	wholly owned by one or more licensed health care practitioners,
1834	or the licensed health care practitioners set forth in this
1835	paragraph and the spouse, parent, child, or sibling of a
1836	licensed health care practitioner, so long as one of the owners
1837	who is a licensed health care practitioner is supervising the
1838	business activities and is legally responsible for the entity's
1839	compliance with all federal and state laws. However, a health
1840	care practitioner may not supervise services beyond the scope of
1841	the practitioner's license, except that, for the purposes of
1842	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1843	provides only services authorized pursuant to s. 456.053(3)(b)
1844	may be supervised by a licensee specified in s. 456.053(3)(b).
1845	(h)  Clinical facilities affiliated with an accredited
1846	medical school at which training is provided for medical
1847	students, residents, or fellows.
1848	(i)  Entities that provide only oncology or radiation
1849	therapy services by physicians licensed under chapter 458 or
1850	chapter 459 or entities that provide oncology or radiation
1851	therapy services by physicians licensed under chapter 458 or
1852	chapter 459 which are owned by a corporation whose shares are
1853	publicly traded on a recognized stock exchange.
1854	(j)  Clinical facilities affiliated with a college of
1855	chiropractic accredited by the Council on Chiropractic Education
1856	at which training is provided for chiropractic students.
1857	(k)  Entities that provide licensed practitioners to staff
1858	emergency departments or to deliver anesthesia services in
1859	facilities licensed under chapter 395 and that derive at least
1860	90 percent of their gross annual revenues from the provision of
1861	such services. Entities claiming an exemption from licensure
1862	under this paragraph must provide documentation demonstrating
1863	compliance.
1864	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1865	perinatology clinical facilities that are a publicly traded
1866	corporation or that are wholly owned, directly or indirectly, by
1867	a publicly traded corporation. As used in this paragraph, a
1868	publicly traded corporation is a corporation that issues
1869	securities traded on an exchange registered with the United
1870	States Securities and Exchange Commission as a national
1871	securities exchange.
1872	(m)  Entities that are owned by a corporation that has $250
1873	million or more in total annual sales of health care services
1874	provided by licensed health care practitioners if one or more of
1875	the owners of the entity is a health care practitioner who is
1876	licensed in this state, is responsible for supervising the
1877	business activities of the entity, and is legally responsible
1878	for the entity's compliance with state law for purposes of this
1879	section.
1880	(n)  Entities that are owned or controlled, directly or
1881	indirectly, by a publicly traded entity with $100 million or
1882	more, in the aggregate, in total annual revenues derived from
1883	providing health care services by licensed health care
1884	practitioners that are employed or contracted by an entity
1885	described in this paragraph.
1886	(7)  "Portable health service or equipment provider" means
1887	an entity that contracts with or employs persons to provide
1888	portable health services or equipment to multiple locations
1889	performing treatment or diagnostic testing of individuals, that
1890	bills third-party payors for those services, and that otherwise
1891	meets the definition of a clinic in subsection (4).
1892	Section 50.  Paragraph (b) of subsection (1) and paragraph
1893	(c) of subsection (4) of section 400.991, Florida Statutes, are
1894	amended to read:
1895	400.991  License requirements; background screenings;
1896	prohibitions.-
1897	(1)
1898	(b)  Each mobile clinic must obtain a separate health care
1899	clinic license and must provide to the agency, at least
1900	quarterly, its projected street location to enable the agency to
1901	locate and inspect such clinic. A portable health service or
1902	equipment provider must obtain a health care clinic license for
1903	a single administrative office and is not required to submit
1904	quarterly projected street locations.
1905	(4)  In addition to the requirements of part II of chapter
1906	408, the applicant must file with the application satisfactory
1907	proof that the clinic is in compliance with this part and
1908	applicable rules, including:
1909	(c)  Proof of financial ability to operate as required
1910	under ss. s. 408.810(8) and 408.8065. As an alternative to
1911	submitting proof of financial ability to operate as required
1912	under s. 408.810(8), the applicant may file a surety bond of at
1913	least $500,000 which guarantees that the clinic will act in full
1914	conformity with all legal requirements for operating a clinic,
1915	payable to the agency. The agency may adopt rules to specify
1916	related requirements for such surety bond.
1917	Section 51.  Paragraph (g) of subsection (1) and paragraph
1918	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1919	amended to read:
1920	400.9935  Clinic responsibilities.-
1921	(1)  Each clinic shall appoint a medical director or clinic
1922	director who shall agree in writing to accept legal
1923	responsibility for the following activities on behalf of the
1924	clinic. The medical director or the clinic director shall:
1925	(g)  Conduct systematic reviews of clinic billings to
1926	ensure that the billings are not fraudulent or unlawful. Upon
1927	discovery of an unlawful charge, the medical director or clinic
1928	director shall take immediate corrective action. If the clinic
1929	performs only the technical component of magnetic resonance
1930	imaging, static radiographs, computed tomography, or positron
1931	emission tomography, and provides the professional
1932	interpretation of such services, in a fixed facility that is
1933	accredited by the Joint Commission on Accreditation of
1934	Healthcare Organizations or the Accreditation Association for
1935	Ambulatory Health Care, and the American College of Radiology;
1936	and if, in the preceding quarter, the percentage of scans
1937	performed by that clinic which was billed to all personal injury
1938	protection insurance carriers was less than 15 percent, the
1939	chief financial officer of the clinic may, in a written
1940	acknowledgment provided to the agency, assume the responsibility
1941	for the conduct of the systematic reviews of clinic billings to
1942	ensure that the billings are not fraudulent or unlawful.
1943	(7)(a)  Each clinic engaged in magnetic resonance imaging
1944	services must be accredited by the Joint Commission on
1945	Accreditation of Healthcare Organizations, the American College
1946	of Radiology, or the Accreditation Association for Ambulatory
1947	Health Care, within 1 year after licensure. A clinic that is
1948	accredited by the American College of Radiology or is within the
1949	original 1-year period after licensure and replaces its core
1950	magnetic resonance imaging equipment shall be given 1 year after
1951	the date on which the equipment is replaced to attain
1952	accreditation. However, a clinic may request a single, 6-month
1953	extension if it provides evidence to the agency establishing
1954	that, for good cause shown, such clinic cannot be accredited
1955	within 1 year after licensure, and that such accreditation will
1956	be completed within the 6-month extension. After obtaining
1957	accreditation as required by this subsection, each such clinic
1958	must maintain accreditation as a condition of renewal of its
1959	license. A clinic that files a change of ownership application
1960	must comply with the original accreditation timeframe
1961	requirements of the transferor. The agency shall deny a change
1962	of ownership application if the clinic is not in compliance with
1963	the accreditation requirements. When a clinic adds, replaces, or
1964	modifies magnetic resonance imaging equipment and the
1965	accreditation agency requires new accreditation, the clinic must
1966	be accredited within 1 year after the date of the addition,
1967	replacement, or modification but may request a single, 6-month
1968	extension if the clinic provides evidence of good cause to the
1969	agency.
1970	Section 52.  Paragraph (a) of subsection (2) of section
1971	408.033, Florida Statutes, is amended to read:
1972	408.033  Local and state health planning.-
1973	(2)  FUNDING.-
1974	(a)  The Legislature intends that the cost of local health
1975	councils be borne by assessments on selected health care
1976	facilities subject to facility licensure by the Agency for
1977	Health Care Administration, including abortion clinics, assisted
1978	living facilities, ambulatory surgical centers, birthing
1979	centers, clinical laboratories except community nonprofit blood
1980	banks and clinical laboratories operated by practitioners for
1981	exclusive use regulated under s. 483.035, home health agencies,
1982	hospices, hospitals, intermediate care facilities for the
1983	developmentally disabled, nursing homes, health care clinics,
1984	and multiphasic testing centers and by assessments on
1985	organizations subject to certification by the agency pursuant to
1986	chapter 641, part III, including health maintenance
1987	organizations and prepaid health clinics. Fees assessed may be
1988	collected prospectively at the time of licensure renewal and
1989	prorated for the licensure period.
1990	Section 53.  Subsection (2) of section 408.034, Florida
1991	Statutes, is amended to read:
1992	408.034  Duties and responsibilities of agency; rules.-
1993	(2)  In the exercise of its authority to issue licenses to
1994	health care facilities and health service providers, as provided
1995	under chapters 393 and 395 and parts II, and IV, and VIII of
1996	chapter 400, the agency may not issue a license to any health
1997	care facility or health service provider that fails to receive a
1998	certificate of need or an exemption for the licensed facility or
1999	service.
2000	Section 54.  Paragraph (d) of subsection (1) and paragraph
2001	(m) of subsection (3) of section 408.036, Florida Statutes, are
2002	amended to read:
2003	408.036  Projects subject to review; exemptions.-
2004	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
2005	health-care-related projects, as described in paragraphs (a)-
2006	(g), are subject to review and must file an application for a
2007	certificate of need with the agency. The agency is exclusively
2008	responsible for determining whether a health-care-related
2009	project is subject to review under ss. 408.031-408.045.
2010	(d)  The establishment of a hospice or hospice inpatient
2011	facility, except as provided in s. 408.043.
2012	(3)  EXEMPTIONS.-Upon request, the following projects are
2013	subject to exemption from the provisions of subsection (1):
2014	(m)1.  For the provision of adult open-heart services in a
2015	hospital located within the boundaries of a health service
2016	planning district, as defined in s. 408.032(5), which has
2017	experienced an annual net out-migration of at least 600 open-
2018	heart-surgery cases for 3 consecutive years according to the
2019	most recent data reported to the agency, and the district's
2020	population per licensed and operational open-heart programs
2021	exceeds the state average of population per licensed and
2022	operational open-heart programs by at least 25 percent. All
2023	hospitals within a health service planning district which meet
2024	the criteria reference in sub-subparagraphs 2.a.-h. shall be
2025	eligible for this exemption on July 1, 2004, and shall receive
2026	the exemption upon filing for it and subject to the following:
2027	a.  A hospital that has received a notice of intent to
2028	grant a certificate of need or a final order of the agency
2029	granting a certificate of need for the establishment of an open-
2030	heart-surgery program is entitled to receive a letter of
2031	exemption for the establishment of an adult open-heart-surgery
2032	program upon filing a request for exemption and complying with
2033	the criteria enumerated in sub-subparagraphs 2.a.-h., and is
2034	entitled to immediately commence operation of the program.
2035	b.  An otherwise eligible hospital that has not received a
2036	notice of intent to grant a certificate of need or a final order
2037	of the agency granting a certificate of need for the
2038	establishment of an open-heart-surgery program is entitled to
2039	immediately receive a letter of exemption for the establishment
2040	of an adult open-heart-surgery program upon filing a request for
2041	exemption and complying with the criteria enumerated in sub-
2042	subparagraphs 2.a.-h., but is not entitled to commence operation
2043	of its program until December 31, 2006.
2044	2.  A hospital shall be exempt from the certificate-of-need
2045	review for the establishment of an open-heart-surgery program
2046	when the application for exemption submitted under this
2047	paragraph complies with the following criteria:
2048	a.  The applicant must certify that it will meet and
2049	continuously maintain the minimum licensure requirements adopted
2050	by the agency governing adult open-heart programs, including the
2051	most current guidelines of the American College of Cardiology
2052	and American Heart Association Guidelines for Adult Open Heart
2053	Programs.
2054	b.  The applicant must certify that it will maintain
2055	sufficient appropriate equipment and health personnel to ensure
2056	quality and safety.
2057	c.  The applicant must certify that it will maintain
2058	appropriate times of operation and protocols to ensure
2059	availability and appropriate referrals in the event of
2060	emergencies.
2061	d.  The applicant can demonstrate that it has discharged at
2062	least 300 inpatients with a principal diagnosis of ischemic
2063	heart disease for the most recent 12-month period as reported to
2064	the agency.
2065	e.  The applicant is a general acute care hospital that is
2066	in operation for 3 years or more.
2067	f.  The applicant is performing more than 300 diagnostic
2068	cardiac catheterization procedures per year, combined inpatient
2069	and outpatient.
2070	g.  The applicant's payor mix at a minimum reflects the
2071	community average for Medicaid, charity care, and self-pay
2072	patients or the applicant must certify that it will provide a
2073	minimum of 5 percent of Medicaid, charity care, and self-pay to
2074	open-heart-surgery patients.
2075	h.  If the applicant fails to meet the established criteria
2076	for open-heart programs or fails to reach 300 surgeries per year
2077	by the end of its third year of operation, it must show cause
2078	why its exemption should not be revoked.
2079	3.  By December 31, 2004, and annually thereafter, the
2080	agency shall submit a report to the Legislature providing
2081	information concerning the number of requests for exemption it
2082	has received under this paragraph during the calendar year and
2083	the number of exemptions it has granted or denied during the
2084	calendar year.
2085	Section 55.  Paragraph (c) of subsection (1) of section
2086	408.037, Florida Statutes, is amended to read:
2087	408.037  Application content.-
2088	(1)  Except as provided in subsection (2) for a general
2089	hospital, an application for a certificate of need must contain:
2090	(c)  An audited financial statement of the applicant or the
2091	applicant's parent corporation if audited financial statements
2092	of the applicant do not exist. In an application submitted by an
2093	existing health care facility, health maintenance organization,
2094	or hospice, financial condition documentation must include, but
2095	need not be limited to, a balance sheet and a profit-and-loss
2096	statement of the 2 previous fiscal years' operation.
2097	Section 56.  Subsection (2) of section 408.043, Florida
2098	Statutes, is amended to read:
2099	408.043  Special provisions.-
2100	(2)  HOSPICES.-When an application is made for a
2101	certificate of need to establish or to expand a hospice, the
2102	need for such hospice shall be determined on the basis of the
2103	need for and availability of hospice services in the community.
2104	The formula on which the certificate of need is based shall
2105	discourage regional monopolies and promote competition. The
2106	inpatient hospice care component of a hospice which is a
2107	freestanding facility, or a part of a facility, which is
2108	primarily engaged in providing inpatient care and related
2109	services and is not licensed as a health care facility shall
2110	also be required to obtain a certificate of need. Provision of
2111	hospice care by any current provider of health care is a
2112	significant change in service and therefore requires a
2113	certificate of need for such services.
2114	Section 57.  Paragraph (k) of subsection (3) of section
2115	408.05, Florida Statutes, is amended to read:
2116	408.05  Florida Center for Health Information and Policy
2117	Analysis.-
2118	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
2119	produce comparable and uniform health information and statistics
2120	for the development of policy recommendations, the agency shall
2121	perform the following functions:
2122	(k)  Develop, in conjunction with the State Consumer Health
2123	Information and Policy Advisory Council, and implement a long-
2124	range plan for making available health care quality measures and
2125	financial data that will allow consumers to compare health care
2126	services. The health care quality measures and financial data
2127	the agency must make available shall include, but is not limited
2128	to, pharmaceuticals, physicians, health care facilities, and
2129	health plans and managed care entities. The agency shall update
2130	the plan and report on the status of its implementation
2131	annually. The agency shall also make the plan and status report
2132	available to the public on its Internet website. As part of the
2133	plan, the agency shall identify the process and timeframes for
2134	implementation, any barriers to implementation, and
2135	recommendations of changes in the law that may be enacted by the
2136	Legislature to eliminate the barriers. As preliminary elements
2137	of the plan, the agency shall:
2138	1.  Make available patient-safety indicators, inpatient
2139	quality indicators, and performance outcome and patient charge
2140	data collected from health care facilities pursuant to s.
2141	408.061(1)(a) and (2). The terms "patient-safety indicators" and
2142	"inpatient quality indicators" shall be as defined by the
2143	Centers for Medicare and Medicaid Services, the National Quality
2144	Forum, the Joint Commission on Accreditation of Healthcare
2145	Organizations, the Agency for Healthcare Research and Quality,
2146	the Centers for Disease Control and Prevention, or a similar
2147	national entity that establishes standards to measure the
2148	performance of health care providers, or by other states. The
2149	agency shall determine which conditions, procedures, health care
2150	quality measures, and patient charge data to disclose based upon
2151	input from the council. When determining which conditions and
2152	procedures are to be disclosed, the council and the agency shall
2153	consider variation in costs, variation in outcomes, and
2154	magnitude of variations and other relevant information. When
2155	determining which health care quality measures to disclose, the
2156	agency:
2157	a.  Shall consider such factors as volume of cases; average
2158	patient charges; average length of stay; complication rates;
2159	mortality rates; and infection rates, among others, which shall
2160	be adjusted for case mix and severity, if applicable.
2161	b.  May consider such additional measures that are adopted
2162	by the Centers for Medicare and Medicaid Studies, National
2163	Quality Forum, the Joint Commission on Accreditation of
2164	Healthcare Organizations, the Agency for Healthcare Research and
2165	Quality, Centers for Disease Control and Prevention, or a
2166	similar national entity that establishes standards to measure
2167	the performance of health care providers, or by other states.
2168
2169	When determining which patient charge data to disclose, the
2170	agency shall include such measures as the average of
2171	undiscounted charges on frequently performed procedures and
2172	preventive diagnostic procedures, the range of procedure charges
2173	from highest to lowest, average net revenue per adjusted patient
2174	day, average cost per adjusted patient day, and average cost per
2175	admission, among others.
2176	2.  Make available performance measures, benefit design,
2177	and premium cost data from health plans licensed pursuant to
2178	chapter 627 or chapter 641. The agency shall determine which
2179	health care quality measures and member and subscriber cost data
2180	to disclose, based upon input from the council. When determining
2181	which data to disclose, the agency shall consider information
2182	that may be required by either individual or group purchasers to
2183	assess the value of the product, which may include membership
2184	satisfaction, quality of care, current enrollment or membership,
2185	coverage areas, accreditation status, premium costs, plan costs,
2186	premium increases, range of benefits, copayments and
2187	deductibles, accuracy and speed of claims payment, credentials
2188	of physicians, number of providers, names of network providers,
2189	and hospitals in the network. Health plans shall make available
2190	to the agency any such data or information that is not currently
2191	reported to the agency or the office.
2192	3.  Determine the method and format for public disclosure
2193	of data reported pursuant to this paragraph. The agency shall
2194	make its determination based upon input from the State Consumer
2195	Health Information and Policy Advisory Council. At a minimum,
2196	the data shall be made available on the agency's Internet
2197	website in a manner that allows consumers to conduct an
2198	interactive search that allows them to view and compare the
2199	information for specific providers. The website must include
2200	such additional information as is determined necessary to ensure
2201	that the website enhances informed decisionmaking among
2202	consumers and health care purchasers, which shall include, at a
2203	minimum, appropriate guidance on how to use the data and an
2204	explanation of why the data may vary from provider to provider.
2205	4.  Publish on its website undiscounted charges for no
2206	fewer than 150 of the most commonly performed adult and
2207	pediatric procedures, including outpatient, inpatient,
2208	diagnostic, and preventative procedures.
2209	Section 58.  Paragraph (a) of subsection (1) of section
2210	408.061, Florida Statutes, is amended to read:
2211	408.061  Data collection; uniform systems of financial
2212	reporting; information relating to physician charges;
2213	confidential information; immunity.-
2214	(1)  The agency shall require the submission by health care
2215	facilities, health care providers, and health insurers of data
2216	necessary to carry out the agency's duties. Specifications for
2217	data to be collected under this section shall be developed by
2218	the agency with the assistance of technical advisory panels
2219	including representatives of affected entities, consumers,
2220	purchasers, and such other interested parties as may be
2221	determined by the agency.
2222	(a)  Data submitted by health care facilities, including
2223	the facilities as defined in chapter 395, shall include, but are
2224	not limited to: case-mix data, patient admission and discharge
2225	data, hospital emergency department data which shall include the
2226	number of patients treated in the emergency department of a
2227	licensed hospital reported by patient acuity level, data on
2228	hospital-acquired infections as specified by rule, data on
2229	complications as specified by rule, data on readmissions as
2230	specified by rule, with patient and provider-specific
2231	identifiers included, actual charge data by diagnostic groups,
2232	financial data, accounting data, operating expenses, expenses
2233	incurred for rendering services to patients who cannot or do not
2234	pay, interest charges, depreciation expenses based on the
2235	expected useful life of the property and equipment involved, and
2236	demographic data. The agency shall adopt nationally recognized
2237	risk adjustment methodologies or software consistent with the
2238	standards of the Agency for Healthcare Research and Quality and
2239	as selected by the agency for all data submitted as required by
2240	this section. Data may be obtained from documents such as, but
2241	not limited to: leases, contracts, debt instruments, itemized
2242	patient bills, medical record abstracts, and related diagnostic
2243	information. Reported data elements shall be reported
2244	electronically and in accordance with rule 59E-7.012, Florida
2245	Administrative Code. Data submitted shall be certified by the
2246	chief executive officer or an appropriate and duly authorized
2247	representative or employee of the licensed facility that the
2248	information submitted is true and accurate.
2249	Section 59.  Subsection (43) of section 408.07, Florida
2250	Statutes, is amended to read:
2251	408.07  Definitions.-As used in this chapter, with the
2252	exception of ss. 408.031-408.045, the term:
2253	(43)  "Rural hospital" means an acute care hospital
2254	licensed under chapter 395, having 100 or fewer licensed beds
2255	and an emergency room, and which is:
2256	(a)  The sole provider within a county with a population
2257	density of no greater than 100 persons per square mile;
2258	(b)  An acute care hospital, in a county with a population
2259	density of no greater than 100 persons per square mile, which is
2260	at least 30 minutes of travel time, on normally traveled roads
2261	under normal traffic conditions, from another acute care
2262	hospital within the same county;
2263	(c)  A hospital supported by a tax district or subdistrict
2264	whose boundaries encompass a population of 100 persons or fewer
2265	per square mile;
2266	(d)  A hospital with a service area that has a population
2267	of 100 persons or fewer per square mile. As used in this
2268	paragraph, the term "service area" means the fewest number of
2269	zip codes that account for 75 percent of the hospital's
2270	discharges for the most recent 5-year period, based on
2271	information available from the hospital inpatient discharge
2272	database in the Florida Center for Health Information and Policy
2273	Analysis at the Agency for Health Care Administration; or
2274	(e)  A critical access hospital.
2275
2276	Population densities used in this subsection must be based upon
2277	the most recently completed United States census. A hospital
2278	that received funds under s. 409.9116 for a quarter beginning no
2279	later than July 1, 2002, is deemed to have been and shall
2280	continue to be a rural hospital from that date through June 30,
2281	2015, if the hospital continues to have 100 or fewer licensed
2282	beds and an emergency room, or meets the criteria of s.
2283	395.602(2)(e)4. An acute care hospital that has not previously
2284	been designated as a rural hospital and that meets the criteria
2285	of this subsection shall be granted such designation upon
2286	application, including supporting documentation, to the Agency
2287	for Health Care Administration.
2288	Section 60.  Section 408.10, Florida Statutes, is amended
2289	to read:
2290	408.10  Consumer complaints.-The agency shall:
2291	(1)  publish and make available to the public a toll-free
2292	telephone number for the purpose of handling consumer complaints
2293	and shall serve as a liaison between consumer entities and other
2294	private entities and governmental entities for the disposition
2295	of problems identified by consumers of health care.
2296	(2)  Be empowered to investigate consumer complaints
2297	relating to problems with health care facilities' billing
2298	practices and issue reports to be made public in any cases where
2299	the agency determines the health care facility has engaged in
2300	billing practices which are unreasonable and unfair to the
2301	consumer.
2302	Section 61.  Subsections (12) through (30) of section
2303	408.802, Florida Statutes, are renumbered as subsections (11)
2304	through (29), respectively, and present subsection (11) of that
2305	section is amended to read:
2306	408.802  Applicability.-The provisions of this part apply
2307	to the provision of services that require licensure as defined
2308	in this part and to the following entities licensed, registered,
2309	or certified by the agency, as described in chapters 112, 383,
2310	390, 394, 395, 400, 429, 440, 483, and 765:
2311	(11)  Private review agents, as provided under part I of
2312	chapter 395.
2313	Section 62.  Subsection (3) is added to section 408.804,
2314	Florida Statutes, to read:
2315	408.804  License required; display.-
2316	(3)  Any person who knowingly alters, defaces, or falsifies
2317	a license certificate issued by the agency, or causes or
2318	procures any person to commit such an offense, commits a
2319	misdemeanor of the second degree, punishable as provided in s.
2320	775.082 or s 775.083. Any licensee or provider who displays an
2321	altered, defaced, or falsified license certificate is subject to
2322	the penalties set forth in s. 408.815 and an administrative fine
2323	of $1,000 for each day of illegal display.
2324	Section 63.  Paragraph (d) of subsection (2) of section
2325	408.806, Florida Statutes, is amended, and paragraph (e) is
2326	added to that subsection, to read:
2327	408.806  License application process.-
2328	(2)
2329	(d)  The agency shall notify the licensee by mail or
2330	electronically at least 90 days before the expiration of a
2331	license that a renewal license is necessary to continue
2332	operation. The licensee's failure to timely file submit a
2333	renewal application and license application fee with the agency
2334	shall result in a $50 per day late fee charged to the licensee
2335	by the agency; however, the aggregate amount of the late fee may
2336	not exceed 50 percent of the licensure fee or $500, whichever is
2337	less. The agency shall provide a courtesy notice to the licensee
2338	by United States mail, electronically, or by any other manner at
2339	its address of record or mailing address, if provided, at least
2340	90 days prior to the expiration of a license informing the
2341	licensee of the expiration of the license. If the licensee does
2342	not receive the courtesy notice, the licensee continues to be
2343	legally obligated to timely file the renewal application and
2344	license application fee with the agency and is not excused from
2345	the payment of a late fee. If an application is received after
2346	the required filing date and exhibits a hand-canceled postmark
2347	obtained from a United States post office dated on or before the
2348	required filing date, no fine will be levied.
2349	(e)  The applicant must pay the late fee before a late
2350	application is considered complete and failure to pay the late
2351	fee is considered an omission from the application for licensure
2352	pursuant to paragraph (3)(b).
2353	Section 64.  Paragraph (b) of subsection (1) of section
2354	408.8065, Florida Statutes, is amended to read:
2355	408.8065  Additional licensure requirements for home health
2356	agencies, home medical equipment providers, and health care
2357	clinics.-
2358	(1)  An applicant for initial licensure, or initial
2359	licensure due to a change of ownership, as a home health agency,
2360	home medical equipment provider, or health care clinic shall:
2361	(b)  Submit projected pro forma financial statements,
2362	including a balance sheet, income and expense statement, and a
2363	statement of cash flows for the first 2 years of operation which
2364	provide evidence that the applicant has sufficient assets,
2365	credit, and projected revenues to cover liabilities and
2366	expenses.
2367
2368	All documents required under this subsection must be prepared in
2369	accordance with generally accepted accounting principles and may
2370	be in a compilation form. The financial statements must be
2371	signed by a certified public accountant.
2372	Section 65.  Subsections (5) through (8) of section
2373	408.809, Florida Statutes are renumbered as subsections (6)
2374	through (9), respectively, and subsection (4) of that section is
2375	amended to read:
2376	408.809  Background screening; prohibited offenses.-
2377	(4)  In addition to the offenses listed in s. 435.04, all
2378	persons required to undergo background screening pursuant to
2379	this part or authorizing statutes must not have an arrest
2380	awaiting final disposition for, must not have been found guilty
2381	of, regardless of adjudication, or entered a plea of nolo
2382	contendere or guilty to, and must not have been adjudicated
2383	delinquent and the record not have been sealed or expunged for
2384	any of the following offenses or any similar offense of another
2385	jurisdiction:
2386	(a)  Any authorizing statutes, if the offense was a felony.
2387	(b)  This chapter, if the offense was a felony.
2388	(c)  Section 409.920, relating to Medicaid provider fraud.
2389	(d)  Section 409.9201, relating to Medicaid fraud.
2390	(e)  Section 741.28, relating to domestic violence.
2391	(f)  Section 817.034, relating to fraudulent acts through
2392	mail, wire, radio, electromagnetic, photoelectronic, or
2393	photooptical systems.
2394	(g)  Section 817.234, relating to false and fraudulent
2395	insurance claims.
2396	(h)  Section 817.505, relating to patient brokering.
2397	(i)  Section 817.568, relating to criminal use of personal
2398	identification information.
2399	(j)  Section 817.60, relating to obtaining a credit card
2400	through fraudulent means.
2401	(k)  Section 817.61, relating to fraudulent use of credit
2402	cards, if the offense was a felony.
2403	(l)  Section 831.01, relating to forgery.
2404	(m)  Section 831.02, relating to uttering forged
2405	instruments.
2406	(n)  Section 831.07, relating to forging bank bills,
2407	checks, drafts, or promissory notes.
2408	(o)  Section 831.09, relating to uttering forged bank
2409	bills, checks, drafts, or promissory notes.
2410	(p)  Section 831.30, relating to fraud in obtaining
2411	medicinal drugs.
2412	(q)  Section 831.31, relating to the sale, manufacture,
2413	delivery, or possession with the intent to sell, manufacture, or
2414	deliver any counterfeit controlled substance, if the offense was
2415	a felony.
2416	(5)  A person who serves as a controlling interest of, is
2417	employed by, or contracts with a licensee on July 31, 2010, who
2418	has been screened and qualified according to standards specified
2419	in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
2420	in accordance with the schedule provided in paragraphs (a)-(c).
2421	The agency may adopt rules to establish a schedule to stagger
2422	the implementation of the required rescreening over the 5-year
2423	period, beginning July 31, 2010, through July 31, 2015. If, upon
2424	rescreening, such person has a disqualifying offense that was
2425	not a disqualifying offense at the time of the last screening,
2426	but is a current disqualifying offense and was committed before
2427	the last screening, he or she may apply for an exemption from
2428	the appropriate licensing agency and, if agreed to by the
2429	employer, may continue to perform his or her duties until the
2430	licensing agency renders a decision on the application for
2431	exemption if the person is eligible to apply for an exemption
2432	and the exemption request is received by the agency within 30
2433	days after receipt of the rescreening results by the person. The
2434	rescreening schedule shall be:
2435	(a)  Individuals whose last screening was conducted before
2436	December 31, 2003, must be rescreened by July 31, 2013.
2437	(b)  Individuals whose last screening was conducted between
2438	January 1, 2004, through December 31, 2007, must be rescreened
2439	by July 31, 2014.
2440	(c)  Individuals whose last screening was conducted between
2441	January 1, 2008, through July 31, 2010, must be rescreened by
2442	July 31, 2015.
2443	Section 66.  Subsection (9) of section 408.810, Florida
2444	Statutes, is amended to read:
2445	408.810  Minimum licensure requirements.-In addition to the
2446	licensure requirements specified in this part, authorizing
2447	statutes, and applicable rules, each applicant and licensee must
2448	comply with the requirements of this section in order to obtain
2449	and maintain a license.
2450	(9)  A controlling interest may not withhold from the
2451	agency any evidence of financial instability, including, but not
2452	limited to, checks returned due to insufficient funds,
2453	delinquent accounts, nonpayment of withholding taxes, unpaid
2454	utility expenses, nonpayment for essential services, or adverse
2455	court action concerning the financial viability of the provider
2456	or any other provider licensed under this part that is under the
2457	control of the controlling interest. A controlling interest
2458	shall notify the agency within 10 days after a court action to
2459	initiate bankruptcy, foreclosure, or eviction proceedings
2460	concerning the provider in which the controlling interest is a
2461	petitioner or defendant. Any person who violates this subsection
2462	commits a misdemeanor of the second degree, punishable as
2463	provided in s. 775.082 or s. 775.083. Each day of continuing
2464	violation is a separate offense.
2465	Section 67.  Subsection (3) is added to section 408.813,
2466	Florida Statutes, to read:
2467	408.813  Administrative fines; violations.-As a penalty for
2468	any violation of this part, authorizing statutes, or applicable
2469	rules, the agency may impose an administrative fine.
2470	(3)  The agency may impose an administrative fine for a
2471	violation that is not designated as a class I, class II, class
2472	III, or class IV violation. Unless otherwise specified by law,
2473	the amount of the fine shall not exceed $500 for each violation.
2474	Unclassified violations may include:
2475	(a)  Violating any term or condition of a license.
2476	(b)  Violating any provision of this part, authorizing
2477	statutes, or applicable rules.
2478	(c)  Exceeding licensed capacity.
2479	(d)  Providing services beyond the scope of the license.
2480	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2481	Section 68.  Subsection (5) is added to section 408.815,
2482	Florida Statutes, to read:
2483	408.815  License or application denial; revocation.-
2484	(5)  In order to ensure the health, safety, and welfare of
2485	clients when a license has been denied, revoked, or is set to
2486	terminate, the agency may extend the license expiration date for
2487	a period of up to 30 days for the sole purpose of allowing the
2488	safe and orderly discharge of clients. The agency may impose
2489	conditions on the extension, including, but not limited to,
2490	prohibiting or limiting admissions, expedited discharge
2491	planning, required status reports, and mandatory monitoring by
2492	the agency or third parties. When imposing these conditions, the
2493	agency shall take into consideration the nature and number of
2494	clients, the availability and location of acceptable alternative
2495	placements, and the ability of the licensee to continue
2496	providing care to the clients. The agency may terminate the
2497	extension or modify the conditions at any time. This authority
2498	is in addition to any other authority granted to the agency
2499	under chapter 120, this part, and authorizing statutes but
2500	creates no right or entitlement to an extension of a license
2501	expiration date.
2502	Section 69.  Subsection (1) of section 409.91196, Florida
2503	Statutes, is amended to read:
2504	409.91196  Supplemental rebate agreements; public records
2505	and public meetings exemption.-
2506	(1)  The rebate amount, percent of rebate, manufacturer's
2507	pricing, and supplemental rebate, and other trade secrets as
2508	defined in s. 688.002 that the agency has identified for use in
2509	negotiations, held by the Agency for Health Care Administration
2510	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2511	119.07(1) and s. 24(a), Art. I of the State Constitution.
2512	Section 70.  Paragraph (a) of subsection (39) of section
2513	409.912, Florida Statutes, is amended to read:
2514	409.912  Cost-effective purchasing of health care.-The
2515	agency shall purchase goods and services for Medicaid recipients
2516	in the most cost-effective manner consistent with the delivery
2517	of quality medical care. To ensure that medical services are
2518	effectively utilized, the agency may, in any case, require a
2519	confirmation or second physician's opinion of the correct
2520	diagnosis for purposes of authorizing future services under the
2521	Medicaid program. This section does not restrict access to
2522	emergency services or poststabilization care services as defined
2523	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2524	shall be rendered in a manner approved by the agency. The agency
2525	shall maximize the use of prepaid per capita and prepaid
2526	aggregate fixed-sum basis services when appropriate and other
2527	alternative service delivery and reimbursement methodologies,
2528	including competitive bidding pursuant to s. 287.057, designed
2529	to facilitate the cost-effective purchase of a case-managed
2530	continuum of care. The agency shall also require providers to
2531	minimize the exposure of recipients to the need for acute
2532	inpatient, custodial, and other institutional care and the
2533	inappropriate or unnecessary use of high-cost services. The
2534	agency shall contract with a vendor to monitor and evaluate the
2535	clinical practice patterns of providers in order to identify
2536	trends that are outside the normal practice patterns of a
2537	provider's professional peers or the national guidelines of a
2538	provider's professional association. The vendor must be able to
2539	provide information and counseling to a provider whose practice
2540	patterns are outside the norms, in consultation with the agency,
2541	to improve patient care and reduce inappropriate utilization.
2542	The agency may mandate prior authorization, drug therapy
2543	management, or disease management participation for certain
2544	populations of Medicaid beneficiaries, certain drug classes, or
2545	particular drugs to prevent fraud, abuse, overuse, and possible
2546	dangerous drug interactions. The Pharmaceutical and Therapeutics
2547	Committee shall make recommendations to the agency on drugs for
2548	which prior authorization is required. The agency shall inform
2549	the Pharmaceutical and Therapeutics Committee of its decisions
2550	regarding drugs subject to prior authorization. The agency is
2551	authorized to limit the entities it contracts with or enrolls as
2552	Medicaid providers by developing a provider network through
2553	provider credentialing. The agency may competitively bid single-
2554	source-provider contracts if procurement of goods or services
2555	results in demonstrated cost savings to the state without
2556	limiting access to care. The agency may limit its network based
2557	on the assessment of beneficiary access to care, provider
2558	availability, provider quality standards, time and distance
2559	standards for access to care, the cultural competence of the
2560	provider network, demographic characteristics of Medicaid
2561	beneficiaries, practice and provider-to-beneficiary standards,
2562	appointment wait times, beneficiary use of services, provider
2563	turnover, provider profiling, provider licensure history,
2564	previous program integrity investigations and findings, peer
2565	review, provider Medicaid policy and billing compliance records,
2566	clinical and medical record audits, and other factors. Providers
2567	shall not be entitled to enrollment in the Medicaid provider
2568	network. The agency shall determine instances in which allowing
2569	Medicaid beneficiaries to purchase durable medical equipment and
2570	other goods is less expensive to the Medicaid program than long-
2571	term rental of the equipment or goods. The agency may establish
2572	rules to facilitate purchases in lieu of long-term rentals in
2573	order to protect against fraud and abuse in the Medicaid program
2574	as defined in s. 409.913. The agency may seek federal waivers
2575	necessary to administer these policies.
2576	(39)(a)  The agency shall implement a Medicaid prescribed-
2577	drug spending-control program that includes the following
2578	components:
2579	1.  A Medicaid preferred drug list, which shall be a
2580	listing of cost-effective therapeutic options recommended by the
2581	Medicaid Pharmacy and Therapeutics Committee established
2582	pursuant to s. 409.91195 and adopted by the agency for each
2583	therapeutic class on the preferred drug list. At the discretion
2584	of the committee, and when feasible, the preferred drug list
2585	should include at least two products in a therapeutic class. The
2586	agency may post the preferred drug list and updates to the
2587	preferred drug list on an Internet website without following the
2588	rulemaking procedures of chapter 120. Antiretroviral agents are
2589	excluded from the preferred drug list. The agency shall also
2590	limit the amount of a prescribed drug dispensed to no more than
2591	a 34-day supply unless the drug products' smallest marketed
2592	package is greater than a 34-day supply, or the drug is
2593	determined by the agency to be a maintenance drug in which case
2594	a 100-day maximum supply may be authorized. The agency is
2595	authorized to seek any federal waivers necessary to implement
2596	these cost-control programs and to continue participation in the
2597	federal Medicaid rebate program, or alternatively to negotiate
2598	state-only manufacturer rebates. The agency may adopt rules to
2599	implement this subparagraph. The agency shall continue to
2600	provide unlimited contraceptive drugs and items. The agency must
2601	establish procedures to ensure that:
2602	a.  There is a response to a request for prior consultation
2603	by telephone or other telecommunication device within 24 hours
2604	after receipt of a request for prior consultation; and
2605	b.  A 72-hour supply of the drug prescribed is provided in
2606	an emergency or when the agency does not provide a response
2607	within 24 hours as required by sub-subparagraph a.
2608	2.  Reimbursement to pharmacies for Medicaid prescribed
2609	drugs shall be set at the lesser of: the average wholesale price
2610	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2611	plus 4.75 percent, the federal upper limit (FUL), the state
2612	maximum allowable cost (SMAC), or the usual and customary (UAC)
2613	charge billed by the provider.
2614	3.  For a prescribed drug billed as a 340B prescribed
2615	medication, the claim must meet the requirements of the Deficit
2616	Reduction Act of 2005 and the federal 340B program, contain a
2617	national drug code, and be billed at the actual acquisition cost
2618	or payment shall be denied.
2619	4.3.  The agency shall develop and implement a process for
2620	managing the drug therapies of Medicaid recipients who are using
2621	significant numbers of prescribed drugs each month. The
2622	management process may include, but is not limited to,
2623	comprehensive, physician-directed medical-record reviews, claims
2624	analyses, and case evaluations to determine the medical
2625	necessity and appropriateness of a patient's treatment plan and
2626	drug therapies. The agency may contract with a private
2627	organization to provide drug-program-management services. The
2628	Medicaid drug benefit management program shall include
2629	initiatives to manage drug therapies for HIV/AIDS patients,
2630	patients using 20 or more unique prescriptions in a 180-day
2631	period, and the top 1,000 patients in annual spending. The
2632	agency shall enroll any Medicaid recipient in the drug benefit
2633	management program if he or she meets the specifications of this
2634	provision and is not enrolled in a Medicaid health maintenance
2635	organization.
2636	5.4.  The agency may limit the size of its pharmacy network
2637	based on need, competitive bidding, price negotiations,
2638	credentialing, or similar criteria. The agency shall give
2639	special consideration to rural areas in determining the size and
2640	location of pharmacies included in the Medicaid pharmacy
2641	network. A pharmacy credentialing process may include criteria
2642	such as a pharmacy's full-service status, location, size,
2643	patient educational programs, patient consultation, disease
2644	management services, and other characteristics. The agency may
2645	impose a moratorium on Medicaid pharmacy enrollment when it is
2646	determined that it has a sufficient number of Medicaid-
2647	participating providers. The agency must allow dispensing
2648	practitioners to participate as a part of the Medicaid pharmacy
2649	network regardless of the practitioner's proximity to any other
2650	entity that is dispensing prescription drugs under the Medicaid
2651	program. A dispensing practitioner must meet all credentialing
2652	requirements applicable to his or her practice, as determined by
2653	the agency.
2654	6.5.  The agency shall develop and implement a program that
2655	requires Medicaid practitioners who prescribe drugs to use a
2656	counterfeit-proof prescription pad for Medicaid prescriptions.
2657	The agency shall require the use of standardized counterfeit-
2658	proof prescription pads by Medicaid-participating prescribers or
2659	prescribers who write prescriptions for Medicaid recipients. The
2660	agency may implement the program in targeted geographic areas or
2661	statewide.
2662	7.6.  The agency may enter into arrangements that require
2663	manufacturers of generic drugs prescribed to Medicaid recipients
2664	to provide rebates of at least 15.1 percent of the average
2665	manufacturer price for the manufacturer's generic products.
2666	These arrangements shall require that if a generic-drug
2667	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2668	at a level below 15.1 percent, the manufacturer must provide a
2669	supplemental rebate to the state in an amount necessary to
2670	achieve a 15.1-percent rebate level.
2671	8.7.  The agency may establish a preferred drug list as
2672	described in this subsection, and, pursuant to the establishment
2673	of such preferred drug list, it is authorized to negotiate
2674	supplemental rebates from manufacturers that are in addition to
2675	those required by Title XIX of the Social Security Act and at no
2676	less than 14 percent of the average manufacturer price as
2677	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2678	the federal or supplemental rebate, or both, equals or exceeds
2679	29 percent. There is no upper limit on the supplemental rebates
2680	the agency may negotiate. The agency may determine that specific
2681	products, brand-name or generic, are competitive at lower rebate
2682	percentages. Agreement to pay the minimum supplemental rebate
2683	percentage will guarantee a manufacturer that the Medicaid
2684	Pharmaceutical and Therapeutics Committee will consider a
2685	product for inclusion on the preferred drug list. However, a
2686	pharmaceutical manufacturer is not guaranteed placement on the
2687	preferred drug list by simply paying the minimum supplemental
2688	rebate. Agency decisions will be made on the clinical efficacy
2689	of a drug and recommendations of the Medicaid Pharmaceutical and
2690	Therapeutics Committee, as well as the price of competing
2691	products minus federal and state rebates. The agency is
2692	authorized to contract with an outside agency or contractor to
2693	conduct negotiations for supplemental rebates. For the purposes
2694	of this section, the term "supplemental rebates" means cash
2695	rebates. Effective July 1, 2004, value-added programs as a
2696	substitution for supplemental rebates are prohibited. The agency
2697	is authorized to seek any federal waivers to implement this
2698	initiative.
2699	9.8.  The Agency for Health Care Administration shall
2700	expand home delivery of pharmacy products. To assist Medicaid
2701	patients in securing their prescriptions and reduce program
2702	costs, the agency shall expand its current mail-order-pharmacy
2703	diabetes-supply program to include all generic and brand-name
2704	drugs used by Medicaid patients with diabetes. Medicaid
2705	recipients in the current program may obtain nondiabetes drugs
2706	on a voluntary basis. This initiative is limited to the
2707	geographic area covered by the current contract. The agency may
2708	seek and implement any federal waivers necessary to implement
2709	this subparagraph.
2710	10.9.  The agency shall limit to one dose per month any
2711	drug prescribed to treat erectile dysfunction.
2712	11.10.a.  The agency may implement a Medicaid behavioral
2713	drug management system. The agency may contract with a vendor
2714	that has experience in operating behavioral drug management
2715	systems to implement this program. The agency is authorized to
2716	seek federal waivers to implement this program.
2717	b.  The agency, in conjunction with the Department of
2718	Children and Family Services, may implement the Medicaid
2719	behavioral drug management system that is designed to improve
2720	the quality of care and behavioral health prescribing practices
2721	based on best practice guidelines, improve patient adherence to
2722	medication plans, reduce clinical risk, and lower prescribed
2723	drug costs and the rate of inappropriate spending on Medicaid
2724	behavioral drugs. The program may include the following
2725	elements:
2726	(I)  Provide for the development and adoption of best
2727	practice guidelines for behavioral health-related drugs such as
2728	antipsychotics, antidepressants, and medications for treating
2729	bipolar disorders and other behavioral conditions; translate
2730	them into practice; review behavioral health prescribers and
2731	compare their prescribing patterns to a number of indicators
2732	that are based on national standards; and determine deviations
2733	from best practice guidelines.
2734	(II)  Implement processes for providing feedback to and
2735	educating prescribers using best practice educational materials
2736	and peer-to-peer consultation.
2737	(III)  Assess Medicaid beneficiaries who are outliers in
2738	their use of behavioral health drugs with regard to the numbers
2739	and types of drugs taken, drug dosages, combination drug
2740	therapies, and other indicators of improper use of behavioral
2741	health drugs.
2742	(IV)  Alert prescribers to patients who fail to refill
2743	prescriptions in a timely fashion, are prescribed multiple same-
2744	class behavioral health drugs, and may have other potential
2745	medication problems.
2746	(V)  Track spending trends for behavioral health drugs and
2747	deviation from best practice guidelines.
2748	(VI)  Use educational and technological approaches to
2749	promote best practices, educate consumers, and train prescribers
2750	in the use of practice guidelines.
2751	(VII)  Disseminate electronic and published materials.
2752	(VIII)  Hold statewide and regional conferences.
2753	(IX)  Implement a disease management program with a model
2754	quality-based medication component for severely mentally ill
2755	individuals and emotionally disturbed children who are high
2756	users of care.
2757	12.11.a.  The agency shall implement a Medicaid
2758	prescription drug management system. The agency may contract
2759	with a vendor that has experience in operating prescription drug
2760	management systems in order to implement this system. Any
2761	management system that is implemented in accordance with this
2762	subparagraph must rely on cooperation between physicians and
2763	pharmacists to determine appropriate practice patterns and
2764	clinical guidelines to improve the prescribing, dispensing, and
2765	use of drugs in the Medicaid program. The agency may seek
2766	federal waivers to implement this program.
2767	b.  The drug management system must be designed to improve
2768	the quality of care and prescribing practices based on best
2769	practice guidelines, improve patient adherence to medication
2770	plans, reduce clinical risk, and lower prescribed drug costs and
2771	the rate of inappropriate spending on Medicaid prescription
2772	drugs. The program must:
2773	(I)  Provide for the development and adoption of best
2774	practice guidelines for the prescribing and use of drugs in the
2775	Medicaid program, including translating best practice guidelines
2776	into practice; reviewing prescriber patterns and comparing them
2777	to indicators that are based on national standards and practice
2778	patterns of clinical peers in their community, statewide, and
2779	nationally; and determine deviations from best practice
2780	guidelines.
2781	(II)  Implement processes for providing feedback to and
2782	educating prescribers using best practice educational materials
2783	and peer-to-peer consultation.
2784	(III)  Assess Medicaid recipients who are outliers in their
2785	use of a single or multiple prescription drugs with regard to
2786	the numbers and types of drugs taken, drug dosages, combination
2787	drug therapies, and other indicators of improper use of
2788	prescription drugs.
2789	(IV)  Alert prescribers to patients who fail to refill
2790	prescriptions in a timely fashion, are prescribed multiple drugs
2791	that may be redundant or contraindicated, or may have other
2792	potential medication problems.
2793	(V)  Track spending trends for prescription drugs and
2794	deviation from best practice guidelines.
2795	(VI)  Use educational and technological approaches to
2796	promote best practices, educate consumers, and train prescribers
2797	in the use of practice guidelines.
2798	(VII)  Disseminate electronic and published materials.
2799	(VIII)  Hold statewide and regional conferences.
2800	(IX)  Implement disease management programs in cooperation
2801	with physicians and pharmacists, along with a model quality-
2802	based medication component for individuals having chronic
2803	medical conditions.
2804	13.12.  The agency is authorized to contract for drug
2805	rebate administration, including, but not limited to,
2806	calculating rebate amounts, invoicing manufacturers, negotiating
2807	disputes with manufacturers, and maintaining a database of
2808	rebate collections.
2809	14.13.  The agency may specify the preferred daily dosing
2810	form or strength for the purpose of promoting best practices
2811	with regard to the prescribing of certain drugs as specified in
2812	the General Appropriations Act and ensuring cost-effective
2813	prescribing practices.
2814	15.14.  The agency may require prior authorization for
2815	Medicaid-covered prescribed drugs. The agency may, but is not
2816	required to, prior-authorize the use of a product:
2817	a.  For an indication not approved in labeling;
2818	b.  To comply with certain clinical guidelines; or
2819	c.  If the product has the potential for overuse, misuse,
2820	or abuse.
2821
2822	The agency may require the prescribing professional to provide
2823	information about the rationale and supporting medical evidence
2824	for the use of a drug. The agency shall accept electronic prior
2825	authorization requests from prescribers or pharmacists for any
2826	drug requiring prior authorization and may post prior
2827	authorization criteria and protocol and updates to the list of
2828	drugs that are subject to prior authorization on an Internet
2829	website without amending its rule or engaging in additional
2830	rulemaking.
2831	16.15.  The agency, in conjunction with the Pharmaceutical
2832	and Therapeutics Committee, may require age-related prior
2833	authorizations for certain prescribed drugs. The agency may
2834	preauthorize the use of a drug for a recipient who may not meet
2835	the age requirement or may exceed the length of therapy for use
2836	of this product as recommended by the manufacturer and approved
2837	by the Food and Drug Administration. Prior authorization may
2838	require the prescribing professional to provide information
2839	about the rationale and supporting medical evidence for the use
2840	of a drug.
2841	17.16.  The agency shall implement a step-therapy prior
2842	authorization approval process for medications excluded from the
2843	preferred drug list. Medications listed on the preferred drug
2844	list must be used within the previous 12 months prior to the
2845	alternative medications that are not listed. The step-therapy
2846	prior authorization may require the prescriber to use the
2847	medications of a similar drug class or for a similar medical
2848	indication unless contraindicated in the Food and Drug
2849	Administration labeling. The trial period between the specified
2850	steps may vary according to the medical indication. The step-
2851	therapy approval process shall be developed in accordance with
2852	the committee as stated in s. 409.91195(7) and (8). A drug
2853	product may be approved without meeting the step-therapy prior
2854	authorization criteria if the prescribing physician provides the
2855	agency with additional written medical or clinical documentation
2856	that the product is medically necessary because:
2857	a.  There is not a drug on the preferred drug list to treat
2858	the disease or medical condition which is an acceptable clinical
2859	alternative;
2860	b.  The alternatives have been ineffective in the treatment
2861	of the beneficiary's disease; or
2862	c.  Based on historic evidence and known characteristics of
2863	the patient and the drug, the drug is likely to be ineffective,
2864	or the number of doses have been ineffective.
2865
2866	The agency shall work with the physician to determine the best
2867	alternative for the patient. The agency may adopt rules waiving
2868	the requirements for written clinical documentation for specific
2869	drugs in limited clinical situations.
2870	18.17.  The agency shall implement a return and reuse
2871	program for drugs dispensed by pharmacies to institutional
2872	recipients, which includes payment of a $5 restocking fee for
2873	the implementation and operation of the program. The return and
2874	reuse program shall be implemented electronically and in a
2875	manner that promotes efficiency. The program must permit a
2876	pharmacy to exclude drugs from the program if it is not
2877	practical or cost-effective for the drug to be included and must
2878	provide for the return to inventory of drugs that cannot be
2879	credited or returned in a cost-effective manner. The agency
2880	shall determine if the program has reduced the amount of
2881	Medicaid prescription drugs which are destroyed on an annual
2882	basis and if there are additional ways to ensure more
2883	prescription drugs are not destroyed which could safely be
2884	reused. The agency's conclusion and recommendations shall be
2885	reported to the Legislature by December 1, 2005.
2886	Section 71.  Subsections (3) and (4) of section 429.07,
2887	Florida Statutes, are amended, and subsections (6) and (7) are
2888	added to that section, to read:
2889	429.07  License required; fee; inspections.-
2890	(3)  In addition to the requirements of s. 408.806, each
2891	license granted by the agency must state the type of care for
2892	which the license is granted. Licenses shall be issued for one
2893	or more of the following categories of care: standard, extended
2894	congregate care, limited nursing services, or limited mental
2895	health.
2896	(a)  A standard license shall be issued to a facility
2897	facilities providing one or more of the personal services
2898	identified in s. 429.02. Such licensee facilities may also
2899	employ or contract with a person licensed under part I of
2900	chapter 464 to administer medications and perform other tasks as
2901	specified in s. 429.255.
2902	(b)  An extended congregate care license shall be issued to
2903	a licensee facilities providing, directly or through contract,
2904	services beyond those authorized in paragraph (a), including
2905	services performed by persons licensed under part I of chapter
2906	464 and supportive services, as defined by rule, to persons who
2907	would otherwise be disqualified from continued residence in a
2908	facility licensed under this part.
2909	1.  In order for extended congregate care services to be
2910	provided, the agency must first determine that all requirements
2911	established in law and rule are met and must specifically
2912	designate, on the facility's license, that such services may be
2913	provided and whether the designation applies to all or part of
2914	the facility. Such designation may be made at the time of
2915	initial licensure or relicensure, or upon request in writing by
2916	a licensee under this part and part II of chapter 408. The
2917	notification of approval or the denial of the request shall be
2918	made in accordance with part II of chapter 408. An existing
2919	licensee facilities qualifying to provide extended congregate
2920	care services must have maintained a standard license and may
2921	not have been subject to administrative sanctions during the
2922	previous 2 years, or since initial licensure if the facility has
2923	been licensed for less than 2 years, for any of the following
2924	reasons:
2925	a.  A class I or class II violation;
2926	b.  Three or more repeat or recurring class III violations
2927	of identical or similar resident care standards from which a
2928	pattern of noncompliance is found by the agency;
2929	c.  Three or more class III violations that were not
2930	corrected in accordance with the corrective action plan approved
2931	by the agency;
2932	d.  Violation of resident care standards which results in
2933	requiring the facility to employ the services of a consultant
2934	pharmacist or consultant dietitian;
2935	e.  Denial, suspension, or revocation of a license for
2936	another facility licensed under this part in which the applicant
2937	for an extended congregate care license has at least 25 percent
2938	ownership interest; or
2939	f.  Imposition of a moratorium pursuant to this part or
2940	part II of chapter 408 or initiation of injunctive proceedings.
2941	2.  A facility that is licensed to provide extended
2942	congregate care services shall maintain a written progress
2943	report for on each person who receives services which describes
2944	the type, amount, duration, scope, and outcome of services that
2945	are rendered and the general status of the resident's health. A
2946	registered nurse, or appropriate designee, representing the
2947	agency shall visit the facility at least quarterly to monitor
2948	residents who are receiving extended congregate care services
2949	and to determine if the facility is in compliance with this
2950	part, part II of chapter 408, and relevant rules. One of the
2951	visits may be in conjunction with the regular survey. The
2952	monitoring visits may be provided through contractual
2953	arrangements with appropriate community agencies. A registered
2954	nurse shall serve as part of the team that inspects the
2955	facility. The agency may waive one of the required yearly
2956	monitoring visits for a facility that has been licensed for at
2957	least 24 months to provide extended congregate care services,
2958	if, during the inspection, the registered nurse determines that
2959	extended congregate care services are being provided
2960	appropriately, and if the facility has no class I or class II
2961	violations and no uncorrected class III violations. The agency
2962	must first consult with the long-term care ombudsman council for
2963	the area in which the facility is located to determine if any
2964	complaints have been made and substantiated about the quality of
2965	services or care. The agency may not waive one of the required
2966	yearly monitoring visits if complaints have been made and
2967	substantiated.
2968	3.  A facility that is licensed to provide extended
2969	congregate care services must:
2970	a.  Demonstrate the capability to meet unanticipated
2971	resident service needs.
2972	b.  Offer a physical environment that promotes a homelike
2973	setting, provides for resident privacy, promotes resident
2974	independence, and allows sufficient congregate space as defined
2975	by rule.
2976	c.  Have sufficient staff available, taking into account
2977	the physical plant and firesafety features of the building, to
2978	assist with the evacuation of residents in an emergency.
2979	d.  Adopt and follow policies and procedures that maximize
2980	resident independence, dignity, choice, and decisionmaking to
2981	permit residents to age in place, so that moves due to changes
2982	in functional status are minimized or avoided.
2983	e.  Allow residents or, if applicable, a resident's
2984	representative, designee, surrogate, guardian, or attorney in
2985	fact to make a variety of personal choices, participate in
2986	developing service plans, and share responsibility in
2987	decisionmaking.
2988	f.  Implement the concept of managed risk.
2989	g.  Provide, directly or through contract, the services of
2990	a person licensed under part I of chapter 464.
2991	h.  In addition to the training mandated in s. 429.52,
2992	provide specialized training as defined by rule for facility
2993	staff.
2994	4.  A facility that is licensed to provide extended
2995	congregate care services is exempt from the criteria for
2996	continued residency set forth in rules adopted under s. 429.41.
2997	A licensed facility must adopt its own requirements within
2998	guidelines for continued residency set forth by rule. However,
2999	the facility may not serve residents who require 24-hour nursing
3000	supervision. A licensed facility that provides extended
3001	congregate care services must also provide each resident with a
3002	written copy of facility policies governing admission and
3003	retention.
3004	5.  The primary purpose of extended congregate care
3005	services is to allow residents, as they become more impaired,
3006	the option of remaining in a familiar setting from which they
3007	would otherwise be disqualified for continued residency. A
3008	facility licensed to provide extended congregate care services
3009	may also admit an individual who exceeds the admission criteria
3010	for a facility with a standard license, if the individual is
3011	determined appropriate for admission to the extended congregate
3012	care facility.
3013	6.  Before the admission of an individual to a facility
3014	licensed to provide extended congregate care services, the
3015	individual must undergo a medical examination as provided in s.
3016	429.26(4) and the facility must develop a preliminary service
3017	plan for the individual.
3018	7.  When a licensee facility can no longer provide or
3019	arrange for services in accordance with the resident's service
3020	plan and needs and the licensee's facility's policy, the
3021	licensee facility shall make arrangements for relocating the
3022	person in accordance with s. 429.28(1)(k).
3023	8.  Failure to provide extended congregate care services
3024	may result in denial of extended congregate care license
3025	renewal.
3026	(c)  A limited nursing services license shall be issued to
3027	a facility that provides services beyond those authorized in
3028	paragraph (a) and as specified in this paragraph.
3029	1.  In order for limited nursing services to be provided in
3030	a facility licensed under this part, the agency must first
3031	determine that all requirements established in law and rule are
3032	met and must specifically designate, on the facility's license,
3033	that such services may be provided. Such designation may be made
3034	at the time of initial licensure or relicensure, or upon request
3035	in writing by a licensee under this part and part II of chapter
3036	408. Notification of approval or denial of such request shall be
3037	made in accordance with part II of chapter 408. Existing
3038	facilities qualifying to provide limited nursing services shall
3039	have maintained a standard license and may not have been subject
3040	to administrative sanctions that affect the health, safety, and
3041	welfare of residents for the previous 2 years or since initial
3042	licensure if the facility has been licensed for less than 2
3043	years.
3044	2.  Facilities that are licensed to provide limited nursing
3045	services shall maintain a written progress report on each person
3046	who receives such nursing services, which report describes the
3047	type, amount, duration, scope, and outcome of services that are
3048	rendered and the general status of the resident's health. A
3049	registered nurse representing the agency shall visit such
3050	facilities at least twice a year to monitor residents who are
3051	receiving limited nursing services and to determine if the
3052	facility is in compliance with applicable provisions of this
3053	part, part II of chapter 408, and related rules. The monitoring
3054	visits may be provided through contractual arrangements with
3055	appropriate community agencies. A registered nurse shall also
3056	serve as part of the team that inspects such facility.
3057	3.  A person who receives limited nursing services under
3058	this part must meet the admission criteria established by the
3059	agency for assisted living facilities. When a resident no longer
3060	meets the admission criteria for a facility licensed under this
3061	part, arrangements for relocating the person shall be made in
3062	accordance with s. 429.28(1)(k), unless the facility is licensed
3063	to provide extended congregate care services.
3064	(4)  In accordance with s. 408.805, an applicant or
3065	licensee shall pay a fee for each license application submitted
3066	under this part, part II of chapter 408, and applicable rules.
3067	The amount of the fee shall be established by rule.
3068	(a)  The biennial license fee required of a facility is
3069	$300 per license, with an additional fee of $71 $50 per resident
3070	based on the total licensed resident capacity of the facility,
3071	except that no additional fee will be assessed for beds
3072	designated for recipients of optional state supplementation
3073	payments provided for in s. 409.212. The total fee may not
3074	exceed $10,000.
3075	(b)  In addition to the total fee assessed under paragraph
3076	(a), the agency shall require facilities that are licensed to
3077	provide extended congregate care services under this part to pay
3078	an additional fee per licensed facility. The amount of the
3079	biennial fee shall be $400 per license, with an additional fee
3080	of $10 per resident based on the total licensed resident
3081	capacity of the facility.
3082	(c)  In addition to the total fee assessed under paragraph
3083	(a), the agency shall require facilities that are licensed to
3084	provide limited nursing services under this part to pay an
3085	additional fee per licensed facility. The amount of the biennial
3086	fee shall be $250 per license, with an additional fee of $10 per
3087	resident based on the total licensed resident capacity of the
3088	facility.
3089	(6)  In order to determine whether the facility is
3090	adequately protecting residents' rights as provided in s.
3091	429.28, the agency's standard licensure survey shall include
3092	private informal conversations with a sample of residents and
3093	consultation with the ombudsman council in the planning and
3094	service area in which the facility is located to discuss
3095	residents' experiences within the facility.
3096	(7)  An assisted living facility that has been cited within
3097	the previous 24-month period for a class I or class II
3098	violation, regardless of the status of any enforcement or
3099	disciplinary action, is subject to periodic unannounced
3100	monitoring to determine if the facility is in compliance with
3101	this part, part II of chapter 408, and applicable rules.
3102	Monitoring may occur through a desk review or an onsite
3103	assessment. If the class I or class II violation relates to
3104	providing or failing to provide nursing care, a registered nurse
3105	must participate in monitoring activities during the 12-month
3106	period following the violation.
3107	Section 72.  Subsection (7) of section 429.11, Florida
3108	Statutes, is renumbered as subsection (6), and present
3109	subsection (6) of that section is amended to read:
3110	429.11  Initial application for license; provisional
3111	license.-
3112	(6)  In addition to the license categories available in s.
3113	408.808, a provisional license may be issued to an applicant
3114	making initial application for licensure or making application
3115	for a change of ownership. A provisional license shall be
3116	limited in duration to a specific period of time not to exceed 6
3117	months, as determined by the agency.
3118	Section 73.  Section 429.12, Florida Statutes, is amended
3119	to read:
3120	429.12  Sale or transfer of ownership of a facility.-It is
3121	the intent of the Legislature to protect the rights of the
3122	residents of an assisted living facility when the facility is
3123	sold or the ownership thereof is transferred. Therefore, in
3124	addition to the requirements of part II of chapter 408, whenever
3125	a facility is sold or the ownership thereof is transferred,
3126	including leasing,:
3127	(1)  the transferee shall notify the residents, in writing,
3128	of the change of ownership within 7 days after receipt of the
3129	new license.
3130	(2)  The transferor of a facility the license of which is
3131	denied pending an administrative hearing shall, as a part of the
3132	written change-of-ownership contract, advise the transferee that
3133	a plan of correction must be submitted by the transferee and
3134	approved by the agency at least 7 days before the change of
3135	ownership and that failure to correct the condition which
3136	resulted in the moratorium pursuant to part II of chapter 408 or
3137	denial of licensure is grounds for denial of the transferee's
3138	license.
3139	Section 74.  Subsection (5) of section 429.14, Florida
3140	Statutes, is amended to read:
3141	429.14  Administrative penalties.-
3142	(5)  An action taken by the agency to suspend, deny, or
3143	revoke a facility's license under this part or part II of
3144	chapter 408, in which the agency claims that the facility owner
3145	or an employee of the facility has threatened the health,
3146	safety, or welfare of a resident of the facility, shall be heard
3147	by the Division of Administrative Hearings of the Department of
3148	Management Services within 120 days after receipt of the
3149	facility's request for a hearing, unless that time limitation is
3150	waived by both parties. The administrative law judge must render
3151	a decision within 30 days after receipt of a proposed
3152	recommended order.
3153	Section 75.  Subsections (1), (4), and (5) of section
3154	429.17, Florida Statutes, are amended to read:
3155	429.17  Expiration of license; renewal; conditional
3156	license.-
3157	(1)  Limited nursing, Extended congregate care, and limited
3158	mental health licenses shall expire at the same time as the
3159	facility's standard license, regardless of when issued.
3160	(4)  In addition to the license categories available in s.
3161	408.808, a conditional license may be issued to an applicant for
3162	license renewal if the applicant fails to meet all standards and
3163	requirements for licensure. A conditional license issued under
3164	this subsection shall be limited in duration to a specific
3165	period of time not to exceed 6 months, as determined by the
3166	agency, and shall be accompanied by an agency-approved plan of
3167	correction.
3168	(5)  When an extended congregate care or limited nursing
3169	license is requested during a facility's biennial license
3170	period, the fee shall be prorated in order to permit the
3171	additional license to expire at the end of the biennial license
3172	period. The fee shall be calculated as of the date the
3173	additional license application is received by the agency.
3174	Section 76.  Subsections (6) through (10) of section
3175	429.23, Florida Statutes, are renumbered as subsections (5)
3176	through (9), respectively, and present subsection (5) of that
3177	section is amended to read:
3178	429.23  Internal risk management and quality assurance
3179	program; adverse incidents and reporting requirements.-
3180	(5)  Each facility shall report monthly to the agency any
3181	liability claim filed against it. The report must include the
3182	name of the resident, the dates of the incident leading to the
3183	claim, if applicable, and the type of injury or violation of
3184	rights alleged to have occurred. This report is not discoverable
3185	in any civil or administrative action, except in such actions
3186	brought by the agency to enforce the provisions of this part.
3187	Section 77.  Paragraph (a) of subsection (1) and subsection
3188	(2) of section 429.255, Florida Statutes, are amended to read:
3189	429.255  Use of personnel; emergency care.-
3190	(1)(a)  Persons under contract to the facility or, facility
3191	staff, or volunteers, who are licensed according to part I of
3192	chapter 464, or those persons exempt under s. 464.022(1), and
3193	others as defined by rule, may administer medications to
3194	residents, take residents' vital signs, manage individual weekly
3195	pill organizers for residents who self-administer medication,
3196	give prepackaged enemas ordered by a physician, observe
3197	residents, document observations on the appropriate resident's
3198	record, report observations to the resident's physician, and
3199	contract or allow residents or a resident's representative,
3200	designee, surrogate, guardian, or attorney in fact to contract
3201	with a third party, provided residents meet the criteria for
3202	appropriate placement as defined in s. 429.26. Persons under
3203	contract to the facility or facility staff who are licensed
3204	according to part I of chapter 464 may provide limited nursing
3205	services. Nursing assistants certified pursuant to part II of
3206	chapter 464 may take residents' vital signs as directed by a
3207	licensed nurse or physician. The facility is responsible for
3208	maintaining documentation of services provided under this
3209	paragraph and as required by rule and for ensuring that staff
3210	are adequately trained to monitor residents receiving these
3211	services.
3212	(2)  In facilities licensed to provide extended congregate
3213	care, persons under contract to the facility or, facility staff,
3214	or volunteers, who are licensed according to part I of chapter
3215	464, or those persons exempt under s. 464.022(1), or those
3216	persons certified as nursing assistants pursuant to part II of
3217	chapter 464, may also perform all duties within the scope of
3218	their license or certification, as approved by the facility
3219	administrator and pursuant to this part.
3220	Section 78.  Subsections (4), (5), (6), and (7) of section
3221	429.28, Florida Statutes, are renumbered as subsections (3),
3222	(4), (5), and (6), respectively, and present subsections (3) and
3223	(6) of that section are amended to read:
3224	429.28  Resident bill of rights.-
3225	(3)(a)  The agency shall conduct a survey to determine
3226	general compliance with facility standards and compliance with
3227	residents' rights as a prerequisite to initial licensure or
3228	licensure renewal.
3229	(b)  In order to determine whether the facility is
3230	adequately protecting residents' rights, the biennial survey
3231	shall include private informal conversations with a sample of
3232	residents and consultation with the ombudsman council in the
3233	planning and service area in which the facility is located to
3234	discuss residents' experiences within the facility.
3235	(c)  During any calendar year in which no survey is
3236	conducted, the agency shall conduct at least one monitoring
3237	visit of each facility cited in the previous year for a class I
3238	or class II violation, or more than three uncorrected class III
3239	violations.
3240	(d)  The agency may conduct periodic followup inspections
3241	as necessary to monitor the compliance of facilities with a
3242	history of any class I, class II, or class III violations that
3243	threaten the health, safety, or security of residents.
3244	(e)  The agency may conduct complaint investigations as
3245	warranted to investigate any allegations of noncompliance with
3246	requirements required under this part or rules adopted under
3247	this part.
3248	(5)(6)  Any facility which terminates the residency of an
3249	individual who participated in activities specified in
3250	subsection (4) (5) shall show good cause in a court of competent
3251	jurisdiction.
3252	Section 79.  Subsections (4) and (5) of section 429.41,
3253	Florida Statutes, are renumbered as subsections (3) and (4),
3254	respectively, and paragraphs (i) and (j) of subsection (1) and
3255	present subsection (3) of that section are amended to read:
3256	429.41  Rules establishing standards.-
3257	(1)  It is the intent of the Legislature that rules
3258	published and enforced pursuant to this section shall include
3259	criteria by which a reasonable and consistent quality of
3260	resident care and quality of life may be ensured and the results
3261	of such resident care may be demonstrated. Such rules shall also
3262	ensure a safe and sanitary environment that is residential and
3263	noninstitutional in design or nature. It is further intended
3264	that reasonable efforts be made to accommodate the needs and
3265	preferences of residents to enhance the quality of life in a
3266	facility. The agency, in consultation with the department, may
3267	adopt rules to administer the requirements of part II of chapter
3268	408. In order to provide safe and sanitary facilities and the
3269	highest quality of resident care accommodating the needs and
3270	preferences of residents, the department, in consultation with
3271	the agency, the Department of Children and Family Services, and
3272	the Department of Health, shall adopt rules, policies, and
3273	procedures to administer this part, which must include
3274	reasonable and fair minimum standards in relation to:
3275	(i)  Facilities holding an a limited nursing, extended
3276	congregate care, or limited mental health license.
3277	(j)  The establishment of specific criteria to define
3278	appropriateness of resident admission and continued residency in
3279	a facility holding a standard, limited nursing, extended
3280	congregate care, and limited mental health license.
3281	(3)  The department shall submit a copy of proposed rules
3282	to the Speaker of the House of Representatives, the President of
3283	the Senate, and appropriate committees of substance for review
3284	and comment prior to the promulgation thereof. Rules promulgated
3285	by the department shall encourage the development of homelike
3286	facilities which promote the dignity, individuality, personal
3287	strengths, and decisionmaking ability of residents.
3288	Section 80.  Subsections (1) and (2) of section 429.53,
3289	Florida Statutes, are amended to read:
3290	429.53  Consultation by the agency.-
3291	(1)  The area offices of licensure and certification of the
3292	agency shall provide consultation to the following upon request:
3293	(a)  A licensee of a facility.
3294	(b)  A person interested in obtaining a license to operate
3295	a facility under this part.
3296	(2)  As used in this section, "consultation" includes:
3297	(a)  An explanation of the requirements of this part and
3298	rules adopted pursuant thereto;
3299	(b)  An explanation of the license application and renewal
3300	procedures; and
3301	(c)  The provision of a checklist of general local and
3302	state approvals required prior to constructing or developing a
3303	facility and a listing of the types of agencies responsible for
3304	such approvals;
3305	(d)  An explanation of benefits and financial assistance
3306	available to a recipient of supplemental security income
3307	residing in a facility;
3308	(c)(e)  Any other information which the agency deems
3309	necessary to promote compliance with the requirements of this
3310	part; and
3311	(f)  A preconstruction review of a facility to ensure
3312	compliance with agency rules and this part.
3313	Section 81.  Subsection (6) of section 429.71, Florida
3314	Statutes, is renumbered as subsection (5), and subsection (1)
3315	and present subsection (5) of that section are amended to read:
3316	429.71  Classification of violations deficiencies;
3317	administrative fines.-
3318	(1)  In addition to the requirements of part II of chapter
3319	408 and in addition to any other liability or penalty provided
3320	by law, the agency may impose an administrative fine on a
3321	provider according to the following classification:
3322	(a)  Class I violations are defined in s. 408.813 those
3323	conditions or practices related to the operation and maintenance
3324	of an adult family-care home or to the care of residents which
3325	the agency determines present an imminent danger to the
3326	residents or guests of the facility or a substantial probability
3327	that death or serious physical or emotional harm would result
3328	therefrom. The condition or practice that constitutes a class I
3329	violation must be abated or eliminated within 24 hours, unless a
3330	fixed period, as determined by the agency, is required for
3331	correction. A class I violation deficiency is subject to an
3332	administrative fine in an amount not less than $500 and not
3333	exceeding $1,000 for each violation. A fine may be levied
3334	notwithstanding the correction of the deficiency.
3335	(b)  Class II violations are defined in s. 408.813 those
3336	conditions or practices related to the operation and maintenance
3337	of an adult family-care home or to the care of residents which
3338	the agency determines directly threaten the physical or
3339	emotional health, safety, or security of the residents, other
3340	than class I violations. A class II violation is subject to an
3341	administrative fine in an amount not less than $250 and not
3342	exceeding $500 for each violation. A citation for a class II
3343	violation must specify the time within which the violation is
3344	required to be corrected. If a class II violation is corrected
3345	within the time specified, no civil penalty shall be imposed,
3346	unless it is a repeated offense.
3347	(c)  Class III violations are defined in s. 408.813 those
3348	conditions or practices related to the operation and maintenance
3349	of an adult family-care home or to the care of residents which
3350	the agency determines indirectly or potentially threaten the
3351	physical or emotional health, safety, or security of residents,
3352	other than class I or class II violations. A class III violation
3353	is subject to an administrative fine in an amount not less than
3354	$100 and not exceeding $250 for each violation. A citation for a
3355	class III violation shall specify the time within which the
3356	violation is required to be corrected. If a class III violation
3357	is corrected within the time specified, no civil penalty shall
3358	be imposed, unless it is a repeated violation offense.
3359	(d)  Class IV violations are defined in s. 408.813 those
3360	conditions or occurrences related to the operation and
3361	maintenance of an adult family-care home, or related to the
3362	required reports, forms, or documents, which do not have the
3363	potential of negatively affecting the residents. A provider that
3364	does not correct A class IV violation within the time limit
3365	specified by the agency is subject to an administrative fine in
3366	an amount not less than $50 and not exceeding $100 for each
3367	violation. Any class IV violation that is corrected during the
3368	time the agency survey is conducted will be identified as an
3369	agency finding and not as a violation, unless it is a repeat
3370	violation.
3371	(5)  As an alternative to or in conjunction with an
3372	administrative action against a provider, the agency may request
3373	a plan of corrective action that demonstrates a good faith
3374	effort to remedy each violation by a specific date, subject to
3375	the approval of the agency.
3376	Section 82.  Section 429.915, Florida Statutes, is amended
3377	to read:
3378	429.915  Conditional license.-In addition to the license
3379	categories available in part II of chapter 408, the agency may
3380	issue a conditional license to an applicant for license renewal
3381	or change of ownership if the applicant fails to meet all
3382	standards and requirements for licensure. A conditional license
3383	issued under this subsection must be limited to a specific
3384	period not exceeding 6 months, as determined by the agency, and
3385	must be accompanied by an approved plan of correction.
3386	Section 83.  Paragraphs (b) and (g) of subsection (3) of
3387	section 430.80, Florida Statutes, are amended to read:
3388	430.80  Implementation of a teaching nursing home pilot
3389	project.-
3390	(3)  To be designated as a teaching nursing home, a nursing
3391	home licensee must, at a minimum:
3392	(b)  Participate in a nationally recognized accreditation
3393	program and hold a valid accreditation, such as the
3394	accreditation awarded by the Joint Commission on Accreditation
3395	of Healthcare Organizations, or, at the time of initial
3396	designation, possess a Gold Seal Award as conferred by the state
3397	on its licensed nursing home;
3398	(g)  Maintain insurance coverage pursuant to s.
3399	400.141(1)(q)(s) or proof of financial responsibility in a
3400	minimum amount of $750,000. Such proof of financial
3401	responsibility may include:
3402	1.  Maintaining an escrow account consisting of cash or
3403	assets eligible for deposit in accordance with s. 625.52; or
3404	2.  Obtaining and maintaining pursuant to chapter 675 an
3405	unexpired, irrevocable, nontransferable and nonassignable letter
3406	of credit issued by any bank or savings association organized
3407	and existing under the laws of this state or any bank or savings
3408	association organized under the laws of the United States that
3409	has its principal place of business in this state or has a
3410	branch office which is authorized to receive deposits in this
3411	state. The letter of credit shall be used to satisfy the
3412	obligation of the facility to the claimant upon presentment of a
3413	final judgment indicating liability and awarding damages to be
3414	paid by the facility or upon presentment of a settlement
3415	agreement signed by all parties to the agreement when such final
3416	judgment or settlement is a result of a liability claim against
3417	the facility.
3418	Section 84.  Paragraph (d) of subsection (9) of section
3419	440.102, Florida Statutes, is amended to read:
3420	440.102  Drug-free workplace program requirements.-The
3421	following provisions apply to a drug-free workplace program
3422	implemented pursuant to law or to rules adopted by the Agency
3423	for Health Care Administration:
3424	(9)  DRUG-TESTING STANDARDS FOR LABORATORIES.-
3425	(d)  The laboratory shall submit to the Agency for Health
3426	Care Administration a monthly report with statistical
3427	information regarding the testing of employees and job
3428	applicants. The report must include information on the methods
3429	of analysis conducted, the drugs tested for, the number of
3430	positive and negative results for both initial tests and
3431	confirmation tests, and any other information deemed appropriate
3432	by the Agency for Health Care Administration. A monthly report
3433	must not identify specific employees or job applicants.
3434	Section 85.  Paragraph (a) of subsection (2) of section
3435	440.13, Florida Statutes, is amended to read:
3436	440.13  Medical services and supplies; penalty for
3437	violations; limitations.-
3438	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3439	(a)  Subject to the limitations specified elsewhere in this
3440	chapter, the employer shall furnish to the employee such
3441	medically necessary remedial treatment, care, and attendance for
3442	such period as the nature of the injury or the process of
3443	recovery may require, which is in accordance with established
3444	practice parameters and protocols of treatment as provided for
3445	in this chapter, including medicines, medical supplies, durable
3446	medical equipment, orthoses, prostheses, and other medically
3447	necessary apparatus. Remedial treatment, care, and attendance,
3448	including work-hardening programs or pain-management programs
3449	accredited by the Commission on Accreditation of Rehabilitation
3450	Facilities or the Joint Commission on the Accreditation of
3451	Health Organizations or pain-management programs affiliated with
3452	medical schools, shall be considered as covered treatment only
3453	when such care is given based on a referral by a physician as
3454	defined in this chapter. Medically necessary treatment, care,
3455	and attendance does not include chiropractic services in excess
3456	of 24 treatments or rendered 12 weeks beyond the date of the
3457	initial chiropractic treatment, whichever comes first, unless
3458	the carrier authorizes additional treatment or the employee is
3459	catastrophically injured.
3460
3461	Failure of the carrier to timely comply with this subsection
3462	shall be a violation of this chapter and the carrier shall be
3463	subject to penalties as provided for in s. 440.525.
3464	Section 86.  Subsection (1) of section 483.035, Florida
3465	Statutes, is amended to read:
3466	483.035  Clinical laboratories operated by practitioners
3467	for exclusive use; licensure and regulation.-
3468	(1)  A clinical laboratory operated by one or more
3469	practitioners licensed under chapter 458, chapter 459, chapter
3470	460, chapter 461, chapter 462, part I of chapter 464, or chapter
3471	466, exclusively in connection with the diagnosis and treatment
3472	of their own patients, must be licensed under this part and must
3473	comply with the provisions of this part, except that the agency
3474	shall adopt rules for staffing, for personnel, including
3475	education and training of personnel, for proficiency testing,
3476	and for construction standards relating to the licensure and
3477	operation of the laboratory based upon and not exceeding the
3478	same standards contained in the federal Clinical Laboratory
3479	Improvement Amendments of 1988 and the federal regulations
3480	adopted thereunder.
3481	Section 87.  Subsections (1) and (9) of section 483.051,
3482	Florida Statutes, are amended to read:
3483	483.051  Powers and duties of the agency.-The agency shall
3484	adopt rules to implement this part, which rules must include,
3485	but are not limited to, the following:
3486	(1)  LICENSING; QUALIFICATIONS.-The agency shall provide
3487	for biennial licensure of all nonwaived clinical laboratories
3488	meeting the requirements of this part and shall prescribe the
3489	qualifications necessary for such licensure, including, but not
3490	limited to, application for or proof of a federal Clinical
3491	Laboratory Improvement Amendment (CLIA) certificate. For
3492	purposes of this section, the term "nonwaived clinical
3493	laboratories" means laboratories that perform any test that the
3494	Centers for Medicare and Medicaid Services has determined does
3495	not qualify for a certificate of waiver under the Clinical
3496	Laboratory Improvement Amendments of 1988 and the federal rules
3497	adopted thereunder.
3498	(9)  ALTERNATE-SITE TESTING.-The agency, in consultation
3499	with the Board of Clinical Laboratory Personnel, shall adopt, by
3500	rule, the criteria for alternate-site testing to be performed
3501	under the supervision of a clinical laboratory director. The
3502	elements to be addressed in the rule include, but are not
3503	limited to: a hospital internal needs assessment; a protocol of
3504	implementation including tests to be performed and who will
3505	perform the tests; criteria to be used in selecting the method
3506	of testing to be used for alternate-site testing; minimum
3507	training and education requirements for those who will perform
3508	alternate-site testing, such as documented training, licensure,
3509	certification, or other medical professional background not
3510	limited to laboratory professionals; documented inservice
3511	training as well as initial and ongoing competency validation;
3512	an appropriate internal and external quality control protocol;
3513	an internal mechanism for identifying and tracking alternate-
3514	site testing by the central laboratory; and recordkeeping
3515	requirements. Alternate-site testing locations must register
3516	when the clinical laboratory applies to renew its license. For
3517	purposes of this subsection, the term "alternate-site testing"
3518	means any laboratory testing done under the administrative
3519	control of a hospital, but performed out of the physical or
3520	administrative confines of the central laboratory.
3521	Section 88.  Section 483.294, Florida Statutes, is amended
3522	to read:
3523	483.294  Inspection of centers.-In accordance with s.
3524	408.811, the agency shall biennially, at least once annually,
3525	inspect the premises and operations of all centers subject to
3526	licensure under this part.
3527	Section 89.  Subsection (4) is added to section 626.9541,
3528	Florida Statutes, to read:
3529	626.9541  Unfair methods of competition and unfair or
3530	deceptive acts or practices defined; alternative rates of
3531	payment; wellness programs.-
3532	(4)  WELLNESS PROGRAMS.-An insurer issuing a group or
3533	individual health benefit plan may offer a voluntary wellness or
3534	health-improvement program that allows for rewards or
3535	incentives, including, but not limited to, merchandise, gift
3536	cards, debit cards, premium discounts or rebates, contributions
3537	towards a member's health savings account, modifications to
3538	copayment, deductible, or coinsurance amounts, or any
3539	combination of these incentives, to encourage or reward
3540	participation in the program. The health plan member may be
3541	required to provide verification, such as a statement from his
3542	or her physician, that a medical condition makes it unreasonably
3543	difficult or medically inadvisable for the individual to
3544	participate in the wellness program. Any reward or incentive
3545	established under this subsection is not an insurance benefit
3546	and does not violate this section. This subsection does not
3547	prohibit an insurer from offering incentives or rewards to
3548	members for adherence to wellness or health improvement programs
3549	if otherwise allowed by state or federal law. Notwithstanding
3550	any provision of this subsection, no insurer, nor its agent, may
3551	use any incentive authorized by this subsection for the purpose
3552	of redirecting patients from one health care insurance plan to
3553	another.
3554	Section 90.  Subsection (1) of section 627.645, Florida
3555	Statutes, is amended to read:
3556	627.645  Denial of health insurance claims restricted.-
3557	(1)  No claim for payment under a health insurance policy
3558	or self-insured program of health benefits for treatment, care,
3559	or services in a licensed hospital which is accredited by the
3560	Joint Commission on the Accreditation of Hospitals, the American
3561	Osteopathic Association, or the Commission on the Accreditation
3562	of Rehabilitative Facilities shall be denied because such
3563	hospital lacks major surgical facilities and is primarily of a
3564	rehabilitative nature, if such rehabilitation is specifically
3565	for treatment of physical disability.
3566	Section 91.  Paragraph (c) of subsection (2) of section
3567	627.668, Florida Statutes, is amended to read:
3568	627.668  Optional coverage for mental and nervous disorders
3569	required; exception.-
3570	(2)  Under group policies or contracts, inpatient hospital
3571	benefits, partial hospitalization benefits, and outpatient
3572	benefits consisting of durational limits, dollar amounts,
3573	deductibles, and coinsurance factors shall not be less favorable
3574	than for physical illness generally, except that:
3575	(c)  Partial hospitalization benefits shall be provided
3576	under the direction of a licensed physician. For purposes of
3577	this part, the term "partial hospitalization services" is
3578	defined as those services offered by a program accredited by the
3579	Joint Commission on Accreditation of Hospitals (JCAH) or in
3580	compliance with equivalent standards. Alcohol rehabilitation
3581	programs accredited by the Joint Commission on Accreditation of
3582	Hospitals or approved by the state and licensed drug abuse
3583	rehabilitation programs shall also be qualified providers under
3584	this section. In any benefit year, if partial hospitalization
3585	services or a combination of inpatient and partial
3586	hospitalization are utilized, the total benefits paid for all
3587	such services shall not exceed the cost of 30 days of inpatient
3588	hospitalization for psychiatric services, including physician
3589	fees, which prevail in the community in which the partial
3590	hospitalization services are rendered. If partial
3591	hospitalization services benefits are provided beyond the limits
3592	set forth in this paragraph, the durational limits, dollar
3593	amounts, and coinsurance factors thereof need not be the same as
3594	those applicable to physical illness generally.
3595	Section 92.  Subsection (3) of section 627.669, Florida
3596	Statutes, is amended to read:
3597	627.669  Optional coverage required for substance abuse
3598	impaired persons; exception.-
3599	(3)  The benefits provided under this section shall be
3600	applicable only if treatment is provided by, or under the
3601	supervision of, or is prescribed by, a licensed physician or
3602	licensed psychologist and if services are provided in a program
3603	accredited by the Joint Commission on Accreditation of Hospitals
3604	or approved by the state.
3605	Section 93.  Paragraph (a) of subsection (1) of section
3606	627.736, Florida Statutes, is amended to read:
3607	627.736  Required personal injury protection benefits;
3608	exclusions; priority; claims.-
3609	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3610	with the security requirements of s. 627.733 shall provide
3611	personal injury protection to the named insured, relatives
3612	residing in the same household, persons operating the insured
3613	motor vehicle, passengers in such motor vehicle, and other
3614	persons struck by such motor vehicle and suffering bodily injury
3615	while not an occupant of a self-propelled vehicle, subject to
3616	the provisions of subsection (2) and paragraph (4)(e), to a
3617	limit of $10,000 for loss sustained by any such person as a
3618	result of bodily injury, sickness, disease, or death arising out
3619	of the ownership, maintenance, or use of a motor vehicle as
3620	follows:
3621	(a)  Medical benefits.-Eighty percent of all reasonable
3622	expenses for medically necessary medical, surgical, X-ray,
3623	dental, and rehabilitative services, including prosthetic
3624	devices, and medically necessary ambulance, hospital, and
3625	nursing services. However, the medical benefits shall provide
3626	reimbursement only for such services and care that are lawfully
3627	provided, supervised, ordered, or prescribed by a physician
3628	licensed under chapter 458 or chapter 459, a dentist licensed
3629	under chapter 466, or a chiropractic physician licensed under
3630	chapter 460 or that are provided by any of the following persons
3631	or entities:
3632	1.  A hospital or ambulatory surgical center licensed under
3633	chapter 395.
3634	2.  A person or entity licensed under ss. 401.2101-401.45
3635	that provides emergency transportation and treatment.
3636	3.  An entity wholly owned by one or more physicians
3637	licensed under chapter 458 or chapter 459, chiropractic
3638	physicians licensed under chapter 460, or dentists licensed
3639	under chapter 466 or by such practitioner or practitioners and
3640	the spouse, parent, child, or sibling of that practitioner or
3641	those practitioners.
3642	4.  An entity wholly owned, directly or indirectly, by a
3643	hospital or hospitals.
3644	5.  A health care clinic licensed under ss. 400.990-400.995
3645	that is:
3646	a.  Accredited by the Joint Commission on Accreditation of
3647	Healthcare Organizations, the American Osteopathic Association,
3648	the Commission on Accreditation of Rehabilitation Facilities, or
3649	the Accreditation Association for Ambulatory Health Care, Inc.;
3650	or
3651	b.  A health care clinic that:
3652	(I)  Has a medical director licensed under chapter 458,
3653	chapter 459, or chapter 460;
3654	(II)  Has been continuously licensed for more than 3 years
3655	or is a publicly traded corporation that issues securities
3656	traded on an exchange registered with the United States
3657	Securities and Exchange Commission as a national securities
3658	exchange; and
3659	(III)  Provides at least four of the following medical
3660	specialties:
3661	(A)  General medicine.
3662	(B)  Radiography.
3663	(C)  Orthopedic medicine.
3664	(D)  Physical medicine.
3665	(E)  Physical therapy.
3666	(F)  Physical rehabilitation.
3667	(G)  Prescribing or dispensing outpatient prescription
3668	medication.
3669	(H)  Laboratory services.
3670
3671	The Financial Services Commission shall adopt by rule the form
3672	that must be used by an insurer and a health care provider
3673	specified in subparagraph 3., subparagraph 4., or subparagraph
3674	5. to document that the health care provider meets the criteria
3675	of this paragraph, which rule must include a requirement for a
3676	sworn statement or affidavit.
3677
3678	Only insurers writing motor vehicle liability insurance in this
3679	state may provide the required benefits of this section, and no
3680	such insurer shall require the purchase of any other motor
3681	vehicle coverage other than the purchase of property damage
3682	liability coverage as required by s. 627.7275 as a condition for
3683	providing such required benefits. Insurers may not require that
3684	property damage liability insurance in an amount greater than
3685	$10,000 be purchased in conjunction with personal injury
3686	protection. Such insurers shall make benefits and required
3687	property damage liability insurance coverage available through
3688	normal marketing channels. Any insurer writing motor vehicle
3689	liability insurance in this state who fails to comply with such
3690	availability requirement as a general business practice shall be
3691	deemed to have violated part IX of chapter 626, and such
3692	violation shall constitute an unfair method of competition or an
3693	unfair or deceptive act or practice involving the business of
3694	insurance; and any such insurer committing such violation shall
3695	be subject to the penalties afforded in such part, as well as
3696	those which may be afforded elsewhere in the insurance code.
3697	Section 94.  Section 633.081, Florida Statutes, is amended
3698	to read:
3699	633.081  Inspection of buildings and equipment; orders;
3700	firesafety inspection training requirements; certification;
3701	disciplinary action.-The State Fire Marshal and her or his
3702	agents shall, at any reasonable hour, when the State Fire
3703	Marshal has reasonable cause to believe that a violation of this
3704	chapter or s. 509.215, or a rule promulgated thereunder, or a
3705	minimum firesafety code adopted by a local authority, may exist,
3706	inspect any and all buildings and structures which are subject
3707	to the requirements of this chapter or s. 509.215 and rules
3708	promulgated thereunder. The authority to inspect shall extend to
3709	all equipment, vehicles, and chemicals which are located within
3710	the premises of any such building or structure. The State Fire
3711	Marshal and her or his agents shall inspect nursing homes
3712	licensed under part II of chapter 400 only once every calendar
3713	year and upon receiving a complaint forming the basis of a
3714	reasonable cause to believe that a violation of this chapter or
3715	s. 509.215, or a rule promulgated thereunder, or a minimum
3716	firesafety code adopted by a local authority may exist and upon
3717	identifying such a violation in the course of conducting
3718	orientation or training activities within a nursing home.
3719	(1)  Each county, municipality, and special district that
3720	has firesafety enforcement responsibilities shall employ or
3721	contract with a firesafety inspector. Except as provided in s.
3722	633.082(2), the firesafety inspector must conduct all firesafety
3723	inspections that are required by law. The governing body of a
3724	county, municipality, or special district that has firesafety
3725	enforcement responsibilities may provide a schedule of fees to
3726	pay only the costs of inspections conducted pursuant to this
3727	subsection and related administrative expenses. Two or more
3728	counties, municipalities, or special districts that have
3729	firesafety enforcement responsibilities may jointly employ or
3730	contract with a firesafety inspector.
3731	(2)  Except as provided in s. 633.082(2), every firesafety
3732	inspection conducted pursuant to state or local firesafety
3733	requirements shall be by a person certified as having met the
3734	inspection training requirements set by the State Fire Marshal.
3735	Such person shall:
3736	(a)  Be a high school graduate or the equivalent as
3737	determined by the department;
3738	(b)  Not have been found guilty of, or having pleaded
3739	guilty or nolo contendere to, a felony or a crime punishable by
3740	imprisonment of 1 year or more under the law of the United
3741	States, or of any state thereof, which involves moral turpitude,
3742	without regard to whether a judgment of conviction has been
3743	entered by the court having jurisdiction of such cases;
3744	(c)  Have her or his fingerprints on file with the
3745	department or with an agency designated by the department;
3746	(d)  Have good moral character as determined by the
3747	department;
3748	(e)  Be at least 18 years of age;
3749	(f)  Have satisfactorily completed the firesafety inspector
3750	certification examination as prescribed by the department; and
3751	(g)1.  Have satisfactorily completed, as determined by the
3752	department, a firesafety inspector training program of not less
3753	than 200 hours established by the department and administered by
3754	agencies and institutions approved by the department for the
3755	purpose of providing basic certification training for firesafety
3756	inspectors; or
3757	2.  Have received in another state training which is
3758	determined by the department to be at least equivalent to that
3759	required by the department for approved firesafety inspector
3760	education and training programs in this state.
3761	(3)  Each special state firesafety inspection which is
3762	required by law and is conducted by or on behalf of an agency of
3763	the state must be performed by an individual who has met the
3764	provision of subsection (2), except that the duration of the
3765	training program shall not exceed 120 hours of specific training
3766	for the type of property that such special state firesafety
3767	inspectors are assigned to inspect.
3768	(4)  A firefighter certified pursuant to s. 633.35 may
3769	conduct firesafety inspections, under the supervision of a
3770	certified firesafety inspector, while on duty as a member of a
3771	fire department company conducting inservice firesafety
3772	inspections without being certified as a firesafety inspector,
3773	if such firefighter has satisfactorily completed an inservice
3774	fire department company inspector training program of at least
3775	24 hours' duration as provided by rule of the department.
3776	(5)  Every firesafety inspector or special state firesafety
3777	inspector certificate is valid for a period of 3 years from the
3778	date of issuance. Renewal of certification shall be subject to
3779	the affected person's completing proper application for renewal
3780	and meeting all of the requirements for renewal as established
3781	under this chapter or by rule promulgated thereunder, which
3782	shall include completion of at least 40 hours during the
3783	preceding 3-year period of continuing education as required by
3784	the rule of the department or, in lieu thereof, successful
3785	passage of an examination as established by the department.
3786	(6)  The State Fire Marshal may deny, refuse to renew,
3787	suspend, or revoke the certificate of a firesafety inspector or
3788	special state firesafety inspector if it finds that any of the
3789	following grounds exist:
3790	(a)  Any cause for which issuance of a certificate could
3791	have been refused had it then existed and been known to the
3792	State Fire Marshal.
3793	(b)  Violation of this chapter or any rule or order of the
3794	State Fire Marshal.
3795	(c)  Falsification of records relating to the certificate.
3796	(d)  Having been found guilty of or having pleaded guilty
3797	or nolo contendere to a felony, whether or not a judgment of
3798	conviction has been entered.
3799	(e)  Failure to meet any of the renewal requirements.
3800	(f)  Having been convicted of a crime in any jurisdiction
3801	which directly relates to the practice of fire code inspection,
3802	plan review, or administration.
3803	(g)  Making or filing a report or record that the
3804	certificateholder knows to be false, or knowingly inducing
3805	another to file a false report or record, or knowingly failing
3806	to file a report or record required by state or local law, or
3807	knowingly impeding or obstructing such filing, or knowingly
3808	inducing another person to impede or obstruct such filing.
3809	(h)  Failing to properly enforce applicable fire codes or
3810	permit requirements within this state which the
3811	certificateholder knows are applicable by committing willful
3812	misconduct, gross negligence, gross misconduct, repeated
3813	negligence, or negligence resulting in a significant danger to
3814	life or property.
3815	(i)  Accepting labor, services, or materials at no charge
3816	or at a noncompetitive rate from any person who performs work
3817	that is under the enforcement authority of the certificateholder
3818	and who is not an immediate family member of the
3819	certificateholder. For the purpose of this paragraph, the term
3820	"immediate family member" means a spouse, child, parent,
3821	sibling, grandparent, aunt, uncle, or first cousin of the person
3822	or the person's spouse or any person who resides in the primary
3823	residence of the certificateholder.
3824	(7)  The Division of State Fire Marshal and the Florida
3825	Building Code Administrators and Inspectors Board, established
3826	pursuant to s. 468.605, shall enter into a reciprocity agreement
3827	to facilitate joint recognition of continuing education
3828	recertification hours for certificateholders licensed under s.
3829	468.609 and firesafety inspectors certified under subsection
3830	(2).
3831	(8)  The State Fire Marshal shall develop by rule an
3832	advanced training and certification program for firesafety
3833	inspectors having fire code management responsibilities. The
3834	program must be consistent with the appropriate provisions of
3835	NFPA 1037, or similar standards adopted by the division, and
3836	establish minimum training, education, and experience levels for
3837	firesafety inspectors having fire code management
3838	responsibilities.
3839	(9)  The department shall provide by rule for the
3840	certification of firesafety inspectors.
3841	Section 95.  Subsection (12) of section 641.495, Florida
3842	Statutes, is amended to read:
3843	641.495  Requirements for issuance and maintenance of
3844	certificate.-
3845	(12)  The provisions of part I of chapter 395 do not apply
3846	to a health maintenance organization that, on or before January
3847	1, 1991, provides not more than 10 outpatient holding beds for
3848	short-term and hospice-type patients in an ambulatory care
3849	facility for its members, provided that such health maintenance
3850	organization maintains current accreditation by the Joint
3851	Commission on Accreditation of Health Care Organizations, the
3852	Accreditation Association for Ambulatory Health Care, or the
3853	National Committee for Quality Assurance.
3854	Section 96.  Subsection (13) of section 651.118, Florida
3855	Statutes, is amended to read:
3856	651.118  Agency for Health Care Administration;
3857	certificates of need; sheltered beds; community beds.-
3858	(13)  Residents, as defined in this chapter, are not
3859	considered new admissions for the purpose of s.
3860	400.141(1)(n)(o)1.d.
3861	Section 97.  Subsection (2) of section 766.1015, Florida
3862	Statutes, is amended to read:
3863	766.1015  Civil immunity for members of or consultants to
3864	certain boards, committees, or other entities.-
3865	(2)  Such committee, board, group, commission, or other
3866	entity must be established in accordance with state law or in
3867	accordance with requirements of the Joint Commission on
3868	Accreditation of Healthcare Organizations, established and duly
3869	constituted by one or more public or licensed private hospitals
3870	or behavioral health agencies, or established by a governmental
3871	agency. To be protected by this section, the act, decision,
3872	omission, or utterance may not be made or done in bad faith or
3873	with malicious intent.
3874	Section 98.  Subsection (4) of section 766.202, Florida
3875	Statutes, is amended to read:
3876	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3877	766.201-766.212, the term:
3878	(4)  "Health care provider" means any hospital, ambulatory
3879	surgical center, or mobile surgical facility as defined and
3880	licensed under chapter 395; a birth center licensed under
3881	chapter 383; any person licensed under chapter 458, chapter 459,
3882	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3883	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3884	or chapter 486; a clinical lab licensed under chapter 483; a
3885	health maintenance organization certificated under part I of
3886	chapter 641; a blood bank; a plasma center; an industrial
3887	clinic; a renal dialysis facility; or a professional association
3888	partnership, corporation, joint venture, or other association
3889	for professional activity by health care providers.
3890	Section 99.  This act shall take effect July 1, 2011.

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