CS/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 additional housekeeping and sanitation
38	procedures in licensed facilities for infection control
39	purposes; requiring licensed facility beds to conform to
40	standards specified by the Agency for Health Care
41	Administration, the Florida Building Code, and the Florida
42	Fire Prevention Code; amending s. 395.10972, F.S.;
43	revising a reference to the Florida Society of Healthcare
44	Risk Management to conform to the current designation;
45	amending s. 395.2050, F.S.; revising a reference to the
46	federal Health Care Financing Administration to conform to
47	the current designation; amending s. 395.3036, F.S.;
48	correcting a reference; repealing s. 395.3037, F.S.,
49	relating to redundant definitions; amending ss. 154.11,
50	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
51	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
52	F.S.; revising references to the Joint Commission on
53	Accreditation of Healthcare Organizations, the Commission
54	on Accreditation of Rehabilitation Facilities, and the
55	Council on Accreditation to conform to their current
56	designations; amending s. 395.4025, F.S.; authorizing the
57	Department of Health to grant additional extensions for
58	trauma center applicants under certain circumstances;
59	amending s. 395.602, F.S.; revising the definition of the
60	term "rural hospital" to delete an obsolete provision;
61	amending s. 400.021, F.S.; revising the definition of the
62	term "geriatric outpatient clinic" to include additional
63	staff; revising the term "resident care plan"; removing a
64	provision that requires certain signatures on the plan;
65	amending s. 400.0255, F.S.; correcting an obsolete cross-
66	reference to administrative rules; amending s. 400.063,
67	F.S.; deleting an obsolete provision; amending ss. 400.071
68	and 400.0712, F.S.; revising applicability of general
69	licensure requirements under part II of ch. 408, F.S., the
70	Health Care Licensing Procedures Act, to applications for
71	nursing home licensure; revising provisions governing
72	inactive licenses; amending s. 400.111, F.S.; providing
73	for disclosure of controlling interest of a nursing home
74	facility upon request by the Agency for Health Care
75	Administration; amending s. 400.1183, F.S.; revising
76	grievance record maintenance and reporting requirements
77	for nursing homes; amending s. 400.141, F.S.; providing
78	criteria for the provision of respite services by nursing
79	homes; requiring a written plan of care; requiring a
80	contract for services; requiring resident release to
81	caregivers to be designated in writing; providing an
82	exemption to the application of discharge planning rules;
83	providing for residents' rights; providing for use of
84	personal medications; providing terms of respite stay;
85	providing for communication of patient information;
86	requiring a physician's order for care and proof of a
87	physical examination; providing for services for respite
88	patients and duties of facilities with respect to such
89	patients; conforming a cross-reference; requiring
90	facilities to maintain clinical records that meet
91	specified standards; providing a fine relating to an
92	admissions moratorium; deleting requirement for facilities
93	to submit certain information related to management
94	companies to the agency; deleting a requirement for
95	facilities to notify the agency of certain bankruptcy
96	filings to conform to changes made by the act; providing a
97	limit on fees charged by a facility for copies of patient
98	records; amending s. 400.142, F.S.; deleting language
99	relating to agency adoption of rules; repealing s.
100	400.145, F.S., relating to records of care and treatment
101	of residents; repealing ss. 400.0234 and 429.294, F.S.,
102	relating to availability of facility records for
103	investigation of resident's rights violations and
104	defenses; amending 400.147, F.S.; removing a requirement
105	for nursing homes and related health care facilities to
106	notify the agency within a specified period of time after
107	receipt of an adverse incident report; revising reporting
108	requirements for licensed nursing home facilities relating
109	to adverse incidents; repealing s. 400.148, F.S., relating
110	to the Medicaid "Up-or-Out" Quality of Care Contract
111	Management Program; amending s. 400.179, F.S.; deleting an
112	obsolete provision; amending s. 400.19, F.S.; revising
113	inspection requirements; amending s. 400.23, F.S.;
114	deleting an obsolete provision; correcting a reference;
115	directing the agency to adopt rules for minimum staffing
116	standards in nursing homes that serve persons under 21
117	years of age; providing minimum staffing standards;
118	amending s. 400.275, F.S.; revising agency duties with
119	regard to training nursing home surveyor teams; revising
120	requirements for team members; amending s. 400.462, F.S.;
121	revising the definition of the term "remuneration" as it
122	applies to home health agencies; amending s. 400.484,
123	F.S.; revising the schedule of home health agency
124	inspection violations; amending s. 400.506, F.S.; deleting
125	language relating to exemptions from penalties imposed on
126	nurse registries if a nurse registry does not bill the
127	Florida Medicaid Program; providing criteria for an
128	administrator to manage a nurse registry; amending s.
129	400.509, F.S.; revising the service providers exempt from
130	licensure registration to include organizations that
131	provide companion services only for persons with
132	developmental disabilities; amending s. 400.606, F.S.;
133	revising the content requirements of the plan accompanying
134	an initial or change-of-ownership application for
135	licensure of a hospice; revising requirements relating to
136	certificates of need for certain hospice facilities;
137	amending s. 400.607, F.S.; revising grounds for agency
138	action against a hospice; amending s. 400.915, F.S.;
139	correcting an obsolete cross-reference to administrative
140	rules; amending s. 400.931, F.S.; deleting a requirement
141	that an applicant for a home medical equipment provider
142	license submit a surety bond to the agency; requiring
143	applicants to submit documentation of accreditation within
144	a specified period of time; amending s. 400.932, F.S.;
145	revising grounds for the imposition of administrative
146	penalties for certain violations by an employee of a home
147	medical equipment provider; amending s. 400.967, F.S.;
148	revising the schedule of inspection violations for
149	intermediate care facilities for the developmentally
150	disabled; providing a penalty for certain violations;
151	amending s. 400.9905, F.S.; revising the definitions of
152	the terms "clinic" and "portable equipment provider";
153	providing that part X of ch. 400, F.S., the Health Care
154	Clinic Act, does not apply to certain clinical facilities,
155	an entity owned by a corporation with a specified amount
156	of annual sales of health care services under certain
157	circumstances, an entity owned or controlled by a publicly
158	traded entity with a specified amount of annual revenues,
159	or an entity that employs a specified number of licensed
160	health care practitioners under certain conditions;
161	amending s. 400.991, F.S.; conforming terminology;
162	revising application requirements relating to
163	documentation of financial ability to operate a mobile
164	clinic; amending s. 408.033, F.S.; permitting fees
165	assessed on certain health care facilities to be collected
166	prospectively at the time of licensure renewal and
167	prorated for the licensure period; amending s. 408.034,
168	F.S.; revising agency authority relating to licensing of
169	intermediate care facilities for the developmentally
170	disabled; amending s. 408.036, F.S.; deleting an exemption
171	from certain certificate-of-need review requirements for a
172	hospice or a hospice inpatient facility; deleting a
173	requirement that the agency submit a report regarding
174	requests for exemption; amending s. 408.037, F.S.;
175	revising certificate-of-need requirements for general
176	hospital applicants to evaluate the applicant's parent
177	corporation if audited financial statements of the
178	applicant do not exist; amending s. 408.043, F.S.;
179	revising requirements for certain freestanding inpatient
180	hospice care facilities to obtain a certificate of need;
181	amending s. 408.061, F.S.; revising health care facility
182	data reporting requirements; amending s. 408.10, F.S.;
183	removing agency authority to investigate certain consumer
184	complaints; amending s. 408.802, F.S.; removing
185	applicability of part II of ch. 408, F.S., relating to
186	general licensure requirements, to private review agents;
187	amending s. 408.804, F.S.; providing penalties for
188	altering, defacing, or falsifying a license certificate
189	issued by the agency or displaying such an altered,
190	defaced, or falsified certificate; amending s. 408.806,
191	F.S.; revising agency responsibilities for notification of
192	licensees of impending expiration of a license; requiring
193	payment of a late fee for a license application to be
194	considered complete under certain circumstances; amending
195	s. 408.8065, F.S.; requiring home health agencies, home
196	medical equipment providers, and health care clinics to
197	submit projected financial statements; amending s.
198	408.809, F.S., relating to background screening of
199	specified employees of health care providers; revising
200	provisions for required rescreening; removing provisions
201	authorizing the agency to adopt rules establishing a
202	rescreening schedule; establishing a rescreening schedule;
203	amending s. 408.810, F.S.; requiring disclosure of
204	information by a controlling interest of certain court
205	actions relating to financial instability within a
206	specified time period; amending s. 408.813, F.S.;
207	authorizing the agency to impose fines for unclassified
208	violations of part II of ch. 408, F.S.; amending s.
209	408.815, F.S.; providing for certain mitigating
210	circumstances to be considered for any application subject
211	to denial; authorizing the agency to extend a license
212	expiration date under certain circumstances; amending s.
213	s. 409.212, F.S.; increasing the limit on the amount of
214	additional supplementation provided by a third party under
215	the optional state supplementation program; amending s.
216	409.91196, F.S.; revising components of a Medicaid
217	prescribed-drug spending-control program; conforming a
218	cross-reference; amending s. 409.912, F.S.; revising
219	procedures for implementation of a Medicaid prescribed-
220	drug spending-control program; amending s. 429.07, F.S.;
221	deleting the requirement for an assisted living facility
222	to obtain an additional license in order to provide
223	limited nursing services; deleting the requirement for the
224	agency to conduct quarterly monitoring visits of
225	facilities that hold a license to provide extended
226	congregate care services; deleting the requirement for the
227	department to report annually on the status of and
228	recommendations related to extended congregate care;
229	deleting the requirement for the agency to conduct
230	monitoring visits at least twice a year to facilities
231	providing limited nursing services; eliminating the
232	license fee for the limited nursing services license;
233	transferring from another provision of law the requirement
234	that the standard survey of an assisted living facility
235	include specific actions to determine whether the facility
236	is adequately protecting residents' rights; providing that
237	under specified conditions an assisted living facility
238	that has a class I or class II violation is subject to
239	periodic unannounced monitoring; requiring a registered
240	nurse to participate in certain monitoring visits;
241	amending s. 429.11, F.S.; revising licensure application
242	requirements for assisted living facilities to eliminate
243	provisional licenses; amending s. 429.12, F.S.; deleting a
244	requirement that a transferor of an assisted living
245	facility advise the transferee to submit a plan for
246	correction of certain deficiencies to the Agency for
247	Health Care Administration before ownership of the
248	facility is transferred; amending s. 429.14, F.S.;
249	clarifying provisions relating to a facility's request for
250	a hearing under certain circumstances; amending s. 429.17,
251	F.S.; deleting provisions relating to the limited nursing
252	services license; revising agency responsibilities
253	regarding the issuance of conditional licenses; amending
254	s. 429.195, F.S.; revising the list of entities prohibited
255	from providing rebates; providing exceptions to prohibited
256	patient brokering for assisted living facilities; amending
257	s. 429.23, F.S.; deleting reporting requirements for
258	assisted living facilities relating to liability claims;
259	amending s. 429.255, F.S.; eliminating provisions
260	authorizing the use of volunteers to provide certain
261	health-care-related services in assisted living
262	facilities; authorizing assisted living facilities to
263	provide limited nursing services; requiring an assisted
264	living facility to be responsible for certain
265	recordkeeping and staff to be trained to monitor residents
266	receiving certain health-care-related services; amending
267	s. 429.28, F.S.; deleting a requirement for a biennial
268	survey of an assisted living facility, to conform to
269	changes made by the act; conforming a cross-reference;
270	amending s. 429.41, F.S., relating to rulemaking;
271	conforming provisions to changes made by the act; deleting
272	the requirement for the Department of Elderly Affairs to
273	submit a copy of proposed rules to the Legislature;
274	amending s. 429.53, F.S.; revising provisions relating to
275	consultation by the agency; revising a definition;
276	amending s. 429.71, F.S.; revising schedule of inspection
277	violations for adult family-care homes; amending s.
278	429.915, F.S.; revising agency responsibilities regarding
279	the issuance of conditional licenses; amending s. 440.102,
280	F.S.; deleting the requirement for laboratories to submit
281	a monthly report to the agency with statistical
282	information regarding the testing of employees and job
283	applicants; amending s. 456.053, F.S.; revising the
284	definition of the term "group practice" as it relates to
285	financial arrangements of referring health care providers
286	and providers of health care services to include group
287	practices that provide radiation therapy services under
288	certain circumstances; amending s. 483.035, F.S.;
289	requiring certain clinical laboratories operated by one or
290	more practitioners licensed under part I of ch. 464, F.S.,
291	the Nurse Practice Act, to be licensed under part I of ch.
292	483, F.S., the Florida Clinical Laboratory Law; amending
293	s. 483.051, F.S.; establishing qualifications necessary
294	for clinical laboratory licensure; amending s. 483.294,
295	F.S.; revising frequency of agency inspections of
296	multiphasic health testing centers; amending s. 499.003,
297	F.S.; removing the requirement for certain prescription
298	drug purchasers to maintain a separate inventory of
299	certain prescription drugs; amending s. 633.081, F.S.;
300	limiting State Fire Marshal inspections of nursing homes
301	to once a year; providing for additional inspections based
302	on complaints and violations identified in the course of
303	orientation or training activities; amending s. 766.202,
304	F.S.; adding persons licensed under part XIV of ch. 468,
305	F.S., relating to orthotics, prosthetics, and pedorthics,
306	to the definition of "health care provider"; amending s.
307	817.505, F.S.; creating an exception to the patient
308	brokering prohibition for assisted living facilities;
309	amending ss. 394.4787, 400.0239, 408.07, 430.80, and
310	651.118, F.S.; conforming terminology and references to
311	changes made by the act; revising a reference;
312	establishing that assisted living facility licensure fees
313	have been adjusted by Consumer Price Index since 1998 and
314	are not intended to be reset by this act; providing an
315	effective date.
316
317	Be It Enacted by the Legislature of the State of Florida:
318
319	Section 1.  Subsection (1) of section 83.42, Florida
320	Statutes, is amended to read:
321	83.42  Exclusions from application of part.-This part does
322	not apply to:
323	(1)  Residency or detention in a facility, whether public
324	or private, when residence or detention is incidental to the
325	provision of medical, geriatric, educational, counseling,
326	religious, or similar services. For residents of a facility
327	licensed under part II of chapter 400, the provisions of s.
328	400.0255 are the exclusive procedures for all transfers and
329	discharges.
330	Section 2.  Paragraphs (f) through (k) of subsection (10)
331	of section 112.0455, Florida Statutes, are redesignated as
332	paragraphs (e) through (j), respectively, paragraph (e) of
333	subsection (12) is redesignated as paragraph (d), and present
334	paragraph (e) of subsection (10), present paragraph (d) of
335	subsection (12), and paragraph (e) of subsection (14) of that
336	section are amended to read:
337	112.0455  Drug-Free Workplace Act.-
338	(10)  EMPLOYER PROTECTION.-
339	(e)  Nothing in this section shall be construed to operate
340	retroactively, and nothing in this section shall abrogate the
341	right of an employer under state law to conduct drug tests prior
342	to January 1, 1990. A drug test conducted by an employer prior
343	to January 1, 1990, is not subject to this section.
344	(12)  DRUG-TESTING STANDARDS; LABORATORIES.-
345	(d)  The laboratory shall submit to the Agency for Health
346	Care Administration a monthly report with statistical
347	information regarding the testing of employees and job
348	applicants. The reports shall include information on the methods
349	of analyses conducted, the drugs tested for, the number of
350	positive and negative results for both initial and confirmation
351	tests, and any other information deemed appropriate by the
352	Agency for Health Care Administration. No monthly report shall
353	identify specific employees or job applicants.
354	(14)  DISCIPLINE REMEDIES.-
355	(e)  Upon resolving an appeal filed pursuant to paragraph
356	(c), and finding a violation of this section, the commission may
357	order the following relief:
358	1.  Rescind the disciplinary action, expunge related
359	records from the personnel file of the employee or job applicant
360	and reinstate the employee.
361	2.  Order compliance with paragraph (10)(f)(g).
362	3.  Award back pay and benefits.
363	4.  Award the prevailing employee or job applicant the
364	necessary costs of the appeal, reasonable attorney's fees, and
365	expert witness fees.
366	Section 3.  Paragraph (n) of subsection (1) of section
367	154.11, Florida Statutes, is amended to read:
368	154.11  Powers of board of trustees.-
369	(1)  The board of trustees of each public health trust
370	shall be deemed to exercise a public and essential governmental
371	function of both the state and the county and in furtherance
372	thereof it shall, subject to limitation by the governing body of
373	the county in which such board is located, have all of the
374	powers necessary or convenient to carry out the operation and
375	governance of designated health care facilities, including, but
376	without limiting the generality of, the foregoing:
377	(n)  To appoint originally the staff of physicians to
378	practice in any designated facility owned or operated by the
379	board and to approve the bylaws and rules to be adopted by the
380	medical staff of any designated facility owned and operated by
381	the board, such governing regulations to be in accordance with
382	the standards of the Joint Commission on the Accreditation of
383	Hospitals which provide, among other things, for the method of
384	appointing additional staff members and for the removal of staff
385	members.
386	Section 4.  Subsection (15) of section 318.21, Florida
387	Statutes, is amended to read:
388	318.21  Disposition of civil penalties by county courts.-
389	All civil penalties received by a county court pursuant to the
390	provisions of this chapter shall be distributed and paid monthly
391	as follows:
392	(15)  Of the additional fine assessed under s. 318.18(3)(e)
393	for a violation of s. 316.1893, 50 percent of the moneys
394	received from the fines shall be remitted to the Department of
395	Revenue and deposited into the Brain and Spinal Cord Injury
396	Trust Fund of Department of Health and shall be appropriated to
397	the Department of Health Agency for Health Care Administration
398	as general revenue to provide an enhanced Medicaid payment to
399	nursing homes that serve Medicaid recipients with brain and
400	spinal cord injuries that are medically complex and who are
401	technologically and respiratory dependent. The remaining 50
402	percent of the moneys received from the enhanced fine imposed
403	under s. 318.18(3)(e) shall be remitted to the Department of
404	Revenue and deposited into the Department of Health Emergency
405	Medical Services Trust Fund to provide financial support to
406	certified trauma centers in the counties where enhanced penalty
407	zones are established to ensure the availability and
408	accessibility of trauma services. Funds deposited into the
409	Emergency Medical Services Trust Fund under this subsection
410	shall be allocated as follows:
411	(a)  Fifty percent shall be allocated equally among all
412	Level I, Level II, and pediatric trauma centers in recognition
413	of readiness costs for maintaining trauma services.
414	(b)  Fifty percent shall be allocated among Level I, Level
415	II, and pediatric trauma centers based on each center's relative
416	volume of trauma cases as reported in the Department of Health
417	Trauma Registry.
418	Section 5.  Section 383.325, Florida Statutes, is repealed.
419	Section 6.  Subsection (7) of section 394.4787, Florida
420	Statutes, is amended to read:
421	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
422	and 394.4789.-As used in this section and ss. 394.4786,
423	394.4788, and 394.4789:
424	(7)  "Specialty psychiatric hospital" means a hospital
425	licensed by the agency pursuant to s. 395.002(26)(28) and part
426	II of chapter 408 as a specialty psychiatric hospital.
427	Section 7.  Subsection (2) of section 394.741, Florida
428	Statutes, is amended to read:
429	394.741  Accreditation requirements for providers of
430	behavioral health care services.-
431	(2)  Notwithstanding any provision of law to the contrary,
432	accreditation shall be accepted by the agency and department in
433	lieu of the agency's and department's facility licensure onsite
434	review requirements and shall be accepted as a substitute for
435	the department's administrative and program monitoring
436	requirements, except as required by subsections (3) and (4),
437	for:
438	(a)  Any organization from which the department purchases
439	behavioral health care services that is accredited by the Joint
440	Commission on Accreditation of Healthcare Organizations or the
441	Council on Accreditation for Children and Family Services, or
442	has those services that are being purchased by the department
443	accredited by the Commission on Accreditation of Rehabilitation
444	Facilities CARF-the Rehabilitation Accreditation Commission.
445	(b)  Any mental health facility licensed by the agency or
446	any substance abuse component licensed by the department that is
447	accredited by the Joint Commission on Accreditation of
448	Healthcare Organizations, the Commission on Accreditation of
449	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
450	Commission, or the Council on Accreditation of Children and
451	Family Services.
452	(c)  Any network of providers from which the department or
453	the agency purchases behavioral health care services accredited
454	by the Joint Commission on Accreditation of Healthcare
455	Organizations, the Commission on Accreditation of Rehabilitation
456	Facilities CARF-the Rehabilitation Accreditation Commission, the
457	Council on Accreditation of Children and Family Services, or the
458	National Committee for Quality Assurance. A provider
459	organization, which is part of an accredited network, is
460	afforded the same rights under this part.
461	Section 8.  Present subsections (15) through (32) of
462	section 395.002, Florida Statutes, are renumbered as subsections
463	(14) through (28), respectively, and present subsections (1),
464	(14), (24), (30), and (31) and paragraph (c) of present
465	subsection (28) of that section are amended to read:
466	395.002  Definitions.-As used in this chapter:
467	(1)  "Accrediting organizations" means nationally
468	recognized or approved accrediting organizations whose standards
469	incorporate comparable licensure requirements as determined by
470	the agency the Joint Commission on Accreditation of Healthcare
471	Organizations, the American Osteopathic Association, the
472	Commission on Accreditation of Rehabilitation Facilities, and
473	the Accreditation Association for Ambulatory Health Care, Inc.
474	(14)  "Initial denial determination" means a determination
475	by a private review agent that the health care services
476	furnished or proposed to be furnished to a patient are
477	inappropriate, not medically necessary, or not reasonable.
478	(24)  "Private review agent" means any person or entity
479	which performs utilization review services for third-party
480	payors on a contractual basis for outpatient or inpatient
481	services. However, the term shall not include full-time
482	employees, personnel, or staff of health insurers, health
483	maintenance organizations, or hospitals, or wholly owned
484	subsidiaries thereof or affiliates under common ownership, when
485	performing utilization review for their respective hospitals,
486	health maintenance organizations, or insureds of the same
487	insurance group. For this purpose, health insurers, health
488	maintenance organizations, and hospitals, or wholly owned
489	subsidiaries thereof or affiliates under common ownership,
490	include such entities engaged as administrators of self-
491	insurance as defined in s. 624.031.
492	(26)(28)  "Specialty hospital" means any facility which
493	meets the provisions of subsection (12), and which regularly
494	makes available either:
495	(c)  Intensive residential treatment programs for children
496	and adolescents as defined in subsection (14) (15).
497	(30)  "Utilization review" means a system for reviewing the
498	medical necessity or appropriateness in the allocation of health
499	care resources of hospital services given or proposed to be
500	given to a patient or group of patients.
501	(31)  "Utilization review plan" means a description of the
502	policies and procedures governing utilization review activities
503	performed by a private review agent.
504	Section 9.  Paragraph (c) of subsection (1) and paragraph
505	(b) of subsection (2) of section 395.003, Florida Statutes, are
506	amended to read:
507	395.003  Licensure; denial, suspension, and revocation.-
508	(1)
509	(c)  Until July 1, 2006, additional emergency departments
510	located off the premises of licensed hospitals may not be
511	authorized by the agency.
512	(2)
513	(b)  The agency shall, at the request of a licensee that is
514	a teaching hospital as defined in s. 408.07(45), issue a single
515	license to a licensee for facilities that have been previously
516	licensed as separate premises, provided such separately licensed
517	facilities, taken together, constitute the same premises as
518	defined in s. 395.002(22)(23). Such license for the single
519	premises shall include all of the beds, services, and programs
520	that were previously included on the licenses for the separate
521	premises. The granting of a single license under this paragraph
522	shall not in any manner reduce the number of beds, services, or
523	programs operated by the licensee.
524	Section 10.  Subsection (3) of section 395.0161, Florida
525	Statutes, is amended to read:
526	395.0161  Licensure inspection.-
527	(3)  In accordance with s. 408.805, an applicant or
528	licensee shall pay a fee for each license application submitted
529	under this part, part II of chapter 408, and applicable rules.
530	With the exception of state-operated licensed facilities, each
531	facility licensed under this part shall pay to the agency, at
532	the time of inspection, the following fees:
533	(a)  Inspection for licensure.-A fee shall be paid which is
534	not less than $8 per hospital bed, nor more than $12 per
535	hospital bed, except that the minimum fee shall be $400 per
536	facility.
537	(b)  Inspection for lifesafety only.-A fee shall be paid
538	which is not less than 75 cents per hospital bed, nor more than
539	$1.50 per hospital bed, except that the minimum fee shall be $40
540	per facility.
541	Section 11.  Paragraph (e) of subsection (2) and subsection
542	(4) of section 395.0193, Florida Statutes, are amended to read:
543	395.0193  Licensed facilities; peer review; disciplinary
544	powers; agency or partnership with physicians.-
545	(2)  Each licensed facility, as a condition of licensure,
546	shall provide for peer review of physicians who deliver health
547	care services at the facility. Each licensed facility shall
548	develop written, binding procedures by which such peer review
549	shall be conducted. Such procedures shall include:
550	(e)  Recording of agendas and minutes which do not contain
551	confidential material, for review by the Division of Medical
552	Quality Assurance of the department Health Quality Assurance of
553	the agency.
554	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
555	actions taken under subsection (3) shall be reported in writing
556	to the Division of Medical Quality Assurance of the department
557	Health Quality Assurance of the agency within 30 working days
558	after its initial occurrence, regardless of the pendency of
559	appeals to the governing board of the hospital. The notification
560	shall identify the disciplined practitioner, the action taken,
561	and the reason for such action. All final disciplinary actions
562	taken under subsection (3), if different from those which were
563	reported to the department agency within 30 days after the
564	initial occurrence, shall be reported within 10 working days to
565	the Division of Medical Quality Assurance of the department
566	Health Quality Assurance of the agency in writing and shall
567	specify the disciplinary action taken and the specific grounds
568	therefor. The division shall review each report and determine
569	whether it potentially involved conduct by the licensee that is
570	subject to disciplinary action, in which case s. 456.073 shall
571	apply. The reports are not subject to inspection under s.
572	119.07(1) even if the division's investigation results in a
573	finding of probable cause.
574	Section 12.  Section 395.1023, Florida Statutes, is amended
575	to read:
576	395.1023  Child abuse and neglect cases; duties.-Each
577	licensed facility shall adopt a protocol that, at a minimum,
578	requires the facility to:
579	(1)  Incorporate a facility policy that every staff member
580	has an affirmative duty to report, pursuant to chapter 39, any
581	actual or suspected case of child abuse, abandonment, or
582	neglect; and
583	(2)  In any case involving suspected child abuse,
584	abandonment, or neglect, designate, at the request of the
585	Department of Children and Family Services, a staff physician to
586	act as a liaison between the hospital and the Department of
587	Children and Family Services office which is investigating the
588	suspected abuse, abandonment, or neglect, and the child
589	protection team, as defined in s. 39.01, when the case is
590	referred to such a team.
591
592	Each general hospital and appropriate specialty hospital shall
593	comply with the provisions of this section and shall notify the
594	agency and the Department of Children and Family Services of its
595	compliance by sending a copy of its policy to the agency and the
596	Department of Children and Family Services as required by rule.
597	The failure by a general hospital or appropriate specialty
598	hospital to comply shall be punished by a fine not exceeding
599	$1,000, to be fixed, imposed, and collected by the agency. Each
600	day in violation is considered a separate offense.
601	Section 13.  Subsection (2) and paragraph (d) of subsection
602	(3) of section 395.1041, Florida Statutes, are amended to read:
603	395.1041  Access to emergency services and care.-
604	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
605	shall establish and maintain an inventory of hospitals with
606	emergency services. The inventory shall list all services within
607	the service capability of the hospital, and such services shall
608	appear on the face of the hospital license. Each hospital having
609	emergency services shall notify the agency of its service
610	capability in the manner and form prescribed by the agency. The
611	agency shall use the inventory to assist emergency medical
612	services providers and others in locating appropriate emergency
613	medical care. The inventory shall also be made available to the
614	general public. On or before August 1, 1992, the agency shall
615	request that each hospital identify the services which are
616	within its service capability. On or before November 1, 1992,
617	the agency shall notify each hospital of the service capability
618	to be included in the inventory. The hospital has 15 days from
619	the date of receipt to respond to the notice. By December 1,
620	1992, the agency shall publish a final inventory. Each hospital
621	shall reaffirm its service capability when its license is
622	renewed and shall notify the agency of the addition of a new
623	service or the termination of a service prior to a change in its
624	service capability.
625	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
626	FACILITY OR HEALTH CARE PERSONNEL.-
627	(d)1.  Every hospital shall ensure the provision of
628	services within the service capability of the hospital, at all
629	times, either directly or indirectly through an arrangement with
630	another hospital, through an arrangement with one or more
631	physicians, or as otherwise made through prior arrangements. A
632	hospital may enter into an agreement with another hospital for
633	purposes of meeting its service capability requirement, and
634	appropriate compensation or other reasonable conditions may be
635	negotiated for these backup services.
636	2.  If any arrangement requires the provision of emergency
637	medical transportation, such arrangement must be made in
638	consultation with the applicable provider and may not require
639	the emergency medical service provider to provide transportation
640	that is outside the routine service area of that provider or in
641	a manner that impairs the ability of the emergency medical
642	service provider to timely respond to prehospital emergency
643	calls.
644	3.  A hospital shall not be required to ensure service
645	capability at all times as required in subparagraph 1. if, prior
646	to the receiving of any patient needing such service capability,
647	such hospital has demonstrated to the agency that it lacks the
648	ability to ensure such capability and it has exhausted all
649	reasonable efforts to ensure such capability through backup
650	arrangements. In reviewing a hospital's demonstration of lack of
651	ability to ensure service capability, the agency shall consider
652	factors relevant to the particular case, including the
653	following:
654	a.  Number and proximity of hospitals with the same service
655	capability.
656	b.  Number, type, credentials, and privileges of
657	specialists.
658	c.  Frequency of procedures.
659	d.  Size of hospital.
660	4.  The agency shall publish proposed rules implementing a
661	reasonable exemption procedure by November 1, 1992. Subparagraph
662	1. shall become effective upon the effective date of said rules
663	or January 31, 1993, whichever is earlier. For a period not to
664	exceed 1 year from the effective date of subparagraph 1., a
665	hospital requesting an exemption shall be deemed to be exempt
666	from offering the service until the agency initially acts to
667	deny or grant the original request. The agency has 45 days after
668	from the date of receipt of the request to approve or deny the
669	request. After the first year from the effective date of
670	subparagraph 1., If the agency fails to initially act within
671	that the time period, the hospital is deemed to be exempt from
672	offering the service until the agency initially acts to deny the
673	request.
674	Section 14.  Section 395.1046, Florida Statutes, is
675	repealed.
676	Section 15.  Paragraphs (b) and (e) of subsection (1) of
677	section 395.1055, Florida Statutes, are amended to read:
678	395.1055  Rules and enforcement.-
679	(1)  The agency shall adopt rules pursuant to ss.
680	120.536(1) and 120.54 to implement the provisions of this part,
681	which shall include reasonable and fair minimum standards for
682	ensuring that:
683	(b)  Infection control, housekeeping, sanitary conditions,
684	and medical record procedures that will adequately protect
685	patient care and safety are established and implemented. These
686	procedures shall require housekeeping and sanitation staff to
687	wear masks and gloves when cleaning patient rooms and
688	disinfecting environmental surfaces in patient rooms in
689	accordance with the time instructions on the label of the
690	disinfectant used by the hospital. The agency may impose an
691	administrative fine for each day that a violation of this
692	paragraph occurs.
693	(e)  Licensed facility beds conform to minimum space,
694	equipment, and furnishings standards as specified by the agency,
695	the Florida Building Code, and the Florida Fire Prevention Code
696	department.
697	Section 16.  Subsection (1) of section 395.10972, Florida
698	Statutes, is amended to read:
699	395.10972  Health Care Risk Manager Advisory Council.-The
700	Secretary of Health Care Administration may appoint a seven-
701	member advisory council to advise the agency on matters
702	pertaining to health care risk managers. The members of the
703	council shall serve at the pleasure of the secretary. The
704	council shall designate a chair. The council shall meet at the
705	call of the secretary or at those times as may be required by
706	rule of the agency. The members of the advisory council shall
707	receive no compensation for their services, but shall be
708	reimbursed for travel expenses as provided in s. 112.061. The
709	council shall consist of individuals representing the following
710	areas:
711	(1)  Two shall be active health care risk managers,
712	including one risk manager who is recommended by and a member of
713	the Florida Society for of Healthcare Risk Management and
714	Patient Safety.
715	Section 17.  Subsection (3) of section 395.2050, Florida
716	Statutes, is amended to read:
717	395.2050  Routine inquiry for organ and tissue donation;
718	certification for procurement activities; death records review.-
719	(3)  Each organ procurement organization designated by the
720	federal Centers for Medicare and Medicaid Services Health Care
721	Financing Administration and licensed by the state shall conduct
722	an annual death records review in the organ procurement
723	organization's affiliated donor hospitals. The organ procurement
724	organization shall enlist the services of every Florida licensed
725	tissue bank and eye bank affiliated with or providing service to
726	the donor hospital and operating in the same service area to
727	participate in the death records review.
728	Section 18.  Subsection (2) of section 395.3036, Florida
729	Statutes, is amended to read:
730	395.3036  Confidentiality of records and meetings of
731	corporations that lease public hospitals or other public health
732	care facilities.-The records of a private corporation that
733	leases a public hospital or other public health care facility
734	are confidential and exempt from the provisions of s. 119.07(1)
735	and s. 24(a), Art. I of the State Constitution, and the meetings
736	of the governing board of a private corporation are exempt from
737	s. 286.011 and s. 24(b), Art. I of the State Constitution when
738	the public lessor complies with the public finance
739	accountability provisions of s. 155.40(5) with respect to the
740	transfer of any public funds to the private lessee and when the
741	private lessee meets at least three of the five following
742	criteria:
743	(2)  The public lessor and the private lessee do not
744	commingle any of their funds in any account maintained by either
745	of them, other than the payment of the rent and administrative
746	fees or the transfer of funds pursuant to s. 155.40 subsection
747	(2).
748	Section 19.  Section 395.3037, Florida Statutes, is
749	repealed.
750	Section 20.  Subsections (1), (4), and (5) of section
751	395.3038, Florida Statutes, are amended to read:
752	395.3038  State-listed primary stroke centers and
753	comprehensive stroke centers; notification of hospitals.-
754	(1)  The agency shall make available on its website and to
755	the department a list of the name and address of each hospital
756	that meets the criteria for a primary stroke center and the name
757	and address of each hospital that meets the criteria for a
758	comprehensive stroke center. The list of primary and
759	comprehensive stroke centers shall include only those hospitals
760	that attest in an affidavit submitted to the agency that the
761	hospital meets the named criteria, or those hospitals that
762	attest in an affidavit submitted to the agency that the hospital
763	is certified as a primary or a comprehensive stroke center by
764	the Joint Commission on Accreditation of Healthcare
765	Organizations.
766	(4)  The agency shall adopt by rule criteria for a primary
767	stroke center which are substantially similar to the
768	certification standards for primary stroke centers of the Joint
769	Commission on Accreditation of Healthcare Organizations.
770	(5)  The agency shall adopt by rule criteria for a
771	comprehensive stroke center. However, if the Joint Commission on
772	Accreditation of Healthcare Organizations establishes criteria
773	for a comprehensive stroke center, the agency shall establish
774	criteria for a comprehensive stroke center which are
775	substantially similar to those criteria established by the Joint
776	Commission on Accreditation of Healthcare Organizations.
777	Section 21.  Paragraph (d) of subsection (2) of section
778	395.4025, Florida Statutes, is amended to read:
779	395.4025  Trauma centers; selection; quality assurance;
780	records.-
781	(2)
782	(d)1.  Notwithstanding other provisions in this section,
783	the department may grant up to an additional 18 months to a
784	hospital applicant that is unable to meet all requirements as
785	provided in paragraph (c) at the time of application if the
786	number of applicants in the service area in which the applicant
787	is located is equal to or less than the service area allocation,
788	as provided by rule of the department. An applicant that is
789	granted additional time pursuant to this paragraph shall submit
790	a plan for departmental approval which includes timelines and
791	activities that the applicant proposes to complete in order to
792	meet application requirements. Any applicant that demonstrates
793	an ongoing effort to complete the activities within the
794	timelines outlined in the plan shall be included in the number
795	of trauma centers at such time that the department has conducted
796	a provisional review of the application and has determined that
797	the application is complete and that the hospital has the
798	critical elements required for a trauma center. An applicant
799	that has received an additional 18 months pursuant to this
800	paragraph shall be granted up to two additional 6-month
801	extensions to meet all requirements as provided in paragraph
802	(c), if construction related to a critical element is delayed as
803	a result of governmental action or inaction with respect to
804	regulations or permitting, and the applicant has made a good
805	faith effort to comply with the applicable regulations or obtain
806	the required permits.
807	2.  Timeframes provided in subsections (1)-(8) shall be
808	stayed until the department determines that the application is
809	complete and that the hospital has the critical elements
810	required for a trauma center.
811	Section 22.  Paragraph (e) of subsection (2) of section
812	395.602, Florida Statutes, is amended to read:
813	395.602  Rural hospitals.-
814	(2)  DEFINITIONS.-As used in this part:
815	(e)  "Rural hospital" means an acute care hospital licensed
816	under this chapter, having 100 or fewer licensed beds and an
817	emergency room, which is:
818	1.  The sole provider within a county with a population
819	density of no greater than 100 persons per square mile;
820	2.  An acute care hospital, in a county with a population
821	density of no greater than 100 persons per square mile, which is
822	at least 30 minutes of travel time, on normally traveled roads
823	under normal traffic conditions, from any other acute care
824	hospital within the same county;
825	3.  A hospital supported by a tax district or subdistrict
826	whose boundaries encompass a population of 100 persons or fewer
827	per square mile;
828	4.  A hospital in a constitutional charter county with a
829	population of over 1 million persons that has imposed a local
830	option health service tax pursuant to law and in an area that
831	was directly impacted by a catastrophic event on August 24,
832	1992, for which the Governor of Florida declared a state of
833	emergency pursuant to chapter 125, and has 120 beds or less that
834	serves an agricultural community with an emergency room
835	utilization of no less than 20,000 visits and a Medicaid
836	inpatient utilization rate greater than 15 percent;
837	4.5.  A hospital with a service area that has a population
838	of 100 persons or fewer per square mile. As used in this
839	subparagraph, the term "service area" means the fewest number of
840	zip codes that account for 75 percent of the hospital's
841	discharges for the most recent 5-year period, based on
842	information available from the hospital inpatient discharge
843	database in the Florida Center for Health Information and Policy
844	Analysis at the Agency for Health Care Administration; or
845	5.6.  A hospital designated as a critical access hospital,
846	as defined in s. 408.07(15).
847
848	Population densities used in this paragraph must be based upon
849	the most recently completed United States census. A hospital
850	that received funds under s. 409.9116 for a quarter beginning no
851	later than July 1, 2002, is deemed to have been and shall
852	continue to be a rural hospital from that date through June 30,
853	2015, if the hospital continues to have 100 or fewer licensed
854	beds and an emergency room, or meets the criteria of
855	subparagraph 4. An acute care hospital that has not previously
856	been designated as a rural hospital and that meets the criteria
857	of this paragraph shall be granted such designation upon
858	application, including supporting documentation to the Agency
859	for Health Care Administration.
860	Section 23.  Subsections (8) and (16) of section 400.021,
861	Florida Statutes, are amended to read:
862	400.021  Definitions.-When used in this part, unless the
863	context otherwise requires, the term:
864	(8)  "Geriatric outpatient clinic" means a site for
865	providing outpatient health care to persons 60 years of age or
866	older, which is staffed by a registered nurse or a physician
867	assistant, or a licensed practical nurse under the direct
868	supervision of a registered nurse, advanced registered nurse
869	practitioner, physician assistant, or physician.
870	(16)  "Resident care plan" means a written plan developed,
871	maintained, and reviewed not less than quarterly by a registered
872	nurse, with participation from other facility staff and the
873	resident or his or her designee or legal representative, which
874	includes a comprehensive assessment of the needs of an
875	individual resident; the type and frequency of services required
876	to provide the necessary care for the resident to attain or
877	maintain the highest practicable physical, mental, and
878	psychosocial well-being; a listing of services provided within
879	or outside the facility to meet those needs; and an explanation
880	of service goals. The resident care plan must be signed by the
881	director of nursing or another registered nurse employed by the
882	facility to whom institutional responsibilities have been
883	delegated and by the resident, the resident's designee, or the
884	resident's legal representative. The facility may not use an
885	agency or temporary registered nurse to satisfy the foregoing
886	requirement and must document the institutional responsibilities
887	that have been delegated to the registered nurse.
888	Section 24.  Paragraph (g) of subsection (2) of section
889	400.0239, Florida Statutes, is amended to read:
890	400.0239  Quality of Long-Term Care Facility Improvement
891	Trust Fund.-
892	(2)  Expenditures from the trust fund shall be allowable
893	for direct support of the following:
894	(g)  Other initiatives authorized by the Centers for
895	Medicare and Medicaid Services for the use of federal civil
896	monetary penalties, including projects recommended through the
897	Medicaid "Up-or-Out" Quality of Care Contract Management Program
898	pursuant to s. 400.148.
899	Section 25.  Subsection (15) of section 400.0255, Florida
900	Statutes, is amended to read
901	400.0255  Resident transfer or discharge; requirements and
902	procedures; hearings.-
903	(15)(a)  The department's Office of Appeals Hearings shall
904	conduct hearings under this section. The office shall notify the
905	facility of a resident's request for a hearing.
906	(b)  The department shall, by rule, establish procedures to
907	be used for fair hearings requested by residents. These
908	procedures shall be equivalent to the procedures used for fair
909	hearings for other Medicaid cases appearing in s. 409.285 and
910	applicable rules, chapter 10-2, part VI, Florida Administrative
911	Code. The burden of proof must be clear and convincing evidence.
912	A hearing decision must be rendered within 90 days after receipt
913	of the request for hearing.
914	(c)  If the hearing decision is favorable to the resident
915	who has been transferred or discharged, the resident must be
916	readmitted to the facility's first available bed.
917	(d)  The decision of the hearing officer shall be final.
918	Any aggrieved party may appeal the decision to the district
919	court of appeal in the appellate district where the facility is
920	located. Review procedures shall be conducted in accordance with
921	the Florida Rules of Appellate Procedure.
922	Section 26.  Subsection (2) of section 400.063, Florida
923	Statutes, is amended to read:
924	400.063  Resident protection.-
925	(2)  The agency is authorized to establish for each
926	facility, subject to intervention by the agency, a separate bank
927	account for the deposit to the credit of the agency of any
928	moneys received from the Health Care Trust Fund or any other
929	moneys received for the maintenance and care of residents in the
930	facility, and the agency is authorized to disburse moneys from
931	such account to pay obligations incurred for the purposes of
932	this section. The agency is authorized to requisition moneys
933	from the Health Care Trust Fund in advance of an actual need for
934	cash on the basis of an estimate by the agency of moneys to be
935	spent under the authority of this section. Any bank account
936	established under this section need not be approved in advance
937	of its creation as required by s. 17.58, but shall be secured by
938	depository insurance equal to or greater than the balance of
939	such account or by the pledge of collateral security in
940	conformance with criteria established in s. 18.11. The agency
941	shall notify the Chief Financial Officer of any such account so
942	established and shall make a quarterly accounting to the Chief
943	Financial Officer for all moneys deposited in such account.
944	Section 27.  Subsections (1) and (5) of section 400.071,
945	Florida Statutes, are amended to read:
946	400.071  Application for license.-
947	(1)  In addition to the requirements of part II of chapter
948	408, the application for a license shall be under oath and must
949	contain the following:
950	(a)  The location of the facility for which a license is
951	sought and an indication, as in the original application, that
952	such location conforms to the local zoning ordinances.
953	(b)  A signed affidavit disclosing any financial or
954	ownership interest that a controlling interest as defined in
955	part II of chapter 408 has held in the last 5 years in any
956	entity licensed by this state or any other state to provide
957	health or residential care which has closed voluntarily or
958	involuntarily; has filed for bankruptcy; has had a receiver
959	appointed; has had a license denied, suspended, or revoked; or
960	has had an injunction issued against it which was initiated by a
961	regulatory agency. The affidavit must disclose the reason any
962	such entity was closed, whether voluntarily or involuntarily.
963	(c)  The total number of beds and the total number of
964	Medicare and Medicaid certified beds.
965	(b)(d)  Information relating to the applicant and employees
966	which the agency requires by rule. The applicant must
967	demonstrate that sufficient numbers of qualified staff, by
968	training or experience, will be employed to properly care for
969	the type and number of residents who will reside in the
970	facility.
971	(e)  Copies of any civil verdict or judgment involving the
972	applicant rendered within the 10 years preceding the
973	application, relating to medical negligence, violation of
974	residents' rights, or wrongful death. As a condition of
975	licensure, the licensee agrees to provide to the agency copies
976	of any new verdict or judgment involving the applicant, relating
977	to such matters, within 30 days after filing with the clerk of
978	the court. The information required in this paragraph shall be
979	maintained in the facility's licensure file and in an agency
980	database which is available as a public record.
981	(5)  As a condition of licensure, each facility must
982	establish and submit with its application a plan for quality
983	assurance and for conducting risk management.
984	Section 28.  Section 400.0712, Florida Statutes, is amended
985	to read:
986	400.0712  Application for inactive license.-
987	(1)  As specified in this section, the agency may issue an
988	inactive license to a nursing home facility for all or a portion
989	of its beds. Any request by a licensee that a nursing home or
990	portion of a nursing home become inactive must be submitted to
991	the agency in the approved format. The facility may not initiate
992	any suspension of services, notify residents, or initiate
993	inactivity before receiving approval from the agency; and a
994	licensee that violates this provision may not be issued an
995	inactive license.
996	(1)(2)  In addition to the powers granted under part II of
997	chapter 408, the agency may issue an inactive license for a
998	portion of the total beds to a nursing home that chooses to use
999	an unoccupied contiguous portion of the facility for an
1000	alternative use to meet the needs of elderly persons through the
1001	use of less restrictive, less institutional services.
1002	(a)  An inactive license issued under this subsection may
1003	be granted for a period not to exceed the current licensure
1004	expiration date but may be renewed by the agency at the time of
1005	licensure renewal.
1006	(b)  A request to extend the inactive license must be
1007	submitted to the agency in the approved format and approved by
1008	the agency in writing.
1009	(c)  Nursing homes that receive an inactive license to
1010	provide alternative services shall not receive preference for
1011	participation in the Assisted Living for the Elderly Medicaid
1012	waiver.
1013	(2)(3)  The agency shall adopt rules pursuant to ss.
1014	120.536(1) and 120.54 necessary to implement this section.
1015	Section 29.  Section 400.111, Florida Statutes, is amended
1016	to read:
1017	400.111  Disclosure of controlling interest.-In addition to
1018	the requirements of part II of chapter 408, when requested by
1019	the agency, the licensee shall submit a signed affidavit
1020	disclosing any financial or ownership interest that a
1021	controlling interest has held within the last 5 years in any
1022	entity licensed by the state or any other state to provide
1023	health or residential care which entity has closed voluntarily
1024	or involuntarily; has filed for bankruptcy; has had a receiver
1025	appointed; has had a license denied, suspended, or revoked; or
1026	has had an injunction issued against it which was initiated by a
1027	regulatory agency. The affidavit must disclose the reason such
1028	entity was closed, whether voluntarily or involuntarily.
1029	Section 30.  Subsection (2) of section 400.1183, Florida
1030	Statutes, is amended to read:
1031	400.1183  Resident grievance procedures.-
1032	(2)  Each facility shall maintain records of all grievances
1033	and shall retain a log for agency inspection of report to the
1034	agency at the time of relicensure the total number of grievances
1035	handled during the prior licensure period, a categorization of
1036	the cases underlying the grievances, and the final disposition
1037	of the grievances.
1038	Section 31.  Section 400.141, Florida Statutes, is amended
1039	to read:
1040	400.141  Administration and management of nursing home
1041	facilities.-
1042	(1)  Every licensed facility shall comply with all
1043	applicable standards and rules of the agency and shall:
1044	(a)  Be under the administrative direction and charge of a
1045	licensed administrator.
1046	(b)  Appoint a medical director licensed pursuant to
1047	chapter 458 or chapter 459. The agency may establish by rule
1048	more specific criteria for the appointment of a medical
1049	director.
1050	(c)  Have available the regular, consultative, and
1051	emergency services of physicians licensed by the state.
1052	(d)  Provide for resident use of a community pharmacy as
1053	specified in s. 400.022(1)(q). Any other law to the contrary
1054	notwithstanding, a registered pharmacist licensed in Florida,
1055	that is under contract with a facility licensed under this
1056	chapter or chapter 429, shall repackage a nursing facility
1057	resident's bulk prescription medication which has been packaged
1058	by another pharmacist licensed in any state in the United States
1059	into a unit dose system compatible with the system used by the
1060	nursing facility, if the pharmacist is requested to offer such
1061	service. In order to be eligible for the repackaging, a resident
1062	or the resident's spouse must receive prescription medication
1063	benefits provided through a former employer as part of his or
1064	her retirement benefits, a qualified pension plan as specified
1065	in s. 4972 of the Internal Revenue Code, a federal retirement
1066	program as specified under 5 C.F.R. s. 831, or a long-term care
1067	policy as defined in s. 627.9404(1). A pharmacist who correctly
1068	repackages and relabels the medication and the nursing facility
1069	which correctly administers such repackaged medication under
1070	this paragraph may not be held liable in any civil or
1071	administrative action arising from the repackaging. In order to
1072	be eligible for the repackaging, a nursing facility resident for
1073	whom the medication is to be repackaged shall sign an informed
1074	consent form provided by the facility which includes an
1075	explanation of the repackaging process and which notifies the
1076	resident of the immunities from liability provided in this
1077	paragraph. A pharmacist who repackages and relabels prescription
1078	medications, as authorized under this paragraph, may charge a
1079	reasonable fee for costs resulting from the implementation of
1080	this provision.
1081	(e)  Provide for the access of the facility residents to
1082	dental and other health-related services, recreational services,
1083	rehabilitative services, and social work services appropriate to
1084	their needs and conditions and not directly furnished by the
1085	licensee. When a geriatric outpatient nurse clinic is conducted
1086	in accordance with rules adopted by the agency, outpatients
1087	attending such clinic shall not be counted as part of the
1088	general resident population of the nursing home facility, nor
1089	shall the nursing staff of the geriatric outpatient clinic be
1090	counted as part of the nursing staff of the facility, until the
1091	outpatient clinic load exceeds 15 a day.
1092	(f)  Be allowed and encouraged by the agency to provide
1093	other needed services under certain conditions. If the facility
1094	has a standard licensure status, and has had no class I or class
1095	II deficiencies during the past 2 years or has been awarded a
1096	Gold Seal under the program established in s. 400.235, it may be
1097	encouraged by the agency to provide services, including, but not
1098	limited to, respite and adult day services, which enable
1099	individuals to move in and out of the facility. A facility is
1100	not subject to any additional licensure requirements for
1101	providing these services, under the following conditions:.
1102	1.  Respite care may be offered to persons in need of
1103	short-term or temporary nursing home services. For each person
1104	admitted under the respite care program, the facility licensee
1105	must:
1106	a.  Have a written abbreviated plan of care that, at a
1107	minimum, includes nutritional requirements, medication orders,
1108	physician orders, nursing assessments, and dietary preferences.
1109	The nursing or physician assessments may take the place of all
1110	other assessments required for full-time residents.
1111	b.  Have a contract that, at a minimum, specifies the
1112	services to be provided to the respite resident, including
1113	charges for services, activities, equipment, emergency medical
1114	services, and the administration of medications. If multiple
1115	respite admissions for a single person are anticipated, the
1116	original contract is valid for 1 year after the date of
1117	execution.
1118	c.  Ensure that each resident is released to his or her
1119	caregiver or an individual designated in writing by the
1120	caregiver.
1121	2.  A person admitted under the respite care program is:
1122	a.  Exempt from requirements in rule related to discharge
1123	planning.
1124	b.  Covered by the residents' rights set forth in s.
1125	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
1126	shall not be considered trust funds subject to the requirements
1127	of s. 400.022(1)(h) until the resident has been in the facility
1128	for more than 14 consecutive days.
1129	c.  Allowed to use his or her personal medications for the
1130	respite stay if permitted by facility policy. The facility must
1131	obtain a physician's order for the medications. The caregiver
1132	may provide information regarding the medications as part of the
1133	nursing assessment and that information must agree with the
1134	physician's order. Medications shall be released with the
1135	resident upon discharge in accordance with current physician's
1136	orders.
1137	3.  A person receiving respite care is entitled to reside
1138	in the facility for a total of 60 days within a contract year or
1139	within a calendar year if the contract is for less than 12
1140	months. However, each single stay may not exceed 14 days. If a
1141	stay exceeds 14 consecutive days, the facility must comply with
1142	all assessment and care planning requirements applicable to
1143	nursing home residents.
1144	4.  A person receiving respite care must reside in a
1145	licensed nursing home bed.
1146	5.  A prospective respite resident must provide medical
1147	information from a physician, physician assistant, or nurse
1148	practitioner and other information from the primary caregiver as
1149	may be required by the facility before or at the time of
1150	admission to receive respite care. The medical information must
1151	include a physician's order for respite care and proof of a
1152	physical examination by a licensed physician, physician
1153	assistant, or nurse practitioner. The physician's order and
1154	physical examination may be used to provide intermittent respite
1155	care for up to 12 months after the date the order is written.
1156	6.  The facility must assume the duties of the primary
1157	caregiver. To ensure continuity of care and services, the
1158	resident is entitled to retain his or her personal physician and
1159	must have access to medically necessary services such as
1160	physical therapy, occupational therapy, or speech therapy, as
1161	needed. The facility must arrange for transportation to these
1162	services if necessary. Respite care must be provided in
1163	accordance with this part and rules adopted by the agency.
1164	However, the agency shall, by rule, adopt modified requirements
1165	for resident assessment, resident care plans, resident
1166	contracts, physician orders, and other provisions, as
1167	appropriate, for short-term or temporary nursing home services.
1168	7.  The agency shall allow for shared programming and staff
1169	in a facility which meets minimum standards and offers services
1170	pursuant to this paragraph, but, if the facility is cited for
1171	deficiencies in patient care, may require additional staff and
1172	programs appropriate to the needs of service recipients. A
1173	person who receives respite care may not be counted as a
1174	resident of the facility for purposes of the facility's licensed
1175	capacity unless that person receives 24-hour respite care. A
1176	person receiving either respite care for 24 hours or longer or
1177	adult day services must be included when calculating minimum
1178	staffing for the facility. Any costs and revenues generated by a
1179	nursing home facility from nonresidential programs or services
1180	shall be excluded from the calculations of Medicaid per diems
1181	for nursing home institutional care reimbursement.
1182	(g)  If the facility has a standard license or is a Gold
1183	Seal facility, exceeds the minimum required hours of licensed
1184	nursing and certified nursing assistant direct care per resident
1185	per day, and is part of a continuing care facility licensed
1186	under chapter 651 or a retirement community that offers other
1187	services pursuant to part III of this chapter or part I or part
1188	III of chapter 429 on a single campus, be allowed to share
1189	programming and staff. At the time of inspection and in the
1190	semiannual report required pursuant to paragraph (o), a
1191	continuing care facility or retirement community that uses this
1192	option must demonstrate through staffing records that minimum
1193	staffing requirements for the facility were met. Licensed nurses
1194	and certified nursing assistants who work in the nursing home
1195	facility may be used to provide services elsewhere on campus if
1196	the facility exceeds the minimum number of direct care hours
1197	required per resident per day and the total number of residents
1198	receiving direct care services from a licensed nurse or a
1199	certified nursing assistant does not cause the facility to
1200	violate the staffing ratios required under s. 400.23(3)(a).
1201	Compliance with the minimum staffing ratios shall be based on
1202	total number of residents receiving direct care services,
1203	regardless of where they reside on campus. If the facility
1204	receives a conditional license, it may not share staff until the
1205	conditional license status ends. This paragraph does not
1206	restrict the agency's authority under federal or state law to
1207	require additional staff if a facility is cited for deficiencies
1208	in care which are caused by an insufficient number of certified
1209	nursing assistants or licensed nurses. The agency may adopt
1210	rules for the documentation necessary to determine compliance
1211	with this provision.
1212	(h)  Maintain the facility premises and equipment and
1213	conduct its operations in a safe and sanitary manner.
1214	(i)  If the licensee furnishes food service, provide a
1215	wholesome and nourishing diet sufficient to meet generally
1216	accepted standards of proper nutrition for its residents and
1217	provide such therapeutic diets as may be prescribed by attending
1218	physicians. In making rules to implement this paragraph, the
1219	agency shall be guided by standards recommended by nationally
1220	recognized professional groups and associations with knowledge
1221	of dietetics.
1222	(j)  Keep full records of resident admissions and
1223	discharges; medical and general health status, including medical
1224	records, personal and social history, and identity and address
1225	of next of kin or other persons who may have responsibility for
1226	the affairs of the residents; and individual resident care plans
1227	including, but not limited to, prescribed services, service
1228	frequency and duration, and service goals. The records shall be
1229	open to inspection by the agency. The facility must maintain
1230	clinical records on each resident in accordance with accepted
1231	professional standards and practices that are complete,
1232	accurately documented, readily accessible, and systematically
1233	organized.
1234	(k)  Keep such fiscal records of its operations and
1235	conditions as may be necessary to provide information pursuant
1236	to this part.
1237	(l)  Furnish copies of personnel records for employees
1238	affiliated with such facility, to any other facility licensed by
1239	this state requesting this information pursuant to this part.
1240	Such information contained in the records may include, but is
1241	not limited to, disciplinary matters and any reason for
1242	termination. Any facility releasing such records pursuant to
1243	this part shall be considered to be acting in good faith and may
1244	not be held liable for information contained in such records,
1245	absent a showing that the facility maliciously falsified such
1246	records.
1247	(m)  Publicly display a poster provided by the agency
1248	containing the names, addresses, and telephone numbers for the
1249	state's abuse hotline, the State Long-Term Care Ombudsman, the
1250	Agency for Health Care Administration consumer hotline, the
1251	Advocacy Center for Persons with Disabilities, the Florida
1252	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1253	with a clear description of the assistance to be expected from
1254	each.
1255	(n)  Submit to the agency the information specified in s.
1256	400.071(1)(b) for a management company within 30 days after the
1257	effective date of the management agreement.
1258	(n)(o)1.  Submit semiannually to the agency, or more
1259	frequently if requested by the agency, information regarding
1260	facility staff-to-resident ratios, staff turnover, and staff
1261	stability, including information regarding certified nursing
1262	assistants, licensed nurses, the director of nursing, and the
1263	facility administrator. For purposes of this reporting:
1264	a.  Staff-to-resident ratios must be reported in the
1265	categories specified in s. 400.23(3)(a) and applicable rules.
1266	The ratio must be reported as an average for the most recent
1267	calendar quarter.
1268	b.  Staff turnover must be reported for the most recent 12-
1269	month period ending on the last workday of the most recent
1270	calendar quarter prior to the date the information is submitted.
1271	The turnover rate must be computed quarterly, with the annual
1272	rate being the cumulative sum of the quarterly rates. The
1273	turnover rate is the total number of terminations or separations
1274	experienced during the quarter, excluding any employee
1275	terminated during a probationary period of 3 months or less,
1276	divided by the total number of staff employed at the end of the
1277	period for which the rate is computed, and expressed as a
1278	percentage.
1279	c.  The formula for determining staff stability is the
1280	total number of employees that have been employed for more than
1281	12 months, divided by the total number of employees employed at
1282	the end of the most recent calendar quarter, and expressed as a
1283	percentage.
1284	d.  A nursing facility that has failed to comply with state
1285	minimum-staffing requirements for 2 consecutive days is
1286	prohibited from accepting new admissions until the facility has
1287	achieved the minimum-staffing requirements for a period of 6
1288	consecutive days. For the purposes of this sub-subparagraph, any
1289	person who was a resident of the facility and was absent from
1290	the facility for the purpose of receiving medical care at a
1291	separate location or was on a leave of absence is not considered
1292	a new admission. Failure to impose such an admissions moratorium
1293	is subject to a $1,000 fine constitutes a class II deficiency.
1294	2.e.  A nursing facility which does not have a conditional
1295	license may be cited for failure to comply with the standards in
1296	s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
1297	standards on 2 consecutive days or if it has failed to meet at
1298	least 97 percent of those standards on any one day.
1299	3.f.  A facility which has a conditional license must be in
1300	compliance with the standards in s. 400.23(3)(a) at all times.
1301	2.  This paragraph does not limit the agency's ability to
1302	impose a deficiency or take other actions if a facility does not
1303	have enough staff to meet the residents' needs.
1304	(o)(p)  Notify a licensed physician when a resident
1305	exhibits signs of dementia or cognitive impairment or has a
1306	change of condition in order to rule out the presence of an
1307	underlying physiological condition that may be contributing to
1308	such dementia or impairment. The notification must occur within
1309	30 days after the acknowledgment of such signs by facility
1310	staff. If an underlying condition is determined to exist, the
1311	facility shall arrange, with the appropriate health care
1312	provider, the necessary care and services to treat the
1313	condition.
1314	(p)(q)  If the facility implements a dining and hospitality
1315	attendant program, ensure that the program is developed and
1316	implemented under the supervision of the facility director of
1317	nursing. A licensed nurse, licensed speech or occupational
1318	therapist, or a registered dietitian must conduct training of
1319	dining and hospitality attendants. A person employed by a
1320	facility as a dining and hospitality attendant must perform
1321	tasks under the direct supervision of a licensed nurse.
1322	(r)  Report to the agency any filing for bankruptcy
1323	protection by the facility or its parent corporation,
1324	divestiture or spin-off of its assets, or corporate
1325	reorganization within 30 days after the completion of such
1326	activity.
1327	(q)(s)  Maintain general and professional liability
1328	insurance coverage that is in force at all times. In lieu of
1329	general and professional liability insurance coverage, a state-
1330	designated teaching nursing home and its affiliated assisted
1331	living facilities created under s. 430.80 may demonstrate proof
1332	of financial responsibility as provided in s. 430.80(3)(g).
1333	(r)(t)  Maintain in the medical record for each resident a
1334	daily chart of certified nursing assistant services provided to
1335	the resident. The certified nursing assistant who is caring for
1336	the resident must complete this record by the end of his or her
1337	shift. This record must indicate assistance with activities of
1338	daily living, assistance with eating, and assistance with
1339	drinking, and must record each offering of nutrition and
1340	hydration for those residents whose plan of care or assessment
1341	indicates a risk for malnutrition or dehydration.
1342	(s)(u)  Before November 30 of each year, subject to the
1343	availability of an adequate supply of the necessary vaccine,
1344	provide for immunizations against influenza viruses to all its
1345	consenting residents in accordance with the recommendations of
1346	the United States Centers for Disease Control and Prevention,
1347	subject to exemptions for medical contraindications and
1348	religious or personal beliefs. Subject to these exemptions, any
1349	consenting person who becomes a resident of the facility after
1350	November 30 but before March 31 of the following year must be
1351	immunized within 5 working days after becoming a resident.
1352	Immunization shall not be provided to any resident who provides
1353	documentation that he or she has been immunized as required by
1354	this paragraph. This paragraph does not prohibit a resident from
1355	receiving the immunization from his or her personal physician if
1356	he or she so chooses. A resident who chooses to receive the
1357	immunization from his or her personal physician shall provide
1358	proof of immunization to the facility. The agency may adopt and
1359	enforce any rules necessary to comply with or implement this
1360	paragraph.
1361	(t)(v)  Assess all residents for eligibility for
1362	pneumococcal polysaccharide vaccination (PPV) and vaccinate
1363	residents when indicated within 60 days after the effective date
1364	of this act in accordance with the recommendations of the United
1365	States Centers for Disease Control and Prevention, subject to
1366	exemptions for medical contraindications and religious or
1367	personal beliefs. Residents admitted after the effective date of
1368	this act shall be assessed within 5 working days of admission
1369	and, when indicated, vaccinated within 60 days in accordance
1370	with the recommendations of the United States Centers for
1371	Disease Control and Prevention, subject to exemptions for
1372	medical contraindications and religious or personal beliefs.
1373	Immunization shall not be provided to any resident who provides
1374	documentation that he or she has been immunized as required by
1375	this paragraph. This paragraph does not prohibit a resident from
1376	receiving the immunization from his or her personal physician if
1377	he or she so chooses. A resident who chooses to receive the
1378	immunization from his or her personal physician shall provide
1379	proof of immunization to the facility. The agency may adopt and
1380	enforce any rules necessary to comply with or implement this
1381	paragraph.
1382	(u)(w)  Annually encourage and promote to its employees the
1383	benefits associated with immunizations against influenza viruses
1384	in accordance with the recommendations of the United States
1385	Centers for Disease Control and Prevention. The agency may adopt
1386	and enforce any rules necessary to comply with or implement this
1387	paragraph.
1388
1389	This subsection does not limit the agency's ability to impose a
1390	deficiency or take other actions if a facility does not have
1391	enough staff to meet the residents' needs.
1392	(2)  Facilities that have been awarded a Gold Seal under
1393	the program established in s. 400.235 may develop a plan to
1394	provide certified nursing assistant training as prescribed by
1395	federal regulations and state rules and may apply to the agency
1396	for approval of their program.
1397	(3)  A facility may charge a reasonable fee for the copying
1398	of resident records. The fee may not exceed $1 per page for the
1399	first 25 pages and 25 cents per page for each page in excess of
1400	25 pages.
1401	Section 32.  Subsection (3) of section 400.142, Florida
1402	Statutes, is amended to read:
1403	400.142  Emergency medication kits; orders not to
1404	resuscitate.-
1405	(3)  Facility staff may withhold or withdraw
1406	cardiopulmonary resuscitation if presented with an order not to
1407	resuscitate executed pursuant to s. 401.45. The agency shall
1408	adopt rules providing for the implementation of such orders.
1409	Facility staff and facilities shall not be subject to criminal
1410	prosecution or civil liability, nor be considered to have
1411	engaged in negligent or unprofessional conduct, for withholding
1412	or withdrawing cardiopulmonary resuscitation pursuant to such an
1413	order and rules adopted by the agency. The absence of an order
1414	not to resuscitate executed pursuant to s. 401.45 does not
1415	preclude a physician from withholding or withdrawing
1416	cardiopulmonary resuscitation as otherwise permitted by law.
1417	Section 33.  Sections 400.0234, 400.145, and 429.294,
1418	Florida Statutes, are repealed.
1419	Section 34.  Subsection (9) and subsections (11) through
1420	(15) of section 400.147, Florida Statutes, are renumbered as
1421	subsections (8) through (13), respectively, and present
1422	subsections (7), (8), and (10) of that section are amended to
1423	read:
1424	400.147  Internal risk management and quality assurance
1425	program.-
1426	(7)  The facility shall initiate an investigation and shall
1427	notify the agency within 1 business day after the risk manager
1428	or his or her designee has received a report pursuant to
1429	paragraph (1)(d). Each facility shall complete the investigation
1430	and submit a report to the agency within 15 calendar days after
1431	an incident is determined to be an adverse incident. The
1432	notification must be made in writing and be provided
1433	electronically, by facsimile device or overnight mail delivery.
1434	The agency shall develop a form for reporting this information
1435	and the notification must include the name of the risk manager
1436	of the facility, information regarding the identity of the
1437	affected resident, the type of adverse incident, the initiation
1438	of an investigation by the facility, and whether the events
1439	causing or resulting in the adverse incident represent a
1440	potential risk to any other resident. The notification is
1441	confidential as provided by law and is not discoverable or
1442	admissible in any civil or administrative action, except in
1443	disciplinary proceedings by the agency or the appropriate
1444	regulatory board. The agency may investigate, as it deems
1445	appropriate, any such incident and prescribe measures that must
1446	or may be taken in response to the incident. The agency shall
1447	review each report incident and determine whether it potentially
1448	involved conduct by the health care professional who is subject
1449	to disciplinary action, in which case the provisions of s.
1450	456.073 shall apply.
1451	(8)(a)  Each facility shall complete the investigation and
1452	submit an adverse incident report to the agency for each adverse
1453	incident within 15 calendar days after its occurrence. If, after
1454	a complete investigation, the risk manager determines that the
1455	incident was not an adverse incident as defined in subsection
1456	(5), the facility shall include this information in the report.
1457	The agency shall develop a form for reporting this information.
1458	(b)  The information reported to the agency pursuant to
1459	paragraph (a) which relates to persons licensed under chapter
1460	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1461	by the agency. The agency shall determine whether any of the
1462	incidents potentially involved conduct by a health care
1463	professional who is subject to disciplinary action, in which
1464	case the provisions of s. 456.073 shall apply.
1465	(c)  The report submitted to the agency must also contain
1466	the name of the risk manager of the facility.
1467	(d)  The adverse incident report is confidential as
1468	provided by law and is not discoverable or admissible in any
1469	civil or administrative action, except in disciplinary
1470	proceedings by the agency or the appropriate regulatory board.
1471	(10)  By the 10th of each month, each facility subject to
1472	this section shall report any notice received pursuant to s.
1473	400.0233(2) and each initial complaint that was filed with the
1474	clerk of the court and served on the facility during the
1475	previous month by a resident or a resident's family member,
1476	guardian, conservator, or personal legal representative. The
1477	report must include the name of the resident, the resident's
1478	date of birth and social security number, the Medicaid
1479	identification number for Medicaid-eligible persons, the date or
1480	dates of the incident leading to the claim or dates of
1481	residency, if applicable, and the type of injury or violation of
1482	rights alleged to have occurred. Each facility shall also submit
1483	a copy of the notices received pursuant to s. 400.0233(2) and
1484	complaints filed with the clerk of the court. This report is
1485	confidential as provided by law and is not discoverable or
1486	admissible in any civil or administrative action, except in such
1487	actions brought by the agency to enforce the provisions of this
1488	part.
1489	Section 35.  Section 400.148, Florida Statutes, is
1490	repealed.
1491	Section 36.  Paragraph (e) of subsection (2) of section
1492	400.179, Florida Statutes, is amended to read:
1493	400.179  Liability for Medicaid underpayments and
1494	overpayments.-
1495	(2)  Because any transfer of a nursing facility may expose
1496	the fact that Medicaid may have underpaid or overpaid the
1497	transferor, and because in most instances, any such underpayment
1498	or overpayment can only be determined following a formal field
1499	audit, the liabilities for any such underpayments or
1500	overpayments shall be as follows:
1501	(e)  For the 2009-2010 fiscal year only, the provisions of
1502	paragraph (d) shall not apply. This paragraph expires July 1,
1503	2010.
1504	Section 37.  Subsection (3) of section 400.19, Florida
1505	Statutes, is amended to read:
1506	400.19  Right of entry and inspection.-
1507	(3)  The agency shall every 15 months conduct at least one
1508	unannounced inspection to determine compliance by the licensee
1509	with statutes, and with rules promulgated under the provisions
1510	of those statutes, governing minimum standards of construction,
1511	quality and adequacy of care, and rights of residents. The
1512	survey shall be conducted every 6 months for the next 2-year
1513	period if the facility has been cited for a class I deficiency,
1514	has been cited for two or more class II deficiencies arising
1515	from separate surveys or investigations within a 60-day period,
1516	or has had three or more substantiated complaints within a 6-
1517	month period, each resulting in at least one class I or class II
1518	deficiency. In addition to any other fees or fines in this part,
1519	the agency shall assess a fine for each facility that is subject
1520	to the 6-month survey cycle. The fine for the 2-year period
1521	shall be $6,000, one-half to be paid at the completion of each
1522	survey. The agency may adjust this fine by the change in the
1523	Consumer Price Index, based on the 12 months immediately
1524	preceding the increase, to cover the cost of the additional
1525	surveys. The agency shall verify through subsequent inspection
1526	that any deficiency identified during inspection is corrected.
1527	However, the agency may verify the correction of a class III or
1528	class IV deficiency unrelated to resident rights or resident
1529	care without reinspecting the facility if adequate written
1530	documentation has been received from the facility, which
1531	provides assurance that the deficiency has been corrected. The
1532	giving or causing to be given of advance notice of such
1533	unannounced inspections by an employee of the agency to any
1534	unauthorized person shall constitute cause for suspension of not
1535	fewer than 5 working days according to the provisions of chapter
1536	110.
1537	Section 38.  Subsection (5) of section 400.23, Florida
1538	Statutes, is amended to read:
1539	400.23  Rules; evaluation and deficiencies; licensure
1540	status.-
1541	(5)(a)  The agency, in collaboration with the Division of
1542	Children's Medical Services Network of the Department of Health,
1543	must, no later than December 31, 1993, adopt rules for minimum
1544	standards of care for persons under 21 years of age who reside
1545	in nursing home facilities. The rules must include a methodology
1546	for reviewing a nursing home facility under ss. 408.031-408.045
1547	which serves only persons under 21 years of age. A facility may
1548	be exempt from these standards for specific persons between 18
1549	and 21 years of age, if the person's physician agrees that
1550	minimum standards of care based on age are not necessary.
1551	(b)  The agency, in collaboration with the Division of
1552	Children's Medical Services Network, shall adopt rules for
1553	minimum staffing requirements for nursing home facilities that
1554	serve persons under 21 years of age, which shall apply in lieu
1555	of the standards contained in subsection (3).
1556	1.  For persons under 21 years of age who require skilled
1557	care, the requirements shall include a minimum combined average
1558	of licensed nurses, respiratory therapists, respiratory care
1559	practitioners, and certified nursing assistants of 3.9 hours of
1560	direct care per resident per day for each nursing home facility.
1561	2.  For persons under 21 years of age who are fragile, the
1562	requirements shall include a minimum combined average of
1563	licensed nurses, respiratory therapists, respiratory care
1564	practitioners, and certified nursing assistants of 5 hours of
1565	direct care per resident per day for each nursing home facility.
1566	Section 39.  Subsection (1) of section 400.275, Florida
1567	Statutes, is amended to read:
1568	400.275  Agency duties.-
1569	(1)  The agency shall ensure that each newly hired nursing
1570	home surveyor, as a part of basic training, is assigned full-
1571	time to a licensed nursing home for at least 2 days within a 7-
1572	day period to observe facility operations outside of the survey
1573	process before the surveyor begins survey responsibilities. Such
1574	observations may not be the sole basis of a deficiency citation
1575	against the facility. The agency may not assign an individual to
1576	be a member of a survey team for purposes of a survey,
1577	evaluation, or consultation visit at a nursing home facility in
1578	which the surveyor was an employee within the preceding 2 5
1579	years.
1580	Section 40.  Subsection (27) of section 400.462, Florida
1581	Statutes, is amended to read:
1582	400.462  Definitions.-As used in this part, the term:
1583	(27)  "Remuneration" means any payment or other benefit
1584	made directly or indirectly, overtly or covertly, in cash or in
1585	kind. However, when the term is used in any provision of law
1586	relating to a health care provider, such term does not mean an
1587	item with an individual value of up to $15, including, but not
1588	limited to, plaques, certificates, trophies, or novelties that
1589	are intended solely for presentation or are customarily given
1590	away solely for promotional, recognition, or advertising
1591	purposes.
1592	Section 41.  Subsection (2) of section 400.484, Florida
1593	Statutes, is amended to read:
1594	400.484  Right of inspection; violations deficiencies;
1595	fines.-
1596	(2)  The agency shall impose fines for various classes of
1597	violations deficiencies in accordance with the following
1598	schedule:
1599	(a)  Class I violations are defined in s. 408.813. A class
1600	I deficiency is any act, omission, or practice that results in a
1601	patient's death, disablement, or permanent injury, or places a
1602	patient at imminent risk of death, disablement, or permanent
1603	injury. Upon finding a class I violation deficiency, the agency
1604	shall impose an administrative fine in the amount of $15,000 for
1605	each occurrence and each day that the violation deficiency
1606	exists.
1607	(b)  Class II violations are defined in s. 408.813. A class
1608	II deficiency is any act, omission, or practice that has a
1609	direct adverse effect on the health, safety, or security of a
1610	patient. Upon finding a class II violation deficiency, the
1611	agency shall impose an administrative fine in the amount of
1612	$5,000 for each occurrence and each day that the violation
1613	deficiency exists.
1614	(c)  Class III violations are defined in s. 408.813. A
1615	class III deficiency is any act, omission, or practice that has
1616	an indirect, adverse effect on the health, safety, or security
1617	of a patient. Upon finding an uncorrected or repeated class III
1618	violation deficiency, the agency shall impose an administrative
1619	fine not to exceed $1,000 for each occurrence and each day that
1620	the uncorrected or repeated violation deficiency exists.
1621	(d)  Class IV violations are defined in s. 408.813. A class
1622	IV deficiency is any act, omission, or practice related to
1623	required reports, forms, or documents which does not have the
1624	potential of negatively affecting patients. These violations are
1625	of a type that the agency determines do not threaten the health,
1626	safety, or security of patients. Upon finding an uncorrected or
1627	repeated class IV violation deficiency, the agency shall impose
1628	an administrative fine not to exceed $500 for each occurrence
1629	and each day that the uncorrected or repeated violation
1630	deficiency exists.
1631	Section 42.  Subsections (16) and (17) of section 400.506,
1632	Florida Statutes, are renumbered as subsections (17) and (18),
1633	respectively, paragraph (a) of subsection (15) is amended, and a
1634	new subsection (16) is added to that section, to read:
1635	400.506  Licensure of nurse registries; requirements;
1636	penalties.-
1637	(15)(a)  The agency may deny, suspend, or revoke the
1638	license of a nurse registry and shall impose a fine of $5,000
1639	against a nurse registry that:
1640	1.  Provides services to residents in an assisted living
1641	facility for which the nurse registry does not receive fair
1642	market value remuneration.
1643	2.  Provides staffing to an assisted living facility for
1644	which the nurse registry does not receive fair market value
1645	remuneration.
1646	3.  Fails to provide the agency, upon request, with copies
1647	of all contracts with assisted living facilities which were
1648	executed within the last 5 years.
1649	4.  Gives remuneration to a case manager, discharge
1650	planner, facility-based staff member, or third-party vendor who
1651	is involved in the discharge planning process of a facility
1652	licensed under chapter 395 or this chapter and from whom the
1653	nurse registry receives referrals. A nurse registry is exempt
1654	from this subparagraph if it does not bill the Florida Medicaid
1655	program or the Medicare program or share a controlling interest
1656	with any entity licensed, registered, or certified under part II
1657	of chapter 408 that bills the Florida Medicaid program or the
1658	Medicare program.
1659	5.  Gives remuneration to a physician, a member of the
1660	physician's office staff, or an immediate family member of the
1661	physician, and the nurse registry received a patient referral in
1662	the last 12 months from that physician or the physician's office
1663	staff. A nurse registry is exempt from this subparagraph if it
1664	does not bill the Florida Medicaid program or the Medicare
1665	program or share a controlling interest with any entity
1666	licensed, registered, or certified under part II of chapter 408
1667	that bills the Florida Medicaid program or the Medicare program.
1668	(16)  An administrator may manage only one nurse registry,
1669	except that an administrator may manage up to five registries if
1670	all five registries have identical controlling interests as
1671	defined in s. 408.803 and are located within one agency
1672	geographic service area or within an immediately contiguous
1673	county. An administrator shall designate, in writing, for each
1674	licensed entity, a qualified alternate administrator to serve
1675	during the administrator's absence.
1676	Section 43.  Subsection (1) of section 400.509, Florida
1677	Statutes, is amended to read:
1678	400.509  Registration of particular service providers
1679	exempt from licensure; certificate of registration; regulation
1680	of registrants.-
1681	(1)  Any organization that provides companion services or
1682	homemaker services and does not provide a home health service to
1683	a person is exempt from licensure under this part. However, any
1684	organization that provides companion services or homemaker
1685	services must register with the agency. An organization under
1686	contract with the Agency for Persons with Disabilities that
1687	provides companion services only for persons with a
1688	developmental disability, as defined in s. 393.063, are exempt
1689	from registration.
1690	Section 44.  Paragraph (i) of subsection (1) and subsection
1691	(4) of section 400.606, Florida Statutes, are amended to read:
1692	400.606  License; application; renewal; conditional license
1693	or permit; certificate of need.-
1694	(1)  In addition to the requirements of part II of chapter
1695	408, the initial application and change of ownership application
1696	must be accompanied by a plan for the delivery of home,
1697	residential, and homelike inpatient hospice services to
1698	terminally ill persons and their families. Such plan must
1699	contain, but need not be limited to:
1700	(i)  The projected annual operating cost of the hospice.
1701	If the applicant is an existing licensed health care provider,
1702	the application must be accompanied by a copy of the most recent
1703	profit-loss statement and, if applicable, the most recent
1704	licensure inspection report.
1705	(4)  A freestanding hospice facility that is primarily
1706	engaged in providing inpatient and related services and that is
1707	not otherwise licensed as a health care facility shall be
1708	required to obtain a certificate of need. However, a
1709	freestanding hospice facility with six or fewer beds shall not
1710	be required to comply with institutional standards such as, but
1711	not limited to, standards requiring sprinkler systems, emergency
1712	electrical systems, or special lavatory devices.
1713	Section 45.  Subsection (2) of section 400.607, Florida
1714	Statutes, is amended to read:
1715	400.607  Denial, suspension, revocation of license;
1716	emergency actions; imposition of administrative fine; grounds.-
1717	(2)  A violation of this part, part II of chapter 408, or
1718	applicable rules Any of the following actions by a licensed
1719	hospice or any of its employees shall be grounds for
1720	administrative action by the agency against a hospice.:
1721	(a)  A violation of the provisions of this part, part II of
1722	chapter 408, or applicable rules.
1723	(b)  An intentional or negligent act materially affecting
1724	the health or safety of a patient.
1725	Section 46.  Section 400.915, Florida Statutes, is amended
1726	to read:
1727	400.915  Construction and renovation; requirements.-The
1728	requirements for the construction or renovation of a PPEC center
1729	shall comply with:
1730	(1)  The provisions of chapter 553, which pertain to
1731	building construction standards, including plumbing, electrical
1732	code, glass, manufactured buildings, accessibility for the
1733	physically disabled;
1734	(2)  The provisions of s. 633.022 and applicable rules
1735	pertaining to physical minimum standards for nonresidential
1736	child care physical facilities in rule 10M-12.003, Florida
1737	Administrative Code, Child Care Standards; and
1738	(3)  The standards or rules adopted pursuant to this part
1739	and part II of chapter 408.
1740	Section 47.  Subsection (1) of section 400.925, Florida
1741	Statutes, is amended to read:
1742	400.925  Definitions.-As used in this part, the term:
1743	(1)  "Accrediting organizations" means the Joint Commission
1744	on Accreditation of Healthcare Organizations or other national
1745	accreditation agencies whose standards for accreditation are
1746	comparable to those required by this part for licensure.
1747	Section 48.  Subsection (2) of section 400.931, Florida
1748	Statutes, is amended to read:
1749	400.931  Application for license; fee; provisional license;
1750	temporary permit.-
1751	(2)  An applicant for initial licensure, change of
1752	ownership, or renewal to operate a licensed home medical
1753	equipment provider at a location outside the state must submit
1754	documentation of accreditation or an application for
1755	accreditation from an accrediting organization that is
1756	recognized by the agency. An applicant that has applied for
1757	accreditation must provide proof of accreditation that is not
1758	conditional or provisional within 120 days after the date the
1759	agency receives the application for licensure or the application
1760	shall be withdrawn from further consideration. Such
1761	accreditation must be maintained by the home medical equipment
1762	provider to maintain licensure. As an alternative to submitting
1763	proof of financial ability to operate as required in s.
1764	408.810(8), the applicant may submit a $50,000 surety bond to
1765	the agency.
1766	Section 49.  Subsection (2) of section 400.932, Florida
1767	Statutes, is amended to read:
1768	400.932  Administrative penalties.-
1769	(2)  A violation of this part, part II of chapter 408, or
1770	applicable rules Any of the following actions by an employee of
1771	a home medical equipment provider shall be are grounds for
1772	administrative action or penalties by the agency.:
1773	(a)  Violation of this part, part II of chapter 408, or
1774	applicable rules.
1775	(b)  An intentional, reckless, or negligent act that
1776	materially affects the health or safety of a patient.
1777	Section 50.  Subsection (3) of section 400.967, Florida
1778	Statutes, is amended to read:
1779	400.967  Rules and classification of violations
1780	deficiencies.-
1781	(3)  The agency shall adopt rules to provide that, when the
1782	criteria established under this part and part II of chapter 408
1783	are not met, such violations deficiencies shall be classified
1784	according to the nature of the violation deficiency. The agency
1785	shall indicate the classification on the face of the notice of
1786	deficiencies as follows:
1787	(a)  Class I violations deficiencies are defined in s.
1788	408.813 those which the agency determines present an imminent
1789	danger to the residents or guests of the facility or a
1790	substantial probability that death or serious physical harm
1791	would result therefrom. The condition or practice constituting a
1792	class I violation must be abated or eliminated immediately,
1793	unless a fixed period of time, as determined by the agency, is
1794	required for correction. A class I violation deficiency is
1795	subject to a civil penalty in an amount not less than $5,000 and
1796	not exceeding $10,000 for each violation deficiency. A fine may
1797	be levied notwithstanding the correction of the violation
1798	deficiency.
1799	(b)  Class II violations deficiencies are defined in s.
1800	408.813 those which the agency determines have a direct or
1801	immediate relationship to the health, safety, or security of the
1802	facility residents, other than class I deficiencies. A class II
1803	violation deficiency is subject to a civil penalty in an amount
1804	not less than $1,000 and not exceeding $5,000 for each violation
1805	deficiency. A citation for a class II violation deficiency shall
1806	specify the time within which the violation deficiency must be
1807	corrected. If a class II violation deficiency is corrected
1808	within the time specified, no civil penalty shall be imposed,
1809	unless it is a repeated offense.
1810	(c)  Class III violations deficiencies are defined in s.
1811	408.813 those which the agency determines to have an indirect or
1812	potential relationship to the health, safety, or security of the
1813	facility residents, other than class I or class II deficiencies.
1814	A class III violation deficiency is subject to a civil penalty
1815	of not less than $500 and not exceeding $1,000 for each
1816	deficiency. A citation for a class III violation deficiency
1817	shall specify the time within which the violation deficiency
1818	must be corrected. If a class III violation deficiency is
1819	corrected within the time specified, no civil penalty shall be
1820	imposed, unless it is a repeated offense.
1821	(d)  Class IV violations are defined in s. 408.813. Upon
1822	finding an uncorrected or repeated class IV violation, the
1823	agency shall impose an administrative fine not to exceed $500
1824	for each occurrence and each day that the uncorrected or
1825	repeated violation exists.
1826	Section 51.  Subsections (4) and (7) of section 400.9905,
1827	Florida Statutes, are amended to read:
1828	400.9905  Definitions.-
1829	(4)  "Clinic" means an entity at which health care services
1830	are provided to individuals and which tenders charges for
1831	reimbursement for such services, including a mobile clinic and a
1832	portable health service or equipment provider. For purposes of
1833	this part, the term does not include and the licensure
1834	requirements of this part do not apply to:
1835	(a)  Entities licensed or registered by the state under
1836	chapter 395; or entities licensed or registered by the state and
1837	providing only health care services within the scope of services
1838	authorized under their respective licenses granted under ss.
1839	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1840	chapter except part X, chapter 429, chapter 463, chapter 465,
1841	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1842	chapter 651; end-stage renal disease providers authorized under
1843	42 C.F.R. part 405, subpart U; or providers certified under 42
1844	C.F.R. part 485, subpart B or subpart H; or any entity that
1845	provides neonatal or pediatric hospital-based health care
1846	services or other health care services by licensed practitioners
1847	solely within a hospital licensed under chapter 395.
1848	(b)  Entities that own, directly or indirectly, entities
1849	licensed or registered by the state pursuant to chapter 395; or
1850	entities that own, directly or indirectly, entities licensed or
1851	registered by the state and providing only health care services
1852	within the scope of services authorized pursuant to their
1853	respective licenses granted under ss. 383.30-383.335, chapter
1854	390, chapter 394, chapter 397, this chapter except part X,
1855	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1856	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1857	disease providers authorized under 42 C.F.R. part 405, subpart
1858	U; or providers certified under 42 C.F.R. part 485, subpart B or
1859	subpart H; or any entity that provides neonatal or pediatric
1860	hospital-based health care services by licensed practitioners
1861	solely within a hospital licensed under chapter 395.
1862	(c)  Entities that are owned, directly or indirectly, by an
1863	entity licensed or registered by the state pursuant to chapter
1864	395; or entities that are owned, directly or indirectly, by an
1865	entity licensed or registered by the state and providing only
1866	health care services within the scope of services authorized
1867	pursuant to their respective licenses granted under ss. 383.30-
1868	383.335, chapter 390, chapter 394, chapter 397, this chapter
1869	except part X, chapter 429, chapter 463, chapter 465, chapter
1870	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1871	651; end-stage renal disease providers authorized under 42
1872	C.F.R. part 405, subpart U; or providers certified under 42
1873	C.F.R. part 485, subpart B or subpart H; or any entity that
1874	provides neonatal or pediatric hospital-based health care
1875	services by licensed practitioners solely within a hospital
1876	under chapter 395.
1877	(d)  Entities that are under common ownership, directly or
1878	indirectly, with an entity licensed or registered by the state
1879	pursuant to chapter 395; or entities that are under common
1880	ownership, directly or indirectly, with an entity licensed or
1881	registered by the state and providing only health care services
1882	within the scope of services authorized pursuant to their
1883	respective licenses granted under ss. 383.30-383.335, chapter
1884	390, chapter 394, chapter 397, this chapter except part X,
1885	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1886	part I of chapter 483, chapter 484, or chapter 651; end-stage
1887	renal disease providers authorized under 42 C.F.R. part 405,
1888	subpart U; or providers certified under 42 C.F.R. part 485,
1889	subpart B or subpart H; or any entity that provides neonatal or
1890	pediatric hospital-based health care services by licensed
1891	practitioners solely within a hospital licensed under chapter
1892	395.
1893	(e)  An entity that is exempt from federal taxation under
1894	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1895	under 26 U.S.C. s. 409 that has a board of trustees not less
1896	than two-thirds of which are Florida-licensed health care
1897	practitioners and provides only physical therapy services under
1898	physician orders, any community college or university clinic,
1899	and any entity owned or operated by the federal or state
1900	government, including agencies, subdivisions, or municipalities
1901	thereof.
1902	(f)  A sole proprietorship, group practice, partnership, or
1903	corporation that provides health care services by physicians
1904	covered by s. 627.419, that is directly supervised by one or
1905	more of such physicians, and that is wholly owned by one or more
1906	of those physicians or by a physician and the spouse, parent,
1907	child, or sibling of that physician.
1908	(g)  A sole proprietorship, group practice, partnership, or
1909	corporation that provides health care services by licensed
1910	health care practitioners under chapter 457, chapter 458,
1911	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1912	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1913	chapter 490, chapter 491, or part I, part III, part X, part
1914	XIII, or part XIV of chapter 468, or s. 464.012, which are
1915	wholly owned by one or more licensed health care practitioners,
1916	or the licensed health care practitioners set forth in this
1917	paragraph and the spouse, parent, child, or sibling of a
1918	licensed health care practitioner, so long as one of the owners
1919	who is a licensed health care practitioner is supervising the
1920	business activities and is legally responsible for the entity's
1921	compliance with all federal and state laws. However, a health
1922	care practitioner may not supervise services beyond the scope of
1923	the practitioner's license, except that, for the purposes of
1924	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1925	provides only services authorized pursuant to s. 456.053(3)(b)
1926	may be supervised by a licensee specified in s. 456.053(3)(b).
1927	(h)  Clinical facilities affiliated with an accredited
1928	medical school at which training is provided for medical
1929	students, residents, or fellows.
1930	(i)  Entities that provide only oncology or radiation
1931	therapy services by physicians licensed under chapter 458 or
1932	chapter 459 or entities that provide oncology or radiation
1933	therapy services by physicians licensed under chapter 458 or
1934	chapter 459 which are owned by a corporation whose shares are
1935	publicly traded on a recognized stock exchange.
1936	(j)  Clinical facilities affiliated with a college of
1937	chiropractic accredited by the Council on Chiropractic Education
1938	at which training is provided for chiropractic students.
1939	(k)  Entities that provide licensed practitioners to staff
1940	emergency departments or to deliver anesthesia services in
1941	facilities licensed under chapter 395 and that derive at least
1942	90 percent of their gross annual revenues from the provision of
1943	such services. Entities claiming an exemption from licensure
1944	under this paragraph must provide documentation demonstrating
1945	compliance.
1946	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1947	perinatology clinical facilities that are a publicly traded
1948	corporation or that are wholly owned, directly or indirectly, by
1949	a publicly traded corporation. As used in this paragraph, a
1950	publicly traded corporation is a corporation that issues
1951	securities traded on an exchange registered with the United
1952	States Securities and Exchange Commission as a national
1953	securities exchange.
1954	(m)  Entities that are owned by a corporation that has $250
1955	million or more in total annual sales of health care services
1956	provided by licensed health care practitioners if one or more of
1957	the owners of the entity is a health care practitioner who is
1958	licensed in this state, is responsible for supervising the
1959	business activities of the entity, and is legally responsible
1960	for the entity's compliance with state law for purposes of this
1961	section.
1962	(n)  Entities that are owned or controlled, directly or
1963	indirectly, by a publicly traded entity with $100 million or
1964	more, in the aggregate, in total annual revenues derived from
1965	providing health care services by licensed health care
1966	practitioners that are employed or contracted by an entity
1967	described in this paragraph.
1968	(o)  Entities that employ 50 or more health care
1969	practitioners licensed under chapter 458 or chapter 459 when the
1970	billing for medical services is under a single tax
1971	identification number. The application for exemption under this
1972	paragraph shall contain information that includes the name,
1973	residence address, business address, and phone number of the
1974	entity that owns the practice; a complete list of the names and
1975	contact information of all the officers and directors of the
1976	entity; the name, residence address, business address, and
1977	medical license number of each licensed Florida health care
1978	practitioner employed by the entity; the corporate tax
1979	identification number of the entity seeking an exemption; a
1980	listing of health care services to be provided by the entity at
1981	the health care clinics owned or operated by the entity and a
1982	certified statement prepared by an independent certified public
1983	accountant which states that the entity and the health care
1984	clinics owned or operated by the entity have not received
1985	payment for health care services under personal injury
1986	protection insurance coverage for the previous year. If the
1987	agency determines that an entity that is exempt under this
1988	paragraph has received payments for medical services under
1989	personal injury protection insurance coverage the agency may
1990	deny or revoke the exemption from licensure under this
1991	paragraph.
1992	(7)  "Portable health service or equipment provider" means
1993	an entity that contracts with or employs persons to provide
1994	portable health services or equipment to multiple locations
1995	performing treatment or diagnostic testing of individuals, that
1996	bills third-party payors for those services, and that otherwise
1997	meets the definition of a clinic in subsection (4).
1998	Section 52.  Paragraph (b) of subsection (1) and paragraph
1999	(c) of subsection (4) of section 400.991, Florida Statutes, are
2000	amended to read:
2001	400.991  License requirements; background screenings;
2002	prohibitions.-
2003	(1)
2004	(b)  Each mobile clinic must obtain a separate health care
2005	clinic license and must provide to the agency, at least
2006	quarterly, its projected street location to enable the agency to
2007	locate and inspect such clinic. A portable health service or
2008	equipment provider must obtain a health care clinic license for
2009	a single administrative office and is not required to submit
2010	quarterly projected street locations.
2011	(4)  In addition to the requirements of part II of chapter
2012	408, the applicant must file with the application satisfactory
2013	proof that the clinic is in compliance with this part and
2014	applicable rules, including:
2015	(c)  Proof of financial ability to operate as required
2016	under ss. s. 408.810(8) and 408.8065. As an alternative to
2017	submitting proof of financial ability to operate as required
2018	under s. 408.810(8), the applicant may file a surety bond of at
2019	least $500,000 which guarantees that the clinic will act in full
2020	conformity with all legal requirements for operating a clinic,
2021	payable to the agency. The agency may adopt rules to specify
2022	related requirements for such surety bond.
2023	Section 53.  Paragraph (g) of subsection (1) and paragraph
2024	(a) of subsection (7) of section 400.9935, Florida Statutes, are
2025	amended to read:
2026	400.9935  Clinic responsibilities.-
2027	(1)  Each clinic shall appoint a medical director or clinic
2028	director who shall agree in writing to accept legal
2029	responsibility for the following activities on behalf of the
2030	clinic. The medical director or the clinic director shall:
2031	(g)  Conduct systematic reviews of clinic billings to
2032	ensure that the billings are not fraudulent or unlawful. Upon
2033	discovery of an unlawful charge, the medical director or clinic
2034	director shall take immediate corrective action. If the clinic
2035	performs only the technical component of magnetic resonance
2036	imaging, static radiographs, computed tomography, or positron
2037	emission tomography, and provides the professional
2038	interpretation of such services, in a fixed facility that is
2039	accredited by the Joint Commission on Accreditation of
2040	Healthcare Organizations or the Accreditation Association for
2041	Ambulatory Health Care, and the American College of Radiology;
2042	and if, in the preceding quarter, the percentage of scans
2043	performed by that clinic which was billed to all personal injury
2044	protection insurance carriers was less than 15 percent, the
2045	chief financial officer of the clinic may, in a written
2046	acknowledgment provided to the agency, assume the responsibility
2047	for the conduct of the systematic reviews of clinic billings to
2048	ensure that the billings are not fraudulent or unlawful.
2049	(7)(a)  Each clinic engaged in magnetic resonance imaging
2050	services must be accredited by the Joint Commission on
2051	Accreditation of Healthcare Organizations, the American College
2052	of Radiology, or the Accreditation Association for Ambulatory
2053	Health Care, within 1 year after licensure. A clinic that is
2054	accredited by the American College of Radiology or is within the
2055	original 1-year period after licensure and replaces its core
2056	magnetic resonance imaging equipment shall be given 1 year after
2057	the date on which the equipment is replaced to attain
2058	accreditation. However, a clinic may request a single, 6-month
2059	extension if it provides evidence to the agency establishing
2060	that, for good cause shown, such clinic cannot be accredited
2061	within 1 year after licensure, and that such accreditation will
2062	be completed within the 6-month extension. After obtaining
2063	accreditation as required by this subsection, each such clinic
2064	must maintain accreditation as a condition of renewal of its
2065	license. A clinic that files a change of ownership application
2066	must comply with the original accreditation timeframe
2067	requirements of the transferor. The agency shall deny a change
2068	of ownership application if the clinic is not in compliance with
2069	the accreditation requirements. When a clinic adds, replaces, or
2070	modifies magnetic resonance imaging equipment and the
2071	accreditation agency requires new accreditation, the clinic must
2072	be accredited within 1 year after the date of the addition,
2073	replacement, or modification but may request a single, 6-month
2074	extension if the clinic provides evidence of good cause to the
2075	agency.
2076	Section 54.  Paragraph (a) of subsection (2) of section
2077	408.033, Florida Statutes, is amended to read:
2078	408.033  Local and state health planning.-
2079	(2)  FUNDING.-
2080	(a)  The Legislature intends that the cost of local health
2081	councils be borne by assessments on selected health care
2082	facilities subject to facility licensure by the Agency for
2083	Health Care Administration, including abortion clinics, assisted
2084	living facilities, ambulatory surgical centers, birthing
2085	centers, clinical laboratories except community nonprofit blood
2086	banks and clinical laboratories operated by practitioners for
2087	exclusive use regulated under s. 483.035, home health agencies,
2088	hospices, hospitals, intermediate care facilities for the
2089	developmentally disabled, nursing homes, health care clinics,
2090	and multiphasic testing centers and by assessments on
2091	organizations subject to certification by the agency pursuant to
2092	chapter 641, part III, including health maintenance
2093	organizations and prepaid health clinics. Fees assessed may be
2094	collected prospectively at the time of licensure renewal and
2095	prorated for the licensure period.
2096	Section 55.  Subsection (2) of section 408.034, Florida
2097	Statutes, is amended to read:
2098	408.034  Duties and responsibilities of agency; rules.-
2099	(2)  In the exercise of its authority to issue licenses to
2100	health care facilities and health service providers, as provided
2101	under chapters 393 and 395 and parts II, and IV, and VIII of
2102	chapter 400, the agency may not issue a license to any health
2103	care facility or health service provider that fails to receive a
2104	certificate of need or an exemption for the licensed facility or
2105	service.
2106	Section 56.  Paragraph (d) of subsection (1) and paragraph
2107	(m) of subsection (3) of section 408.036, Florida Statutes, are
2108	amended to read:
2109	408.036  Projects subject to review; exemptions.-
2110	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
2111	health-care-related projects, as described in paragraphs (a)-
2112	(g), are subject to review and must file an application for a
2113	certificate of need with the agency. The agency is exclusively
2114	responsible for determining whether a health-care-related
2115	project is subject to review under ss. 408.031-408.045.
2116	(d)  The establishment of a hospice or hospice inpatient
2117	facility, except as provided in s. 408.043.
2118	(3)  EXEMPTIONS.-Upon request, the following projects are
2119	subject to exemption from the provisions of subsection (1):
2120	(m)1.  For the provision of adult open-heart services in a
2121	hospital located within the boundaries of a health service
2122	planning district, as defined in s. 408.032(5), which has
2123	experienced an annual net out-migration of at least 600 open-
2124	heart-surgery cases for 3 consecutive years according to the
2125	most recent data reported to the agency, and the district's
2126	population per licensed and operational open-heart programs
2127	exceeds the state average of population per licensed and
2128	operational open-heart programs by at least 25 percent. All
2129	hospitals within a health service planning district which meet
2130	the criteria reference in sub-subparagraphs 2.a.-h. shall be
2131	eligible for this exemption on July 1, 2004, and shall receive
2132	the exemption upon filing for it and subject to the following:
2133	a.  A hospital that has received a notice of intent to
2134	grant a certificate of need or a final order of the agency
2135	granting a certificate of need for the establishment of an open-
2136	heart-surgery program is entitled to receive a letter of
2137	exemption for the establishment of an adult open-heart-surgery
2138	program upon filing a request for exemption and complying with
2139	the criteria enumerated in sub-subparagraphs 2.a.-h., and is
2140	entitled to immediately commence operation of the program.
2141	b.  An otherwise eligible hospital that has not received a
2142	notice of intent to grant a certificate of need or a final order
2143	of the agency granting a certificate of need for the
2144	establishment of an open-heart-surgery program is entitled to
2145	immediately receive a letter of exemption for the establishment
2146	of an adult open-heart-surgery program upon filing a request for
2147	exemption and complying with the criteria enumerated in sub-
2148	subparagraphs 2.a.-h., but is not entitled to commence operation
2149	of its program until December 31, 2006.
2150	2.  A hospital shall be exempt from the certificate-of-need
2151	review for the establishment of an open-heart-surgery program
2152	when the application for exemption submitted under this
2153	paragraph complies with the following criteria:
2154	a.  The applicant must certify that it will meet and
2155	continuously maintain the minimum licensure requirements adopted
2156	by the agency governing adult open-heart programs, including the
2157	most current guidelines of the American College of Cardiology
2158	and American Heart Association Guidelines for Adult Open Heart
2159	Programs.
2160	b.  The applicant must certify that it will maintain
2161	sufficient appropriate equipment and health personnel to ensure
2162	quality and safety.
2163	c.  The applicant must certify that it will maintain
2164	appropriate times of operation and protocols to ensure
2165	availability and appropriate referrals in the event of
2166	emergencies.
2167	d.  The applicant can demonstrate that it has discharged at
2168	least 300 inpatients with a principal diagnosis of ischemic
2169	heart disease for the most recent 12-month period as reported to
2170	the agency.
2171	e.  The applicant is a general acute care hospital that is
2172	in operation for 3 years or more.
2173	f.  The applicant is performing more than 300 diagnostic
2174	cardiac catheterization procedures per year, combined inpatient
2175	and outpatient.
2176	g.  The applicant's payor mix at a minimum reflects the
2177	community average for Medicaid, charity care, and self-pay
2178	patients or the applicant must certify that it will provide a
2179	minimum of 5 percent of Medicaid, charity care, and self-pay to
2180	open-heart-surgery patients.
2181	h.  If the applicant fails to meet the established criteria
2182	for open-heart programs or fails to reach 300 surgeries per year
2183	by the end of its third year of operation, it must show cause
2184	why its exemption should not be revoked.
2185	3.  By December 31, 2004, and annually thereafter, the
2186	agency shall submit a report to the Legislature providing
2187	information concerning the number of requests for exemption it
2188	has received under this paragraph during the calendar year and
2189	the number of exemptions it has granted or denied during the
2190	calendar year.
2191	Section 57.  Paragraph (c) of subsection (1) of section
2192	408.037, Florida Statutes, is amended to read:
2193	408.037  Application content.-
2194	(1)  Except as provided in subsection (2) for a general
2195	hospital, an application for a certificate of need must contain:
2196	(c)  An audited financial statement of the applicant or the
2197	applicant's parent corporation if audited financial statements
2198	of the applicant do not exist. In an application submitted by an
2199	existing health care facility, health maintenance organization,
2200	or hospice, financial condition documentation must include, but
2201	need not be limited to, a balance sheet and a profit-and-loss
2202	statement of the 2 previous fiscal years' operation.
2203	Section 58.  Subsection (2) of section 408.043, Florida
2204	Statutes, is amended to read:
2205	408.043  Special provisions.-
2206	(2)  HOSPICES.-When an application is made for a
2207	certificate of need to establish or to expand a hospice, the
2208	need for such hospice shall be determined on the basis of the
2209	need for and availability of hospice services in the community.
2210	The formula on which the certificate of need is based shall
2211	discourage regional monopolies and promote competition. The
2212	inpatient hospice care component of a hospice which is a
2213	freestanding facility, or a part of a facility, which is
2214	primarily engaged in providing inpatient care and related
2215	services and is not licensed as a health care facility shall
2216	also be required to obtain a certificate of need. Provision of
2217	hospice care by any current provider of health care is a
2218	significant change in service and therefore requires a
2219	certificate of need for such services.
2220	Section 59.  Paragraph (k) of subsection (3) of section
2221	408.05, Florida Statutes, is amended to read:
2222	408.05  Florida Center for Health Information and Policy
2223	Analysis.-
2224	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
2225	produce comparable and uniform health information and statistics
2226	for the development of policy recommendations, the agency shall
2227	perform the following functions:
2228	(k)  Develop, in conjunction with the State Consumer Health
2229	Information and Policy Advisory Council, and implement a long-
2230	range plan for making available health care quality measures and
2231	financial data that will allow consumers to compare health care
2232	services. The health care quality measures and financial data
2233	the agency must make available shall include, but is not limited
2234	to, pharmaceuticals, physicians, health care facilities, and
2235	health plans and managed care entities. The agency shall update
2236	the plan and report on the status of its implementation
2237	annually. The agency shall also make the plan and status report
2238	available to the public on its Internet website. As part of the
2239	plan, the agency shall identify the process and timeframes for
2240	implementation, any barriers to implementation, and
2241	recommendations of changes in the law that may be enacted by the
2242	Legislature to eliminate the barriers. As preliminary elements
2243	of the plan, the agency shall:
2244	1.  Make available patient-safety indicators, inpatient
2245	quality indicators, and performance outcome and patient charge
2246	data collected from health care facilities pursuant to s.
2247	408.061(1)(a) and (2). The terms "patient-safety indicators" and
2248	"inpatient quality indicators" shall be as defined by the
2249	Centers for Medicare and Medicaid Services, the National Quality
2250	Forum, the Joint Commission on Accreditation of Healthcare
2251	Organizations, the Agency for Healthcare Research and Quality,
2252	the Centers for Disease Control and Prevention, or a similar
2253	national entity that establishes standards to measure the
2254	performance of health care providers, or by other states. The
2255	agency shall determine which conditions, procedures, health care
2256	quality measures, and patient charge data to disclose based upon
2257	input from the council. When determining which conditions and
2258	procedures are to be disclosed, the council and the agency shall
2259	consider variation in costs, variation in outcomes, and
2260	magnitude of variations and other relevant information. When
2261	determining which health care quality measures to disclose, the
2262	agency:
2263	a.  Shall consider such factors as volume of cases; average
2264	patient charges; average length of stay; complication rates;
2265	mortality rates; and infection rates, among others, which shall
2266	be adjusted for case mix and severity, if applicable.
2267	b.  May consider such additional measures that are adopted
2268	by the Centers for Medicare and Medicaid Studies, National
2269	Quality Forum, the Joint Commission on Accreditation of
2270	Healthcare Organizations, the Agency for Healthcare Research and
2271	Quality, Centers for Disease Control and Prevention, or a
2272	similar national entity that establishes standards to measure
2273	the performance of health care providers, or by other states.
2274
2275	When determining which patient charge data to disclose, the
2276	agency shall include such measures as the average of
2277	undiscounted charges on frequently performed procedures and
2278	preventive diagnostic procedures, the range of procedure charges
2279	from highest to lowest, average net revenue per adjusted patient
2280	day, average cost per adjusted patient day, and average cost per
2281	admission, among others.
2282	2.  Make available performance measures, benefit design,
2283	and premium cost data from health plans licensed pursuant to
2284	chapter 627 or chapter 641. The agency shall determine which
2285	health care quality measures and member and subscriber cost data
2286	to disclose, based upon input from the council. When determining
2287	which data to disclose, the agency shall consider information
2288	that may be required by either individual or group purchasers to
2289	assess the value of the product, which may include membership
2290	satisfaction, quality of care, current enrollment or membership,
2291	coverage areas, accreditation status, premium costs, plan costs,
2292	premium increases, range of benefits, copayments and
2293	deductibles, accuracy and speed of claims payment, credentials
2294	of physicians, number of providers, names of network providers,
2295	and hospitals in the network. Health plans shall make available
2296	to the agency any such data or information that is not currently
2297	reported to the agency or the office.
2298	3.  Determine the method and format for public disclosure
2299	of data reported pursuant to this paragraph. The agency shall
2300	make its determination based upon input from the State Consumer
2301	Health Information and Policy Advisory Council. At a minimum,
2302	the data shall be made available on the agency's Internet
2303	website in a manner that allows consumers to conduct an
2304	interactive search that allows them to view and compare the
2305	information for specific providers. The website must include
2306	such additional information as is determined necessary to ensure
2307	that the website enhances informed decisionmaking among
2308	consumers and health care purchasers, which shall include, at a
2309	minimum, appropriate guidance on how to use the data and an
2310	explanation of why the data may vary from provider to provider.
2311	4.  Publish on its website undiscounted charges for no
2312	fewer than 150 of the most commonly performed adult and
2313	pediatric procedures, including outpatient, inpatient,
2314	diagnostic, and preventative procedures.
2315	Section 60.  Paragraph (a) of subsection (1) of section
2316	408.061, Florida Statutes, is amended to read:
2317	408.061  Data collection; uniform systems of financial
2318	reporting; information relating to physician charges;
2319	confidential information; immunity.-
2320	(1)  The agency shall require the submission by health care
2321	facilities, health care providers, and health insurers of data
2322	necessary to carry out the agency's duties. Specifications for
2323	data to be collected under this section shall be developed by
2324	the agency with the assistance of technical advisory panels
2325	including representatives of affected entities, consumers,
2326	purchasers, and such other interested parties as may be
2327	determined by the agency.
2328	(a)  Data submitted by health care facilities, including
2329	the facilities as defined in chapter 395, shall include, but are
2330	not limited to: case-mix data, patient admission and discharge
2331	data, hospital emergency department data which shall include the
2332	number of patients treated in the emergency department of a
2333	licensed hospital reported by patient acuity level, data on
2334	hospital-acquired infections as specified by rule, data on
2335	complications as specified by rule, data on readmissions as
2336	specified by rule, with patient and provider-specific
2337	identifiers included, actual charge data by diagnostic groups,
2338	financial data, accounting data, operating expenses, expenses
2339	incurred for rendering services to patients who cannot or do not
2340	pay, interest charges, depreciation expenses based on the
2341	expected useful life of the property and equipment involved, and
2342	demographic data. The agency shall adopt nationally recognized
2343	risk adjustment methodologies or software consistent with the
2344	standards of the Agency for Healthcare Research and Quality and
2345	as selected by the agency for all data submitted as required by
2346	this section. Data may be obtained from documents such as, but
2347	not limited to: leases, contracts, debt instruments, itemized
2348	patient bills, medical record abstracts, and related diagnostic
2349	information. Reported data elements shall be reported
2350	electronically and in accordance with rule 59E-7.012, Florida
2351	Administrative Code. Data submitted shall be certified by the
2352	chief executive officer or an appropriate and duly authorized
2353	representative or employee of the licensed facility that the
2354	information submitted is true and accurate.
2355	Section 61.  Subsection (43) of section 408.07, Florida
2356	Statutes, is amended to read:
2357	408.07  Definitions.-As used in this chapter, with the
2358	exception of ss. 408.031-408.045, the term:
2359	(43)  "Rural hospital" means an acute care hospital
2360	licensed under chapter 395, having 100 or fewer licensed beds
2361	and an emergency room, and which is:
2362	(a)  The sole provider within a county with a population
2363	density of no greater than 100 persons per square mile;
2364	(b)  An acute care hospital, in a county with a population
2365	density of no greater than 100 persons per square mile, which is
2366	at least 30 minutes of travel time, on normally traveled roads
2367	under normal traffic conditions, from another acute care
2368	hospital within the same county;
2369	(c)  A hospital supported by a tax district or subdistrict
2370	whose boundaries encompass a population of 100 persons or fewer
2371	per square mile;
2372	(d)  A hospital with a service area that has a population
2373	of 100 persons or fewer per square mile. As used in this
2374	paragraph, the term "service area" means the fewest number of
2375	zip codes that account for 75 percent of the hospital's
2376	discharges for the most recent 5-year period, based on
2377	information available from the hospital inpatient discharge
2378	database in the Florida Center for Health Information and Policy
2379	Analysis at the Agency for Health Care Administration; or
2380	(e)  A critical access hospital.
2381
2382	Population densities used in this subsection must be based upon
2383	the most recently completed United States census. A hospital
2384	that received funds under s. 409.9116 for a quarter beginning no
2385	later than July 1, 2002, is deemed to have been and shall
2386	continue to be a rural hospital from that date through June 30,
2387	2015, if the hospital continues to have 100 or fewer licensed
2388	beds and an emergency room, or meets the criteria of s.
2389	395.602(2)(e)4. An acute care hospital that has not previously
2390	been designated as a rural hospital and that meets the criteria
2391	of this subsection shall be granted such designation upon
2392	application, including supporting documentation, to the Agency
2393	for Health Care Administration.
2394	Section 62.  Section 408.10, Florida Statutes, is amended
2395	to read:
2396	408.10  Consumer complaints.-The agency shall:
2397	(1)  publish and make available to the public a toll-free
2398	telephone number for the purpose of handling consumer complaints
2399	and shall serve as a liaison between consumer entities and other
2400	private entities and governmental entities for the disposition
2401	of problems identified by consumers of health care.
2402	(2)  Be empowered to investigate consumer complaints
2403	relating to problems with health care facilities' billing
2404	practices and issue reports to be made public in any cases where
2405	the agency determines the health care facility has engaged in
2406	billing practices which are unreasonable and unfair to the
2407	consumer.
2408	Section 63.  Subsections (12) through (30) of section
2409	408.802, Florida Statutes, are renumbered as subsections (11)
2410	through (29), respectively, and present subsection (11) of that
2411	section is amended to read:
2412	408.802  Applicability.-The provisions of this part apply
2413	to the provision of services that require licensure as defined
2414	in this part and to the following entities licensed, registered,
2415	or certified by the agency, as described in chapters 112, 383,
2416	390, 394, 395, 400, 429, 440, 483, and 765:
2417	(11)  Private review agents, as provided under part I of
2418	chapter 395.
2419	Section 64.  Subsection (3) is added to section 408.804,
2420	Florida Statutes, to read:
2421	408.804  License required; display.-
2422	(3)  Any person who knowingly alters, defaces, or falsifies
2423	a license certificate issued by the agency, or causes or
2424	procures any person to commit such an offense, commits a
2425	misdemeanor of the second degree, punishable as provided in s.
2426	775.082 or s 775.083. Any licensee or provider who displays an
2427	altered, defaced, or falsified license certificate is subject to
2428	the penalties set forth in s. 408.815 and an administrative fine
2429	of $1,000 for each day of illegal display.
2430	Section 65.  Paragraph (d) of subsection (2) of section
2431	408.806, Florida Statutes, is amended, and paragraph (e) is
2432	added to that subsection, to read:
2433	408.806  License application process.-
2434	(2)
2435	(d)  The agency shall notify the licensee by mail or
2436	electronically at least 90 days before the expiration of a
2437	license that a renewal license is necessary to continue
2438	operation. The licensee's failure to timely file submit a
2439	renewal application and license application fee with the agency
2440	shall result in a $50 per day late fee charged to the licensee
2441	by the agency; however, the aggregate amount of the late fee may
2442	not exceed 50 percent of the licensure fee or $500, whichever is
2443	less. The agency shall provide a courtesy notice to the licensee
2444	by United States mail, electronically, or by any other manner at
2445	its address of record or mailing address, if provided, at least
2446	90 days prior to the expiration of a license informing the
2447	licensee of the expiration of the license. If the licensee does
2448	not receive the courtesy notice, the licensee continues to be
2449	legally obligated to timely file the renewal application and
2450	license application fee with the agency and is not excused from
2451	the payment of a late fee. If an application is received after
2452	the required filing date and exhibits a hand-canceled postmark
2453	obtained from a United States post office dated on or before the
2454	required filing date, no fine will be levied.
2455	(e)  The applicant must pay the late fee before a late
2456	application is considered complete and failure to pay the late
2457	fee is considered an omission from the application for licensure
2458	pursuant to paragraph (3)(b).
2459	Section 66.  Paragraph (b) of subsection (1) of section
2460	408.8065, Florida Statutes, is amended to read:
2461	408.8065  Additional licensure requirements for home health
2462	agencies, home medical equipment providers, and health care
2463	clinics.-
2464	(1)  An applicant for initial licensure, or initial
2465	licensure due to a change of ownership, as a home health agency,
2466	home medical equipment provider, or health care clinic shall:
2467	(b)  Submit projected pro forma financial statements,
2468	including a balance sheet, income and expense statement, and a
2469	statement of cash flows for the first 2 years of operation which
2470	provide evidence that the applicant has sufficient assets,
2471	credit, and projected revenues to cover liabilities and
2472	expenses.
2473
2474	All documents required under this subsection must be prepared in
2475	accordance with generally accepted accounting principles and may
2476	be in a compilation form. The financial statements must be
2477	signed by a certified public accountant.
2478	Section 67.  Subsections (5) through (8) of section
2479	408.809, Florida Statutes are renumbered as subsections (6)
2480	through (9), respectively, and subsection (4) of that section is
2481	amended to read:
2482	408.809  Background screening; prohibited offenses.-
2483	(4)  In addition to the offenses listed in s. 435.04, all
2484	persons required to undergo background screening pursuant to
2485	this part or authorizing statutes must not have an arrest
2486	awaiting final disposition for, must not have been found guilty
2487	of, regardless of adjudication, or entered a plea of nolo
2488	contendere or guilty to, and must not have been adjudicated
2489	delinquent and the record not have been sealed or expunged for
2490	any of the following offenses or any similar offense of another
2491	jurisdiction:
2492	(a)  Any authorizing statutes, if the offense was a felony.
2493	(b)  This chapter, if the offense was a felony.
2494	(c)  Section 409.920, relating to Medicaid provider fraud.
2495	(d)  Section 409.9201, relating to Medicaid fraud.
2496	(e)  Section 741.28, relating to domestic violence.
2497	(f)  Section 817.034, relating to fraudulent acts through
2498	mail, wire, radio, electromagnetic, photoelectronic, or
2499	photooptical systems.
2500	(g)  Section 817.234, relating to false and fraudulent
2501	insurance claims.
2502	(h)  Section 817.505, relating to patient brokering.
2503	(i)  Section 817.568, relating to criminal use of personal
2504	identification information.
2505	(j)  Section 817.60, relating to obtaining a credit card
2506	through fraudulent means.
2507	(k)  Section 817.61, relating to fraudulent use of credit
2508	cards, if the offense was a felony.
2509	(l)  Section 831.01, relating to forgery.
2510	(m)  Section 831.02, relating to uttering forged
2511	instruments.
2512	(n)  Section 831.07, relating to forging bank bills,
2513	checks, drafts, or promissory notes.
2514	(o)  Section 831.09, relating to uttering forged bank
2515	bills, checks, drafts, or promissory notes.
2516	(p)  Section 831.30, relating to fraud in obtaining
2517	medicinal drugs.
2518	(q)  Section 831.31, relating to the sale, manufacture,
2519	delivery, or possession with the intent to sell, manufacture, or
2520	deliver any counterfeit controlled substance, if the offense was
2521	a felony.
2522	(5)  A person who serves as a controlling interest of, is
2523	employed by, or contracts with a licensee on July 31, 2010, who
2524	has been screened and qualified according to standards specified
2525	in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
2526	in accordance with the schedule provided in paragraphs (a)-(c).
2527	The agency may adopt rules to establish a schedule to stagger
2528	the implementation of the required rescreening over the 5-year
2529	period, beginning July 31, 2010, through July 31, 2015. If, upon
2530	rescreening, such person has a disqualifying offense that was
2531	not a disqualifying offense at the time of the last screening,
2532	but is a current disqualifying offense and was committed before
2533	the last screening, he or she may apply for an exemption from
2534	the appropriate licensing agency and, if agreed to by the
2535	employer, may continue to perform his or her duties until the
2536	licensing agency renders a decision on the application for
2537	exemption if the person is eligible to apply for an exemption
2538	and the exemption request is received by the agency within 30
2539	days after receipt of the rescreening results by the person. The
2540	rescreening schedule shall be:
2541	(a)  Individuals whose last screening was conducted before
2542	December 31, 2003, must be rescreened by July 31, 2013.
2543	(b)  Individuals whose last screening was conducted between
2544	January 1, 2004, through December 31, 2007, must be rescreened
2545	by July 31, 2014.
2546	(c)  Individuals whose last screening was conducted between
2547	January 1, 2008, through July 31, 2010, must be rescreened by
2548	July 31, 2015.
2549	Section 68.  Subsection (9) of section 408.810, Florida
2550	Statutes, is amended to read:
2551	408.810  Minimum licensure requirements.-In addition to the
2552	licensure requirements specified in this part, authorizing
2553	statutes, and applicable rules, each applicant and licensee must
2554	comply with the requirements of this section in order to obtain
2555	and maintain a license.
2556	(9)  A controlling interest may not withhold from the
2557	agency any evidence of financial instability, including, but not
2558	limited to, checks returned due to insufficient funds,
2559	delinquent accounts, nonpayment of withholding taxes, unpaid
2560	utility expenses, nonpayment for essential services, or adverse
2561	court action concerning the financial viability of the provider
2562	or any other provider licensed under this part that is under the
2563	control of the controlling interest. A controlling interest
2564	shall notify the agency within 10 days after a court action to
2565	initiate bankruptcy, foreclosure, or eviction proceedings
2566	concerning the provider in which the controlling interest is a
2567	petitioner or defendant. Any person who violates this subsection
2568	commits a misdemeanor of the second degree, punishable as
2569	provided in s. 775.082 or s. 775.083. Each day of continuing
2570	violation is a separate offense.
2571	Section 69.  Subsection (3) is added to section 408.813,
2572	Florida Statutes, to read:
2573	408.813  Administrative fines; violations.-As a penalty for
2574	any violation of this part, authorizing statutes, or applicable
2575	rules, the agency may impose an administrative fine.
2576	(3)  The agency may impose an administrative fine for a
2577	violation that is not designated as a class I, class II, class
2578	III, or class IV violation. Unless otherwise specified by law,
2579	the amount of the fine shall not exceed $500 for each violation.
2580	Unclassified violations may include:
2581	(a)  Violating any term or condition of a license.
2582	(b)  Violating any provision of this part, authorizing
2583	statutes, or applicable rules.
2584	(c)  Exceeding licensed capacity.
2585	(d)  Providing services beyond the scope of the license.
2586	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2587	Section 70.  Subsection (4) of section 408.815, Florida
2588	Statutes, is amended, and subsections (5) and (6) are added to
2589	that section, to read:
2590	408.815  License or application denial; revocation.-
2591	(4)  Unless an applicant is determined by the agency to
2592	satisfy the provisions of subsection (5) for the action in
2593	question, the agency shall deny an application for a license or
2594	license renewal based upon any of the following actions of an
2595	applicant, a controlling interest of the applicant, or any
2596	entity in which a controlling interest of the applicant was an
2597	owner or officer when the following actions occurred In addition
2598	to the grounds provided in authorizing statutes, the agency
2599	shall deny an application for a license or license renewal if
2600	the applicant or a person having a controlling interest in an
2601	applicant has been:
2602	(a)  Conviction Convicted of, or enters a plea of guilty or
2603	nolo contendere to, regardless of adjudication, a felony under
2604	chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
2605	42 U.S.C. ss. 1395-1396, Medicare fraud, Medicaid fraud, or
2606	insurance fraud, unless the sentence and any subsequent period
2607	of probation for such convictions or plea ended more than 15
2608	years prior to the date of the application;
2609	(b)  Termination Terminated for cause from the Medicare
2610	program or a state Florida Medicaid program pursuant to s.
2611	409.913, unless the applicant has been in good standing with the
2612	Medicare program or a state Florida Medicaid program for the
2613	most recent 5 years and the termination occurred at least 20
2614	years before the date of the application.; or
2615	(c)  Terminated for cause, pursuant to the appeals
2616	procedures established by the state or Federal Government, from
2617	the federal Medicare program or from any other state Medicaid
2618	program, unless the applicant has been in good standing with a
2619	state Medicaid program or the federal Medicare program for the
2620	most recent 5 years and the termination occurred at least 20
2621	years prior to the date of the application.
2622	(5)  For any application subject to denial under subsection
2623	(4), the agency may consider mitigating circumstances, as
2624	applicable, including, but not limited to:
2625	(a)  Completion or lawful release from confinement,
2626	supervision, or sanction, including any terms of probation, and
2627	full restitution;
2628	(b)  Execution of a compliance plan with the agency;
2629	(c)  Compliance with any integrity agreement or compliance
2630	plan with any other government agency;
2631	(d)  Determination by the Medicare program or a state
2632	Medicaid program that the controlling interest or entity in
2633	which the controlling interest was an owner or officer is
2634	currently allowed to participate in the Medicare program or a
2635	state Medicaid program, either directly as a provider or
2636	indirectly as an owner or officer of a provider entity;
2637	(e)  Continuation of licensure by the controlling interest
2638	or entity in which the controlling interest was an owner or
2639	officer, either directly as a licensee or indirectly as an owner
2640	or officer of a licensed entity in the state where the action
2641	occurred;
2642	(f)  Overall impact upon the public health, safety, or
2643	welfare; or
2644	(g)  Determination that license denial is not commensurate
2645	with the prior action taken by the Medicare program or a state
2646	Medicaid program.
2647
2648	After considering the circumstances set forth in this
2649	subsection, the agency shall grant the license, with or without
2650	conditions, grant a provisional license for a period of no more
2651	than the licensure cycle, with or without conditions, or deny
2652	the license.
2653	(6)  In order to ensure the health, safety, and welfare of
2654	clients when a license has been denied, revoked, or is set to
2655	terminate, the agency may extend the license expiration date for
2656	a period of up to 30 days for the sole purpose of allowing the
2657	safe and orderly discharge of clients. The agency may impose
2658	conditions on the extension, including, but not limited to,
2659	prohibiting or limiting admissions, expedited discharge
2660	planning, required status reports, and mandatory monitoring by
2661	the agency or third parties. When imposing these conditions, the
2662	agency shall take into consideration the nature and number of
2663	clients, the availability and location of acceptable alternative
2664	placements, and the ability of the licensee to continue
2665	providing care to the clients. The agency may terminate the
2666	extension or modify the conditions at any time. This authority
2667	is in addition to any other authority granted to the agency
2668	under chapter 120, this part, and authorizing statutes but
2669	creates no right or entitlement to an extension of a license
2670	expiration date.
2671	Section 71.  Paragraph (c) of subsection (4) of section
2672	409.212, Florida Statutes, is amended to read:
2673	409.212  Optional supplementation.-
2674	(4)  In addition to the amount of optional supplementation
2675	provided by the state, a person may receive additional
2676	supplementation from third parties to contribute to his or her
2677	cost of care. Additional supplementation may be provided under
2678	the following conditions:
2679	(c)  The additional supplementation shall not exceed three
2680	two times the provider rate recognized under the optional state
2681	supplementation program.
2682	Section 72.  Subsection (1) of section 409.91196, Florida
2683	Statutes, is amended to read:
2684	409.91196  Supplemental rebate agreements; public records
2685	and public meetings exemption.-
2686	(1)  The rebate amount, percent of rebate, manufacturer's
2687	pricing, and supplemental rebate, and other trade secrets as
2688	defined in s. 688.002 that the agency has identified for use in
2689	negotiations, held by the Agency for Health Care Administration
2690	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2691	119.07(1) and s. 24(a), Art. I of the State Constitution.
2692	Section 73.  Paragraph (a) of subsection (39) of section
2693	409.912, Florida Statutes, is amended to read:
2694	409.912  Cost-effective purchasing of health care.-The
2695	agency shall purchase goods and services for Medicaid recipients
2696	in the most cost-effective manner consistent with the delivery
2697	of quality medical care. To ensure that medical services are
2698	effectively utilized, the agency may, in any case, require a
2699	confirmation or second physician's opinion of the correct
2700	diagnosis for purposes of authorizing future services under the
2701	Medicaid program. This section does not restrict access to
2702	emergency services or poststabilization care services as defined
2703	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2704	shall be rendered in a manner approved by the agency. The agency
2705	shall maximize the use of prepaid per capita and prepaid
2706	aggregate fixed-sum basis services when appropriate and other
2707	alternative service delivery and reimbursement methodologies,
2708	including competitive bidding pursuant to s. 287.057, designed
2709	to facilitate the cost-effective purchase of a case-managed
2710	continuum of care. The agency shall also require providers to
2711	minimize the exposure of recipients to the need for acute
2712	inpatient, custodial, and other institutional care and the
2713	inappropriate or unnecessary use of high-cost services. The
2714	agency shall contract with a vendor to monitor and evaluate the
2715	clinical practice patterns of providers in order to identify
2716	trends that are outside the normal practice patterns of a
2717	provider's professional peers or the national guidelines of a
2718	provider's professional association. The vendor must be able to
2719	provide information and counseling to a provider whose practice
2720	patterns are outside the norms, in consultation with the agency,
2721	to improve patient care and reduce inappropriate utilization.
2722	The agency may mandate prior authorization, drug therapy
2723	management, or disease management participation for certain
2724	populations of Medicaid beneficiaries, certain drug classes, or
2725	particular drugs to prevent fraud, abuse, overuse, and possible
2726	dangerous drug interactions. The Pharmaceutical and Therapeutics
2727	Committee shall make recommendations to the agency on drugs for
2728	which prior authorization is required. The agency shall inform
2729	the Pharmaceutical and Therapeutics Committee of its decisions
2730	regarding drugs subject to prior authorization. The agency is
2731	authorized to limit the entities it contracts with or enrolls as
2732	Medicaid providers by developing a provider network through
2733	provider credentialing. The agency may competitively bid single-
2734	source-provider contracts if procurement of goods or services
2735	results in demonstrated cost savings to the state without
2736	limiting access to care. The agency may limit its network based
2737	on the assessment of beneficiary access to care, provider
2738	availability, provider quality standards, time and distance
2739	standards for access to care, the cultural competence of the
2740	provider network, demographic characteristics of Medicaid
2741	beneficiaries, practice and provider-to-beneficiary standards,
2742	appointment wait times, beneficiary use of services, provider
2743	turnover, provider profiling, provider licensure history,
2744	previous program integrity investigations and findings, peer
2745	review, provider Medicaid policy and billing compliance records,
2746	clinical and medical record audits, and other factors. Providers
2747	shall not be entitled to enrollment in the Medicaid provider
2748	network. The agency shall determine instances in which allowing
2749	Medicaid beneficiaries to purchase durable medical equipment and
2750	other goods is less expensive to the Medicaid program than long-
2751	term rental of the equipment or goods. The agency may establish
2752	rules to facilitate purchases in lieu of long-term rentals in
2753	order to protect against fraud and abuse in the Medicaid program
2754	as defined in s. 409.913. The agency may seek federal waivers
2755	necessary to administer these policies.
2756	(39)(a)  The agency shall implement a Medicaid prescribed-
2757	drug spending-control program that includes the following
2758	components:
2759	1.  A Medicaid preferred drug list, which shall be a
2760	listing of cost-effective therapeutic options recommended by the
2761	Medicaid Pharmacy and Therapeutics Committee established
2762	pursuant to s. 409.91195 and adopted by the agency for each
2763	therapeutic class on the preferred drug list. At the discretion
2764	of the committee, and when feasible, the preferred drug list
2765	should include at least two products in a therapeutic class. The
2766	agency may post the preferred drug list and updates to the
2767	preferred drug list on an Internet website without following the
2768	rulemaking procedures of chapter 120. Antiretroviral agents are
2769	excluded from the preferred drug list. The agency shall also
2770	limit the amount of a prescribed drug dispensed to no more than
2771	a 34-day supply unless the drug products' smallest marketed
2772	package is greater than a 34-day supply, or the drug is
2773	determined by the agency to be a maintenance drug in which case
2774	a 100-day maximum supply may be authorized. The agency is
2775	authorized to seek any federal waivers necessary to implement
2776	these cost-control programs and to continue participation in the
2777	federal Medicaid rebate program, or alternatively to negotiate
2778	state-only manufacturer rebates. The agency may adopt rules to
2779	implement this subparagraph. The agency shall continue to
2780	provide unlimited contraceptive drugs and items. The agency must
2781	establish procedures to ensure that:
2782	a.  There is a response to a request for prior consultation
2783	by telephone or other telecommunication device within 24 hours
2784	after receipt of a request for prior consultation; and
2785	b.  A 72-hour supply of the drug prescribed is provided in
2786	an emergency or when the agency does not provide a response
2787	within 24 hours as required by sub-subparagraph a.
2788	2.  Reimbursement to pharmacies for Medicaid prescribed
2789	drugs shall be set at the lesser of: the average wholesale price
2790	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2791	plus 4.75 percent, the federal upper limit (FUL), the state
2792	maximum allowable cost (SMAC), or the usual and customary (UAC)
2793	charge billed by the provider.
2794	3.  For a prescribed drug billed as a 340B prescribed
2795	medication rendered to all Medicaid-eligible individuals,
2796	including claims for cost sharing for which the agency is
2797	responsible, the claim must meet the requirements of the Deficit
2798	Reduction Act of 2005 and the federal 340B program and contain a
2799	national drug code.
2800	4.3.  The agency shall develop and implement a process for
2801	managing the drug therapies of Medicaid recipients who are using
2802	significant numbers of prescribed drugs each month. The
2803	management process may include, but is not limited to,
2804	comprehensive, physician-directed medical-record reviews, claims
2805	analyses, and case evaluations to determine the medical
2806	necessity and appropriateness of a patient's treatment plan and
2807	drug therapies. The agency may contract with a private
2808	organization to provide drug-program-management services. The
2809	Medicaid drug benefit management program shall include
2810	initiatives to manage drug therapies for HIV/AIDS patients,
2811	patients using 20 or more unique prescriptions in a 180-day
2812	period, and the top 1,000 patients in annual spending. The
2813	agency shall enroll any Medicaid recipient in the drug benefit
2814	management program if he or she meets the specifications of this
2815	provision and is not enrolled in a Medicaid health maintenance
2816	organization.
2817	5.4.  The agency may limit the size of its pharmacy network
2818	based on need, competitive bidding, price negotiations,
2819	credentialing, or similar criteria. The agency shall give
2820	special consideration to rural areas in determining the size and
2821	location of pharmacies included in the Medicaid pharmacy
2822	network. A pharmacy credentialing process may include criteria
2823	such as a pharmacy's full-service status, location, size,
2824	patient educational programs, patient consultation, disease
2825	management services, and other characteristics. The agency may
2826	impose a moratorium on Medicaid pharmacy enrollment when it is
2827	determined that it has a sufficient number of Medicaid-
2828	participating providers. The agency must allow dispensing
2829	practitioners to participate as a part of the Medicaid pharmacy
2830	network regardless of the practitioner's proximity to any other
2831	entity that is dispensing prescription drugs under the Medicaid
2832	program. A dispensing practitioner must meet all credentialing
2833	requirements applicable to his or her practice, as determined by
2834	the agency.
2835	6.5.  The agency shall develop and implement a program that
2836	requires Medicaid practitioners who prescribe drugs to use a
2837	counterfeit-proof prescription pad for Medicaid prescriptions.
2838	The agency shall require the use of standardized counterfeit-
2839	proof prescription pads by Medicaid-participating prescribers or
2840	prescribers who write prescriptions for Medicaid recipients. The
2841	agency may implement the program in targeted geographic areas or
2842	statewide.
2843	7.6.  The agency may enter into arrangements that require
2844	manufacturers of generic drugs prescribed to Medicaid recipients
2845	to provide rebates of at least 15.1 percent of the average
2846	manufacturer price for the manufacturer's generic products.
2847	These arrangements shall require that if a generic-drug
2848	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2849	at a level below 15.1 percent, the manufacturer must provide a
2850	supplemental rebate to the state in an amount necessary to
2851	achieve a 15.1-percent rebate level.
2852	8.7.  The agency may establish a preferred drug list as
2853	described in this subsection, and, pursuant to the establishment
2854	of such preferred drug list, it is authorized to negotiate
2855	supplemental rebates from manufacturers that are in addition to
2856	those required by Title XIX of the Social Security Act and at no
2857	less than 14 percent of the average manufacturer price as
2858	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2859	the federal or supplemental rebate, or both, equals or exceeds
2860	29 percent. There is no upper limit on the supplemental rebates
2861	the agency may negotiate. The agency may determine that specific
2862	products, brand-name or generic, are competitive at lower rebate
2863	percentages. Agreement to pay the minimum supplemental rebate
2864	percentage will guarantee a manufacturer that the Medicaid
2865	Pharmaceutical and Therapeutics Committee will consider a
2866	product for inclusion on the preferred drug list. However, a
2867	pharmaceutical manufacturer is not guaranteed placement on the
2868	preferred drug list by simply paying the minimum supplemental
2869	rebate. Agency decisions will be made on the clinical efficacy
2870	of a drug and recommendations of the Medicaid Pharmaceutical and
2871	Therapeutics Committee, as well as the price of competing
2872	products minus federal and state rebates. The agency is
2873	authorized to contract with an outside agency or contractor to
2874	conduct negotiations for supplemental rebates. For the purposes
2875	of this section, the term "supplemental rebates" means cash
2876	rebates. Effective July 1, 2004, value-added programs as a
2877	substitution for supplemental rebates are prohibited. The agency
2878	is authorized to seek any federal waivers to implement this
2879	initiative.
2880	9.8.  The Agency for Health Care Administration shall
2881	expand home delivery of pharmacy products. To assist Medicaid
2882	patients in securing their prescriptions and reduce program
2883	costs, the agency shall expand its current mail-order-pharmacy
2884	diabetes-supply program to include all generic and brand-name
2885	drugs used by Medicaid patients with diabetes. Medicaid
2886	recipients in the current program may obtain nondiabetes drugs
2887	on a voluntary basis. This initiative is limited to the
2888	geographic area covered by the current contract. The agency may
2889	seek and implement any federal waivers necessary to implement
2890	this subparagraph.
2891	10.9.  The agency shall limit to one dose per month any
2892	drug prescribed to treat erectile dysfunction.
2893	11.10.a.  The agency may implement a Medicaid behavioral
2894	drug management system. The agency may contract with a vendor
2895	that has experience in operating behavioral drug management
2896	systems to implement this program. The agency is authorized to
2897	seek federal waivers to implement this program.
2898	b.  The agency, in conjunction with the Department of
2899	Children and Family Services, may implement the Medicaid
2900	behavioral drug management system that is designed to improve
2901	the quality of care and behavioral health prescribing practices
2902	based on best practice guidelines, improve patient adherence to
2903	medication plans, reduce clinical risk, and lower prescribed
2904	drug costs and the rate of inappropriate spending on Medicaid
2905	behavioral drugs. The program may include the following
2906	elements:
2907	(I)  Provide for the development and adoption of best
2908	practice guidelines for behavioral health-related drugs such as
2909	antipsychotics, antidepressants, and medications for treating
2910	bipolar disorders and other behavioral conditions; translate
2911	them into practice; review behavioral health prescribers and
2912	compare their prescribing patterns to a number of indicators
2913	that are based on national standards; and determine deviations
2914	from best practice guidelines.
2915	(II)  Implement processes for providing feedback to and
2916	educating prescribers using best practice educational materials
2917	and peer-to-peer consultation.
2918	(III)  Assess Medicaid beneficiaries who are outliers in
2919	their use of behavioral health drugs with regard to the numbers
2920	and types of drugs taken, drug dosages, combination drug
2921	therapies, and other indicators of improper use of behavioral
2922	health drugs.
2923	(IV)  Alert prescribers to patients who fail to refill
2924	prescriptions in a timely fashion, are prescribed multiple same-
2925	class behavioral health drugs, and may have other potential
2926	medication problems.
2927	(V)  Track spending trends for behavioral health drugs and
2928	deviation from best practice guidelines.
2929	(VI)  Use educational and technological approaches to
2930	promote best practices, educate consumers, and train prescribers
2931	in the use of practice guidelines.
2932	(VII)  Disseminate electronic and published materials.
2933	(VIII)  Hold statewide and regional conferences.
2934	(IX)  Implement a disease management program with a model
2935	quality-based medication component for severely mentally ill
2936	individuals and emotionally disturbed children who are high
2937	users of care.
2938	12.11.a.  The agency shall implement a Medicaid
2939	prescription drug management system. The agency may contract
2940	with a vendor that has experience in operating prescription drug
2941	management systems in order to implement this system. Any
2942	management system that is implemented in accordance with this
2943	subparagraph must rely on cooperation between physicians and
2944	pharmacists to determine appropriate practice patterns and
2945	clinical guidelines to improve the prescribing, dispensing, and
2946	use of drugs in the Medicaid program. The agency may seek
2947	federal waivers to implement this program.
2948	b.  The drug management system must be designed to improve
2949	the quality of care and prescribing practices based on best
2950	practice guidelines, improve patient adherence to medication
2951	plans, reduce clinical risk, and lower prescribed drug costs and
2952	the rate of inappropriate spending on Medicaid prescription
2953	drugs. The program must:
2954	(I)  Provide for the development and adoption of best
2955	practice guidelines for the prescribing and use of drugs in the
2956	Medicaid program, including translating best practice guidelines
2957	into practice; reviewing prescriber patterns and comparing them
2958	to indicators that are based on national standards and practice
2959	patterns of clinical peers in their community, statewide, and
2960	nationally; and determine deviations from best practice
2961	guidelines.
2962	(II)  Implement processes for providing feedback to and
2963	educating prescribers using best practice educational materials
2964	and peer-to-peer consultation.
2965	(III)  Assess Medicaid recipients who are outliers in their
2966	use of a single or multiple prescription drugs with regard to
2967	the numbers and types of drugs taken, drug dosages, combination
2968	drug therapies, and other indicators of improper use of
2969	prescription drugs.
2970	(IV)  Alert prescribers to patients who fail to refill
2971	prescriptions in a timely fashion, are prescribed multiple drugs
2972	that may be redundant or contraindicated, or may have other
2973	potential medication problems.
2974	(V)  Track spending trends for prescription drugs and
2975	deviation from best practice guidelines.
2976	(VI)  Use educational and technological approaches to
2977	promote best practices, educate consumers, and train prescribers
2978	in the use of practice guidelines.
2979	(VII)  Disseminate electronic and published materials.
2980	(VIII)  Hold statewide and regional conferences.
2981	(IX)  Implement disease management programs in cooperation
2982	with physicians and pharmacists, along with a model quality-
2983	based medication component for individuals having chronic
2984	medical conditions.
2985	13.12.  The agency is authorized to contract for drug
2986	rebate administration, including, but not limited to,
2987	calculating rebate amounts, invoicing manufacturers, negotiating
2988	disputes with manufacturers, and maintaining a database of
2989	rebate collections.
2990	14.13.  The agency may specify the preferred daily dosing
2991	form or strength for the purpose of promoting best practices
2992	with regard to the prescribing of certain drugs as specified in
2993	the General Appropriations Act and ensuring cost-effective
2994	prescribing practices.
2995	15.14.  The agency may require prior authorization for
2996	Medicaid-covered prescribed drugs. The agency may, but is not
2997	required to, prior-authorize the use of a product:
2998	a.  For an indication not approved in labeling;
2999	b.  To comply with certain clinical guidelines; or
3000	c.  If the product has the potential for overuse, misuse,
3001	or abuse.
3002
3003	The agency may require the prescribing professional to provide
3004	information about the rationale and supporting medical evidence
3005	for the use of a drug. The agency shall accept electronic prior
3006	authorization requests from prescribers or pharmacists for any
3007	drug requiring prior authorization and may post prior
3008	authorization criteria and protocol and updates to the list of
3009	drugs that are subject to prior authorization on an Internet
3010	website without amending its rule or engaging in additional
3011	rulemaking.
3012	16.15.  The agency, in conjunction with the Pharmaceutical
3013	and Therapeutics Committee, may require age-related prior
3014	authorizations for certain prescribed drugs. The agency may
3015	preauthorize the use of a drug for a recipient who may not meet
3016	the age requirement or may exceed the length of therapy for use
3017	of this product as recommended by the manufacturer and approved
3018	by the Food and Drug Administration. Prior authorization may
3019	require the prescribing professional to provide information
3020	about the rationale and supporting medical evidence for the use
3021	of a drug.
3022	17.16.  The agency shall implement a step-therapy prior
3023	authorization approval process for medications excluded from the
3024	preferred drug list. Medications listed on the preferred drug
3025	list must be used within the previous 12 months prior to the
3026	alternative medications that are not listed. The step-therapy
3027	prior authorization may require the prescriber to use the
3028	medications of a similar drug class or for a similar medical
3029	indication unless contraindicated in the Food and Drug
3030	Administration labeling. The trial period between the specified
3031	steps may vary according to the medical indication. The step-
3032	therapy approval process shall be developed in accordance with
3033	the committee as stated in s. 409.91195(7) and (8). A drug
3034	product may be approved without meeting the step-therapy prior
3035	authorization criteria if the prescribing physician provides the
3036	agency with additional written medical or clinical documentation
3037	that the product is medically necessary because:
3038	a.  There is not a drug on the preferred drug list to treat
3039	the disease or medical condition which is an acceptable clinical
3040	alternative;
3041	b.  The alternatives have been ineffective in the treatment
3042	of the beneficiary's disease; or
3043	c.  Based on historic evidence and known characteristics of
3044	the patient and the drug, the drug is likely to be ineffective,
3045	or the number of doses have been ineffective.
3046
3047	The agency shall work with the physician to determine the best
3048	alternative for the patient. The agency may adopt rules waiving
3049	the requirements for written clinical documentation for specific
3050	drugs in limited clinical situations.
3051	18.17.  The agency shall implement a return and reuse
3052	program for drugs dispensed by pharmacies to institutional
3053	recipients, which includes payment of a $5 restocking fee for
3054	the implementation and operation of the program. The return and
3055	reuse program shall be implemented electronically and in a
3056	manner that promotes efficiency. The program must permit a
3057	pharmacy to exclude drugs from the program if it is not
3058	practical or cost-effective for the drug to be included and must
3059	provide for the return to inventory of drugs that cannot be
3060	credited or returned in a cost-effective manner. The agency
3061	shall determine if the program has reduced the amount of
3062	Medicaid prescription drugs which are destroyed on an annual
3063	basis and if there are additional ways to ensure more
3064	prescription drugs are not destroyed which could safely be
3065	reused. The agency's conclusion and recommendations shall be
3066	reported to the Legislature by December 1, 2005.
3067	Section 74.  Subsection (3) and paragraph (c) of subsection
3068	(4) of section 429.07, Florida Statutes, are amended, and
3069	subsections (6) and (7) are added to that section, to read:
3070	429.07  License required; fee; inspections.-
3071	(3)  In addition to the requirements of s. 408.806, each
3072	license granted by the agency must state the type of care for
3073	which the license is granted. Licenses shall be issued for one
3074	or more of the following categories of care: standard, extended
3075	congregate care, limited nursing services, or limited mental
3076	health.
3077	(a)  A standard license shall be issued to a facility
3078	facilities providing one or more of the personal services
3079	identified in s. 429.02. Such licensee facilities may also
3080	employ or contract with a person licensed under part I of
3081	chapter 464 to administer medications and perform other tasks as
3082	specified in s. 429.255.
3083	(b)  An extended congregate care license shall be issued to
3084	a licensee facilities providing, directly or through contract,
3085	services beyond those authorized in paragraph (a), including
3086	services performed by persons licensed under part I of chapter
3087	464 and supportive services, as defined by rule, to persons who
3088	would otherwise be disqualified from continued residence in a
3089	facility licensed under this part.
3090	1.  In order for extended congregate care services to be
3091	provided, the agency must first determine that all requirements
3092	established in law and rule are met and must specifically
3093	designate, on the facility's license, that such services may be
3094	provided and whether the designation applies to all or part of
3095	the facility. Such designation may be made at the time of
3096	initial licensure or relicensure, or upon request in writing by
3097	a licensee under this part and part II of chapter 408. The
3098	notification of approval or the denial of the request shall be
3099	made in accordance with part II of chapter 408. An existing
3100	licensee facilities qualifying to provide extended congregate
3101	care services must have maintained a standard license and may
3102	not have been subject to administrative sanctions during the
3103	previous 2 years, or since initial licensure if the facility has
3104	been licensed for less than 2 years, for any of the following
3105	reasons:
3106	a.  A class I or class II violation;
3107	b.  Three or more repeat or recurring class III violations
3108	of identical or similar resident care standards from which a
3109	pattern of noncompliance is found by the agency;
3110	c.  Three or more class III violations that were not
3111	corrected in accordance with the corrective action plan approved
3112	by the agency;
3113	d.  Violation of resident care standards which results in
3114	requiring the facility to employ the services of a consultant
3115	pharmacist or consultant dietitian;
3116	e.  Denial, suspension, or revocation of a license for
3117	another facility licensed under this part in which the applicant
3118	for an extended congregate care license has at least 25 percent
3119	ownership interest; or
3120	f.  Imposition of a moratorium pursuant to this part or
3121	part II of chapter 408 or initiation of injunctive proceedings.
3122	2.  A facility that is licensed to provide extended
3123	congregate care services shall maintain a written progress
3124	report for on each person who receives services which describes
3125	the type, amount, duration, scope, and outcome of services that
3126	are rendered and the general status of the resident's health. A
3127	registered nurse, or appropriate designee, representing the
3128	agency shall visit the facility at least quarterly to monitor
3129	residents who are receiving extended congregate care services
3130	and to determine if the facility is in compliance with this
3131	part, part II of chapter 408, and relevant rules. One of the
3132	visits may be in conjunction with the regular survey. The
3133	monitoring visits may be provided through contractual
3134	arrangements with appropriate community agencies. A registered
3135	nurse shall serve as part of the team that inspects the
3136	facility. The agency may waive one of the required yearly
3137	monitoring visits for a facility that has been licensed for at
3138	least 24 months to provide extended congregate care services,
3139	if, during the inspection, the registered nurse determines that
3140	extended congregate care services are being provided
3141	appropriately, and if the facility has no class I or class II
3142	violations and no uncorrected class III violations. The agency
3143	must first consult with the long-term care ombudsman council for
3144	the area in which the facility is located to determine if any
3145	complaints have been made and substantiated about the quality of
3146	services or care. The agency may not waive one of the required
3147	yearly monitoring visits if complaints have been made and
3148	substantiated.
3149	3.  A facility that is licensed to provide extended
3150	congregate care services must:
3151	a.  Demonstrate the capability to meet unanticipated
3152	resident service needs.
3153	b.  Offer a physical environment that promotes a homelike
3154	setting, provides for resident privacy, promotes resident
3155	independence, and allows sufficient congregate space as defined
3156	by rule.
3157	c.  Have sufficient staff available, taking into account
3158	the physical plant and firesafety features of the building, to
3159	assist with the evacuation of residents in an emergency.
3160	d.  Adopt and follow policies and procedures that maximize
3161	resident independence, dignity, choice, and decisionmaking to
3162	permit residents to age in place, so that moves due to changes
3163	in functional status are minimized or avoided.
3164	e.  Allow residents or, if applicable, a resident's
3165	representative, designee, surrogate, guardian, or attorney in
3166	fact to make a variety of personal choices, participate in
3167	developing service plans, and share responsibility in
3168	decisionmaking.
3169	f.  Implement the concept of managed risk.
3170	g.  Provide, directly or through contract, the services of
3171	a person licensed under part I of chapter 464.
3172	h.  In addition to the training mandated in s. 429.52,
3173	provide specialized training as defined by rule for facility
3174	staff.
3175	4.  A facility that is licensed to provide extended
3176	congregate care services is exempt from the criteria for
3177	continued residency set forth in rules adopted under s. 429.41.
3178	A licensed facility must adopt its own requirements within
3179	guidelines for continued residency set forth by rule. However,
3180	the facility may not serve residents who require 24-hour nursing
3181	supervision. A licensed facility that provides extended
3182	congregate care services must also provide each resident with a
3183	written copy of facility policies governing admission and
3184	retention.
3185	5.  The primary purpose of extended congregate care
3186	services is to allow residents, as they become more impaired,
3187	the option of remaining in a familiar setting from which they
3188	would otherwise be disqualified for continued residency. A
3189	facility licensed to provide extended congregate care services
3190	may also admit an individual who exceeds the admission criteria
3191	for a facility with a standard license, if the individual is
3192	determined appropriate for admission to the extended congregate
3193	care facility.
3194	6.  Before the admission of an individual to a facility
3195	licensed to provide extended congregate care services, the
3196	individual must undergo a medical examination as provided in s.
3197	429.26(4) and the facility must develop a preliminary service
3198	plan for the individual.
3199	7.  When a licensee facility can no longer provide or
3200	arrange for services in accordance with the resident's service
3201	plan and needs and the licensee's facility's policy, the
3202	licensee facility shall make arrangements for relocating the
3203	person in accordance with s. 429.28(1)(k).
3204	8.  Failure to provide extended congregate care services
3205	may result in denial of extended congregate care license
3206	renewal.
3207	(c)  A limited nursing services license shall be issued to
3208	a facility that provides services beyond those authorized in
3209	paragraph (a) and as specified in this paragraph.
3210	1.  In order for limited nursing services to be provided in
3211	a facility licensed under this part, the agency must first
3212	determine that all requirements established in law and rule are
3213	met and must specifically designate, on the facility's license,
3214	that such services may be provided. Such designation may be made
3215	at the time of initial licensure or relicensure, or upon request
3216	in writing by a licensee under this part and part II of chapter
3217	408. Notification of approval or denial of such request shall be
3218	made in accordance with part II of chapter 408. Existing
3219	facilities qualifying to provide limited nursing services shall
3220	have maintained a standard license and may not have been subject
3221	to administrative sanctions that affect the health, safety, and
3222	welfare of residents for the previous 2 years or since initial
3223	licensure if the facility has been licensed for less than 2
3224	years.
3225	2.  Facilities that are licensed to provide limited nursing
3226	services shall maintain a written progress report on each person
3227	who receives such nursing services, which report describes the
3228	type, amount, duration, scope, and outcome of services that are
3229	rendered and the general status of the resident's health. A
3230	registered nurse representing the agency shall visit such
3231	facilities at least twice a year to monitor residents who are
3232	receiving limited nursing services and to determine if the
3233	facility is in compliance with applicable provisions of this
3234	part, part II of chapter 408, and related rules. The monitoring
3235	visits may be provided through contractual arrangements with
3236	appropriate community agencies. A registered nurse shall also
3237	serve as part of the team that inspects such facility.
3238	3.  A person who receives limited nursing services under
3239	this part must meet the admission criteria established by the
3240	agency for assisted living facilities. When a resident no longer
3241	meets the admission criteria for a facility licensed under this
3242	part, arrangements for relocating the person shall be made in
3243	accordance with s. 429.28(1)(k), unless the facility is licensed
3244	to provide extended congregate care services.
3245	(4)  In accordance with s. 408.805, an applicant or
3246	licensee shall pay a fee for each license application submitted
3247	under this part, part II of chapter 408, and applicable rules.
3248	The amount of the fee shall be established by rule.
3249	(c)  In addition to the total fee assessed under paragraph
3250	(a), the agency shall require facilities that are licensed to
3251	provide limited nursing services under this part to pay an
3252	additional fee per licensed facility. The amount of the biennial
3253	fee shall be $250 per license, with an additional fee of $10 per
3254	resident based on the total licensed resident capacity of the
3255	facility.
3256	(6)  In order to determine whether the facility is
3257	adequately protecting residents' rights as provided in s.
3258	429.28, the agency's standard licensure survey shall include
3259	private informal conversations with a sample of residents and
3260	consultation with the ombudsman council in the planning and
3261	service area in which the facility is located to discuss
3262	residents' experiences within the facility.
3263	(7)  An assisted living facility that has been cited within
3264	the previous 24-month period for a class I or class II
3265	violation, regardless of the status of any enforcement or
3266	disciplinary action, is subject to periodic unannounced
3267	monitoring to determine if the facility is in compliance with
3268	this part, part II of chapter 408, and applicable rules.
3269	Monitoring may occur through a desk review or an onsite
3270	assessment. If the class I or class II violation relates to
3271	providing or failing to provide nursing care, a registered nurse
3272	must participate in monitoring activities during the 12-month
3273	period following the violation.
3274	Section 75.  Subsection (7) of section 429.11, Florida
3275	Statutes, is renumbered as subsection (6), and present
3276	subsection (6) of that section is amended to read:
3277	429.11  Initial application for license; provisional
3278	license.-
3279	(6)  In addition to the license categories available in s.
3280	408.808, a provisional license may be issued to an applicant
3281	making initial application for licensure or making application
3282	for a change of ownership. A provisional license shall be
3283	limited in duration to a specific period of time not to exceed 6
3284	months, as determined by the agency.
3285	Section 76.  Section 429.12, Florida Statutes, is amended
3286	to read:
3287	429.12  Sale or transfer of ownership of a facility.-It is
3288	the intent of the Legislature to protect the rights of the
3289	residents of an assisted living facility when the facility is
3290	sold or the ownership thereof is transferred. Therefore, in
3291	addition to the requirements of part II of chapter 408, whenever
3292	a facility is sold or the ownership thereof is transferred,
3293	including leasing,:
3294	(1)  the transferee shall notify the residents, in writing,
3295	of the change of ownership within 7 days after receipt of the
3296	new license.
3297	(2)  The transferor of a facility the license of which is
3298	denied pending an administrative hearing shall, as a part of the
3299	written change-of-ownership contract, advise the transferee that
3300	a plan of correction must be submitted by the transferee and
3301	approved by the agency at least 7 days before the change of
3302	ownership and that failure to correct the condition which
3303	resulted in the moratorium pursuant to part II of chapter 408 or
3304	denial of licensure is grounds for denial of the transferee's
3305	license.
3306	Section 77.  Subsection (5) of section 429.14, Florida
3307	Statutes, is amended to read:
3308	429.14  Administrative penalties.-
3309	(5)  An action taken by the agency to suspend, deny, or
3310	revoke a facility's license under this part or part II of
3311	chapter 408, in which the agency claims that the facility owner
3312	or an employee of the facility has threatened the health,
3313	safety, or welfare of a resident of the facility, shall be heard
3314	by the Division of Administrative Hearings of the Department of
3315	Management Services within 120 days after receipt of the
3316	facility's request for a hearing, unless that time limitation is
3317	waived by both parties. The administrative law judge must render
3318	a decision within 30 days after receipt of a proposed
3319	recommended order.
3320	Section 78.  Subsections (1), (4), and (5) of section
3321	429.17, Florida Statutes, are amended to read:
3322	429.17  Expiration of license; renewal; conditional
3323	license.-
3324	(1)  Limited nursing, Extended congregate care, and limited
3325	mental health licenses shall expire at the same time as the
3326	facility's standard license, regardless of when issued.
3327	(4)  In addition to the license categories available in s.
3328	408.808, a conditional license may be issued to an applicant for
3329	license renewal if the applicant fails to meet all standards and
3330	requirements for licensure. A conditional license issued under
3331	this subsection shall be limited in duration to a specific
3332	period of time not to exceed 6 months, as determined by the
3333	agency, and shall be accompanied by an agency-approved plan of
3334	correction.
3335	(5)  When an extended congregate care or limited nursing
3336	license is requested during a facility's biennial license
3337	period, the fee shall be prorated in order to permit the
3338	additional license to expire at the end of the biennial license
3339	period. The fee shall be calculated as of the date the
3340	additional license application is received by the agency.
3341	Section 79.  Section 429.195, Florida Statutes, is amended
3342	to read:
3343	429.195  Rebates prohibited; penalties.-
3344	(1)  It is unlawful for any assisted living facility
3345	licensed under this part to contract or promise to pay or
3346	receive any commission, bonus, kickback, or rebate or engage in
3347	any split-fee arrangement in any form whatsoever with any health
3348	care provider or health care facility pursuant to s. 817.505
3349	physician, surgeon, organization, agency, or person, either
3350	directly or indirectly, for residents referred to an assisted
3351	living facility licensed under this part. A facility may employ
3352	or contract with persons to market the facility, provided the
3353	employee or contract provider clearly indicates that he or she
3354	represents the facility. A person or agency independent of the
3355	facility may provide placement or referral services for a fee to
3356	individuals seeking assistance in finding a suitable facility;
3357	however, any fee paid for placement or referral services must be
3358	paid by the individual looking for a facility, not by the
3359	facility.
3360	(2)  A violation of this section shall be considered
3361	patient brokering and is punishable as provided in s. 817.505.
3362	(3)  This section does not apply to:
3363	(a)  An individual employed by the facility, or with whom
3364	the facility contracts to market the facility, if the employee
3365	or contract provider clearly indicates that he or she works with
3366	or for the facility.
3367	(b)  A referral service that provides information,
3368	consultation, or referrals to consumers to assist them in
3369	finding appropriate care or housing options for seniors or
3370	disabled adults, provided that such referred consumers are not
3371	Medicaid recipients.
3372	(c)  Residents of an assisted living facility who refer
3373	friends, family members, or other individuals with whom they
3374	have a personal relationship to the assisted living facility,
3375	and does not prohibit the assisted living facility from
3376	providing a monetary reward to the resident for making such a
3377	referral.
3378	Section 80.  Subsections (6) through (10) of section
3379	429.23, Florida Statutes, are renumbered as subsections (5)
3380	through (9), respectively, and present subsection (5) of that
3381	section is amended to read:
3382	429.23  Internal risk management and quality assurance
3383	program; adverse incidents and reporting requirements.-
3384	(5)  Each facility shall report monthly to the agency any
3385	liability claim filed against it. The report must include the
3386	name of the resident, the dates of the incident leading to the
3387	claim, if applicable, and the type of injury or violation of
3388	rights alleged to have occurred. This report is not discoverable
3389	in any civil or administrative action, except in such actions
3390	brought by the agency to enforce the provisions of this part.
3391	Section 81.  Paragraph (a) of subsection (1) and subsection
3392	(2) of section 429.255, Florida Statutes, are amended to read:
3393	429.255  Use of personnel; emergency care.-
3394	(1)(a)  Persons under contract to the facility or, facility
3395	staff, or volunteers, who are licensed according to part I of
3396	chapter 464, or those persons exempt under s. 464.022(1), and
3397	others as defined by rule, may administer medications to
3398	residents, take residents' vital signs, manage individual weekly
3399	pill organizers for residents who self-administer medication,
3400	give prepackaged enemas ordered by a physician, observe
3401	residents, document observations on the appropriate resident's
3402	record, report observations to the resident's physician, and
3403	contract or allow residents or a resident's representative,
3404	designee, surrogate, guardian, or attorney in fact to contract
3405	with a third party, provided residents meet the criteria for
3406	appropriate placement as defined in s. 429.26. Persons under
3407	contract to the facility or facility staff who are licensed
3408	according to part I of chapter 464 may provide limited nursing
3409	services. Nursing assistants certified pursuant to part II of
3410	chapter 464 may take residents' vital signs as directed by a
3411	licensed nurse or physician. The facility is responsible for
3412	maintaining documentation of services provided under this
3413	paragraph and as required by rule and for ensuring that staff
3414	are adequately trained to monitor residents receiving these
3415	services.
3416	(2)  In facilities licensed to provide extended congregate
3417	care, persons under contract to the facility or, facility staff,
3418	or volunteers, who are licensed according to part I of chapter
3419	464, or those persons exempt under s. 464.022(1), or those
3420	persons certified as nursing assistants pursuant to part II of
3421	chapter 464, may also perform all duties within the scope of
3422	their license or certification, as approved by the facility
3423	administrator and pursuant to this part.
3424	Section 82.  Subsections (4), (5), (6), and (7) of section
3425	429.28, Florida Statutes, are renumbered as subsections (3),
3426	(4), (5), and (6), respectively, and present subsections (3) and
3427	(6) of that section are amended to read:
3428	429.28  Resident bill of rights.-
3429	(3)(a)  The agency shall conduct a survey to determine
3430	general compliance with facility standards and compliance with
3431	residents' rights as a prerequisite to initial licensure or
3432	licensure renewal.
3433	(b)  In order to determine whether the facility is
3434	adequately protecting residents' rights, the biennial survey
3435	shall include private informal conversations with a sample of
3436	residents and consultation with the ombudsman council in the
3437	planning and service area in which the facility is located to
3438	discuss residents' experiences within the facility.
3439	(c)  During any calendar year in which no survey is
3440	conducted, the agency shall conduct at least one monitoring
3441	visit of each facility cited in the previous year for a class I
3442	or class II violation, or more than three uncorrected class III
3443	violations.
3444	(d)  The agency may conduct periodic followup inspections
3445	as necessary to monitor the compliance of facilities with a
3446	history of any class I, class II, or class III violations that
3447	threaten the health, safety, or security of residents.
3448	(e)  The agency may conduct complaint investigations as
3449	warranted to investigate any allegations of noncompliance with
3450	requirements required under this part or rules adopted under
3451	this part.
3452	(5)(6)  Any facility which terminates the residency of an
3453	individual who participated in activities specified in
3454	subsection (4) (5) shall show good cause in a court of competent
3455	jurisdiction.
3456	Section 83.  Subsections (4) and (5) of section 429.41,
3457	Florida Statutes, are renumbered as subsections (3) and (4),
3458	respectively, and paragraphs (i) and (j) of subsection (1) and
3459	present subsection (3) of that section are amended to read:
3460	429.41  Rules establishing standards.-
3461	(1)  It is the intent of the Legislature that rules
3462	published and enforced pursuant to this section shall include
3463	criteria by which a reasonable and consistent quality of
3464	resident care and quality of life may be ensured and the results
3465	of such resident care may be demonstrated. Such rules shall also
3466	ensure a safe and sanitary environment that is residential and
3467	noninstitutional in design or nature. It is further intended
3468	that reasonable efforts be made to accommodate the needs and
3469	preferences of residents to enhance the quality of life in a
3470	facility. The agency, in consultation with the department, may
3471	adopt rules to administer the requirements of part II of chapter
3472	408. In order to provide safe and sanitary facilities and the
3473	highest quality of resident care accommodating the needs and
3474	preferences of residents, the department, in consultation with
3475	the agency, the Department of Children and Family Services, and
3476	the Department of Health, shall adopt rules, policies, and
3477	procedures to administer this part, which must include
3478	reasonable and fair minimum standards in relation to:
3479	(i)  Facilities holding an a limited nursing, extended
3480	congregate care, or limited mental health license.
3481	(j)  The establishment of specific criteria to define
3482	appropriateness of resident admission and continued residency in
3483	a facility holding a standard, limited nursing, extended
3484	congregate care, and limited mental health license.
3485	(3)  The department shall submit a copy of proposed rules
3486	to the Speaker of the House of Representatives, the President of
3487	the Senate, and appropriate committees of substance for review
3488	and comment prior to the promulgation thereof. Rules promulgated
3489	by the department shall encourage the development of homelike
3490	facilities which promote the dignity, individuality, personal
3491	strengths, and decisionmaking ability of residents.
3492	Section 84.  Subsections (1) and (2) of section 429.53,
3493	Florida Statutes, are amended to read:
3494	429.53  Consultation by the agency.-
3495	(1)  The area offices of licensure and certification of the
3496	agency shall provide consultation to the following upon request:
3497	(a)  A licensee of a facility.
3498	(b)  A person interested in obtaining a license to operate
3499	a facility under this part.
3500	(2)  As used in this section, "consultation" includes:
3501	(a)  An explanation of the requirements of this part and
3502	rules adopted pursuant thereto;
3503	(b)  An explanation of the license application and renewal
3504	procedures; and
3505	(c)  The provision of a checklist of general local and
3506	state approvals required prior to constructing or developing a
3507	facility and a listing of the types of agencies responsible for
3508	such approvals;
3509	(d)  An explanation of benefits and financial assistance
3510	available to a recipient of supplemental security income
3511	residing in a facility;
3512	(c)(e)  Any other information which the agency deems
3513	necessary to promote compliance with the requirements of this
3514	part; and
3515	(f)  A preconstruction review of a facility to ensure
3516	compliance with agency rules and this part.
3517	Section 85.  Subsection (6) of section 429.71, Florida
3518	Statutes, is renumbered as subsection (5), and subsection (1)
3519	and present subsection (5) of that section are amended to read:
3520	429.71  Classification of violations deficiencies;
3521	administrative fines.-
3522	(1)  In addition to the requirements of part II of chapter
3523	408 and in addition to any other liability or penalty provided
3524	by law, the agency may impose an administrative fine on a
3525	provider according to the following classification:
3526	(a)  Class I violations are defined in s. 408.813 those
3527	conditions or practices related to the operation and maintenance
3528	of an adult family-care home or to the care of residents which
3529	the agency determines present an imminent danger to the
3530	residents or guests of the facility or a substantial probability
3531	that death or serious physical or emotional harm would result
3532	therefrom. The condition or practice that constitutes a class I
3533	violation must be abated or eliminated within 24 hours, unless a
3534	fixed period, as determined by the agency, is required for
3535	correction. A class I violation deficiency is subject to an
3536	administrative fine in an amount not less than $500 and not
3537	exceeding $1,000 for each violation. A fine may be levied
3538	notwithstanding the correction of the deficiency.
3539	(b)  Class II violations are defined in s. 408.813 those
3540	conditions or practices related to the operation and maintenance
3541	of an adult family-care home or to the care of residents which
3542	the agency determines directly threaten the physical or
3543	emotional health, safety, or security of the residents, other
3544	than class I violations. A class II violation is subject to an
3545	administrative fine in an amount not less than $250 and not
3546	exceeding $500 for each violation. A citation for a class II
3547	violation must specify the time within which the violation is
3548	required to be corrected. If a class II violation is corrected
3549	within the time specified, no civil penalty shall be imposed,
3550	unless it is a repeated offense.
3551	(c)  Class III violations are defined in s. 408.813 those
3552	conditions or practices related to the operation and maintenance
3553	of an adult family-care home or to the care of residents which
3554	the agency determines indirectly or potentially threaten the
3555	physical or emotional health, safety, or security of residents,
3556	other than class I or class II violations. A class III violation
3557	is subject to an administrative fine in an amount not less than
3558	$100 and not exceeding $250 for each violation. A citation for a
3559	class III violation shall specify the time within which the
3560	violation is required to be corrected. If a class III violation
3561	is corrected within the time specified, no civil penalty shall
3562	be imposed, unless it is a repeated violation offense.
3563	(d)  Class IV violations are defined in s. 408.813 those
3564	conditions or occurrences related to the operation and
3565	maintenance of an adult family-care home, or related to the
3566	required reports, forms, or documents, which do not have the
3567	potential of negatively affecting the residents. A provider that
3568	does not correct A class IV violation within the time limit
3569	specified by the agency is subject to an administrative fine in
3570	an amount not less than $50 and not exceeding $100 for each
3571	violation. Any class IV violation that is corrected during the
3572	time the agency survey is conducted will be identified as an
3573	agency finding and not as a violation, unless it is a repeat
3574	violation.
3575	(5)  As an alternative to or in conjunction with an
3576	administrative action against a provider, the agency may request
3577	a plan of corrective action that demonstrates a good faith
3578	effort to remedy each violation by a specific date, subject to
3579	the approval of the agency.
3580	Section 86.  Section 429.915, Florida Statutes, is amended
3581	to read:
3582	429.915  Conditional license.-In addition to the license
3583	categories available in part II of chapter 408, the agency may
3584	issue a conditional license to an applicant for license renewal
3585	or change of ownership if the applicant fails to meet all
3586	standards and requirements for licensure. A conditional license
3587	issued under this subsection must be limited to a specific
3588	period not exceeding 6 months, as determined by the agency, and
3589	must be accompanied by an approved plan of correction.
3590	Section 87.  Paragraphs (b) and (g) of subsection (3) of
3591	section 430.80, Florida Statutes, are amended to read:
3592	430.80  Implementation of a teaching nursing home pilot
3593	project.-
3594	(3)  To be designated as a teaching nursing home, a nursing
3595	home licensee must, at a minimum:
3596	(b)  Participate in a nationally recognized accreditation
3597	program and hold a valid accreditation, such as the
3598	accreditation awarded by the Joint Commission on Accreditation
3599	of Healthcare Organizations, or, at the time of initial
3600	designation, possess a Gold Seal Award as conferred by the state
3601	on its licensed nursing home;
3602	(g)  Maintain insurance coverage pursuant to s.
3603	400.141(1)(q)(s) or proof of financial responsibility in a
3604	minimum amount of $750,000. Such proof of financial
3605	responsibility may include:
3606	1.  Maintaining an escrow account consisting of cash or
3607	assets eligible for deposit in accordance with s. 625.52; or
3608	2.  Obtaining and maintaining pursuant to chapter 675 an
3609	unexpired, irrevocable, nontransferable and nonassignable letter
3610	of credit issued by any bank or savings association organized
3611	and existing under the laws of this state or any bank or savings
3612	association organized under the laws of the United States that
3613	has its principal place of business in this state or has a
3614	branch office which is authorized to receive deposits in this
3615	state. The letter of credit shall be used to satisfy the
3616	obligation of the facility to the claimant upon presentment of a
3617	final judgment indicating liability and awarding damages to be
3618	paid by the facility or upon presentment of a settlement
3619	agreement signed by all parties to the agreement when such final
3620	judgment or settlement is a result of a liability claim against
3621	the facility.
3622	Section 88.  Paragraph (d) of subsection (9) of section
3623	440.102, Florida Statutes, is amended to read:
3624	440.102  Drug-free workplace program requirements.-The
3625	following provisions apply to a drug-free workplace program
3626	implemented pursuant to law or to rules adopted by the Agency
3627	for Health Care Administration:
3628	(9)  DRUG-TESTING STANDARDS FOR LABORATORIES.-
3629	(d)  The laboratory shall submit to the Agency for Health
3630	Care Administration a monthly report with statistical
3631	information regarding the testing of employees and job
3632	applicants. The report must include information on the methods
3633	of analysis conducted, the drugs tested for, the number of
3634	positive and negative results for both initial tests and
3635	confirmation tests, and any other information deemed appropriate
3636	by the Agency for Health Care Administration. A monthly report
3637	must not identify specific employees or job applicants.
3638	Section 89.  Paragraph (a) of subsection (2) of section
3639	440.13, Florida Statutes, is amended to read:
3640	440.13  Medical services and supplies; penalty for
3641	violations; limitations.-
3642	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3643	(a)  Subject to the limitations specified elsewhere in this
3644	chapter, the employer shall furnish to the employee such
3645	medically necessary remedial treatment, care, and attendance for
3646	such period as the nature of the injury or the process of
3647	recovery may require, which is in accordance with established
3648	practice parameters and protocols of treatment as provided for
3649	in this chapter, including medicines, medical supplies, durable
3650	medical equipment, orthoses, prostheses, and other medically
3651	necessary apparatus. Remedial treatment, care, and attendance,
3652	including work-hardening programs or pain-management programs
3653	accredited by the Commission on Accreditation of Rehabilitation
3654	Facilities or the Joint Commission on the Accreditation of
3655	Health Organizations or pain-management programs affiliated with
3656	medical schools, shall be considered as covered treatment only
3657	when such care is given based on a referral by a physician as
3658	defined in this chapter. Medically necessary treatment, care,
3659	and attendance does not include chiropractic services in excess
3660	of 24 treatments or rendered 12 weeks beyond the date of the
3661	initial chiropractic treatment, whichever comes first, unless
3662	the carrier authorizes additional treatment or the employee is
3663	catastrophically injured.
3664
3665	Failure of the carrier to timely comply with this subsection
3666	shall be a violation of this chapter and the carrier shall be
3667	subject to penalties as provided for in s. 440.525.
3668	Section 90.  Paragraph (h) of subsection (3) of section
3669	456.053, Florida Statutes, is amended to read:
3670	456.053  Financial arrangements between referring health
3671	care providers and providers of health care services.-
3672	(3)  DEFINITIONS.-For the purpose of this section, the
3673	word, phrase, or term:
3674	(h)  "Group practice" means a group of two or more health
3675	care providers legally organized as a partnership, professional
3676	corporation, or similar association:
3677	1.  In which each health care provider who is a member of
3678	the group provides substantially the full range of services
3679	which the health care provider routinely provides, including
3680	medical care, consultation, diagnosis, or treatment, through the
3681	joint use of shared office space, facilities, equipment, and
3682	personnel;
3683	2.  For which substantially all of the services of the
3684	health care providers who are members of the group are provided
3685	through the group and are billed in the name of the group and
3686	amounts so received are treated as receipts of the group; and
3687	3.  In which the overhead expenses of and the income from
3688	the practice are distributed in accordance with methods
3689	previously determined by members of the group; and
3690	4.  In which a group practice that provides radiation
3691	therapy services provides the full range of radiation therapy
3692	services such that no single type of cancer, either as a primary
3693	or secondary diagnosis as described by the International
3694	Statistical Classification of Diseases, constitutes 40 percent
3695	or more of the group's cases that require professional and
3696	technical services for radiation therapy, and in which the
3697	health care providers within the group who are referring
3698	patients for radiation therapy services do not own 50 percent or
3699	more of the group practice. For purposes of this subparagraph,
3700	the term "cases" means a patient's radiation treatment course.
3701	Section 91.  Subsection (1) of section 483.035, Florida
3702	Statutes, is amended to read:
3703	483.035  Clinical laboratories operated by practitioners
3704	for exclusive use; licensure and regulation.-
3705	(1)  A clinical laboratory operated by one or more
3706	practitioners licensed under chapter 458, chapter 459, chapter
3707	460, chapter 461, chapter 462, part I of chapter 464, or chapter
3708	466, exclusively in connection with the diagnosis and treatment
3709	of their own patients, must be licensed under this part and must
3710	comply with the provisions of this part, except that the agency
3711	shall adopt rules for staffing, for personnel, including
3712	education and training of personnel, for proficiency testing,
3713	and for construction standards relating to the licensure and
3714	operation of the laboratory based upon and not exceeding the
3715	same standards contained in the federal Clinical Laboratory
3716	Improvement Amendments of 1988 and the federal regulations
3717	adopted thereunder.
3718	Section 92.  Subsections (1) and (9) of section 483.051,
3719	Florida Statutes, are amended to read:
3720	483.051  Powers and duties of the agency.-The agency shall
3721	adopt rules to implement this part, which rules must include,
3722	but are not limited to, the following:
3723	(1)  LICENSING; QUALIFICATIONS.-The agency shall provide
3724	for biennial licensure of all nonwaived clinical laboratories
3725	meeting the requirements of this part and shall prescribe the
3726	qualifications necessary for such licensure, including, but not
3727	limited to, application for or proof of a federal Clinical
3728	Laboratory Improvement Amendment (CLIA) certificate. For
3729	purposes of this section, the term "nonwaived clinical
3730	laboratories" means laboratories that perform any test that the
3731	Centers for Medicare and Medicaid Services has determined does
3732	not qualify for a certificate of waiver under the Clinical
3733	Laboratory Improvement Amendments of 1988 and the federal rules
3734	adopted thereunder.
3735	(9)  ALTERNATE-SITE TESTING.-The agency, in consultation
3736	with the Board of Clinical Laboratory Personnel, shall adopt, by
3737	rule, the criteria for alternate-site testing to be performed
3738	under the supervision of a clinical laboratory director. The
3739	elements to be addressed in the rule include, but are not
3740	limited to: a hospital internal needs assessment; a protocol of
3741	implementation including tests to be performed and who will
3742	perform the tests; criteria to be used in selecting the method
3743	of testing to be used for alternate-site testing; minimum
3744	training and education requirements for those who will perform
3745	alternate-site testing, such as documented training, licensure,
3746	certification, or other medical professional background not
3747	limited to laboratory professionals; documented inservice
3748	training as well as initial and ongoing competency validation;
3749	an appropriate internal and external quality control protocol;
3750	an internal mechanism for identifying and tracking alternate-
3751	site testing by the central laboratory; and recordkeeping
3752	requirements. Alternate-site testing locations must register
3753	when the clinical laboratory applies to renew its license. For
3754	purposes of this subsection, the term "alternate-site testing"
3755	means any laboratory testing done under the administrative
3756	control of a hospital, but performed out of the physical or
3757	administrative confines of the central laboratory.
3758	Section 93.  Section 483.294, Florida Statutes, is amended
3759	to read:
3760	483.294  Inspection of centers.-In accordance with s.
3761	408.811, the agency shall biennially, at least once annually,
3762	inspect the premises and operations of all centers subject to
3763	licensure under this part.
3764	Section 94.  Paragraph (a) of subsection (54) of section
3765	499.003, Florida Statutes, is amended to read:
3766	499.003  Definitions of terms used in this part.-As used in
3767	this part, the term:
3768	(54)  "Wholesale distribution" means distribution of
3769	prescription drugs to persons other than a consumer or patient,
3770	but does not include:
3771	(a)  Any of the following activities, which is not a
3772	violation of s. 499.005(21) if such activity is conducted in
3773	accordance with s. 499.01(2)(g):
3774	1.  The purchase or other acquisition by a hospital or
3775	other health care entity that is a member of a group purchasing
3776	organization of a prescription drug for its own use from the
3777	group purchasing organization or from other hospitals or health
3778	care entities that are members of that organization.
3779	2.  The sale, purchase, or trade of a prescription drug or
3780	an offer to sell, purchase, or trade a prescription drug by a
3781	charitable organization described in s. 501(c)(3) of the
3782	Internal Revenue Code of 1986, as amended and revised, to a
3783	nonprofit affiliate of the organization to the extent otherwise
3784	permitted by law.
3785	3.  The sale, purchase, or trade of a prescription drug or
3786	an offer to sell, purchase, or trade a prescription drug among
3787	hospitals or other health care entities that are under common
3788	control. For purposes of this subparagraph, "common control"
3789	means the power to direct or cause the direction of the
3790	management and policies of a person or an organization, whether
3791	by ownership of stock, by voting rights, by contract, or
3792	otherwise.
3793	4.  The sale, purchase, trade, or other transfer of a
3794	prescription drug from or for any federal, state, or local
3795	government agency or any entity eligible to purchase
3796	prescription drugs at public health services prices pursuant to
3797	Pub. L. No. 102-585, s. 602 to a contract provider or its
3798	subcontractor for eligible patients of the agency or entity
3799	under the following conditions:
3800	a.  The agency or entity must obtain written authorization
3801	for the sale, purchase, trade, or other transfer of a
3802	prescription drug under this subparagraph from the State Surgeon
3803	General or his or her designee.
3804	b.  The contract provider or subcontractor must be
3805	authorized by law to administer or dispense prescription drugs.
3806	c.  In the case of a subcontractor, the agency or entity
3807	must be a party to and execute the subcontract.
3808	d.  A contract provider or subcontractor must maintain
3809	separate and apart from other prescription drug inventory any
3810	prescription drugs of the agency or entity in its possession.
3811	d.e.  The contract provider and subcontractor must maintain
3812	and produce immediately for inspection all records of movement
3813	or transfer of all the prescription drugs belonging to the
3814	agency or entity, including, but not limited to, the records of
3815	receipt and disposition of prescription drugs. Each contractor
3816	and subcontractor dispensing or administering these drugs must
3817	maintain and produce records documenting the dispensing or
3818	administration. Records that are required to be maintained
3819	include, but are not limited to, a perpetual inventory itemizing
3820	drugs received and drugs dispensed by prescription number or
3821	administered by patient identifier, which must be submitted to
3822	the agency or entity quarterly.
3823	e.f.  The contract provider or subcontractor may administer
3824	or dispense the prescription drugs only to the eligible patients
3825	of the agency or entity or must return the prescription drugs
3826	for or to the agency or entity. The contract provider or
3827	subcontractor must require proof from each person seeking to
3828	fill a prescription or obtain treatment that the person is an
3829	eligible patient of the agency or entity and must, at a minimum,
3830	maintain a copy of this proof as part of the records of the
3831	contractor or subcontractor required under sub-subparagraph e.
3832	f.g.  In addition to the departmental inspection authority
3833	set forth in s. 499.051, the establishment of the contract
3834	provider and subcontractor and all records pertaining to
3835	prescription drugs subject to this subparagraph shall be subject
3836	to inspection by the agency or entity. All records relating to
3837	prescription drugs of a manufacturer under this subparagraph
3838	shall be subject to audit by the manufacturer of those drugs,
3839	without identifying individual patient information.
3840	Section 95.  Subsection (1) of section 627.645, Florida
3841	Statutes, is amended to read:
3842	627.645  Denial of health insurance claims restricted.-
3843	(1)  No claim for payment under a health insurance policy
3844	or self-insured program of health benefits for treatment, care,
3845	or services in a licensed hospital which is accredited by the
3846	Joint Commission on the Accreditation of Hospitals, the American
3847	Osteopathic Association, or the Commission on the Accreditation
3848	of Rehabilitative Facilities shall be denied because such
3849	hospital lacks major surgical facilities and is primarily of a
3850	rehabilitative nature, if such rehabilitation is specifically
3851	for treatment of physical disability.
3852	Section 96.  Paragraph (c) of subsection (2) of section
3853	627.668, Florida Statutes, is amended to read:
3854	627.668  Optional coverage for mental and nervous disorders
3855	required; exception.-
3856	(2)  Under group policies or contracts, inpatient hospital
3857	benefits, partial hospitalization benefits, and outpatient
3858	benefits consisting of durational limits, dollar amounts,
3859	deductibles, and coinsurance factors shall not be less favorable
3860	than for physical illness generally, except that:
3861	(c)  Partial hospitalization benefits shall be provided
3862	under the direction of a licensed physician. For purposes of
3863	this part, the term "partial hospitalization services" is
3864	defined as those services offered by a program accredited by the
3865	Joint Commission on Accreditation of Hospitals (JCAH) or in
3866	compliance with equivalent standards. Alcohol rehabilitation
3867	programs accredited by the Joint Commission on Accreditation of
3868	Hospitals or approved by the state and licensed drug abuse
3869	rehabilitation programs shall also be qualified providers under
3870	this section. In any benefit year, if partial hospitalization
3871	services or a combination of inpatient and partial
3872	hospitalization are utilized, the total benefits paid for all
3873	such services shall not exceed the cost of 30 days of inpatient
3874	hospitalization for psychiatric services, including physician
3875	fees, which prevail in the community in which the partial
3876	hospitalization services are rendered. If partial
3877	hospitalization services benefits are provided beyond the limits
3878	set forth in this paragraph, the durational limits, dollar
3879	amounts, and coinsurance factors thereof need not be the same as
3880	those applicable to physical illness generally.
3881	Section 97.  Subsection (3) of section 627.669, Florida
3882	Statutes, is amended to read:
3883	627.669  Optional coverage required for substance abuse
3884	impaired persons; exception.-
3885	(3)  The benefits provided under this section shall be
3886	applicable only if treatment is provided by, or under the
3887	supervision of, or is prescribed by, a licensed physician or
3888	licensed psychologist and if services are provided in a program
3889	accredited by the Joint Commission on Accreditation of Hospitals
3890	or approved by the state.
3891	Section 98.  Paragraph (a) of subsection (1) of section
3892	627.736, Florida Statutes, is amended to read:
3893	627.736  Required personal injury protection benefits;
3894	exclusions; priority; claims.-
3895	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3896	with the security requirements of s. 627.733 shall provide
3897	personal injury protection to the named insured, relatives
3898	residing in the same household, persons operating the insured
3899	motor vehicle, passengers in such motor vehicle, and other
3900	persons struck by such motor vehicle and suffering bodily injury
3901	while not an occupant of a self-propelled vehicle, subject to
3902	the provisions of subsection (2) and paragraph (4)(e), to a
3903	limit of $10,000 for loss sustained by any such person as a
3904	result of bodily injury, sickness, disease, or death arising out
3905	of the ownership, maintenance, or use of a motor vehicle as
3906	follows:
3907	(a)  Medical benefits.-Eighty percent of all reasonable
3908	expenses for medically necessary medical, surgical, X-ray,
3909	dental, and rehabilitative services, including prosthetic
3910	devices, and medically necessary ambulance, hospital, and
3911	nursing services. However, the medical benefits shall provide
3912	reimbursement only for such services and care that are lawfully
3913	provided, supervised, ordered, or prescribed by a physician
3914	licensed under chapter 458 or chapter 459, a dentist licensed
3915	under chapter 466, or a chiropractic physician licensed under
3916	chapter 460 or that are provided by any of the following persons
3917	or entities:
3918	1.  A hospital or ambulatory surgical center licensed under
3919	chapter 395.
3920	2.  A person or entity licensed under ss. 401.2101-401.45
3921	that provides emergency transportation and treatment.
3922	3.  An entity wholly owned by one or more physicians
3923	licensed under chapter 458 or chapter 459, chiropractic
3924	physicians licensed under chapter 460, or dentists licensed
3925	under chapter 466 or by such practitioner or practitioners and
3926	the spouse, parent, child, or sibling of that practitioner or
3927	those practitioners.
3928	4.  An entity wholly owned, directly or indirectly, by a
3929	hospital or hospitals.
3930	5.  A health care clinic licensed under ss. 400.990-400.995
3931	that is:
3932	a.  Accredited by the Joint Commission on Accreditation of
3933	Healthcare Organizations, the American Osteopathic Association,
3934	the Commission on Accreditation of Rehabilitation Facilities, or
3935	the Accreditation Association for Ambulatory Health Care, Inc.;
3936	or
3937	b.  A health care clinic that:
3938	(I)  Has a medical director licensed under chapter 458,
3939	chapter 459, or chapter 460;
3940	(II)  Has been continuously licensed for more than 3 years
3941	or is a publicly traded corporation that issues securities
3942	traded on an exchange registered with the United States
3943	Securities and Exchange Commission as a national securities
3944	exchange; and
3945	(III)  Provides at least four of the following medical
3946	specialties:
3947	(A)  General medicine.
3948	(B)  Radiography.
3949	(C)  Orthopedic medicine.
3950	(D)  Physical medicine.
3951	(E)  Physical therapy.
3952	(F)  Physical rehabilitation.
3953	(G)  Prescribing or dispensing outpatient prescription
3954	medication.
3955	(H)  Laboratory services.
3956
3957	The Financial Services Commission shall adopt by rule the form
3958	that must be used by an insurer and a health care provider
3959	specified in subparagraph 3., subparagraph 4., or subparagraph
3960	5. to document that the health care provider meets the criteria
3961	of this paragraph, which rule must include a requirement for a
3962	sworn statement or affidavit.
3963
3964	Only insurers writing motor vehicle liability insurance in this
3965	state may provide the required benefits of this section, and no
3966	such insurer shall require the purchase of any other motor
3967	vehicle coverage other than the purchase of property damage
3968	liability coverage as required by s. 627.7275 as a condition for
3969	providing such required benefits. Insurers may not require that
3970	property damage liability insurance in an amount greater than
3971	$10,000 be purchased in conjunction with personal injury
3972	protection. Such insurers shall make benefits and required
3973	property damage liability insurance coverage available through
3974	normal marketing channels. Any insurer writing motor vehicle
3975	liability insurance in this state who fails to comply with such
3976	availability requirement as a general business practice shall be
3977	deemed to have violated part IX of chapter 626, and such
3978	violation shall constitute an unfair method of competition or an
3979	unfair or deceptive act or practice involving the business of
3980	insurance; and any such insurer committing such violation shall
3981	be subject to the penalties afforded in such part, as well as
3982	those which may be afforded elsewhere in the insurance code.
3983	Section 99.  Section 633.081, Florida Statutes, is amended
3984	to read:
3985	633.081  Inspection of buildings and equipment; orders;
3986	firesafety inspection training requirements; certification;
3987	disciplinary action.-The State Fire Marshal and her or his
3988	agents shall, at any reasonable hour, when the State Fire
3989	Marshal has reasonable cause to believe that a violation of this
3990	chapter or s. 509.215, or a rule promulgated thereunder, or a
3991	minimum firesafety code adopted by a local authority, may exist,
3992	inspect any and all buildings and structures which are subject
3993	to the requirements of this chapter or s. 509.215 and rules
3994	promulgated thereunder. The authority to inspect shall extend to
3995	all equipment, vehicles, and chemicals which are located within
3996	the premises of any such building or structure. The State Fire
3997	Marshal and her or his agents shall inspect nursing homes
3998	licensed under part II of chapter 400 only once every calendar
3999	year and upon receiving a complaint forming the basis of a
4000	reasonable cause to believe that a violation of this chapter or
4001	s. 509.215, or a rule promulgated thereunder, or a minimum
4002	firesafety code adopted by a local authority may exist and upon
4003	identifying such a violation in the course of conducting
4004	orientation or training activities within a nursing home.
4005	(1)  Each county, municipality, and special district that
4006	has firesafety enforcement responsibilities shall employ or
4007	contract with a firesafety inspector. Except as provided in s.
4008	633.082(2), the firesafety inspector must conduct all firesafety
4009	inspections that are required by law. The governing body of a
4010	county, municipality, or special district that has firesafety
4011	enforcement responsibilities may provide a schedule of fees to
4012	pay only the costs of inspections conducted pursuant to this
4013	subsection and related administrative expenses. Two or more
4014	counties, municipalities, or special districts that have
4015	firesafety enforcement responsibilities may jointly employ or
4016	contract with a firesafety inspector.
4017	(2)  Except as provided in s. 633.082(2), every firesafety
4018	inspection conducted pursuant to state or local firesafety
4019	requirements shall be by a person certified as having met the
4020	inspection training requirements set by the State Fire Marshal.
4021	Such person shall:
4022	(a)  Be a high school graduate or the equivalent as
4023	determined by the department;
4024	(b)  Not have been found guilty of, or having pleaded
4025	guilty or nolo contendere to, a felony or a crime punishable by
4026	imprisonment of 1 year or more under the law of the United
4027	States, or of any state thereof, which involves moral turpitude,
4028	without regard to whether a judgment of conviction has been
4029	entered by the court having jurisdiction of such cases;
4030	(c)  Have her or his fingerprints on file with the
4031	department or with an agency designated by the department;
4032	(d)  Have good moral character as determined by the
4033	department;
4034	(e)  Be at least 18 years of age;
4035	(f)  Have satisfactorily completed the firesafety inspector
4036	certification examination as prescribed by the department; and
4037	(g)1.  Have satisfactorily completed, as determined by the
4038	department, a firesafety inspector training program of not less
4039	than 200 hours established by the department and administered by
4040	agencies and institutions approved by the department for the
4041	purpose of providing basic certification training for firesafety
4042	inspectors; or
4043	2.  Have received in another state training which is
4044	determined by the department to be at least equivalent to that
4045	required by the department for approved firesafety inspector
4046	education and training programs in this state.
4047	(3)  Each special state firesafety inspection which is
4048	required by law and is conducted by or on behalf of an agency of
4049	the state must be performed by an individual who has met the
4050	provision of subsection (2), except that the duration of the
4051	training program shall not exceed 120 hours of specific training
4052	for the type of property that such special state firesafety
4053	inspectors are assigned to inspect.
4054	(4)  A firefighter certified pursuant to s. 633.35 may
4055	conduct firesafety inspections, under the supervision of a
4056	certified firesafety inspector, while on duty as a member of a
4057	fire department company conducting inservice firesafety
4058	inspections without being certified as a firesafety inspector,
4059	if such firefighter has satisfactorily completed an inservice
4060	fire department company inspector training program of at least
4061	24 hours' duration as provided by rule of the department.
4062	(5)  Every firesafety inspector or special state firesafety
4063	inspector certificate is valid for a period of 3 years from the
4064	date of issuance. Renewal of certification shall be subject to
4065	the affected person's completing proper application for renewal
4066	and meeting all of the requirements for renewal as established
4067	under this chapter or by rule promulgated thereunder, which
4068	shall include completion of at least 40 hours during the
4069	preceding 3-year period of continuing education as required by
4070	the rule of the department or, in lieu thereof, successful
4071	passage of an examination as established by the department.
4072	(6)  The State Fire Marshal may deny, refuse to renew,
4073	suspend, or revoke the certificate of a firesafety inspector or
4074	special state firesafety inspector if it finds that any of the
4075	following grounds exist:
4076	(a)  Any cause for which issuance of a certificate could
4077	have been refused had it then existed and been known to the
4078	State Fire Marshal.
4079	(b)  Violation of this chapter or any rule or order of the
4080	State Fire Marshal.
4081	(c)  Falsification of records relating to the certificate.
4082	(d)  Having been found guilty of or having pleaded guilty
4083	or nolo contendere to a felony, whether or not a judgment of
4084	conviction has been entered.
4085	(e)  Failure to meet any of the renewal requirements.
4086	(f)  Having been convicted of a crime in any jurisdiction
4087	which directly relates to the practice of fire code inspection,
4088	plan review, or administration.
4089	(g)  Making or filing a report or record that the
4090	certificateholder knows to be false, or knowingly inducing
4091	another to file a false report or record, or knowingly failing
4092	to file a report or record required by state or local law, or
4093	knowingly impeding or obstructing such filing, or knowingly
4094	inducing another person to impede or obstruct such filing.
4095	(h)  Failing to properly enforce applicable fire codes or
4096	permit requirements within this state which the
4097	certificateholder knows are applicable by committing willful
4098	misconduct, gross negligence, gross misconduct, repeated
4099	negligence, or negligence resulting in a significant danger to
4100	life or property.
4101	(i)  Accepting labor, services, or materials at no charge
4102	or at a noncompetitive rate from any person who performs work
4103	that is under the enforcement authority of the certificateholder
4104	and who is not an immediate family member of the
4105	certificateholder. For the purpose of this paragraph, the term
4106	"immediate family member" means a spouse, child, parent,
4107	sibling, grandparent, aunt, uncle, or first cousin of the person
4108	or the person's spouse or any person who resides in the primary
4109	residence of the certificateholder.
4110	(7)  The Division of State Fire Marshal and the Florida
4111	Building Code Administrators and Inspectors Board, established
4112	pursuant to s. 468.605, shall enter into a reciprocity agreement
4113	to facilitate joint recognition of continuing education
4114	recertification hours for certificateholders licensed under s.
4115	468.609 and firesafety inspectors certified under subsection
4116	(2).
4117	(8)  The State Fire Marshal shall develop by rule an
4118	advanced training and certification program for firesafety
4119	inspectors having fire code management responsibilities. The
4120	program must be consistent with the appropriate provisions of
4121	NFPA 1037, or similar standards adopted by the division, and
4122	establish minimum training, education, and experience levels for
4123	firesafety inspectors having fire code management
4124	responsibilities.
4125	(9)  The department shall provide by rule for the
4126	certification of firesafety inspectors.
4127	Section 100.  Subsection (12) of section 641.495, Florida
4128	Statutes, is amended to read:
4129	641.495  Requirements for issuance and maintenance of
4130	certificate.-
4131	(12)  The provisions of part I of chapter 395 do not apply
4132	to a health maintenance organization that, on or before January
4133	1, 1991, provides not more than 10 outpatient holding beds for
4134	short-term and hospice-type patients in an ambulatory care
4135	facility for its members, provided that such health maintenance
4136	organization maintains current accreditation by the Joint
4137	Commission on Accreditation of Health Care Organizations, the
4138	Accreditation Association for Ambulatory Health Care, or the
4139	National Committee for Quality Assurance.
4140	Section 101.  Subsection (13) of section 651.118, Florida
4141	Statutes, is amended to read:
4142	651.118  Agency for Health Care Administration;
4143	certificates of need; sheltered beds; community beds.-
4144	(13)  Residents, as defined in this chapter, are not
4145	considered new admissions for the purpose of s.
4146	400.141(1)(n)(o)1.d.
4147	Section 102.  Subsection (2) of section 766.1015, Florida
4148	Statutes, is amended to read:
4149	766.1015  Civil immunity for members of or consultants to
4150	certain boards, committees, or other entities.-
4151	(2)  Such committee, board, group, commission, or other
4152	entity must be established in accordance with state law or in
4153	accordance with requirements of the Joint Commission on
4154	Accreditation of Healthcare Organizations, established and duly
4155	constituted by one or more public or licensed private hospitals
4156	or behavioral health agencies, or established by a governmental
4157	agency. To be protected by this section, the act, decision,
4158	omission, or utterance may not be made or done in bad faith or
4159	with malicious intent.
4160	Section 103.  Subsection (4) of section 766.202, Florida
4161	Statutes, is amended to read:
4162	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
4163	766.201-766.212, the term:
4164	(4)  "Health care provider" means any hospital, ambulatory
4165	surgical center, or mobile surgical facility as defined and
4166	licensed under chapter 395; a birth center licensed under
4167	chapter 383; any person licensed under chapter 458, chapter 459,
4168	chapter 460, chapter 461, chapter 462, chapter 463, part I of
4169	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
4170	or chapter 486; a clinical lab licensed under chapter 483; a
4171	health maintenance organization certificated under part I of
4172	chapter 641; a blood bank; a plasma center; an industrial
4173	clinic; a renal dialysis facility; or a professional association
4174	partnership, corporation, joint venture, or other association
4175	for professional activity by health care providers.
4176	Section 104.  Paragraph (j) is added to subsection (3) of
4177	section 817.505, Florida Statutes, to read:
4178	817.505  Patient brokering prohibited; exceptions;
4179	penalties.-
4180	(3)  This section shall not apply to:
4181	(j)  Any payments by an assisted living facility, as
4182	defined in s. 429.02, or any agreement for or solicitation,
4183	offer, or receipt of such payment by a referral service, which
4184	is permitted under s. 429.195(3).
4185	Section 105.  The per-bed standard assisted living facility
4186	licensure fees, including the total fee, have been adjusted by
4187	the Consumer Price Index annually since 1998 and are not
4188	intended to be reset by this act. In addition to the Consumer
4189	Price Index adjustment, the per-bed fee is increased by $9 to
4190	neutralize the elimination of the limited nursing services
4191	specialty license fee.
4192	Section 106.  This act shall take effect July 1, 2011.

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