Florida Senate - 2011 (Corrected Copy) SB 1736
By Senator Latvala
16-00957E-11 20111736__
1 A bill to be entitled
2 An act relating to health care; amending s. 112.0455,
3 F.S., relating to the Drug-Free Workplace Act;
4 deleting an obsolete provision; deleting a provision
5 that requires a laboratory to submit to the Agency for
6 Health Care Administration a monthly report containing
7 statistical information regarding the testing of
8 employees and job applicants; repealing s. 383.325,
9 F.S., relating to confidentiality of inspection
10 reports of licensed birth center facilities; amending
11 s. 395.002, F.S.; revising and deleting definitions
12 applicable to regulation of hospitals and other
13 licensed facilities; conforming a cross-reference;
14 amending s. 395.003, F.S.; deleting an obsolete
15 provision; conforming a cross-reference; amending s.
16 395.0193, F.S.; requiring a licensed facility to
17 report certain peer review information and final
18 disciplinary actions to the Division of Medical
19 Quality Assurance of the Department of Health rather
20 than the Division of Health Quality Assurance of the
21 Agency for Health Care Administration; amending s.
22 395.1023, F.S.; providing for the Department of
23 Children and Family Services rather than the
24 Department of Health to perform certain functions with
25 respect to child protection cases; requiring certain
26 hospitals to notify the Department of Children and
27 Family Services of compliance; amending s. 395.1041,
28 F.S., relating to hospital emergency services and
29 care; deleting obsolete provisions; repealing s.
30 395.1046, F.S., relating to complaint investigation
31 procedures; amending s. 395.1055, F.S.; requiring
32 licensed facility beds to conform to standards
33 specified by the Agency for Health Care
34 Administration, the Florida Building Code, and the
35 Florida Fire Prevention Code; amending s. 395.10972,
36 F.S.; revising a reference to the Florida Society of
37 Healthcare Risk Management to conform to the current
38 designation; amending s. 395.2050, F.S.; revising a
39 reference to the federal Health Care Financing
40 Administration to conform to the current designation;
41 amending s. 395.3036, F.S.; correcting a reference;
42 repealing s. 395.3037, F.S., relating to redundant
43 definitions; amending ss. 154.11, 394.741, 395.3038,
44 400.925, 400.9935, 408.05, 440.13, 627.645, 627.668,
45 627.669, 627.736, 641.495, and 766.1015, F.S.;
46 revising references to the Joint Commission on
47 Accreditation of Healthcare Organizations, the
48 Commission on Accreditation of Rehabilitation
49 Facilities, and the Council on Accreditation to
50 conform to their current designations; amending s.
51 395.602, F.S.; revising the definition of the term
52 “rural hospital” to delete an obsolete provision;
53 amending s. 400.021, F.S.; revising the definition of
54 the terms “geriatric outpatient clinic” and “resident
55 care plan”; amending s. 400.0255, F.S.; correcting an
56 obsolete cross-reference to administrative rules;
57 amending s. 400.063, F.S.; deleting an obsolete
58 provision; amending ss. 400.071 and 400.0712, F.S.;
59 revising applicability of general licensure
60 requirements under part II of ch. 408, F.S., to
61 applications for nursing home licensure; revising
62 provisions governing inactive licenses; amending s.
63 400.111, F.S.; providing for disclosure of controlling
64 interest of a nursing home facility upon request by
65 the Agency for Health Care Administration; amending s.
66 400.1183, F.S.; revising grievance record maintenance
67 and reporting requirements for nursing homes; amending
68 s. 400.141, F.S.; providing criteria for the provision
69 of respite services by nursing homes; requiring a
70 written plan of care; requiring a contract for
71 services; requiring resident release to caregivers to
72 be designated in writing; providing an exemption to
73 the application of discharge planning rules; providing
74 for residents’ rights; providing for use of personal
75 medications; providing terms of respite stay;
76 providing for communication of patient information;
77 requiring a physician’s order for care and proof of a
78 physical examination; providing for services for
79 respite patients and duties of facilities with respect
80 to such patients; conforming a cross-reference;
81 requiring facilities to maintain clinical records that
82 meet specified standards; providing a fine relating to
83 an admissions moratorium; deleting requirement for
84 facilities to submit certain information related to
85 management companies to the agency; deleting a
86 requirement for facilities to notify the agency of
87 certain bankruptcy filings to conform to changes made
88 by the act; amending s. 400.142, F.S.; deleting
89 language relating to agency adoption of rules;
90 amending 400.147, F.S.; revising reporting
91 requirements for licensed nursing home facilities
92 relating to adverse incidents; repealing s. 400.148,
93 F.S., relating to the Medicaid “Up-or-Out” Quality of
94 Care Contract Management Program; amending s. 400.179,
95 F.S.; deleting an obsolete provision; amending s.
96 400.19, F.S.; revising inspection requirements;
97 amending s. 400.23, F.S.; deleting an obsolete
98 provision; correcting a reference; deleting a
99 requirement that the rules for minimum standards of
100 care for persons under 21 years of age include a
101 certain methodology; directing the agency to adopt
102 rules for minimum staffing standards in nursing homes
103 that serve persons under 21 years of age; providing
104 minimum staffing standards; amending s. 400.275, F.S.;
105 revising agency duties with regard to training nursing
106 home surveyor teams; revising requirements for team
107 members; amending s. 400.484, F.S.; revising the
108 schedule of home health agency inspection violations;
109 amending s. 400.606, F.S.; revising the content
110 requirements of the plan accompanying an initial or
111 change-of-ownership application for licensure of a
112 hospice; revising requirements relating to
113 certificates of need for certain hospice facilities;
114 amending s. 400.607, F.S.; revising grounds for agency
115 action against a hospice; amending s. 400.915, F.S.;
116 correcting an obsolete cross-reference to
117 administrative rules; amending s. 400.931, F.S.;
118 deleting a requirement that an applicant for a home
119 medical equipment provider license submit a surety
120 bond to the agency; amending s. 400.932, F.S.;
121 revising grounds for the imposition of administrative
122 penalties for certain violations by an employee of a
123 home medical equipment provider; amending s. 400.967,
124 F.S.; revising the schedule of inspection violations
125 for intermediate care facilities for the
126 developmentally disabled; providing a penalty for
127 certain violations; amending s. 400.9905, F.S.;
128 revising the definitions of the terms “clinic” and
129 “portable equipment provider”; providing that part X
130 of ch. 400, F.S., the Health Care Clinic Act, does not
131 apply to certain clinical facilities, an entity owned
132 by a corporation with a specified amount of annual
133 sales of health care services under certain
134 circumstances, or an entity owned or controlled by a
135 publicly traded entity with a specified amount of
136 annual revenues; amending s. 400.991, F.S.; conforming
137 terminology; revising application requirements
138 relating to documentation of financial ability to
139 operate a mobile clinic; amending s. 408.034, F.S.;
140 revising agency authority relating to licensing of
141 intermediate care facilities for the developmentally
142 disabled; amending s. 408.036, F.S.; deleting an
143 exemption from certain certificate-of-need review
144 requirements for a hospice or a hospice inpatient
145 facility; amending s. 408.043, F.S.; revising
146 requirements for certain freestanding inpatient
147 hospice care facilities to obtain a certificate of
148 need; amending s. 408.061, F.S.; revising health care
149 facility data reporting requirements; amending s.
150 408.10, F.S.; removing agency authority to investigate
151 certain consumer complaints; amending s. 408.802,
152 F.S.; removing applicability of part II of ch. 408,
153 F.S., relating to general licensure requirements, to
154 private review agents; amending s. 408.804, F.S.;
155 providing penalties for altering, defacing, or
156 falsifying a license certificate issued by the agency
157 or displaying such an altered, defaced, or falsified
158 certificate; amending s. 408.806, F.S.; revising
159 agency responsibilities for notification of licensees
160 of impending expiration of a license; requiring
161 payment of a late fee for a license application to be
162 considered complete under certain circumstances;
163 amending s. 408.813, F.S.; authorizing the agency to
164 impose fines for unclassified violations of part II of
165 ch. 408, F.S.; amending s. 408.815, F.S.; authorizing
166 the agency to extend a license expiration date under
167 certain circumstances; amending s. 409.91196, F.S.;
168 conforming a cross-reference; amending s. 409.912,
169 F.S.; revising procedures for implementation of a
170 Medicaid prescribed-drug spending-control program;
171 amending s. 409.91255, F.S.; transferring
172 administrative responsibility for the application
173 procedure for federally qualified health centers from
174 the Department of Health to the Agency for Health Care
175 Administration; requiring the Florida Association of
176 Community Health Centers, Inc., to provide support and
177 assume administrative costs for the program; amending
178 s. 429.07, F.S.; deleting the requirement for an
179 assisted living facility to obtain an additional
180 license in order to provide limited nursing services;
181 deleting the requirement for the agency to conduct
182 quarterly monitoring visits of facilities that hold a
183 license to provide extended congregate care services;
184 deleting the requirement for the department to report
185 annually on the status of and recommendations related
186 to extended congregate care; deleting the requirement
187 for the agency to conduct monitoring visits at least
188 twice a year to facilities providing limited nursing
189 services; increasing the licensure fees and the
190 maximum fee required for the standard license;
191 increasing the licensure fees for the extended
192 congregate care license; eliminating the license fee
193 for the limited nursing services license; transferring
194 from another provision of law the requirement that a
195 biennial survey of an assisted living facility include
196 specific actions to determine whether the facility is
197 adequately protecting residents’ rights; providing
198 that under specified conditions an assisted living
199 facility that has a class I or class II violation is
200 subject to periodic unannounced monitoring; requiring
201 a registered nurse to participate in certain
202 monitoring visits; amending s. 429.11, F.S.; revising
203 licensure application requirements for assisted living
204 facilities to eliminate provisional licenses; amending
205 s. 429.12, F.S.; deleting a requirement that a
206 transferor of an assisted living facility advise the
207 transferee to submit a plan for correction of certain
208 deficiencies to the Agency for Health Care
209 Administration before ownership of the facility is
210 transferred; amending s. 429.17, F.S.; deleting
211 provisions relating to the limited nursing services
212 license; revising agency responsibilities regarding
213 the issuance of conditional licenses; amending s.
214 429.19, F.S.; clarifying that a monitoring fee may be
215 assessed in addition to an administrative fine;
216 amending s. 429.23, F.S.; deleting reporting
217 requirements for assisted living facilities relating
218 to liability claims; amending s. 429.255, F.S.;
219 eliminating provisions authorizing the use of
220 volunteers to provide certain health-care-related
221 services in assisted living facilities; authorizing
222 assisted living facilities to provide limited nursing
223 services; requiring an assisted living facility to be
224 responsible for certain recordkeeping and staff to be
225 trained to monitor residents receiving certain health
226 care-related services; amending s. 429.28, F.S.;
227 deleting a requirement for a biennial survey of an
228 assisted living facility, to conform to changes made
229 by the act; conforming a cross-reference; amending s.
230 429.35, F.S.; authorizing the agency to provide
231 certain information relating to the inspections of
232 assisted living facilities electronically or through
233 the agency’s Internet website; amending s. 429.41,
234 F.S., relating to rulemaking; conforming provisions to
235 changes made by the act; amending s. 429.53, F.S.;
236 revising provisions relating to consultation by the
237 agency; revising a definition; amending s. 429.54,
238 F.S.; requiring licensed assisted living facilities to
239 electronically report certain data semiannually to the
240 agency in accordance with rules adopted by the
241 department; amending s. 429.71, F.S.; revising
242 schedule of inspection violations for adult family
243 care homes; amending s. 429.915, F.S.; revising agency
244 responsibilities regarding the issuance of conditional
245 licenses; repealing s. 440.102(9)(d), F.S., relating
246 to a laboratory’s requirement to submit to the Agency
247 for Health Care Administration a monthly report
248 containing statistical information regarding the
249 testing of employees and job applicants; amending s.
250 483.294, F.S.; revising frequency of agency
251 inspections of multiphasic health testing centers;
252 amending s. 626.9541, F.S.; authorizing an insurer
253 offering a group or individual health benefit plan to
254 offer a wellness program; authorizing rewards or
255 incentives; providing for verification of a member’s
256 inability to participate for medical reasons;
257 providing that such rewards or incentives are not
258 insurance benefits; amending s. 766.202, F.S.; adding
259 persons licensed under part XIV of ch. 468, F.S., to
260 the definition of “health care provider”; amending ss.
261 394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
262 conforming terminology and references to changes made
263 by the act; revising a reference; providing an
264 effective date.
265
266 Be It Enacted by the Legislature of the State of Florida:
267
268 Section 1. Present paragraphs (f) through (k) of subsection
269 (10) of section 112.0455, Florida Statutes, are redesignated as
270 paragraphs (e) through (j), respectively, and present paragraph
271 (e) of subsection (10), subsection (12), and paragraph (e) of
272 subsection (14) of that section are amended to read:
273 112.0455 Drug-Free Workplace Act.—
274 (10) EMPLOYER PROTECTION.—
275 (e) Nothing in this section shall be construed to operate
276 retroactively, and nothing in this section shall abrogate the
277 right of an employer under state law to conduct drug tests prior
278 to January 1, 1990. A drug test conducted by an employer prior
279 to January 1, 1990, is not subject to this section.
280 (12) DRUG-TESTING STANDARDS; LABORATORIES.—
281 (a) The requirements of part II of chapter 408 apply to the
282 provision of services that require licensure pursuant to this
283 section and part II of chapter 408 and to entities licensed by
284 or applying for such licensure from the Agency for Health Care
285 Administration pursuant to this section. A license issued by the
286 agency is required in order to operate a laboratory.
287 (b) A laboratory may analyze initial or confirmation drug
288 specimens only if:
289 1. The laboratory is licensed and approved by the Agency
290 for Health Care Administration using criteria established by the
291 United States Department of Health and Human Services as general
292 guidelines for modeling the state drug testing program and in
293 accordance with part II of chapter 408. Each applicant for
294 licensure and licensee must comply with all requirements of part
295 II of chapter 408.
296 2. The laboratory has written procedures to ensure chain of
297 custody.
298 3. The laboratory follows proper quality control
299 procedures, including, but not limited to:
300 a. The use of internal quality controls including the use
301 of samples of known concentrations which are used to check the
302 performance and calibration of testing equipment, and periodic
303 use of blind samples for overall accuracy.
304 b. An internal review and certification process for drug
305 test results, conducted by a person qualified to perform that
306 function in the testing laboratory.
307 c. Security measures implemented by the testing laboratory
308 to preclude adulteration of specimens and drug test results.
309 d. Other necessary and proper actions taken to ensure
310 reliable and accurate drug test results.
311 (c) A laboratory shall disclose to the employer a written
312 test result report within 7 working days after receipt of the
313 sample. All laboratory reports of a drug test result shall, at a
314 minimum, state:
315 1. The name and address of the laboratory which performed
316 the test and the positive identification of the person tested.
317 2. Positive results on confirmation tests only, or negative
318 results, as applicable.
319 3. A list of the drugs for which the drug analyses were
320 conducted.
321 4. The type of tests conducted for both initial and
322 confirmation tests and the minimum cutoff levels of the tests.
323 5. Any correlation between medication reported by the
324 employee or job applicant pursuant to subparagraph (8)(b)2. and
325 a positive confirmed drug test result.
326
327 No report shall disclose the presence or absence of any drug
328 other than a specific drug and its metabolites listed pursuant
329 to this section.
330 (d) The laboratory shall submit to the Agency for Health
331 Care Administration a monthly report with statistical
332 information regarding the testing of employees and job
333 applicants. The reports shall include information on the methods
334 of analyses conducted, the drugs tested for, the number of
335 positive and negative results for both initial and confirmation
336 tests, and any other information deemed appropriate by the
337 Agency for Health Care Administration. No monthly report shall
338 identify specific employees or job applicants.
339 (d)(e) Laboratories shall provide technical assistance to
340 the employer, employee, or job applicant for the purpose of
341 interpreting any positive confirmed test results which could
342 have been caused by prescription or nonprescription medication
343 taken by the employee or job applicant.
344 (14) DISCIPLINE REMEDIES.—
345 (e) Upon resolving an appeal filed pursuant to paragraph
346 (c), and finding a violation of this section, the commission may
347 order the following relief:
348 1. Rescind the disciplinary action, expunge related records
349 from the personnel file of the employee or job applicant and
350 reinstate the employee.
351 2. Order compliance with paragraph (10)(f)(g).
352 3. Award back pay and benefits.
353 4. Award the prevailing employee or job applicant the
354 necessary costs of the appeal, reasonable attorney’s fees, and
355 expert witness fees.
356 Section 2. Paragraph (n) of subsection (1) of section
357 154.11, Florida Statutes, is amended to read:
358 154.11 Powers of board of trustees.—
359 (1) The board of trustees of each public health trust shall
360 be deemed to exercise a public and essential governmental
361 function of both the state and the county and in furtherance
362 thereof it shall, subject to limitation by the governing body of
363 the county in which such board is located, have all of the
364 powers necessary or convenient to carry out the operation and
365 governance of designated health care facilities, including, but
366 without limiting the generality of, the foregoing:
367 (n) To appoint originally the staff of physicians to
368 practice in any designated facility owned or operated by the
369 board and to approve the bylaws and rules to be adopted by the
370 medical staff of any designated facility owned and operated by
371 the board, such governing regulations to be in accordance with
372 the standards of the Joint Commission on the Accreditation of
373 Hospitals which provide, among other things, for the method of
374 appointing additional staff members and for the removal of staff
375 members.
376 Section 3. Section 383.325, Florida Statutes, is repealed.
377 Section 4. Subsection (7) of section 394.4787, Florida
378 Statutes, is amended to read:
379 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
380 394.4789.—As used in this section and ss. 394.4786, 394.4788,
381 and 394.4789:
382 (7) “Specialty psychiatric hospital” means a hospital
383 licensed by the agency pursuant to s. 395.002(26)(28) and part
384 II of chapter 408 as a specialty psychiatric hospital.
385 Section 5. Subsection (2) of section 394.741, Florida
386 Statutes, is amended to read:
387 394.741 Accreditation requirements for providers of
388 behavioral health care services.—
389 (2) Notwithstanding any provision of law to the contrary,
390 accreditation shall be accepted by the agency and department in
391 lieu of the agency’s and department’s facility licensure onsite
392 review requirements and shall be accepted as a substitute for
393 the department’s administrative and program monitoring
394 requirements, except as required by subsections (3) and (4),
395 for:
396 (a) Any organization from which the department purchases
397 behavioral health care services that is accredited by the Joint
398 Commission on Accreditation of Healthcare Organizations or the
399 Council on Accreditation for Children and Family Services, or
400 has those services that are being purchased by the department
401 accredited by the Commission on Accreditation of Rehabilitation
402 Facilities CARF—the Rehabilitation Accreditation Commission.
403 (b) Any mental health facility licensed by the agency or
404 any substance abuse component licensed by the department that is
405 accredited by the Joint Commission on Accreditation of
406 Healthcare Organizations, the Commission on Accreditation of
407 Rehabilitation Facilities CARF—the Rehabilitation Accreditation
408 Commission, or the Council on Accreditation of Children and
409 Family Services.
410 (c) Any network of providers from which the department or
411 the agency purchases behavioral health care services accredited
412 by the Joint Commission on Accreditation of Healthcare
413 Organizations, the Commission on Accreditation of Rehabilitation
414 Facilities CARF—the Rehabilitation Accreditation Commission, the
415 Council on Accreditation of Children and Family Services, or the
416 National Committee for Quality Assurance. A provider
417 organization, which is part of an accredited network, is
418 afforded the same rights under this part.
419 Section 6. Present subsections (15) through (32) of section
420 395.002, Florida Statutes, are renumbered as subsections (14)
421 through (28), respectively, and present subsections (1), (14),
422 (24), (30), and (31) and paragraph (c) of present subsection
423 (28) of that section are amended to read:
424 395.002 Definitions.—As used in this chapter:
425 (1) “Accrediting organizations” means nationally recognized
426 or approved accrediting organizations whose standards
427 incorporate comparable licensure requirements as determined by
428 the agency the Joint Commission on Accreditation of Healthcare
429 Organizations, the American Osteopathic Association, the
430 Commission on Accreditation of Rehabilitation Facilities, and
431 the Accreditation Association for Ambulatory Health Care, Inc.
432 (14) “Initial denial determination” means a determination
433 by a private review agent that the health care services
434 furnished or proposed to be furnished to a patient are
435 inappropriate, not medically necessary, or not reasonable.
436 (24) “Private review agent” means any person or entity
437 which performs utilization review services for third-party
438 payors on a contractual basis for outpatient or inpatient
439 services. However, the term shall not include full-time
440 employees, personnel, or staff of health insurers, health
441 maintenance organizations, or hospitals, or wholly owned
442 subsidiaries thereof or affiliates under common ownership, when
443 performing utilization review for their respective hospitals,
444 health maintenance organizations, or insureds of the same
445 insurance group. For this purpose, health insurers, health
446 maintenance organizations, and hospitals, or wholly owned
447 subsidiaries thereof or affiliates under common ownership,
448 include such entities engaged as administrators of self
449 insurance as defined in s. 624.031.
450 (26)(28) “Specialty hospital” means any facility which
451 meets the provisions of subsection (12), and which regularly
452 makes available either:
453 (c) Intensive residential treatment programs for children
454 and adolescents as defined in subsection (14) (15).
455 (30) “Utilization review” means a system for reviewing the
456 medical necessity or appropriateness in the allocation of health
457 care resources of hospital services given or proposed to be
458 given to a patient or group of patients.
459 (31) “Utilization review plan” means a description of the
460 policies and procedures governing utilization review activities
461 performed by a private review agent.
462 Section 7. Paragraph (c) of subsection (1) and paragraph
463 (b) of subsection (2) of section 395.003, Florida Statutes, are
464 amended to read:
465 395.003 Licensure; denial, suspension, and revocation.—
466 (1)
467 (c) Until July 1, 2006, additional emergency departments
468 located off the premises of licensed hospitals may not be
469 authorized by the agency.
470 (2)
471 (b) The agency shall, at the request of a licensee that is
472 a teaching hospital as defined in s. 408.07(45), issue a single
473 license to a licensee for facilities that have been previously
474 licensed as separate premises, provided such separately licensed
475 facilities, taken together, constitute the same premises as
476 defined in s. 395.002(22)(23). Such license for the single
477 premises shall include all of the beds, services, and programs
478 that were previously included on the licenses for the separate
479 premises. The granting of a single license under this paragraph
480 shall not in any manner reduce the number of beds, services, or
481 programs operated by the licensee.
482 Section 8. Paragraph (e) of subsection (2) and subsection
483 (4) of section 395.0193, Florida Statutes, are amended to read:
484 395.0193 Licensed facilities; peer review; disciplinary
485 powers; agency or partnership with physicians.—
486 (2) Each licensed facility, as a condition of licensure,
487 shall provide for peer review of physicians who deliver health
488 care services at the facility. Each licensed facility shall
489 develop written, binding procedures by which such peer review
490 shall be conducted. Such procedures shall include:
491 (e) Recording of agendas and minutes which do not contain
492 confidential material, for review by the Division of Medical
493 Quality Assurance of the department Health Quality Assurance of
494 the agency.
495 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
496 actions taken under subsection (3) shall be reported in writing
497 to the Division of Medical Quality Assurance of the department
498 Health Quality Assurance of the agency within 30 working days
499 after its initial occurrence, regardless of the pendency of
500 appeals to the governing board of the hospital. The notification
501 shall identify the disciplined practitioner, the action taken,
502 and the reason for such action. All final disciplinary actions
503 taken under subsection (3), if different from those which were
504 reported to the department agency within 30 days after the
505 initial occurrence, shall be reported within 10 working days to
506 the Division of Medical Quality Assurance of the department
507 Health Quality Assurance of the agency in writing and shall
508 specify the disciplinary action taken and the specific grounds
509 therefor. The division shall review each report and determine
510 whether it potentially involved conduct by the licensee that is
511 subject to disciplinary action, in which case s. 456.073 shall
512 apply. The reports are not subject to inspection under s.
513 119.07(1) even if the division’s investigation results in a
514 finding of probable cause.
515 Section 9. Section 395.1023, Florida Statutes, is amended
516 to read:
517 395.1023 Child abuse and neglect cases; duties.—Each
518 licensed facility shall adopt a protocol that, at a minimum,
519 requires the facility to:
520 (1) Incorporate a facility policy that every staff member
521 has an affirmative duty to report, pursuant to chapter 39, any
522 actual or suspected case of child abuse, abandonment, or
523 neglect; and
524 (2) In any case involving suspected child abuse,
525 abandonment, or neglect, designate, at the request of the
526 Department of Children and Family Services, a staff physician to
527 act as a liaison between the hospital and the Department of
528 Children and Family Services office which is investigating the
529 suspected abuse, abandonment, or neglect, and the child
530 protection team, as defined in s. 39.01, when the case is
531 referred to such a team.
532
533 Each general hospital and appropriate specialty hospital shall
534 comply with the provisions of this section and shall notify the
535 agency and the Department of Children and Family Services of its
536 compliance by sending a copy of its policy to the agency and the
537 Department of Children and Family Services as required by rule.
538 The failure by a general hospital or appropriate specialty
539 hospital to comply shall be punished by a fine not exceeding
540 $1,000, to be fixed, imposed, and collected by the agency. Each
541 day in violation is considered a separate offense.
542 Section 10. Subsection (2) and paragraph (d) of subsection
543 (3) of section 395.1041, Florida Statutes, are amended to read:
544 395.1041 Access to emergency services and care.—
545 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
546 shall establish and maintain an inventory of hospitals with
547 emergency services. The inventory shall list all services within
548 the service capability of the hospital, and such services shall
549 appear on the face of the hospital license. Each hospital having
550 emergency services shall notify the agency of its service
551 capability in the manner and form prescribed by the agency. The
552 agency shall use the inventory to assist emergency medical
553 services providers and others in locating appropriate emergency
554 medical care. The inventory shall also be made available to the
555 general public. On or before August 1, 1992, the agency shall
556 request that each hospital identify the services which are
557 within its service capability. On or before November 1, 1992,
558 the agency shall notify each hospital of the service capability
559 to be included in the inventory. The hospital has 15 days from
560 the date of receipt to respond to the notice. By December 1,
561 1992, the agency shall publish a final inventory. Each hospital
562 shall reaffirm its service capability when its license is
563 renewed and shall notify the agency of the addition of a new
564 service or the termination of a service prior to a change in its
565 service capability.
566 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
567 FACILITY OR HEALTH CARE PERSONNEL.—
568 (d)1. Every hospital shall ensure the provision of services
569 within the service capability of the hospital, at all times,
570 either directly or indirectly through an arrangement with
571 another hospital, through an arrangement with one or more
572 physicians, or as otherwise made through prior arrangements. A
573 hospital may enter into an agreement with another hospital for
574 purposes of meeting its service capability requirement, and
575 appropriate compensation or other reasonable conditions may be
576 negotiated for these backup services.
577 2. If any arrangement requires the provision of emergency
578 medical transportation, such arrangement must be made in
579 consultation with the applicable provider and may not require
580 the emergency medical service provider to provide transportation
581 that is outside the routine service area of that provider or in
582 a manner that impairs the ability of the emergency medical
583 service provider to timely respond to prehospital emergency
584 calls.
585 3. A hospital shall not be required to ensure service
586 capability at all times as required in subparagraph 1. if, prior
587 to the receiving of any patient needing such service capability,
588 such hospital has demonstrated to the agency that it lacks the
589 ability to ensure such capability and it has exhausted all
590 reasonable efforts to ensure such capability through backup
591 arrangements. In reviewing a hospital’s demonstration of lack of
592 ability to ensure service capability, the agency shall consider
593 factors relevant to the particular case, including the
594 following:
595 a. Number and proximity of hospitals with the same service
596 capability.
597 b. Number, type, credentials, and privileges of
598 specialists.
599 c. Frequency of procedures.
600 d. Size of hospital.
601 4. The agency shall publish proposed rules implementing a
602 reasonable exemption procedure by November 1, 1992. Subparagraph
603 1. shall become effective upon the effective date of said rules
604 or January 31, 1993, whichever is earlier. For a period not to
605 exceed 1 year from the effective date of subparagraph 1., a
606 hospital requesting an exemption shall be deemed to be exempt
607 from offering the service until the agency initially acts to
608 deny or grant the original request. The agency has 45 days after
609 from the date of receipt of the request to approve or deny the
610 request. After the first year from the effective date of
611 subparagraph 1., If the agency fails to initially act within
612 that the time period, the hospital is deemed to be exempt from
613 offering the service until the agency initially acts to deny the
614 request.
615 Section 11. Section 395.1046, Florida Statutes, is
616 repealed.
617 Section 12. Paragraph (e) of subsection (1) of section
618 395.1055, Florida Statutes, is amended to read:
619 395.1055 Rules and enforcement.—
620 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
621 and 120.54 to implement the provisions of this part, which shall
622 include reasonable and fair minimum standards for ensuring that:
623 (e) Licensed facility beds conform to minimum space,
624 equipment, and furnishings standards as specified by the agency,
625 the Florida Building Code, and the Florida Fire Prevention Code
626 department.
627 Section 13. Subsection (1) of section 395.10972, Florida
628 Statutes, is amended to read:
629 395.10972 Health Care Risk Manager Advisory Council.—The
630 Secretary of Health Care Administration may appoint a seven
631 member advisory council to advise the agency on matters
632 pertaining to health care risk managers. The members of the
633 council shall serve at the pleasure of the secretary. The
634 council shall designate a chair. The council shall meet at the
635 call of the secretary or at those times as may be required by
636 rule of the agency. The members of the advisory council shall
637 receive no compensation for their services, but shall be
638 reimbursed for travel expenses as provided in s. 112.061. The
639 council shall consist of individuals representing the following
640 areas:
641 (1) Two shall be active health care risk managers,
642 including one risk manager who is recommended by and a member of
643 the Florida Society for of Healthcare Risk Management and
644 Patient Safety.
645 Section 14. Subsection (3) of section 395.2050, Florida
646 Statutes, is amended to read:
647 395.2050 Routine inquiry for organ and tissue donation;
648 certification for procurement activities; death records review.—
649 (3) Each organ procurement organization designated by the
650 federal Centers for Medicare and Medicaid Services Health Care
651 Financing Administration and licensed by the state shall conduct
652 an annual death records review in the organ procurement
653 organization’s affiliated donor hospitals. The organ procurement
654 organization shall enlist the services of every Florida licensed
655 tissue bank and eye bank affiliated with or providing service to
656 the donor hospital and operating in the same service area to
657 participate in the death records review.
658 Section 15. Subsection (2) of section 395.3036, Florida
659 Statutes, is amended to read:
660 395.3036 Confidentiality of records and meetings of
661 corporations that lease public hospitals or other public health
662 care facilities.—The records of a private corporation that
663 leases a public hospital or other public health care facility
664 are confidential and exempt from the provisions of s. 119.07(1)
665 and s. 24(a), Art. I of the State Constitution, and the meetings
666 of the governing board of a private corporation are exempt from
667 s. 286.011 and s. 24(b), Art. I of the State Constitution when
668 the public lessor complies with the public finance
669 accountability provisions of s. 155.40(5) with respect to the
670 transfer of any public funds to the private lessee and when the
671 private lessee meets at least three of the five following
672 criteria:
673 (2) The public lessor and the private lessee do not
674 commingle any of their funds in any account maintained by either
675 of them, other than the payment of the rent and administrative
676 fees or the transfer of funds pursuant to s. 155.40 subsection
677 (2).
678 Section 16. Section 395.3037, Florida Statutes, is
679 repealed.
680 Section 17. Subsections (1), (4), and (5) of section
681 395.3038, Florida Statutes, are amended to read:
682 395.3038 State-listed primary stroke centers and
683 comprehensive stroke centers; notification of hospitals.—
684 (1) The agency shall make available on its website and to
685 the department a list of the name and address of each hospital
686 that meets the criteria for a primary stroke center and the name
687 and address of each hospital that meets the criteria for a
688 comprehensive stroke center. The list of primary and
689 comprehensive stroke centers shall include only those hospitals
690 that attest in an affidavit submitted to the agency that the
691 hospital meets the named criteria, or those hospitals that
692 attest in an affidavit submitted to the agency that the hospital
693 is certified as a primary or a comprehensive stroke center by
694 the Joint Commission on Accreditation of Healthcare
695 Organizations.
696 (4) The agency shall adopt by rule criteria for a primary
697 stroke center which are substantially similar to the
698 certification standards for primary stroke centers of the Joint
699 Commission on Accreditation of Healthcare Organizations.
700 (5) The agency shall adopt by rule criteria for a
701 comprehensive stroke center. However, if the Joint Commission on
702 Accreditation of Healthcare Organizations establishes criteria
703 for a comprehensive stroke center, the agency shall establish
704 criteria for a comprehensive stroke center which are
705 substantially similar to those criteria established by the Joint
706 Commission on Accreditation of Healthcare Organizations.
707 Section 18. Paragraph (e) of subsection (2) of section
708 395.602, Florida Statutes, is amended to read:
709 395.602 Rural hospitals.—
710 (2) DEFINITIONS.—As used in this part:
711 (e) “Rural hospital” means an acute care hospital licensed
712 under this chapter, having 100 or fewer licensed beds and an
713 emergency room, which is:
714 1. The sole provider within a county with a population
715 density of no greater than 100 persons per square mile;
716 2. An acute care hospital, in a county with a population
717 density of no greater than 100 persons per square mile, which is
718 at least 30 minutes of travel time, on normally traveled roads
719 under normal traffic conditions, from any other acute care
720 hospital within the same county;
721 3. A hospital supported by a tax district or subdistrict
722 whose boundaries encompass a population of 100 persons or fewer
723 per square mile;
724 4. A hospital in a constitutional charter county with a
725 population of over 1 million persons that has imposed a local
726 option health service tax pursuant to law and in an area that
727 was directly impacted by a catastrophic event on August 24,
728 1992, for which the Governor of Florida declared a state of
729 emergency pursuant to chapter 125, and has 120 beds or less that
730 serves an agricultural community with an emergency room
731 utilization of no less than 20,000 visits and a Medicaid
732 inpatient utilization rate greater than 15 percent;
733 4.5. A hospital with a service area that has a population
734 of 100 persons or fewer per square mile. As used in this
735 subparagraph, the term “service area” means the fewest number of
736 zip codes that account for 75 percent of the hospital’s
737 discharges for the most recent 5-year period, based on
738 information available from the hospital inpatient discharge
739 database in the Florida Center for Health Information and Policy
740 Analysis at the Agency for Health Care Administration; or
741 5.6. A hospital designated as a critical access hospital,
742 as defined in s. 408.07(15).
743
744 Population densities used in this paragraph must be based upon
745 the most recently completed United States census. A hospital
746 that received funds under s. 409.9116 for a quarter beginning no
747 later than July 1, 2002, is deemed to have been and shall
748 continue to be a rural hospital from that date through June 30,
749 2015, if the hospital continues to have 100 or fewer licensed
750 beds and an emergency room, or meets the criteria of
751 subparagraph 4. An acute care hospital that has not previously
752 been designated as a rural hospital and that meets the criteria
753 of this paragraph shall be granted such designation upon
754 application, including supporting documentation to the Agency
755 for Health Care Administration.
756 Section 19. Subsections (8) and (16) of section 400.021,
757 Florida Statutes, are amended to read:
758 400.021 Definitions.—When used in this part, unless the
759 context otherwise requires, the term:
760 (8) “Geriatric outpatient clinic” means a site for
761 providing outpatient health care to persons 60 years of age or
762 older, which is staffed by a registered nurse or a physician
763 assistant, or a licensed practical nurse under the direct
764 supervision of a registered nurse, advanced registered nurse
765 practitioner, or physician.
766 (16) “Resident care plan” means a written plan developed,
767 maintained, and reviewed not less than quarterly by a registered
768 nurse, with participation from other facility staff and the
769 resident or his or her designee or legal representative, which
770 includes a comprehensive assessment of the needs of an
771 individual resident; the type and frequency of services required
772 to provide the necessary care for the resident to attain or
773 maintain the highest practicable physical, mental, and
774 psychosocial well-being; a listing of services provided within
775 or outside the facility to meet those needs; and an explanation
776 of service goals. The resident care plan must be signed by the
777 director of nursing or another registered nurse employed by the
778 facility to whom institutional responsibilities have been
779 delegated and by the resident, the resident’s designee, or the
780 resident’s legal representative. The facility may not use an
781 agency or temporary registered nurse to satisfy the foregoing
782 requirement and must document the institutional responsibilities
783 that have been delegated to the registered nurse.
784 Section 20. Paragraph (g) of subsection (2) of section
785 400.0239, Florida Statutes, is amended to read:
786 400.0239 Quality of Long-Term Care Facility Improvement
787 Trust Fund.—
788 (2) Expenditures from the trust fund shall be allowable for
789 direct support of the following:
790 (g) Other initiatives authorized by the Centers for
791 Medicare and Medicaid Services for the use of federal civil
792 monetary penalties, including projects recommended through the
793 Medicaid “Up-or-Out” Quality of Care Contract Management Program
794 pursuant to s. 400.148.
795 Section 21. Subsection (15) of section 400.0255, Florida
796 Statutes, is amended to read
797 400.0255 Resident transfer or discharge; requirements and
798 procedures; hearings.—
799 (15)(a) The department’s Office of Appeals Hearings shall
800 conduct hearings under this section. The office shall notify the
801 facility of a resident’s request for a hearing.
802 (b) The department shall, by rule, establish procedures to
803 be used for fair hearings requested by residents. These
804 procedures shall be equivalent to the procedures used for fair
805 hearings for other Medicaid cases appearing in s. 409.285 and
806 applicable rules, chapter 10-2, part VI, Florida Administrative
807 Code. The burden of proof must be clear and convincing evidence.
808 A hearing decision must be rendered within 90 days after receipt
809 of the request for hearing.
810 (c) If the hearing decision is favorable to the resident
811 who has been transferred or discharged, the resident must be
812 readmitted to the facility’s first available bed.
813 (d) The decision of the hearing officer shall be final. Any
814 aggrieved party may appeal the decision to the district court of
815 appeal in the appellate district where the facility is located.
816 Review procedures shall be conducted in accordance with the
817 Florida Rules of Appellate Procedure.
818 Section 22. Subsection (2) of section 400.063, Florida
819 Statutes, is amended to read:
820 400.063 Resident protection.—
821 (2) The agency is authorized to establish for each
822 facility, subject to intervention by the agency, a separate bank
823 account for the deposit to the credit of the agency of any
824 moneys received from the Health Care Trust Fund or any other
825 moneys received for the maintenance and care of residents in the
826 facility, and the agency is authorized to disburse moneys from
827 such account to pay obligations incurred for the purposes of
828 this section. The agency is authorized to requisition moneys
829 from the Health Care Trust Fund in advance of an actual need for
830 cash on the basis of an estimate by the agency of moneys to be
831 spent under the authority of this section. Any bank account
832 established under this section need not be approved in advance
833 of its creation as required by s. 17.58, but shall be secured by
834 depository insurance equal to or greater than the balance of
835 such account or by the pledge of collateral security in
836 conformance with criteria established in s. 18.11. The agency
837 shall notify the Chief Financial Officer of any such account so
838 established and shall make a quarterly accounting to the Chief
839 Financial Officer for all moneys deposited in such account.
840 Section 23. Subsections (1) and (5) of section 400.071,
841 Florida Statutes, are amended to read:
842 400.071 Application for license.—
843 (1) In addition to the requirements of part II of chapter
844 408, the application for a license shall be under oath and must
845 contain the following:
846 (a) The location of the facility for which a license is
847 sought and an indication, as in the original application, that
848 such location conforms to the local zoning ordinances.
849 (b) A signed affidavit disclosing any financial or
850 ownership interest that a controlling interest as defined in
851 part II of chapter 408 has held in the last 5 years in any
852 entity licensed by this state or any other state to provide
853 health or residential care which has closed voluntarily or
854 involuntarily; has filed for bankruptcy; has had a receiver
855 appointed; has had a license denied, suspended, or revoked; or
856 has had an injunction issued against it which was initiated by a
857 regulatory agency. The affidavit must disclose the reason any
858 such entity was closed, whether voluntarily or involuntarily.
859 (c) The total number of beds and the total number of
860 Medicare and Medicaid certified beds.
861 (b)(d) Information relating to the applicant and employees
862 which the agency requires by rule. The applicant must
863 demonstrate that sufficient numbers of qualified staff, by
864 training or experience, will be employed to properly care for
865 the type and number of residents who will reside in the
866 facility.
867 (e) Copies of any civil verdict or judgment involving the
868 applicant rendered within the 10 years preceding the
869 application, relating to medical negligence, violation of
870 residents’ rights, or wrongful death. As a condition of
871 licensure, the licensee agrees to provide to the agency copies
872 of any new verdict or judgment involving the applicant, relating
873 to such matters, within 30 days after filing with the clerk of
874 the court. The information required in this paragraph shall be
875 maintained in the facility’s licensure file and in an agency
876 database which is available as a public record.
877 (5) As a condition of licensure, each facility must
878 establish and submit with its application a plan for quality
879 assurance and for conducting risk management.
880 Section 24. Section 400.0712, Florida Statutes, is amended
881 to read:
882 400.0712 Application for inactive license.—
883 (1) As specified in this section, the agency may issue an
884 inactive license to a nursing home facility for all or a portion
885 of its beds. Any request by a licensee that a nursing home or
886 portion of a nursing home become inactive must be submitted to
887 the agency in the approved format. The facility may not initiate
888 any suspension of services, notify residents, or initiate
889 inactivity before receiving approval from the agency; and a
890 licensee that violates this provision may not be issued an
891 inactive license.
892 (1)(2) In addition to the powers granted under part II of
893 chapter 408, the agency may issue an inactive license for a
894 portion of the total beds to a nursing home that chooses to use
895 an unoccupied contiguous portion of the facility for an
896 alternative use to meet the needs of elderly persons through the
897 use of less restrictive, less institutional services.
898 (a) An inactive license issued under this subsection may be
899 granted for a period not to exceed the current licensure
900 expiration date but may be renewed by the agency at the time of
901 licensure renewal.
902 (b) A request to extend the inactive license must be
903 submitted to the agency in the approved format and approved by
904 the agency in writing.
905 (c) Nursing homes that receive an inactive license to
906 provide alternative services shall not receive preference for
907 participation in the Assisted Living for the Elderly Medicaid
908 waiver.
909 (2)(3) The agency shall adopt rules pursuant to ss.
910 120.536(1) and 120.54 necessary to implement this section.
911 Section 25. Section 400.111, Florida Statutes, is amended
912 to read:
913 400.111 Disclosure of controlling interest.—In addition to
914 the requirements of part II of chapter 408, when requested by
915 the agency, the licensee shall submit a signed affidavit
916 disclosing any financial or ownership interest that a
917 controlling interest has held within the last 5 years in any
918 entity licensed by the state or any other state to provide
919 health or residential care which entity has closed voluntarily
920 or involuntarily; has filed for bankruptcy; has had a receiver
921 appointed; has had a license denied, suspended, or revoked; or
922 has had an injunction issued against it which was initiated by a
923 regulatory agency. The affidavit must disclose the reason such
924 entity was closed, whether voluntarily or involuntarily.
925 Section 26. Subsection (2) of section 400.1183, Florida
926 Statutes, is amended to read:
927 400.1183 Resident grievance procedures.—
928 (2) Each facility shall maintain records of all grievances
929 and shall retain a log for agency inspection of report to the
930 agency at the time of relicensure the total number of grievances
931 handled during the prior licensure period, a categorization of
932 the cases underlying the grievances, and the final disposition
933 of the grievances.
934 Section 27. Paragraphs (o) through (w) of subsection (1) of
935 section 400.141, Florida Statutes, are redesignated as
936 paragraphs (n) through (u), respectively, and present paragraphs
937 (f), (g), (j), (n), (o), and (r) of that subsection are amended,
938 to read:
939 400.141 Administration and management of nursing home
940 facilities.—
941 (1) Every licensed facility shall comply with all
942 applicable standards and rules of the agency and shall:
943 (f) Be allowed and encouraged by the agency to provide
944 other needed services under certain conditions. If the facility
945 has a standard licensure status, and has had no class I or class
946 II deficiencies during the past 2 years or has been awarded a
947 Gold Seal under the program established in s. 400.235, it may be
948 encouraged by the agency to provide services, including, but not
949 limited to, respite and adult day services, which enable
950 individuals to move in and out of the facility. A facility is
951 not subject to any additional licensure requirements for
952 providing these services, under the following conditions:.
953 1. Respite care may be offered to persons in need of short
954 term or temporary nursing home services. For each person
955 admitted under the respite care program, the facility licensee
956 must:
957 a. Have a written abbreviated plan of care that, at a
958 minimum, includes nutritional requirements, medication orders,
959 physician orders, nursing assessments, and dietary preferences.
960 The nursing or physician assessments may take the place of all
961 other assessments required for full-time residents.
962 b. Have a contract that, at a minimum, specifies the
963 services to be provided to the respite resident, including
964 charges for services, activities, equipment, emergency medical
965 services, and the administration of medications. If multiple
966 respite admissions for a single person are anticipated, the
967 original contract is valid for 1 year after the date of
968 execution.
969 c. Ensure that each resident is released to his or her
970 caregiver or an individual designated in writing by the
971 caregiver.
972 2. A person admitted under the respite care program is:
973 a. Exempt from requirements in rule related to discharge
974 planning.
975 b. Covered by the residents’ rights set forth in s.
976 400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
977 shall not be considered trust funds subject to the requirements
978 of s. 400.022(1)(h) until the resident has been in the facility
979 for more than 14 consecutive days.
980 c. Allowed to use his or her personal medications for the
981 respite stay if permitted by facility policy. The facility must
982 obtain a physician’s order for the medications. The caregiver
983 may provide information regarding the medications as part of the
984 nursing assessment and that information must agree with the
985 physician’s order. Medications shall be released with the
986 resident upon discharge in accordance with current physician’s
987 orders.
988 3. A person receiving respite care is entitled to reside in
989 the facility for a total of 60 days within a contract year or
990 within a calendar year if the contract is for less than 12
991 months. However, each single stay may not exceed 14 days. If a
992 stay exceeds 14 consecutive days, the facility must comply with
993 all assessment and care planning requirements applicable to
994 nursing home residents.
995 4. A person receiving respite care must reside in a
996 licensed nursing home bed.
997 5. A prospective respite resident must provide medical
998 information from a physician, a physician assistant, or a nurse
999 practitioner and other information from the primary caregiver as
1000 may be required by the facility prior to or at the time of
1001 admission to receive respite care. The medical information must
1002 include a physician’s order for respite care and proof of a
1003 physical examination by a licensed physician, physician
1004 assistant, or nurse practitioner. The physician’s order and
1005 physical examination may be used to provide intermittent respite
1006 care for up to 12 months after the date the order is written.
1007 6. The facility must assume the duties of the primary
1008 caregiver. To ensure continuity of care and services, the
1009 resident is entitled to retain his or her personal physician and
1010 must have access to medically necessary services such as
1011 physical therapy, occupational therapy, or speech therapy, as
1012 needed. The facility must arrange for transportation to these
1013 services if necessary. Respite care must be provided in
1014 accordance with this part and rules adopted by the agency.
1015 However, the agency shall, by rule, adopt modified requirements
1016 for resident assessment, resident care plans, resident
1017 contracts, physician orders, and other provisions, as
1018 appropriate, for short-term or temporary nursing home services.
1019 7. The agency shall allow for shared programming and staff
1020 in a facility which meets minimum standards and offers services
1021 pursuant to this paragraph, but, if the facility is cited for
1022 deficiencies in patient care, may require additional staff and
1023 programs appropriate to the needs of service recipients. A
1024 person who receives respite care may not be counted as a
1025 resident of the facility for purposes of the facility’s licensed
1026 capacity unless that person receives 24-hour respite care. A
1027 person receiving either respite care for 24 hours or longer or
1028 adult day services must be included when calculating minimum
1029 staffing for the facility. Any costs and revenues generated by a
1030 nursing home facility from nonresidential programs or services
1031 shall be excluded from the calculations of Medicaid per diems
1032 for nursing home institutional care reimbursement.
1033 (g) If the facility has a standard license or is a Gold
1034 Seal facility, exceeds the minimum required hours of licensed
1035 nursing and certified nursing assistant direct care per resident
1036 per day, and is part of a continuing care facility licensed
1037 under chapter 651 or a retirement community that offers other
1038 services pursuant to part III of this chapter or part I or part
1039 III of chapter 429 on a single campus, be allowed to share
1040 programming and staff. At the time of inspection and in the
1041 semiannual report required pursuant to paragraph (o), A
1042 continuing care facility or retirement community that uses this
1043 option must demonstrate through staffing records that minimum
1044 staffing requirements for the facility were met. Licensed nurses
1045 and certified nursing assistants who work in the nursing home
1046 facility may be used to provide services elsewhere on campus if
1047 the facility exceeds the minimum number of direct care hours
1048 required per resident per day and the total number of residents
1049 receiving direct care services from a licensed nurse or a
1050 certified nursing assistant does not cause the facility to
1051 violate the staffing ratios required under s. 400.23(3)(a).
1052 Compliance with the minimum staffing ratios shall be based on
1053 total number of residents receiving direct care services,
1054 regardless of where they reside on campus. If the facility
1055 receives a conditional license, it may not share staff until the
1056 conditional license status ends. This paragraph does not
1057 restrict the agency’s authority under federal or state law to
1058 require additional staff if a facility is cited for deficiencies
1059 in care which are caused by an insufficient number of certified
1060 nursing assistants or licensed nurses. The agency may adopt
1061 rules for the documentation necessary to determine compliance
1062 with this provision.
1063 (j) Keep full records of resident admissions and
1064 discharges; medical and general health status, including medical
1065 records, personal and social history, and identity and address
1066 of next of kin or other persons who may have responsibility for
1067 the affairs of the residents; and individual resident care plans
1068 including, but not limited to, prescribed services, service
1069 frequency and duration, and service goals. The records shall be
1070 open to inspection by the agency. The facility must maintain
1071 clinical records on each resident in accordance with accepted
1072 professional standards and practices that are complete,
1073 accurately documented, readily accessible, and systematically
1074 organized.
1075 (n) Submit to the agency the information specified in s.
1076 400.071(1)(b) for a management company within 30 days after the
1077 effective date of the management agreement.
1078 (n)(o)1. Submit semiannually to the agency, or more
1079 frequently if requested by the agency, information regarding
1080 facility staff-to-resident ratios, staff turnover, and staff
1081 stability, including information regarding certified nursing
1082 assistants, licensed nurses, the director of nursing, and the
1083 facility administrator. For purposes of this reporting:
1084 a. Staff-to-resident ratios must be reported in the
1085 categories specified in s. 400.23(3)(a) and applicable rules.
1086 The ratio must be reported as an average for the most recent
1087 calendar quarter.
1088 b. Staff turnover must be reported for the most recent 12
1089 month period ending on the last workday of the most recent
1090 calendar quarter prior to the date the information is submitted.
1091 The turnover rate must be computed quarterly, with the annual
1092 rate being the cumulative sum of the quarterly rates. The
1093 turnover rate is the total number of terminations or separations
1094 experienced during the quarter, excluding any employee
1095 terminated during a probationary period of 3 months or less,
1096 divided by the total number of staff employed at the end of the
1097 period for which the rate is computed, and expressed as a
1098 percentage.
1099 c. The formula for determining staff stability is the total
1100 number of employees that have been employed for more than 12
1101 months, divided by the total number of employees employed at the
1102 end of the most recent calendar quarter, and expressed as a
1103 percentage.
1104 d. A nursing facility that has failed to comply with state
1105 minimum-staffing requirements for 2 consecutive days is
1106 prohibited from accepting new admissions until the facility has
1107 achieved the minimum-staffing requirements for a period of 6
1108 consecutive days. For the purposes of this sub-subparagraph, any
1109 person who was a resident of the facility and was absent from
1110 the facility for the purpose of receiving medical care at a
1111 separate location or was on a leave of absence is not considered
1112 a new admission. Failure to impose such an admissions moratorium
1113 is subject to a $1,000 fine constitutes a class II deficiency.
1114 2.e. A nursing facility which does not have a conditional
1115 license may be cited for failure to comply with the standards in
1116 s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
1117 standards on 2 consecutive days or if it has failed to meet at
1118 least 97 percent of those standards on any one day.
1119 3.f. A facility which has a conditional license must be in
1120 compliance with the standards in s. 400.23(3)(a) at all times.
1121 (r)2. This subsection paragraph does not limit the agency’s
1122 ability to impose a deficiency or take other actions if a
1123 facility does not have enough staff to meet the residents’
1124 needs.
1125 (r) Report to the agency any filing for bankruptcy
1126 protection by the facility or its parent corporation,
1127 divestiture or spin-off of its assets, or corporate
1128 reorganization within 30 days after the completion of such
1129 activity.
1130 Section 28. Subsection (3) of section 400.142, Florida
1131 Statutes, is amended to read:
1132 400.142 Emergency medication kits; orders not to
1133 resuscitate.—
1134 (3) Facility staff may withhold or withdraw cardiopulmonary
1135 resuscitation if presented with an order not to resuscitate
1136 executed pursuant to s. 401.45. The agency shall adopt rules
1137 providing for the implementation of such orders. Facility staff
1138 and facilities shall not be subject to criminal prosecution or
1139 civil liability, nor be considered to have engaged in negligent
1140 or unprofessional conduct, for withholding or withdrawing
1141 cardiopulmonary resuscitation pursuant to such an order and
1142 rules adopted by the agency. The absence of an order not to
1143 resuscitate executed pursuant to s. 401.45 does not preclude a
1144 physician from withholding or withdrawing cardiopulmonary
1145 resuscitation as otherwise permitted by law.
1146 Section 29. Present subsections (9), (11), (12), (13),
1147 (14), and (15) of section 400.147, Florida Statutes, are
1148 renumbered as subsections (8), (9), (10), (11), (12), and (13),
1149 respectively, and present subsections (7), (8), and (10) of that
1150 section are amended to read:
1151 400.147 Internal risk management and quality assurance
1152 program.—
1153 (7) The facility shall initiate an investigation and shall
1154 notify the agency within 1 business day after the risk manager
1155 or his or her designee has received a report pursuant to
1156 paragraph (1)(d). Each facility shall complete the investigation
1157 and submit a report to the agency within 15 calendar days if the
1158 incident is determined to be an adverse incident as defined in
1159 subsection (5). The notification must be made in writing and be
1160 provided electronically, by facsimile device or overnight mail
1161 delivery. The agency shall develop a form for reporting this
1162 information, and the notification must include the name of the
1163 risk manager of the facility, information regarding the identity
1164 of the affected resident, the type of adverse incident, the
1165 initiation of an investigation by the facility, and whether the
1166 events causing or resulting in the adverse incident represent a
1167 potential risk to any other resident. The notification is
1168 confidential as provided by law and is not discoverable or
1169 admissible in any civil or administrative action, except in
1170 disciplinary proceedings by the agency or the appropriate
1171 regulatory board. The agency may investigate, as it deems
1172 appropriate, any such incident and prescribe measures that must
1173 or may be taken in response to the incident. The agency shall
1174 review each report incident and determine whether it potentially
1175 involved conduct by the health care professional who is subject
1176 to disciplinary action, in which case the provisions of s.
1177 456.073 shall apply.
1178 (8)(a) Each facility shall complete the investigation and
1179 submit an adverse incident report to the agency for each adverse
1180 incident within 15 calendar days after its occurrence. If, after
1181 a complete investigation, the risk manager determines that the
1182 incident was not an adverse incident as defined in subsection
1183 (5), the facility shall include this information in the report.
1184 The agency shall develop a form for reporting this information.
1185 (b) The information reported to the agency pursuant to
1186 paragraph (a) which relates to persons licensed under chapter
1187 458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1188 by the agency. The agency shall determine whether any of the
1189 incidents potentially involved conduct by a health care
1190 professional who is subject to disciplinary action, in which
1191 case the provisions of s. 456.073 shall apply.
1192 (c) The report submitted to the agency must also contain
1193 the name of the risk manager of the facility.
1194 (d) The adverse incident report is confidential as provided
1195 by law and is not discoverable or admissible in any civil or
1196 administrative action, except in disciplinary proceedings by the
1197 agency or the appropriate regulatory board.
1198 (10) By the 10th of each month, each facility subject to
1199 this section shall report any notice received pursuant to s.
1200 400.0233(2) and each initial complaint that was filed with the
1201 clerk of the court and served on the facility during the
1202 previous month by a resident or a resident’s family member,
1203 guardian, conservator, or personal legal representative. The
1204 report must include the name of the resident, the resident’s
1205 date of birth and social security number, the Medicaid
1206 identification number for Medicaid-eligible persons, the date or
1207 dates of the incident leading to the claim or dates of
1208 residency, if applicable, and the type of injury or violation of
1209 rights alleged to have occurred. Each facility shall also submit
1210 a copy of the notices received pursuant to s. 400.0233(2) and
1211 complaints filed with the clerk of the court. This report is
1212 confidential as provided by law and is not discoverable or
1213 admissible in any civil or administrative action, except in such
1214 actions brought by the agency to enforce the provisions of this
1215 part.
1216 Section 30. Section 400.148, Florida Statutes, is repealed.
1217 Section 31. Paragraph (e) of subsection (2) of section
1218 400.179, Florida Statutes, is amended to read:
1219 400.179 Liability for Medicaid underpayments and
1220 overpayments.—
1221 (2) Because any transfer of a nursing facility may expose
1222 the fact that Medicaid may have underpaid or overpaid the
1223 transferor, and because in most instances, any such underpayment
1224 or overpayment can only be determined following a formal field
1225 audit, the liabilities for any such underpayments or
1226 overpayments shall be as follows:
1227 (e) For the 2009-2010 fiscal year only, the provisions of
1228 paragraph (d) shall not apply. This paragraph expires July 1,
1229 2010.
1230 Section 32. Subsection (3) of section 400.19, Florida
1231 Statutes, is amended to read:
1232 400.19 Right of entry and inspection.—
1233 (3) The agency shall every 15 months conduct at least one
1234 unannounced inspection to determine compliance by the licensee
1235 with statutes, and with rules promulgated under the provisions
1236 of those statutes, governing minimum standards of construction,
1237 quality and adequacy of care, and rights of residents. The
1238 survey shall be conducted every 6 months for the next 2-year
1239 period if the facility has been cited for a class I deficiency,
1240 has been cited for two or more class II deficiencies arising
1241 from separate surveys or investigations within a 60-day period,
1242 or has had three or more substantiated complaints within a 6
1243 month period, each resulting in at least one class I or class II
1244 deficiency. In addition to any other fees or fines in this part,
1245 the agency shall assess a fine for each facility that is subject
1246 to the 6-month survey cycle. The fine for the 2-year period
1247 shall be $6,000, one-half to be paid at the completion of each
1248 survey. The agency may adjust this fine by the change in the
1249 Consumer Price Index, based on the 12 months immediately
1250 preceding the increase, to cover the cost of the additional
1251 surveys. The agency shall verify through subsequent inspection
1252 that any deficiency identified during inspection is corrected.
1253 However, the agency may verify the correction of a class III or
1254 class IV deficiency unrelated to resident rights or resident
1255 care without reinspecting the facility if adequate written
1256 documentation has been received from the facility, which
1257 provides assurance that the deficiency has been corrected. The
1258 giving or causing to be given of advance notice of such
1259 unannounced inspections by an employee of the agency to any
1260 unauthorized person shall constitute cause for suspension of not
1261 fewer than 5 working days according to the provisions of chapter
1262 110.
1263 Section 33. Subsection (5) of section 400.23, Florida
1264 Statutes, is amended to read:
1265 400.23 Rules; evaluation and deficiencies; licensure
1266 status.—
1267 (5)(a) The agency, in collaboration with the Division of
1268 Children’s Medical Services Network of the Department of Health,
1269 must, no later than December 31, 1993, adopt rules for minimum
1270 standards of care for persons under 21 years of age who reside
1271 in nursing home facilities. The rules must include a methodology
1272 for reviewing a nursing home facility under ss. 408.031-408.045
1273 which serves only persons under 21 years of age. A facility may
1274 be exempt from these standards for specific persons between 18
1275 and 21 years of age, if the person’s physician agrees that
1276 minimum standards of care based on age are not necessary.
1277 (b) The agency, in collaboration with the Division of
1278 Children’s Medical Services Network, shall adopt rules for
1279 minimum staffing requirements for nursing home facilities that
1280 serve persons under 21 years of age, which shall apply in lieu
1281 of the standards contained in subsection (3).
1282 1. For persons under 21 years of age who require skilled
1283 care, the requirements shall include a minimum combined average
1284 of licensed nurses, respiratory therapists, respiratory care
1285 practitioners, and certified nursing assistants of 3.9 hours of
1286 direct care per resident per day for each nursing home facility.
1287 2. For persons under 21 years of age who are fragile, the
1288 requirements shall include a minimum combined average of
1289 licensed nurses, respiratory therapists, respiratory care
1290 practitioners, and certified nursing assistants of 5 hours of
1291 direct care per resident per day for each nursing home facility.
1292 Section 34. Subsection (1) of section 400.275, Florida
1293 Statutes, is amended to read:
1294 400.275 Agency duties.—
1295 (1) The agency shall ensure that each newly hired nursing
1296 home surveyor, as a part of basic training, is assigned full
1297 time to a licensed nursing home for at least 2 days within a 7
1298 day period to observe facility operations outside of the survey
1299 process before the surveyor begins survey responsibilities. Such
1300 observations may not be the sole basis of a deficiency citation
1301 against the facility. The agency may not assign an individual to
1302 be a member of a survey team for purposes of a survey,
1303 evaluation, or consultation visit at a nursing home facility in
1304 which the surveyor was an employee within the preceding 2 5
1305 years.
1306 Section 35. Subsection (2) of section 400.484, Florida
1307 Statutes, is amended to read:
1308 400.484 Right of inspection; violations deficiencies;
1309 fines.—
1310 (2) The agency shall impose fines for various classes of
1311 violations deficiencies in accordance with the following
1312 schedule:
1313 (a) Class I violations are defined in s. 408.813. A class I
1314 deficiency is any act, omission, or practice that results in a
1315 patient’s death, disablement, or permanent injury, or places a
1316 patient at imminent risk of death, disablement, or permanent
1317 injury. Upon finding a class I violation deficiency, the agency
1318 shall impose an administrative fine in the amount of $15,000 for
1319 each occurrence and each day that the violation deficiency
1320 exists.
1321 (b) Class II violations are defined in s. 408.813. A class
1322 II deficiency is any act, omission, or practice that has a
1323 direct adverse effect on the health, safety, or security of a
1324 patient. Upon finding a class II violation deficiency, the
1325 agency shall impose an administrative fine in the amount of
1326 $5,000 for each occurrence and each day that the violation
1327 deficiency exists.
1328 (c) Class III violations are defined in s. 408.813. A class
1329 III deficiency is any act, omission, or practice that has an
1330 indirect, adverse effect on the health, safety, or security of a
1331 patient. Upon finding an uncorrected or repeated class III
1332 violation deficiency, the agency shall impose an administrative
1333 fine not to exceed $1,000 for each occurrence and each day that
1334 the uncorrected or repeated violation deficiency exists.
1335 (d) Class IV violations are defined in s. 408.813. A class
1336 IV deficiency is any act, omission, or practice related to
1337 required reports, forms, or documents which does not have the
1338 potential of negatively affecting patients. These violations are
1339 of a type that the agency determines do not threaten the health,
1340 safety, or security of patients. Upon finding an uncorrected or
1341 repeated class IV violation deficiency, the agency shall impose
1342 an administrative fine not to exceed $500 for each occurrence
1343 and each day that the uncorrected or repeated violation
1344 deficiency exists.
1345 Section 36. Paragraph (i) of subsection (1) and subsection
1346 (4) of section 400.606, Florida Statutes, are amended to read:
1347 400.606 License; application; renewal; conditional license
1348 or permit; certificate of need.—
1349 (1) In addition to the requirements of part II of chapter
1350 408, the initial application and change of ownership application
1351 must be accompanied by a plan for the delivery of home,
1352 residential, and homelike inpatient hospice services to
1353 terminally ill persons and their families. Such plan must
1354 contain, but need not be limited to:
1355 (i) The projected annual operating cost of the hospice.
1356
1357 If the applicant is an existing licensed health care provider,
1358 the application must be accompanied by a copy of the most recent
1359 profit-loss statement and, if applicable, the most recent
1360 licensure inspection report.
1361 (4) A freestanding hospice facility that is primarily
1362 engaged in providing inpatient and related services and that is
1363 not otherwise licensed as a health care facility shall be
1364 required to obtain a certificate of need. However, a
1365 freestanding hospice facility with six or fewer beds shall not
1366 be required to comply with institutional standards such as, but
1367 not limited to, standards requiring sprinkler systems, emergency
1368 electrical systems, or special lavatory devices.
1369 Section 37. Subsection (2) of section 400.607, Florida
1370 Statutes, is amended to read:
1371 400.607 Denial, suspension, revocation of license;
1372 emergency actions; imposition of administrative fine; grounds.—
1373 (2) A violation of this part, part II of chapter 408, or
1374 applicable rules Any of the following actions by a licensed
1375 hospice or any of its employees shall be grounds for
1376 administrative action by the agency against a hospice.:
1377 (a) A violation of the provisions of this part, part II of
1378 chapter 408, or applicable rules.
1379 (b) An intentional or negligent act materially affecting
1380 the health or safety of a patient.
1381 Section 38. Section 400.915, Florida Statutes, is amended
1382 to read:
1383 400.915 Construction and renovation; requirements.—The
1384 requirements for the construction or renovation of a PPEC center
1385 shall comply with:
1386 (1) The provisions of chapter 553, which pertain to
1387 building construction standards, including plumbing, electrical
1388 code, glass, manufactured buildings, accessibility for the
1389 physically disabled;
1390 (2) The provisions of s. 633.022 and applicable rules
1391 pertaining to physical minimum standards for nonresidential
1392 child care physical facilities in rule 10M-12.003, Florida
1393 Administrative Code, Child Care Standards; and
1394 (3) The standards or rules adopted pursuant to this part
1395 and part II of chapter 408.
1396 Section 39. Subsection (1) of section 400.925, Florida
1397 Statutes, is amended to read:
1398 400.925 Definitions.—As used in this part, the term:
1399 (1) “Accrediting organizations” means the Joint Commission
1400 on Accreditation of Healthcare Organizations or other national
1401 accreditation agencies whose standards for accreditation are
1402 comparable to those required by this part for licensure.
1403 Section 40. Subsections (3) through (6) of section 400.931,
1404 Florida Statutes, are renumbered as subsections (2) through (5),
1405 respectively, and present subsection (2) of that section is
1406 amended to read:
1407 400.931 Application for license; fee; provisional license;
1408 temporary permit.—
1409 (2) As an alternative to submitting proof of financial
1410 ability to operate as required in s. 408.810(8), the applicant
1411 may submit a $50,000 surety bond to the agency.
1412 Section 41. Subsection (2) of section 400.932, Florida
1413 Statutes, is amended to read:
1414 400.932 Administrative penalties.—
1415 (2) A violation of this part, part II of chapter 408, or
1416 applicable rules Any of the following actions by an employee of
1417 a home medical equipment provider shall be are grounds for
1418 administrative action or penalties by the agency.:
1419 (a) Violation of this part, part II of chapter 408, or
1420 applicable rules.
1421 (b) An intentional, reckless, or negligent act that
1422 materially affects the health or safety of a patient.
1423 Section 42. Subsection (3) of section 400.967, Florida
1424 Statutes, is amended to read:
1425 400.967 Rules and classification of violations
1426 deficiencies.—
1427 (3) The agency shall adopt rules to provide that, when the
1428 criteria established under this part and part II of chapter 408
1429 are not met, such violations deficiencies shall be classified
1430 according to the nature of the violation deficiency. The agency
1431 shall indicate the classification on the face of the notice of
1432 deficiencies as follows:
1433 (a) Class I violations deficiencies are defined in s.
1434 408.813 those which the agency determines present an imminent
1435 danger to the residents or guests of the facility or a
1436 substantial probability that death or serious physical harm
1437 would result therefrom. The condition or practice constituting a
1438 class I violation must be abated or eliminated immediately,
1439 unless a fixed period of time, as determined by the agency, is
1440 required for correction. A class I violation deficiency is
1441 subject to a civil penalty in an amount not less than $5,000 and
1442 not exceeding $10,000 for each violation deficiency. A fine may
1443 be levied notwithstanding the correction of the violation
1444 deficiency.
1445 (b) Class II violations deficiencies are defined in s.
1446 408.813 those which the agency determines have a direct or
1447 immediate relationship to the health, safety, or security of the
1448 facility residents, other than class I deficiencies. A class II
1449 violation deficiency is subject to a civil penalty in an amount
1450 not less than $1,000 and not exceeding $5,000 for each violation
1451 deficiency. A citation for a class II violation deficiency shall
1452 specify the time within which the violation deficiency must be
1453 corrected. If a class II violation deficiency is corrected
1454 within the time specified, no civil penalty shall be imposed,
1455 unless it is a repeated offense.
1456 (c) Class III violations deficiencies are defined in s.
1457 408.813 those which the agency determines to have an indirect or
1458 potential relationship to the health, safety, or security of the
1459 facility residents, other than class I or class II deficiencies.
1460 A class III violation deficiency is subject to a civil penalty
1461 of not less than $500 and not exceeding $1,000 for each
1462 deficiency. A citation for a class III violation deficiency
1463 shall specify the time within which the violation deficiency
1464 must be corrected. If a class III violation deficiency is
1465 corrected within the time specified, no civil penalty shall be
1466 imposed, unless it is a repeated offense.
1467 (d) Class IV violations are defined in s. 408.813. Upon
1468 finding an uncorrected or repeated class IV violation, the
1469 agency shall impose an administrative fine not to exceed $500
1470 for each occurrence and each day that the uncorrected or
1471 repeated violation exists.
1472 Section 43. Subsections (4) and (7) of section 400.9905,
1473 Florida Statutes, are amended to read:
1474 400.9905 Definitions.—
1475 (4) “Clinic” means an entity at which health care services
1476 are provided to individuals and which tenders charges for
1477 reimbursement for such services, including a mobile clinic and a
1478 portable health service or equipment provider. For purposes of
1479 this part, the term does not include and the licensure
1480 requirements of this part do not apply to:
1481 (a) Entities licensed or registered by the state under
1482 chapter 395; or entities licensed or registered by the state and
1483 providing only health care services within the scope of services
1484 authorized under their respective licenses granted under ss.
1485 383.30-383.335, chapter 390, chapter 394, chapter 397, this
1486 chapter except part X, chapter 429, chapter 463, chapter 465,
1487 chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1488 chapter 651; end-stage renal disease providers authorized under
1489 42 C.F.R. part 405, subpart U; or providers certified under 42
1490 C.F.R. part 485, subpart B or subpart H; or any entity that
1491 provides neonatal or pediatric hospital-based health care
1492 services or other health care services by licensed practitioners
1493 solely within a hospital licensed under chapter 395.
1494 (b) Entities that own, directly or indirectly, entities
1495 licensed or registered by the state pursuant to chapter 395; or
1496 entities that own, directly or indirectly, entities licensed or
1497 registered by the state and providing only health care services
1498 within the scope of services authorized pursuant to their
1499 respective licenses granted under ss. 383.30-383.335, chapter
1500 390, chapter 394, chapter 397, this chapter except part X,
1501 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1502 part I of chapter 483, chapter 484, chapter 651; end-stage renal
1503 disease providers authorized under 42 C.F.R. part 405, subpart
1504 U; or providers certified under 42 C.F.R. part 485, subpart B or
1505 subpart H; or any entity that provides neonatal or pediatric
1506 hospital-based health care services by licensed practitioners
1507 solely within a hospital licensed under chapter 395.
1508 (c) Entities that are owned, directly or indirectly, by an
1509 entity licensed or registered by the state pursuant to chapter
1510 395; or entities that are owned, directly or indirectly, by an
1511 entity licensed or registered by the state and providing only
1512 health care services within the scope of services authorized
1513 pursuant to their respective licenses granted under ss. 383.30
1514 383.335, chapter 390, chapter 394, chapter 397, this chapter
1515 except part X, chapter 429, chapter 463, chapter 465, chapter
1516 466, chapter 478, part I of chapter 483, chapter 484, or chapter
1517 651; end-stage renal disease providers authorized under 42
1518 C.F.R. part 405, subpart U; or providers certified under 42
1519 C.F.R. part 485, subpart B or subpart H; or any entity that
1520 provides neonatal or pediatric hospital-based health care
1521 services by licensed practitioners solely within a hospital
1522 under chapter 395.
1523 (d) Entities that are under common ownership, directly or
1524 indirectly, with an entity licensed or registered by the state
1525 pursuant to chapter 395; or entities that are under common
1526 ownership, directly or indirectly, with an entity licensed or
1527 registered by the state and providing only health care services
1528 within the scope of services authorized pursuant to their
1529 respective licenses granted under ss. 383.30-383.335, chapter
1530 390, chapter 394, chapter 397, this chapter except part X,
1531 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1532 part I of chapter 483, chapter 484, or chapter 651; end-stage
1533 renal disease providers authorized under 42 C.F.R. part 405,
1534 subpart U; or providers certified under 42 C.F.R. part 485,
1535 subpart B or subpart H; or any entity that provides neonatal or
1536 pediatric hospital-based health care services by licensed
1537 practitioners solely within a hospital licensed under chapter
1538 395.
1539 (e) An entity that is exempt from federal taxation under 26
1540 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1541 under 26 U.S.C. s. 409 that has a board of trustees not less
1542 than two-thirds of which are Florida-licensed health care
1543 practitioners and provides only physical therapy services under
1544 physician orders, any community college or university clinic,
1545 and any entity owned or operated by the federal or state
1546 government, including agencies, subdivisions, or municipalities
1547 thereof.
1548 (f) A sole proprietorship, group practice, partnership, or
1549 corporation that provides health care services by physicians
1550 covered by s. 627.419, that is directly supervised by one or
1551 more of such physicians, and that is wholly owned by one or more
1552 of those physicians or by a physician and the spouse, parent,
1553 child, or sibling of that physician.
1554 (g) A sole proprietorship, group practice, partnership, or
1555 corporation that provides health care services by licensed
1556 health care practitioners under chapter 457, chapter 458,
1557 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1558 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1559 chapter 490, chapter 491, or part I, part III, part X, part
1560 XIII, or part XIV of chapter 468, or s. 464.012, which are
1561 wholly owned by one or more licensed health care practitioners,
1562 or the licensed health care practitioners set forth in this
1563 paragraph and the spouse, parent, child, or sibling of a
1564 licensed health care practitioner, so long as one of the owners
1565 who is a licensed health care practitioner is supervising the
1566 business activities and is legally responsible for the entity’s
1567 compliance with all federal and state laws. However, a health
1568 care practitioner may not supervise services beyond the scope of
1569 the practitioner’s license, except that, for the purposes of
1570 this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1571 provides only services authorized pursuant to s. 456.053(3)(b)
1572 may be supervised by a licensee specified in s. 456.053(3)(b).
1573 (h) Clinical facilities affiliated with an accredited
1574 medical school at which training is provided for medical
1575 students, residents, or fellows.
1576 (i) Entities that provide only oncology or radiation
1577 therapy services by physicians licensed under chapter 458 or
1578 chapter 459 or entities that provide oncology or radiation
1579 therapy services by physicians licensed under chapter 458 or
1580 chapter 459 which are owned by a corporation whose shares are
1581 publicly traded on a recognized stock exchange.
1582 (j) Clinical facilities affiliated with a college of
1583 chiropractic accredited by the Council on Chiropractic Education
1584 at which training is provided for chiropractic students.
1585 (k) Entities that provide licensed practitioners to staff
1586 emergency departments or to deliver anesthesia services in
1587 facilities licensed under chapter 395 and that derive at least
1588 90 percent of their gross annual revenues from the provision of
1589 such services. Entities claiming an exemption from licensure
1590 under this paragraph must provide documentation demonstrating
1591 compliance.
1592 (l) Orthotic, or prosthetic, pediatric cardiology, or
1593 perinatology clinical facilities that are a publicly traded
1594 corporation or that are wholly owned, directly or indirectly, by
1595 a publicly traded corporation. As used in this paragraph, a
1596 publicly traded corporation is a corporation that issues
1597 securities traded on an exchange registered with the United
1598 States Securities and Exchange Commission as a national
1599 securities exchange.
1600 (m) Entities that are owned by a corporation that has $250
1601 million or more in total annual sales of health care services
1602 provided by licensed health care practitioners if one or more of
1603 the owners of the entity is a health care practitioner who is
1604 licensed in this state, is responsible for supervising the
1605 business activities of the entity, and is legally responsible
1606 for the entity’s compliance with state law for purposes of this
1607 section.
1608 (n) Entities that are owned or controlled, directly or
1609 indirectly, by a publicly traded entity with $100 million or
1610 more, in the aggregate, in total annual revenues derived from
1611 providing health care services by licensed health care
1612 practitioners that are employed or contracted by an entity
1613 described in this paragraph.
1614 (7) “Portable health service or equipment provider” means
1615 an entity that contracts with or employs persons to provide
1616 portable health services or equipment to multiple locations
1617 performing treatment or diagnostic testing of individuals, that
1618 bills third-party payors for those services, and that otherwise
1619 meets the definition of a clinic in subsection (4).
1620 Section 44. Paragraph (b) of subsection (1) and paragraph
1621 (c) of subsection (4) of section 400.991, Florida Statutes, are
1622 amended to read:
1623 400.991 License requirements; background screenings;
1624 prohibitions.—
1625 (1)
1626 (b) Each mobile clinic must obtain a separate health care
1627 clinic license and must provide to the agency, at least
1628 quarterly, its projected street location to enable the agency to
1629 locate and inspect such clinic. A portable health service or
1630 equipment provider must obtain a health care clinic license for
1631 a single administrative office and is not required to submit
1632 quarterly projected street locations.
1633 (4) In addition to the requirements of part II of chapter
1634 408, the applicant must file with the application satisfactory
1635 proof that the clinic is in compliance with this part and
1636 applicable rules, including:
1637 (c) Proof of financial ability to operate as required under
1638 ss. s. 408.810(8) and 408.8065. As an alternative to submitting
1639 proof of financial ability to operate as required under s.
1640 408.810(8), the applicant may file a surety bond of at least
1641 $500,000 which guarantees that the clinic will act in full
1642 conformity with all legal requirements for operating a clinic,
1643 payable to the agency. The agency may adopt rules to specify
1644 related requirements for such surety bond.
1645 Section 45. Paragraph (g) of subsection (1) and paragraph
1646 (a) of subsection (7) of section 400.9935, Florida Statutes, are
1647 amended to read:
1648 400.9935 Clinic responsibilities.—
1649 (1) Each clinic shall appoint a medical director or clinic
1650 director who shall agree in writing to accept legal
1651 responsibility for the following activities on behalf of the
1652 clinic. The medical director or the clinic director shall:
1653 (g) Conduct systematic reviews of clinic billings to ensure
1654 that the billings are not fraudulent or unlawful. Upon discovery
1655 of an unlawful charge, the medical director or clinic director
1656 shall take immediate corrective action. If the clinic performs
1657 only the technical component of magnetic resonance imaging,
1658 static radiographs, computed tomography, or positron emission
1659 tomography, and provides the professional interpretation of such
1660 services, in a fixed facility that is accredited by the Joint
1661 Commission on Accreditation of Healthcare Organizations or the
1662 Accreditation Association for Ambulatory Health Care, and the
1663 American College of Radiology; and if, in the preceding quarter,
1664 the percentage of scans performed by that clinic which was
1665 billed to all personal injury protection insurance carriers was
1666 less than 15 percent, the chief financial officer of the clinic
1667 may, in a written acknowledgment provided to the agency, assume
1668 the responsibility for the conduct of the systematic reviews of
1669 clinic billings to ensure that the billings are not fraudulent
1670 or unlawful.
1671 (7)(a) Each clinic engaged in magnetic resonance imaging
1672 services must be accredited by the Joint Commission on
1673 Accreditation of Healthcare Organizations, the American College
1674 of Radiology, or the Accreditation Association for Ambulatory
1675 Health Care, within 1 year after licensure. A clinic that is
1676 accredited by the American College of Radiology or is within the
1677 original 1-year period after licensure and replaces its core
1678 magnetic resonance imaging equipment shall be given 1 year after
1679 the date on which the equipment is replaced to attain
1680 accreditation. However, a clinic may request a single, 6-month
1681 extension if it provides evidence to the agency establishing
1682 that, for good cause shown, such clinic cannot be accredited
1683 within 1 year after licensure, and that such accreditation will
1684 be completed within the 6-month extension. After obtaining
1685 accreditation as required by this subsection, each such clinic
1686 must maintain accreditation as a condition of renewal of its
1687 license. A clinic that files a change of ownership application
1688 must comply with the original accreditation timeframe
1689 requirements of the transferor. The agency shall deny a change
1690 of ownership application if the clinic is not in compliance with
1691 the accreditation requirements. When a clinic adds, replaces, or
1692 modifies magnetic resonance imaging equipment and the
1693 accreditation agency requires new accreditation, the clinic must
1694 be accredited within 1 year after the date of the addition,
1695 replacement, or modification but may request a single, 6-month
1696 extension if the clinic provides evidence of good cause to the
1697 agency.
1698 Section 46. Subsection (2) of section 408.034, Florida
1699 Statutes, is amended to read:
1700 408.034 Duties and responsibilities of agency; rules.—
1701 (2) In the exercise of its authority to issue licenses to
1702 health care facilities and health service providers, as provided
1703 under chapters 393 and 395 and parts II, and IV, and VIII of
1704 chapter 400, the agency may not issue a license to any health
1705 care facility or health service provider that fails to receive a
1706 certificate of need or an exemption for the licensed facility or
1707 service.
1708 Section 47. Paragraph (d) of subsection (1) of section
1709 408.036, Florida Statutes, is amended to read:
1710 408.036 Projects subject to review; exemptions.—
1711 (1) APPLICABILITY.—Unless exempt under subsection (3), all
1712 health-care-related projects, as described in paragraphs (a)
1713 (g), are subject to review and must file an application for a
1714 certificate of need with the agency. The agency is exclusively
1715 responsible for determining whether a health-care-related
1716 project is subject to review under ss. 408.031-408.045.
1717 (d) The establishment of a hospice or hospice inpatient
1718 facility, except as provided in s. 408.043.
1719 Section 48. Subsection (2) of section 408.043, Florida
1720 Statutes, is amended to read:
1721 408.043 Special provisions.—
1722 (2) HOSPICES.—When an application is made for a certificate
1723 of need to establish or to expand a hospice, the need for such
1724 hospice shall be determined on the basis of the need for and
1725 availability of hospice services in the community. The formula
1726 on which the certificate of need is based shall discourage
1727 regional monopolies and promote competition. The inpatient
1728 hospice care component of a hospice which is a freestanding
1729 facility, or a part of a facility, which is primarily engaged in
1730 providing inpatient care and related services and is not
1731 licensed as a health care facility shall also be required to
1732 obtain a certificate of need. Provision of hospice care by any
1733 current provider of health care is a significant change in
1734 service and therefore requires a certificate of need for such
1735 services.
1736 Section 49. Paragraph (k) of subsection (3) of section
1737 408.05, Florida Statutes, is amended to read:
1738 408.05 Florida Center for Health Information and Policy
1739 Analysis.—
1740 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
1741 produce comparable and uniform health information and statistics
1742 for the development of policy recommendations, the agency shall
1743 perform the following functions:
1744 (k) Develop, in conjunction with the State Consumer Health
1745 Information and Policy Advisory Council, and implement a long
1746 range plan for making available health care quality measures and
1747 financial data that will allow consumers to compare health care
1748 services. The health care quality measures and financial data
1749 the agency must make available shall include, but is not limited
1750 to, pharmaceuticals, physicians, health care facilities, and
1751 health plans and managed care entities. The agency shall update
1752 the plan and report on the status of its implementation
1753 annually. The agency shall also make the plan and status report
1754 available to the public on its Internet website. As part of the
1755 plan, the agency shall identify the process and timeframes for
1756 implementation, any barriers to implementation, and
1757 recommendations of changes in the law that may be enacted by the
1758 Legislature to eliminate the barriers. As preliminary elements
1759 of the plan, the agency shall:
1760 1. Make available patient-safety indicators, inpatient
1761 quality indicators, and performance outcome and patient charge
1762 data collected from health care facilities pursuant to s.
1763 408.061(1)(a) and (2). The terms “patient-safety indicators” and
1764 “inpatient quality indicators” shall be as defined by the
1765 Centers for Medicare and Medicaid Services, the National Quality
1766 Forum, the Joint Commission on Accreditation of Healthcare
1767 Organizations, the Agency for Healthcare Research and Quality,
1768 the Centers for Disease Control and Prevention, or a similar
1769 national entity that establishes standards to measure the
1770 performance of health care providers, or by other states. The
1771 agency shall determine which conditions, procedures, health care
1772 quality measures, and patient charge data to disclose based upon
1773 input from the council. When determining which conditions and
1774 procedures are to be disclosed, the council and the agency shall
1775 consider variation in costs, variation in outcomes, and
1776 magnitude of variations and other relevant information. When
1777 determining which health care quality measures to disclose, the
1778 agency:
1779 a. Shall consider such factors as volume of cases; average
1780 patient charges; average length of stay; complication rates;
1781 mortality rates; and infection rates, among others, which shall
1782 be adjusted for case mix and severity, if applicable.
1783 b. May consider such additional measures that are adopted
1784 by the Centers for Medicare and Medicaid Studies, National
1785 Quality Forum, the Joint Commission on Accreditation of
1786 Healthcare Organizations, the Agency for Healthcare Research and
1787 Quality, Centers for Disease Control and Prevention, or a
1788 similar national entity that establishes standards to measure
1789 the performance of health care providers, or by other states.
1790
1791 When determining which patient charge data to disclose, the
1792 agency shall include such measures as the average of
1793 undiscounted charges on frequently performed procedures and
1794 preventive diagnostic procedures, the range of procedure charges
1795 from highest to lowest, average net revenue per adjusted patient
1796 day, average cost per adjusted patient day, and average cost per
1797 admission, among others.
1798 2. Make available performance measures, benefit design, and
1799 premium cost data from health plans licensed pursuant to chapter
1800 627 or chapter 641. The agency shall determine which health care
1801 quality measures and member and subscriber cost data to
1802 disclose, based upon input from the council. When determining
1803 which data to disclose, the agency shall consider information
1804 that may be required by either individual or group purchasers to
1805 assess the value of the product, which may include membership
1806 satisfaction, quality of care, current enrollment or membership,
1807 coverage areas, accreditation status, premium costs, plan costs,
1808 premium increases, range of benefits, copayments and
1809 deductibles, accuracy and speed of claims payment, credentials
1810 of physicians, number of providers, names of network providers,
1811 and hospitals in the network. Health plans shall make available
1812 to the agency any such data or information that is not currently
1813 reported to the agency or the office.
1814 3. Determine the method and format for public disclosure of
1815 data reported pursuant to this paragraph. The agency shall make
1816 its determination based upon input from the State Consumer
1817 Health Information and Policy Advisory Council. At a minimum,
1818 the data shall be made available on the agency’s Internet
1819 website in a manner that allows consumers to conduct an
1820 interactive search that allows them to view and compare the
1821 information for specific providers. The website must include
1822 such additional information as is determined necessary to ensure
1823 that the website enhances informed decisionmaking among
1824 consumers and health care purchasers, which shall include, at a
1825 minimum, appropriate guidance on how to use the data and an
1826 explanation of why the data may vary from provider to provider.
1827 4. Publish on its website undiscounted charges for no fewer
1828 than 150 of the most commonly performed adult and pediatric
1829 procedures, including outpatient, inpatient, diagnostic, and
1830 preventative procedures.
1831 Section 50. Paragraph (a) of subsection (1) of section
1832 408.061, Florida Statutes, is amended to read:
1833 408.061 Data collection; uniform systems of financial
1834 reporting; information relating to physician charges;
1835 confidential information; immunity.—
1836 (1) The agency shall require the submission by health care
1837 facilities, health care providers, and health insurers of data
1838 necessary to carry out the agency’s duties. Specifications for
1839 data to be collected under this section shall be developed by
1840 the agency with the assistance of technical advisory panels
1841 including representatives of affected entities, consumers,
1842 purchasers, and such other interested parties as may be
1843 determined by the agency.
1844 (a) Data submitted by health care facilities, including the
1845 facilities as defined in chapter 395, shall include, but are not
1846 limited to: case-mix data, patient admission and discharge data,
1847 hospital emergency department data which shall include the
1848 number of patients treated in the emergency department of a
1849 licensed hospital reported by patient acuity level, data on
1850 hospital-acquired infections as specified by rule, data on
1851 complications as specified by rule, data on readmissions as
1852 specified by rule, with patient and provider-specific
1853 identifiers included, actual charge data by diagnostic groups,
1854 financial data, accounting data, operating expenses, expenses
1855 incurred for rendering services to patients who cannot or do not
1856 pay, interest charges, depreciation expenses based on the
1857 expected useful life of the property and equipment involved, and
1858 demographic data. The agency shall adopt nationally recognized
1859 risk adjustment methodologies or software consistent with the
1860 standards of the Agency for Healthcare Research and Quality and
1861 as selected by the agency for all data submitted as required by
1862 this section. Data may be obtained from documents such as, but
1863 not limited to: leases, contracts, debt instruments, itemized
1864 patient bills, medical record abstracts, and related diagnostic
1865 information. Reported data elements shall be reported
1866 electronically and in accordance with rule 59E-7.012, Florida
1867 Administrative Code. Data submitted shall be certified by the
1868 chief executive officer or an appropriate and duly authorized
1869 representative or employee of the licensed facility that the
1870 information submitted is true and accurate.
1871 Section 51. Subsection (43) of section 408.07, Florida
1872 Statutes, is amended to read:
1873 408.07 Definitions.—As used in this chapter, with the
1874 exception of ss. 408.031-408.045, the term:
1875 (43) “Rural hospital” means an acute care hospital licensed
1876 under chapter 395, having 100 or fewer licensed beds and an
1877 emergency room, and which is:
1878 (a) The sole provider within a county with a population
1879 density of no greater than 100 persons per square mile;
1880 (b) An acute care hospital, in a county with a population
1881 density of no greater than 100 persons per square mile, which is
1882 at least 30 minutes of travel time, on normally traveled roads
1883 under normal traffic conditions, from another acute care
1884 hospital within the same county;
1885 (c) A hospital supported by a tax district or subdistrict
1886 whose boundaries encompass a population of 100 persons or fewer
1887 per square mile;
1888 (d) A hospital with a service area that has a population of
1889 100 persons or fewer per square mile. As used in this paragraph,
1890 the term “service area” means the fewest number of zip codes
1891 that account for 75 percent of the hospital’s discharges for the
1892 most recent 5-year period, based on information available from
1893 the hospital inpatient discharge database in the Florida Center
1894 for Health Information and Policy Analysis at the Agency for
1895 Health Care Administration; or
1896 (e) A critical access hospital.
1897
1898 Population densities used in this subsection must be based upon
1899 the most recently completed United States census. A hospital
1900 that received funds under s. 409.9116 for a quarter beginning no
1901 later than July 1, 2002, is deemed to have been and shall
1902 continue to be a rural hospital from that date through June 30,
1903 2015, if the hospital continues to have 100 or fewer licensed
1904 beds and an emergency room, or meets the criteria of s.
1905 395.602(2)(e)4. An acute care hospital that has not previously
1906 been designated as a rural hospital and that meets the criteria
1907 of this subsection shall be granted such designation upon
1908 application, including supporting documentation, to the Agency
1909 for Health Care Administration.
1910 Section 52. Section 408.10, Florida Statutes, is amended to
1911 read:
1912 408.10 Consumer complaints.—The agency shall:
1913 (1) publish and make available to the public a toll-free
1914 telephone number for the purpose of handling consumer complaints
1915 and shall serve as a liaison between consumer entities and other
1916 private entities and governmental entities for the disposition
1917 of problems identified by consumers of health care.
1918 (2) Be empowered to investigate consumer complaints
1919 relating to problems with health care facilities’ billing
1920 practices and issue reports to be made public in any cases where
1921 the agency determines the health care facility has engaged in
1922 billing practices which are unreasonable and unfair to the
1923 consumer.
1924 Section 53. Subsections (12) through (30) of section
1925 408.802, Florida Statutes, are renumbered as subsections (11)
1926 through (29), respectively, and present subsection (11) of that
1927 section is amended to read:
1928 408.802 Applicability.—The provisions of this part apply to
1929 the provision of services that require licensure as defined in
1930 this part and to the following entities licensed, registered, or
1931 certified by the agency, as described in chapters 112, 383, 390,
1932 394, 395, 400, 429, 440, 483, and 765:
1933 (11) Private review agents, as provided under part I of
1934 chapter 395.
1935 Section 54. Subsection (3) is added to section 408.804,
1936 Florida Statutes, to read:
1937 408.804 License required; display.—
1938 (3) Any person who knowingly alters, defaces, or falsifies
1939 a license certificate issued by the agency, or causes or
1940 procures any person to commit such an offense, commits a
1941 misdemeanor of the second degree, punishable as provided in s.
1942 775.082 or s 775.083. Any licensee or provider who displays an
1943 altered, defaced, or falsified license certificate is subject to
1944 the penalties set forth in s. 408.815 and an administrative fine
1945 of $1,000 for each day of illegal display.
1946 Section 55. Paragraph (d) of subsection (2) of section
1947 408.806, Florida Statutes, is amended, to read:
1948 408.806 License application process.—
1949 (2)
1950 (d) The agency shall notify the licensee by mail or
1951 electronically at least 90 days before the expiration of a
1952 license that a renewal license is necessary to continue
1953 operation. The licensee’s failure to timely file submit a
1954 renewal application and license application fee with the agency
1955 shall result in a $50 per day late fee charged to the licensee
1956 by the agency; however, the aggregate amount of the late fee may
1957 not exceed 50 percent of the licensure fee or $500, whichever is
1958 less. The agency shall provide a courtesy notice to the licensee
1959 by United States mail, electronically, or by any other manner at
1960 its address of record or mailing address, if provided, at least
1961 90 days prior to the expiration of a license informing the
1962 licensee of the expiration of the license. If the agency does
1963 not provide the courtesy notice or the licensee does not receive
1964 the courtesy notice, the licensee continues to be legally
1965 obligated to timely file the renewal application and license
1966 application fee with the agency and is not excused from the
1967 payment of a late fee. If an application is received after the
1968 required filing date and exhibits a hand-canceled postmark
1969 obtained from a United States post office dated on or before the
1970 required filing date, no fine will be levied. Payment of the
1971 late fee is required in order for a late application to be
1972 considered complete, and failure to pay the late fee is
1973 considered an omission from the application.
1974 Section 56. Subsection (3) is added to section 408.813,
1975 Florida Statutes, to read:
1976 408.813 Administrative fines; violations.—As a penalty for
1977 any violation of this part, authorizing statutes, or applicable
1978 rules, the agency may impose an administrative fine.
1979 (3) The agency may impose an administrative fine for a
1980 violation that is not designated as a class I, class II, class
1981 III, or class IV violation. Unless otherwise specified by law,
1982 the amount of the fine shall not exceed $500 for each violation.
1983 Unclassified violations may include:
1984 (a) Violating any term or condition of a license.
1985 (b) Violating any provision of this part, authorizing
1986 statutes, or applicable rules.
1987 (c) Exceeding licensed capacity.
1988 (d) Providing services beyond the scope of the license.
1989 (e) Violating a moratorium imposed pursuant to s. 408.814.
1990 Section 57. Subsection (5) is added to section 408.815,
1991 Florida Statutes, to read:
1992 408.815 License or application denial; revocation.—
1993 (5) In order to ensure the health, safety, and welfare of
1994 clients when a license has been denied, revoked, or is set to
1995 terminate, the agency may extend the license expiration date for
1996 a period of up to 30 days for the sole purpose of allowing the
1997 safe and orderly discharge of clients. The agency may impose
1998 conditions on the extension, including, but not limited to,
1999 prohibiting or limiting admissions, expedited discharge
2000 planning, required status reports, and mandatory monitoring by
2001 the agency or third parties. When imposing these conditions, the
2002 agency shall take into consideration the nature and number of
2003 clients, the availability and location of acceptable alternative
2004 placements, and the ability of the licensee to continue
2005 providing care to the clients. The agency may terminate the
2006 extension or modify the conditions at any time. This authority
2007 is in addition to any other authority granted to the agency
2008 under chapter 120, this part, and authorizing statutes but
2009 creates no right or entitlement to an extension of a license
2010 expiration date.
2011 Section 58. Subsection (1) of section 409.91196, Florida
2012 Statutes, is amended to read:
2013 409.91196 Supplemental rebate agreements; public records
2014 and public meetings exemption.—
2015 (1) The rebate amount, percent of rebate, manufacturer’s
2016 pricing, and supplemental rebate, and other trade secrets as
2017 defined in s. 688.002 that the agency has identified for use in
2018 negotiations, held by the Agency for Health Care Administration
2019 under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2020 119.07(1) and s. 24(a), Art. I of the State Constitution.
2021 Section 59. Paragraph (a) of subsection (39) of section
2022 409.912, Florida Statutes, is amended to read:
2023 409.912 Cost-effective purchasing of health care.—The
2024 agency shall purchase goods and services for Medicaid recipients
2025 in the most cost-effective manner consistent with the delivery
2026 of quality medical care. To ensure that medical services are
2027 effectively utilized, the agency may, in any case, require a
2028 confirmation or second physician’s opinion of the correct
2029 diagnosis for purposes of authorizing future services under the
2030 Medicaid program. This section does not restrict access to
2031 emergency services or poststabilization care services as defined
2032 in 42 C.F.R. part 438.114. Such confirmation or second opinion
2033 shall be rendered in a manner approved by the agency. The agency
2034 shall maximize the use of prepaid per capita and prepaid
2035 aggregate fixed-sum basis services when appropriate and other
2036 alternative service delivery and reimbursement methodologies,
2037 including competitive bidding pursuant to s. 287.057, designed
2038 to facilitate the cost-effective purchase of a case-managed
2039 continuum of care. The agency shall also require providers to
2040 minimize the exposure of recipients to the need for acute
2041 inpatient, custodial, and other institutional care and the
2042 inappropriate or unnecessary use of high-cost services. The
2043 agency shall contract with a vendor to monitor and evaluate the
2044 clinical practice patterns of providers in order to identify
2045 trends that are outside the normal practice patterns of a
2046 provider’s professional peers or the national guidelines of a
2047 provider’s professional association. The vendor must be able to
2048 provide information and counseling to a provider whose practice
2049 patterns are outside the norms, in consultation with the agency,
2050 to improve patient care and reduce inappropriate utilization.
2051 The agency may mandate prior authorization, drug therapy
2052 management, or disease management participation for certain
2053 populations of Medicaid beneficiaries, certain drug classes, or
2054 particular drugs to prevent fraud, abuse, overuse, and possible
2055 dangerous drug interactions. The Pharmaceutical and Therapeutics
2056 Committee shall make recommendations to the agency on drugs for
2057 which prior authorization is required. The agency shall inform
2058 the Pharmaceutical and Therapeutics Committee of its decisions
2059 regarding drugs subject to prior authorization. The agency is
2060 authorized to limit the entities it contracts with or enrolls as
2061 Medicaid providers by developing a provider network through
2062 provider credentialing. The agency may competitively bid single
2063 source-provider contracts if procurement of goods or services
2064 results in demonstrated cost savings to the state without
2065 limiting access to care. The agency may limit its network based
2066 on the assessment of beneficiary access to care, provider
2067 availability, provider quality standards, time and distance
2068 standards for access to care, the cultural competence of the
2069 provider network, demographic characteristics of Medicaid
2070 beneficiaries, practice and provider-to-beneficiary standards,
2071 appointment wait times, beneficiary use of services, provider
2072 turnover, provider profiling, provider licensure history,
2073 previous program integrity investigations and findings, peer
2074 review, provider Medicaid policy and billing compliance records,
2075 clinical and medical record audits, and other factors. Providers
2076 shall not be entitled to enrollment in the Medicaid provider
2077 network. The agency shall determine instances in which allowing
2078 Medicaid beneficiaries to purchase durable medical equipment and
2079 other goods is less expensive to the Medicaid program than long
2080 term rental of the equipment or goods. The agency may establish
2081 rules to facilitate purchases in lieu of long-term rentals in
2082 order to protect against fraud and abuse in the Medicaid program
2083 as defined in s. 409.913. The agency may seek federal waivers
2084 necessary to administer these policies.
2085 (39)(a) The agency shall implement a Medicaid prescribed
2086 drug spending-control program that includes the following
2087 components:
2088 1. A Medicaid preferred drug list, which shall be a listing
2089 of cost-effective therapeutic options recommended by the
2090 Medicaid Pharmacy and Therapeutics Committee established
2091 pursuant to s. 409.91195 and adopted by the agency for each
2092 therapeutic class on the preferred drug list. At the discretion
2093 of the committee, and when feasible, the preferred drug list
2094 should include at least two products in a therapeutic class. The
2095 agency may post the preferred drug list and updates to the
2096 preferred drug list on an Internet website without following the
2097 rulemaking procedures of chapter 120. Antiretroviral agents are
2098 excluded from the preferred drug list. The agency shall also
2099 limit the amount of a prescribed drug dispensed to no more than
2100 a 34-day supply unless the drug products’ smallest marketed
2101 package is greater than a 34-day supply, or the drug is
2102 determined by the agency to be a maintenance drug in which case
2103 a 100-day maximum supply may be authorized. The agency is
2104 authorized to seek any federal waivers necessary to implement
2105 these cost-control programs and to continue participation in the
2106 federal Medicaid rebate program, or alternatively to negotiate
2107 state-only manufacturer rebates. The agency may adopt rules to
2108 implement this subparagraph. The agency shall continue to
2109 provide unlimited contraceptive drugs and items. The agency must
2110 establish procedures to ensure that:
2111 a. There is a response to a request for prior consultation
2112 by telephone or other telecommunication device within 24 hours
2113 after receipt of a request for prior consultation; and
2114 b. A 72-hour supply of the drug prescribed is provided in
2115 an emergency or when the agency does not provide a response
2116 within 24 hours as required by sub-subparagraph a.
2117 2. Reimbursement to pharmacies for Medicaid prescribed
2118 drugs shall be set at the lesser of: the average wholesale price
2119 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2120 plus 4.75 percent, the federal upper limit (FUL), the state
2121 maximum allowable cost (SMAC), or the usual and customary (UAC)
2122 charge billed by the provider.
2123 3. For a prescribed drug billed as a 340B prescribed
2124 medication, the claim must meet the requirements of the Deficit
2125 Reduction Act of 2005 and the federal 340B program, contain a
2126 national drug code, and be billed at the actual acquisition cost
2127 or payment shall be denied.
2128 4.3. The agency shall develop and implement a process for
2129 managing the drug therapies of Medicaid recipients who are using
2130 significant numbers of prescribed drugs each month. The
2131 management process may include, but is not limited to,
2132 comprehensive, physician-directed medical-record reviews, claims
2133 analyses, and case evaluations to determine the medical
2134 necessity and appropriateness of a patient’s treatment plan and
2135 drug therapies. The agency may contract with a private
2136 organization to provide drug-program-management services. The
2137 Medicaid drug benefit management program shall include
2138 initiatives to manage drug therapies for HIV/AIDS patients,
2139 patients using 20 or more unique prescriptions in a 180-day
2140 period, and the top 1,000 patients in annual spending. The
2141 agency shall enroll any Medicaid recipient in the drug benefit
2142 management program if he or she meets the specifications of this
2143 provision and is not enrolled in a Medicaid health maintenance
2144 organization.
2145 5.4. The agency may limit the size of its pharmacy network
2146 based on need, competitive bidding, price negotiations,
2147 credentialing, or similar criteria. The agency shall give
2148 special consideration to rural areas in determining the size and
2149 location of pharmacies included in the Medicaid pharmacy
2150 network. A pharmacy credentialing process may include criteria
2151 such as a pharmacy’s full-service status, location, size,
2152 patient educational programs, patient consultation, disease
2153 management services, and other characteristics. The agency may
2154 impose a moratorium on Medicaid pharmacy enrollment when it is
2155 determined that it has a sufficient number of Medicaid
2156 participating providers. The agency must allow dispensing
2157 practitioners to participate as a part of the Medicaid pharmacy
2158 network regardless of the practitioner’s proximity to any other
2159 entity that is dispensing prescription drugs under the Medicaid
2160 program. A dispensing practitioner must meet all credentialing
2161 requirements applicable to his or her practice, as determined by
2162 the agency.
2163 6.5. The agency shall develop and implement a program that
2164 requires Medicaid practitioners who prescribe drugs to use a
2165 counterfeit-proof prescription pad for Medicaid prescriptions.
2166 The agency shall require the use of standardized counterfeit
2167 proof prescription pads by Medicaid-participating prescribers or
2168 prescribers who write prescriptions for Medicaid recipients. The
2169 agency may implement the program in targeted geographic areas or
2170 statewide.
2171 7.6. The agency may enter into arrangements that require
2172 manufacturers of generic drugs prescribed to Medicaid recipients
2173 to provide rebates of at least 15.1 percent of the average
2174 manufacturer price for the manufacturer’s generic products.
2175 These arrangements shall require that if a generic-drug
2176 manufacturer pays federal rebates for Medicaid-reimbursed drugs
2177 at a level below 15.1 percent, the manufacturer must provide a
2178 supplemental rebate to the state in an amount necessary to
2179 achieve a 15.1-percent rebate level.
2180 8.7. The agency may establish a preferred drug list as
2181 described in this subsection, and, pursuant to the establishment
2182 of such preferred drug list, it is authorized to negotiate
2183 supplemental rebates from manufacturers that are in addition to
2184 those required by Title XIX of the Social Security Act and at no
2185 less than 14 percent of the average manufacturer price as
2186 defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2187 the federal or supplemental rebate, or both, equals or exceeds
2188 29 percent. There is no upper limit on the supplemental rebates
2189 the agency may negotiate. The agency may determine that specific
2190 products, brand-name or generic, are competitive at lower rebate
2191 percentages. Agreement to pay the minimum supplemental rebate
2192 percentage will guarantee a manufacturer that the Medicaid
2193 Pharmaceutical and Therapeutics Committee will consider a
2194 product for inclusion on the preferred drug list. However, a
2195 pharmaceutical manufacturer is not guaranteed placement on the
2196 preferred drug list by simply paying the minimum supplemental
2197 rebate. Agency decisions will be made on the clinical efficacy
2198 of a drug and recommendations of the Medicaid Pharmaceutical and
2199 Therapeutics Committee, as well as the price of competing
2200 products minus federal and state rebates. The agency is
2201 authorized to contract with an outside agency or contractor to
2202 conduct negotiations for supplemental rebates. For the purposes
2203 of this section, the term “supplemental rebates” means cash
2204 rebates. Effective July 1, 2004, value-added programs as a
2205 substitution for supplemental rebates are prohibited. The agency
2206 is authorized to seek any federal waivers to implement this
2207 initiative.
2208 9.8. The Agency for Health Care Administration shall expand
2209 home delivery of pharmacy products. To assist Medicaid patients
2210 in securing their prescriptions and reduce program costs, the
2211 agency shall expand its current mail-order-pharmacy diabetes
2212 supply program to include all generic and brand-name drugs used
2213 by Medicaid patients with diabetes. Medicaid recipients in the
2214 current program may obtain nondiabetes drugs on a voluntary
2215 basis. This initiative is limited to the geographic area covered
2216 by the current contract. The agency may seek and implement any
2217 federal waivers necessary to implement this subparagraph.
2218 10.9. The agency shall limit to one dose per month any drug
2219 prescribed to treat erectile dysfunction.
2220 11.10.a. The agency may implement a Medicaid behavioral
2221 drug management system. The agency may contract with a vendor
2222 that has experience in operating behavioral drug management
2223 systems to implement this program. The agency is authorized to
2224 seek federal waivers to implement this program.
2225 b. The agency, in conjunction with the Department of
2226 Children and Family Services, may implement the Medicaid
2227 behavioral drug management system that is designed to improve
2228 the quality of care and behavioral health prescribing practices
2229 based on best practice guidelines, improve patient adherence to
2230 medication plans, reduce clinical risk, and lower prescribed
2231 drug costs and the rate of inappropriate spending on Medicaid
2232 behavioral drugs. The program may include the following
2233 elements:
2234 (I) Provide for the development and adoption of best
2235 practice guidelines for behavioral health-related drugs such as
2236 antipsychotics, antidepressants, and medications for treating
2237 bipolar disorders and other behavioral conditions; translate
2238 them into practice; review behavioral health prescribers and
2239 compare their prescribing patterns to a number of indicators
2240 that are based on national standards; and determine deviations
2241 from best practice guidelines.
2242 (II) Implement processes for providing feedback to and
2243 educating prescribers using best practice educational materials
2244 and peer-to-peer consultation.
2245 (III) Assess Medicaid beneficiaries who are outliers in
2246 their use of behavioral health drugs with regard to the numbers
2247 and types of drugs taken, drug dosages, combination drug
2248 therapies, and other indicators of improper use of behavioral
2249 health drugs.
2250 (IV) Alert prescribers to patients who fail to refill
2251 prescriptions in a timely fashion, are prescribed multiple same
2252 class behavioral health drugs, and may have other potential
2253 medication problems.
2254 (V) Track spending trends for behavioral health drugs and
2255 deviation from best practice guidelines.
2256 (VI) Use educational and technological approaches to
2257 promote best practices, educate consumers, and train prescribers
2258 in the use of practice guidelines.
2259 (VII) Disseminate electronic and published materials.
2260 (VIII) Hold statewide and regional conferences.
2261 (IX) Implement a disease management program with a model
2262 quality-based medication component for severely mentally ill
2263 individuals and emotionally disturbed children who are high
2264 users of care.
2265 12.11.a. The agency shall implement a Medicaid prescription
2266 drug management system. The agency may contract with a vendor
2267 that has experience in operating prescription drug management
2268 systems in order to implement this system. Any management system
2269 that is implemented in accordance with this subparagraph must
2270 rely on cooperation between physicians and pharmacists to
2271 determine appropriate practice patterns and clinical guidelines
2272 to improve the prescribing, dispensing, and use of drugs in the
2273 Medicaid program. The agency may seek federal waivers to
2274 implement this program.
2275 b. The drug management system must be designed to improve
2276 the quality of care and prescribing practices based on best
2277 practice guidelines, improve patient adherence to medication
2278 plans, reduce clinical risk, and lower prescribed drug costs and
2279 the rate of inappropriate spending on Medicaid prescription
2280 drugs. The program must:
2281 (I) Provide for the development and adoption of best
2282 practice guidelines for the prescribing and use of drugs in the
2283 Medicaid program, including translating best practice guidelines
2284 into practice; reviewing prescriber patterns and comparing them
2285 to indicators that are based on national standards and practice
2286 patterns of clinical peers in their community, statewide, and
2287 nationally; and determine deviations from best practice
2288 guidelines.
2289 (II) Implement processes for providing feedback to and
2290 educating prescribers using best practice educational materials
2291 and peer-to-peer consultation.
2292 (III) Assess Medicaid recipients who are outliers in their
2293 use of a single or multiple prescription drugs with regard to
2294 the numbers and types of drugs taken, drug dosages, combination
2295 drug therapies, and other indicators of improper use of
2296 prescription drugs.
2297 (IV) Alert prescribers to patients who fail to refill
2298 prescriptions in a timely fashion, are prescribed multiple drugs
2299 that may be redundant or contraindicated, or may have other
2300 potential medication problems.
2301 (V) Track spending trends for prescription drugs and
2302 deviation from best practice guidelines.
2303 (VI) Use educational and technological approaches to
2304 promote best practices, educate consumers, and train prescribers
2305 in the use of practice guidelines.
2306 (VII) Disseminate electronic and published materials.
2307 (VIII) Hold statewide and regional conferences.
2308 (IX) Implement disease management programs in cooperation
2309 with physicians and pharmacists, along with a model quality
2310 based medication component for individuals having chronic
2311 medical conditions.
2312 13.12. The agency is authorized to contract for drug rebate
2313 administration, including, but not limited to, calculating
2314 rebate amounts, invoicing manufacturers, negotiating disputes
2315 with manufacturers, and maintaining a database of rebate
2316 collections.
2317 14.13. The agency may specify the preferred daily dosing
2318 form or strength for the purpose of promoting best practices
2319 with regard to the prescribing of certain drugs as specified in
2320 the General Appropriations Act and ensuring cost-effective
2321 prescribing practices.
2322 15.14. The agency may require prior authorization for
2323 Medicaid-covered prescribed drugs. The agency may, but is not
2324 required to, prior-authorize the use of a product:
2325 a. For an indication not approved in labeling;
2326 b. To comply with certain clinical guidelines; or
2327 c. If the product has the potential for overuse, misuse, or
2328 abuse.
2329
2330 The agency may require the prescribing professional to provide
2331 information about the rationale and supporting medical evidence
2332 for the use of a drug. The agency may post prior authorization
2333 criteria and protocol and updates to the list of drugs that are
2334 subject to prior authorization on an Internet website without
2335 amending its rule or engaging in additional rulemaking.
2336 16.15. The agency, in conjunction with the Pharmaceutical
2337 and Therapeutics Committee, may require age-related prior
2338 authorizations for certain prescribed drugs. The agency may
2339 preauthorize the use of a drug for a recipient who may not meet
2340 the age requirement or may exceed the length of therapy for use
2341 of this product as recommended by the manufacturer and approved
2342 by the Food and Drug Administration. Prior authorization may
2343 require the prescribing professional to provide information
2344 about the rationale and supporting medical evidence for the use
2345 of a drug.
2346 17.16. The agency shall implement a step-therapy prior
2347 authorization approval process for medications excluded from the
2348 preferred drug list. Medications listed on the preferred drug
2349 list must be used within the previous 12 months prior to the
2350 alternative medications that are not listed. The step-therapy
2351 prior authorization may require the prescriber to use the
2352 medications of a similar drug class or for a similar medical
2353 indication unless contraindicated in the Food and Drug
2354 Administration labeling. The trial period between the specified
2355 steps may vary according to the medical indication. The step
2356 therapy approval process shall be developed in accordance with
2357 the committee as stated in s. 409.91195(7) and (8). A drug
2358 product may be approved without meeting the step-therapy prior
2359 authorization criteria if the prescribing physician provides the
2360 agency with additional written medical or clinical documentation
2361 that the product is medically necessary because:
2362 a. There is not a drug on the preferred drug list to treat
2363 the disease or medical condition which is an acceptable clinical
2364 alternative;
2365 b. The alternatives have been ineffective in the treatment
2366 of the beneficiary’s disease; or
2367 c. Based on historic evidence and known characteristics of
2368 the patient and the drug, the drug is likely to be ineffective,
2369 or the number of doses have been ineffective.
2370
2371 The agency shall work with the physician to determine the best
2372 alternative for the patient. The agency may adopt rules waiving
2373 the requirements for written clinical documentation for specific
2374 drugs in limited clinical situations.
2375 18.17. The agency shall implement a return and reuse
2376 program for drugs dispensed by pharmacies to institutional
2377 recipients, which includes payment of a $5 restocking fee for
2378 the implementation and operation of the program. The return and
2379 reuse program shall be implemented electronically and in a
2380 manner that promotes efficiency. The program must permit a
2381 pharmacy to exclude drugs from the program if it is not
2382 practical or cost-effective for the drug to be included and must
2383 provide for the return to inventory of drugs that cannot be
2384 credited or returned in a cost-effective manner. The agency
2385 shall determine if the program has reduced the amount of
2386 Medicaid prescription drugs which are destroyed on an annual
2387 basis and if there are additional ways to ensure more
2388 prescription drugs are not destroyed which could safely be
2389 reused. The agency’s conclusion and recommendations shall be
2390 reported to the Legislature by December 1, 2005.
2391 Section 60. Section 409.91255, Florida Statutes, is amended
2392 to read:
2393 409.91255 Federally qualified health center access
2394 program.—
2395 (1) SHORT TITLE.—This section may be cited as the
2396 “Community Health Center Access Program Act.”
2397 (2) LEGISLATIVE FINDINGS AND INTENT.—
2398 (a) The Legislature finds that, despite significant
2399 investments in health care programs, nearly 6 more than 2
2400 million low-income Floridians, primarily the working poor and
2401 minority populations, continue to lack access to basic health
2402 care services. Further, the Legislature recognizes that
2403 federally qualified health centers have a proven record of
2404 providing cost-effective, comprehensive primary and preventive
2405 health care and are uniquely qualified to address the lack of
2406 adequate health care services for the uninsured.
2407 (b) It is the intent of the Legislature to recognize the
2408 significance of increased federal investments in federally
2409 qualified health centers and to leverage that investment through
2410 the creation of a program to provide for the expansion of the
2411 primary and preventive health care services offered by federally
2412 qualified health centers. Further, such a program will support
2413 the coordination of federal, state, and local resources to
2414 assist such health centers in developing an expanded community
2415 based primary care delivery system.
2416 (3) ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.—The
2417 agency shall administer Department of Health shall develop a
2418 program for the expansion of federally qualified health centers
2419 for the purpose of providing comprehensive primary and
2420 preventive health care and urgent care services that may reduce
2421 the morbidity, mortality, and cost of care among the uninsured
2422 population of the state. The program shall provide for
2423 distribution of financial assistance to federally qualified
2424 health centers that apply and demonstrate a need for such
2425 assistance in order to sustain or expand the delivery of primary
2426 and preventive health care services. In selecting centers to
2427 receive this financial assistance, the program:
2428 (a) Shall give preference to communities that have few or
2429 no community-based primary care services or in which the current
2430 services are unable to meet the community’s needs. To assist in
2431 the assessment and identification of areas of critical need, the
2432 Florida Association of Community Health Centers, Inc., shall
2433 develop, every 5 years, beginning January 1, 2012, a federally
2434 qualified health center based statewide assessment and strategic
2435 plan.
2436 (b) Shall require that primary care services be provided to
2437 the medically indigent using a sliding fee schedule based on
2438 income.
2439 (c) Shall promote allow innovative and creative uses of
2440 federal, state, and local health care resources.
2441 (d) Shall require that the funds provided be used to pay
2442 for operating costs of a projected expansion in patient
2443 caseloads or services or for capital improvement projects.
2444 Capital improvement projects may include renovations to existing
2445 facilities or construction of new facilities, provided that an
2446 expansion in patient caseloads or services to a new patient
2447 population will occur as a result of the capital expenditures.
2448 The agency department shall include in its standard contract
2449 document a requirement that any state funds provided for the
2450 purchase of or improvements to real property are contingent upon
2451 the contractor granting to the state a security interest in the
2452 property at least to the amount of the state funds provided for
2453 at least 5 years from the date of purchase or the completion of
2454 the improvements or as further required by law. The contract
2455 must include a provision that, as a condition of receipt of
2456 state funding for this purpose, the contractor agrees that, if
2457 it disposes of the property before the agency’s department’s
2458 interest is vacated, the contractor will refund the
2459 proportionate share of the state’s initial investment, as
2460 adjusted by depreciation.
2461 (e) Shall May require in-kind support from other sources.
2462 (f) Shall promote May encourage coordination among
2463 federally qualified health centers, other private sector
2464 providers, and publicly supported programs.
2465 (g) Shall promote allow the development of community
2466 emergency room diversion programs in conjunction with local
2467 resources, providing extended hours of operation to urgent care
2468 patients. Diversion programs shall include case management for
2469 emergency room followup care.
2470 (4) EVALUATION OF APPLICATIONS.—A review panel shall be
2471 established, consisting of four persons appointed by the
2472 Secretary of Health Care Administration State Surgeon General
2473 and three persons appointed by the chief executive officer of
2474 the Florida Association of Community Health Centers, Inc., to
2475 review all applications for financial assistance under the
2476 program. Applicants shall specify in the application whether the
2477 program funds will be used for the expansion of patient
2478 caseloads or services or for capital improvement projects to
2479 expand and improve patient facilities. The panel shall use the
2480 following elements in reviewing application proposals and shall
2481 determine the relative weight for scoring and evaluating these
2482 elements:
2483 (a) The target population to be served.
2484 (b) The health benefits to be provided.
2485 (c) The methods that will be used to measure cost
2486 effectiveness.
2487 (d) How patient satisfaction will be measured.
2488 (e) The proposed internal quality assurance process.
2489 (f) Projected health status outcomes.
2490 (g) How data will be collected to measure cost
2491 effectiveness, health status outcomes, and overall achievement
2492 of the goals of the proposal.
2493 (h) All resources, including cash, in-kind, voluntary, or
2494 other resources that will be dedicated to the proposal.
2495 (5) ADMINISTRATION AND TECHNICAL ASSISTANCE.—The agency
2496 shall Department of Health may contract with the Florida
2497 Association of Community Health Centers, Inc., to develop and
2498 coordinate administer the program and provide technical
2499 assistance to the federally qualified health centers selected to
2500 receive financial assistance. The contracted entity shall be
2501 responsible for program support and assume all costs related to
2502 administration of this program.
2503 Section 61. Subsections (3) and (4) of section 429.07,
2504 Florida Statutes, are amended, and subsections (6) and (7) are
2505 added to that section, to read:
2506 429.07 License required; fee; inspections.—
2507 (3) In addition to the requirements of s. 408.806, each
2508 license granted by the agency must state the type of care for
2509 which the license is granted. Licenses shall be issued for one
2510 or more of the following categories of care: standard, extended
2511 congregate care, limited nursing services, or limited mental
2512 health.
2513 (a) A standard license shall be issued to a facility
2514 facilities providing one or more of the personal services
2515 identified in s. 429.02. Such licensee facilities may also
2516 employ or contract with a person licensed under part I of
2517 chapter 464 to administer medications and perform other tasks as
2518 specified in s. 429.255.
2519 (b) An extended congregate care license shall be issued to
2520 a licensee facilities providing, directly or through contract,
2521 services beyond those authorized in paragraph (a), including
2522 services performed by persons licensed under part I of chapter
2523 464 and supportive services, as defined by rule, to persons who
2524 would otherwise be disqualified from continued residence in a
2525 facility licensed under this part.
2526 1. In order for extended congregate care services to be
2527 provided, the agency must first determine that all requirements
2528 established in law and rule are met and must specifically
2529 designate, on the facility’s license, that such services may be
2530 provided and whether the designation applies to all or part of
2531 the facility. Such designation may be made at the time of
2532 initial licensure or relicensure, or upon request in writing by
2533 a licensee under this part and part II of chapter 408. The
2534 notification of approval or the denial of the request shall be
2535 made in accordance with part II of chapter 408. An existing
2536 licensee facilities qualifying to provide extended congregate
2537 care services must have maintained a standard license and may
2538 not have been subject to administrative sanctions during the
2539 previous 2 years, or since initial licensure if the facility has
2540 been licensed for less than 2 years, for any of the following
2541 reasons:
2542 a. A class I or class II violation;
2543 b. Three or more repeat or recurring class III violations
2544 of identical or similar resident care standards from which a
2545 pattern of noncompliance is found by the agency;
2546 c. Three or more class III violations that were not
2547 corrected in accordance with the corrective action plan approved
2548 by the agency;
2549 d. Violation of resident care standards which results in
2550 requiring the facility to employ the services of a consultant
2551 pharmacist or consultant dietitian;
2552 e. Denial, suspension, or revocation of a license for
2553 another facility licensed under this part in which the applicant
2554 for an extended congregate care license has at least 25 percent
2555 ownership interest; or
2556 f. Imposition of a moratorium pursuant to this part or part
2557 II of chapter 408 or initiation of injunctive proceedings.
2558 2. A facility that is licensed to provide extended
2559 congregate care services shall maintain a written progress
2560 report for on each person who receives services which describes
2561 the type, amount, duration, scope, and outcome of services that
2562 are rendered and the general status of the resident’s health. A
2563 registered nurse, or appropriate designee, representing the
2564 agency shall visit the facility at least quarterly to monitor
2565 residents who are receiving extended congregate care services
2566 and to determine if the facility is in compliance with this
2567 part, part II of chapter 408, and relevant rules. One of the
2568 visits may be in conjunction with the regular survey. The
2569 monitoring visits may be provided through contractual
2570 arrangements with appropriate community agencies. A registered
2571 nurse shall serve as part of the team that inspects the
2572 facility. The agency may waive one of the required yearly
2573 monitoring visits for a facility that has been licensed for at
2574 least 24 months to provide extended congregate care services,
2575 if, during the inspection, the registered nurse determines that
2576 extended congregate care services are being provided
2577 appropriately, and if the facility has no class I or class II
2578 violations and no uncorrected class III violations. The agency
2579 must first consult with the long-term care ombudsman council for
2580 the area in which the facility is located to determine if any
2581 complaints have been made and substantiated about the quality of
2582 services or care. The agency may not waive one of the required
2583 yearly monitoring visits if complaints have been made and
2584 substantiated.
2585 3. A facility that is licensed to provide extended
2586 congregate care services must:
2587 a. Demonstrate the capability to meet unanticipated
2588 resident service needs.
2589 b. Offer a physical environment that promotes a homelike
2590 setting, provides for resident privacy, promotes resident
2591 independence, and allows sufficient congregate space as defined
2592 by rule.
2593 c. Have sufficient staff available, taking into account the
2594 physical plant and firesafety features of the building, to
2595 assist with the evacuation of residents in an emergency.
2596 d. Adopt and follow policies and procedures that maximize
2597 resident independence, dignity, choice, and decisionmaking to
2598 permit residents to age in place, so that moves due to changes
2599 in functional status are minimized or avoided.
2600 e. Allow residents or, if applicable, a resident’s
2601 representative, designee, surrogate, guardian, or attorney in
2602 fact to make a variety of personal choices, participate in
2603 developing service plans, and share responsibility in
2604 decisionmaking.
2605 f. Implement the concept of managed risk.
2606 g. Provide, directly or through contract, the services of a
2607 person licensed under part I of chapter 464.
2608 h. In addition to the training mandated in s. 429.52,
2609 provide specialized training as defined by rule for facility
2610 staff.
2611 4. A facility that is licensed to provide extended
2612 congregate care services is exempt from the criteria for
2613 continued residency set forth in rules adopted under s. 429.41.
2614 A licensed facility must adopt its own requirements within
2615 guidelines for continued residency set forth by rule. However,
2616 the facility may not serve residents who require 24-hour nursing
2617 supervision. A licensed facility that provides extended
2618 congregate care services must also provide each resident with a
2619 written copy of facility policies governing admission and
2620 retention.
2621 5. The primary purpose of extended congregate care services
2622 is to allow residents, as they become more impaired, the option
2623 of remaining in a familiar setting from which they would
2624 otherwise be disqualified for continued residency. A facility
2625 licensed to provide extended congregate care services may also
2626 admit an individual who exceeds the admission criteria for a
2627 facility with a standard license, if the individual is
2628 determined appropriate for admission to the extended congregate
2629 care facility.
2630 6. Before the admission of an individual to a facility
2631 licensed to provide extended congregate care services, the
2632 individual must undergo a medical examination as provided in s.
2633 429.26(4) and the facility must develop a preliminary service
2634 plan for the individual.
2635 7. When a licensee facility can no longer provide or
2636 arrange for services in accordance with the resident’s service
2637 plan and needs and the licensee’s facility’s policy, the
2638 licensee facility shall make arrangements for relocating the
2639 person in accordance with s. 429.28(1)(k).
2640 8. Failure to provide extended congregate care services may
2641 result in denial of extended congregate care license renewal.
2642 (c) A limited nursing services license shall be issued to a
2643 facility that provides services beyond those authorized in
2644 paragraph (a) and as specified in this paragraph.
2645 1. In order for limited nursing services to be provided in
2646 a facility licensed under this part, the agency must first
2647 determine that all requirements established in law and rule are
2648 met and must specifically designate, on the facility’s license,
2649 that such services may be provided. Such designation may be made
2650 at the time of initial licensure or relicensure, or upon request
2651 in writing by a licensee under this part and part II of chapter
2652 408. Notification of approval or denial of such request shall be
2653 made in accordance with part II of chapter 408. Existing
2654 facilities qualifying to provide limited nursing services shall
2655 have maintained a standard license and may not have been subject
2656 to administrative sanctions that affect the health, safety, and
2657 welfare of residents for the previous 2 years or since initial
2658 licensure if the facility has been licensed for less than 2
2659 years.
2660 2. Facilities that are licensed to provide limited nursing
2661 services shall maintain a written progress report on each person
2662 who receives such nursing services, which report describes the
2663 type, amount, duration, scope, and outcome of services that are
2664 rendered and the general status of the resident’s health. A
2665 registered nurse representing the agency shall visit such
2666 facilities at least twice a year to monitor residents who are
2667 receiving limited nursing services and to determine if the
2668 facility is in compliance with applicable provisions of this
2669 part, part II of chapter 408, and related rules. The monitoring
2670 visits may be provided through contractual arrangements with
2671 appropriate community agencies. A registered nurse shall also
2672 serve as part of the team that inspects such facility.
2673 3. A person who receives limited nursing services under
2674 this part must meet the admission criteria established by the
2675 agency for assisted living facilities. When a resident no longer
2676 meets the admission criteria for a facility licensed under this
2677 part, arrangements for relocating the person shall be made in
2678 accordance with s. 429.28(1)(k), unless the facility is licensed
2679 to provide extended congregate care services.
2680 (4) In accordance with s. 408.805, an applicant or licensee
2681 shall pay a fee for each license application submitted under
2682 this part, part II of chapter 408, and applicable rules. The
2683 amount of the fee shall be established by rule.
2684 (a) The biennial license fee required of a facility is $371
2685 $300 per license, with an additional fee of $71 $50 per resident
2686 based on the total licensed resident capacity of the facility,
2687 except that no additional fee will be assessed for beds
2688 designated for recipients of optional state supplementation
2689 payments provided for in s. 409.212. The total fee may not
2690 exceed $18,000 $10,000.
2691 (b) In addition to the total fee assessed under paragraph
2692 (a), the agency shall require facilities that are licensed to
2693 provide extended congregate care services under this part to pay
2694 an additional fee per licensed facility. The amount of the
2695 biennial fee shall be $523 $400 per license, with an additional
2696 fee of $10 per resident based on the total licensed resident
2697 capacity of the facility.
2698 (c) In addition to the total fee assessed under paragraph
2699 (a), the agency shall require facilities that are licensed to
2700 provide limited nursing services under this part to pay an
2701 additional fee per licensed facility. The amount of the biennial
2702 fee shall be $250 per license, with an additional fee of $10 per
2703 resident based on the total licensed resident capacity of the
2704 facility.
2705 (6) In order to determine whether the facility is
2706 adequately protecting residents’ rights as provided in s.
2707 429.28, the agency shall conduct a standard licensure survey,
2708 which shall include private informal conversations with a sample
2709 of residents and consultation with the ombudsman council in the
2710 planning and service area in which the facility is located to
2711 discuss residents’ experiences within the facility.
2712 (7) An assisted living facility that has been cited within
2713 the previous 24-month period for a class I or class II
2714 violation, regardless of the status of any enforcement or
2715 disciplinary action, is subject to periodic unannounced
2716 monitoring to determine if the facility is in compliance with
2717 this part, part II of chapter 408, and applicable rules.
2718 Monitoring may occur through a desk review or an onsite
2719 assessment. If the class I or class II violation relates to
2720 providing or failing to provide nursing care, a registered nurse
2721 must participate in monitoring activities during the 12-month
2722 period following the violation.
2723 Section 62. Subsection (7) of section 429.11, Florida
2724 Statutes, is renumbered as subsection (6), and present
2725 subsection (6) of that section is amended to read:
2726 429.11 Initial application for license; provisional
2727 license.—
2728 (6) In addition to the license categories available in s.
2729 408.808, a provisional license may be issued to an applicant
2730 making initial application for licensure or making application
2731 for a change of ownership. A provisional license shall be
2732 limited in duration to a specific period of time not to exceed 6
2733 months, as determined by the agency.
2734 Section 63. Section 429.12, Florida Statutes, is amended to
2735 read:
2736 429.12 Sale or transfer of ownership of a facility.—It is
2737 the intent of the Legislature to protect the rights of the
2738 residents of an assisted living facility when the facility is
2739 sold or the ownership thereof is transferred. Therefore, in
2740 addition to the requirements of part II of chapter 408, whenever
2741 a facility is sold or the ownership thereof is transferred,
2742 including leasing,:
2743 (1) the transferee shall notify the residents, in writing,
2744 of the change of ownership within 7 days after receipt of the
2745 new license.
2746 (2) The transferor of a facility the license of which is
2747 denied pending an administrative hearing shall, as a part of the
2748 written change-of-ownership contract, advise the transferee that
2749 a plan of correction must be submitted by the transferee and
2750 approved by the agency at least 7 days before the change of
2751 ownership and that failure to correct the condition which
2752 resulted in the moratorium pursuant to part II of chapter 408 or
2753 denial of licensure is grounds for denial of the transferee’s
2754 license.
2755 Section 64. Subsections (1), (4), and (5) of section
2756 429.17, Florida Statutes, are amended to read:
2757 429.17 Expiration of license; renewal; conditional
2758 license.—
2759 (1) Limited nursing, Extended congregate care, and limited
2760 mental health licenses shall expire at the same time as the
2761 facility’s standard license, regardless of when issued.
2762 (4) In addition to the license categories available in s.
2763 408.808, a conditional license may be issued to an applicant for
2764 license renewal if the applicant fails to meet all standards and
2765 requirements for licensure. A conditional license issued under
2766 this subsection shall be limited in duration to a specific
2767 period of time not to exceed 6 months, as determined by the
2768 agency, and shall be accompanied by an agency-approved plan of
2769 correction.
2770 (5) When an extended congregate care or limited nursing
2771 license is requested during a facility’s biennial license
2772 period, the fee shall be prorated in order to permit the
2773 additional license to expire at the end of the biennial license
2774 period. The fee shall be calculated as of the date the
2775 additional license application is received by the agency.
2776 Section 65. Subsection (7) of section 429.19, Florida
2777 Statutes, is amended to read:
2778 429.19 Violations; imposition of administrative fines;
2779 grounds.—
2780 (7) In addition to any administrative fines imposed, the
2781 agency may assess a survey or monitoring fee, equal to the
2782 lesser of one half of the facility’s biennial license and bed
2783 fee or $500, to cover the cost of conducting initial complaint
2784 investigations that result in the finding of a violation that
2785 was the subject of the complaint or to monitor the health,
2786 safety, or security of residents under s. 429.07(7) monitoring
2787 visits conducted under s. 429.28(3)(c) to verify the correction
2788 of the violations.
2789 Section 66. Subsections (6) through (10) of section 429.23,
2790 Florida Statutes, are renumbered as subsections (5) through (9),
2791 respectively, and present subsection (5) of that section is
2792 amended to read:
2793 429.23 Internal risk management and quality assurance
2794 program; adverse incidents and reporting requirements.—
2795 (5) Each facility shall report monthly to the agency any
2796 liability claim filed against it. The report must include the
2797 name of the resident, the dates of the incident leading to the
2798 claim, if applicable, and the type of injury or violation of
2799 rights alleged to have occurred. This report is not discoverable
2800 in any civil or administrative action, except in such actions
2801 brought by the agency to enforce the provisions of this part.
2802 Section 67. Paragraph (a) of subsection (1) and subsection
2803 (2) of section 429.255, Florida Statutes, are amended to read:
2804 429.255 Use of personnel; emergency care.—
2805 (1)(a) Persons under contract to the facility or, facility
2806 staff, or volunteers, who are licensed according to part I of
2807 chapter 464, or those persons exempt under s. 464.022(1), and
2808 others as defined by rule, may administer medications to
2809 residents, take residents’ vital signs, manage individual weekly
2810 pill organizers for residents who self-administer medication,
2811 give prepackaged enemas ordered by a physician, observe
2812 residents, document observations on the appropriate resident’s
2813 record, report observations to the resident’s physician, and
2814 contract or allow residents or a resident’s representative,
2815 designee, surrogate, guardian, or attorney in fact to contract
2816 with a third party, provided residents meet the criteria for
2817 appropriate placement as defined in s. 429.26. Persons under
2818 contract to the facility or facility staff who are licensed
2819 according to part I of chapter 464 may provide limited nursing
2820 services. Nursing assistants certified pursuant to part II of
2821 chapter 464 may take residents’ vital signs as directed by a
2822 licensed nurse or physician. The facility is responsible for
2823 maintaining documentation of services provided under this
2824 paragraph and as required by rule and ensuring that staff are
2825 adequately trained to monitor residents receiving these
2826 services.
2827 (2) In facilities licensed to provide extended congregate
2828 care, persons under contract to the facility or, facility staff,
2829 or volunteers, who are licensed according to part I of chapter
2830 464, or those persons exempt under s. 464.022(1), or those
2831 persons certified as nursing assistants pursuant to part II of
2832 chapter 464, may also perform all duties within the scope of
2833 their license or certification, as approved by the facility
2834 administrator and pursuant to this part.
2835 Section 68. Subsections (4), (5), (6), and (7) of section
2836 429.28, Florida Statutes, are renumbered as subsections (3),
2837 (4), (5), and (6), respectively, and present subsections (3) and
2838 (6) of that section are amended to read:
2839 429.28 Resident bill of rights.—
2840 (3)(a) The agency shall conduct a survey to determine
2841 general compliance with facility standards and compliance with
2842 residents’ rights as a prerequisite to initial licensure or
2843 licensure renewal.
2844 (b) In order to determine whether the facility is
2845 adequately protecting residents’ rights, the biennial survey
2846 shall include private informal conversations with a sample of
2847 residents and consultation with the ombudsman council in the
2848 planning and service area in which the facility is located to
2849 discuss residents’ experiences within the facility.
2850 (c) During any calendar year in which no survey is
2851 conducted, the agency shall conduct at least one monitoring
2852 visit of each facility cited in the previous year for a class I
2853 or class II violation, or more than three uncorrected class III
2854 violations.
2855 (d) The agency may conduct periodic followup inspections as
2856 necessary to monitor the compliance of facilities with a history
2857 of any class I, class II, or class III violations that threaten
2858 the health, safety, or security of residents.
2859 (e) The agency may conduct complaint investigations as
2860 warranted to investigate any allegations of noncompliance with
2861 requirements required under this part or rules adopted under
2862 this part.
2863 (5)(6) Any facility which terminates the residency of an
2864 individual who participated in activities specified in
2865 subsection (4) (5) shall show good cause in a court of competent
2866 jurisdiction.
2867 Section 69. Subsection (2) of section 429.35, Florida
2868 Statutes, is amended to read:
2869 429.35 Maintenance of records; reports.—
2870 (2) Within 60 days after the date of the biennial
2871 inspection visit required under s. 408.811 or within 30 days
2872 after the date of any interim visit, the agency shall forward
2873 the results of the inspection to the local ombudsman council in
2874 whose planning and service area, as defined in part II of
2875 chapter 400, the facility is located; to at least one public
2876 library or, in the absence of a public library, the county seat
2877 in the county in which the inspected assisted living facility is
2878 located; and, when appropriate, to the district Adult Services
2879 and Mental Health Program Offices. This information may be
2880 provided electronically or through the agency’s Internet
2881 website.
2882 Section 70. Paragraphs (i) and (j) of subsection (1) of
2883 section 429.41, Florida Statutes, are amended to read:
2884 429.41 Rules establishing standards.—
2885 (1) It is the intent of the Legislature that rules
2886 published and enforced pursuant to this section shall include
2887 criteria by which a reasonable and consistent quality of
2888 resident care and quality of life may be ensured and the results
2889 of such resident care may be demonstrated. Such rules shall also
2890 ensure a safe and sanitary environment that is residential and
2891 noninstitutional in design or nature. It is further intended
2892 that reasonable efforts be made to accommodate the needs and
2893 preferences of residents to enhance the quality of life in a
2894 facility. The agency, in consultation with the department, may
2895 adopt rules to administer the requirements of part II of chapter
2896 408. In order to provide safe and sanitary facilities and the
2897 highest quality of resident care accommodating the needs and
2898 preferences of residents, the department, in consultation with
2899 the agency, the Department of Children and Family Services, and
2900 the Department of Health, shall adopt rules, policies, and
2901 procedures to administer this part, which must include
2902 reasonable and fair minimum standards in relation to:
2903 (i) Facilities holding an a limited nursing, extended
2904 congregate care, or limited mental health license.
2905 (j) The establishment of specific criteria to define
2906 appropriateness of resident admission and continued residency in
2907 a facility holding a standard, limited nursing, extended
2908 congregate care, and limited mental health license.
2909 Section 71. Subsections (1) and (2) of section 429.53,
2910 Florida Statutes, are amended to read:
2911 429.53 Consultation by the agency.—
2912 (1) The area offices of licensure and certification of the
2913 agency shall provide consultation to the following upon request:
2914 (a) A licensee of a facility.
2915 (b) A person interested in obtaining a license to operate a
2916 facility under this part.
2917 (2) As used in this section, “consultation” includes:
2918 (a) An explanation of the requirements of this part and
2919 rules adopted pursuant thereto;
2920 (b) An explanation of the license application and renewal
2921 procedures; and
2922 (c) The provision of a checklist of general local and state
2923 approvals required prior to constructing or developing a
2924 facility and a listing of the types of agencies responsible for
2925 such approvals;
2926 (d) An explanation of benefits and financial assistance
2927 available to a recipient of supplemental security income
2928 residing in a facility;
2929 (c)(e) Any other information which the agency deems
2930 necessary to promote compliance with the requirements of this
2931 part; and
2932 (f) A preconstruction review of a facility to ensure
2933 compliance with agency rules and this part.
2934 Section 72. Subsections (1) and (2) of section 429.54,
2935 Florida Statutes, are renumbered as subsections (2) and (3),
2936 respectively, and a new subsection (1) is added to that section
2937 to read:
2938 429.54 Collection of information; local subsidy.—
2939 (1) A facility that is licensed under this part must report
2940 electronically to the agency semiannually data related to the
2941 facility, including, but not limited to, the total number of
2942 residents, the number of residents who are receiving limited
2943 mental health services, the number of residents who are
2944 receiving extended congregate care services, the number of
2945 residents who are receiving limited nursing services, and
2946 professional staffing employed by or under contract with the
2947 licensee to provide resident services. The department, in
2948 consultation with the agency, shall adopt rules to administer
2949 this subsection.
2950 Section 73. Subsections (1) and (5) of section 429.71,
2951 Florida Statutes, are amended to read:
2952 429.71 Classification of violations deficiencies;
2953 administrative fines.—
2954 (1) In addition to the requirements of part II of chapter
2955 408 and in addition to any other liability or penalty provided
2956 by law, the agency may impose an administrative fine on a
2957 provider according to the following classification:
2958 (a) Class I violations are defined in s. 408.813 those
2959 conditions or practices related to the operation and maintenance
2960 of an adult family-care home or to the care of residents which
2961 the agency determines present an imminent danger to the
2962 residents or guests of the facility or a substantial probability
2963 that death or serious physical or emotional harm would result
2964 therefrom. The condition or practice that constitutes a class I
2965 violation must be abated or eliminated within 24 hours, unless a
2966 fixed period, as determined by the agency, is required for
2967 correction. A class I violation deficiency is subject to an
2968 administrative fine in an amount not less than $500 and not
2969 exceeding $1,000 for each violation. A fine may be levied
2970 notwithstanding the correction of the deficiency.
2971 (b) Class II violations are defined in s. 408.813 those
2972 conditions or practices related to the operation and maintenance
2973 of an adult family-care home or to the care of residents which
2974 the agency determines directly threaten the physical or
2975 emotional health, safety, or security of the residents, other
2976 than class I violations. A class II violation is subject to an
2977 administrative fine in an amount not less than $250 and not
2978 exceeding $500 for each violation. A citation for a class II
2979 violation must specify the time within which the violation is
2980 required to be corrected. If a class II violation is corrected
2981 within the time specified, no civil penalty shall be imposed,
2982 unless it is a repeated offense.
2983 (c) Class III violations are defined in s. 408.813 those
2984 conditions or practices related to the operation and maintenance
2985 of an adult family-care home or to the care of residents which
2986 the agency determines indirectly or potentially threaten the
2987 physical or emotional health, safety, or security of residents,
2988 other than class I or class II violations. A class III violation
2989 is subject to an administrative fine in an amount not less than
2990 $100 and not exceeding $250 for each violation. A citation for a
2991 class III violation shall specify the time within which the
2992 violation is required to be corrected. If a class III violation
2993 is corrected within the time specified, no civil penalty shall
2994 be imposed, unless it is a repeated violation offense.
2995 (d) Class IV violations are defined in s. 408.813 those
2996 conditions or occurrences related to the operation and
2997 maintenance of an adult family-care home, or related to the
2998 required reports, forms, or documents, which do not have the
2999 potential of negatively affecting the residents. A provider that
3000 does not correct A class IV violation within the time limit
3001 specified by the agency is subject to an administrative fine in
3002 an amount not less than $50 and not exceeding $100 for each
3003 violation. Any class IV violation that is corrected during the
3004 time the agency survey is conducted will be identified as an
3005 agency finding and not as a violation, unless it is a repeat
3006 violation.
3007 (5) As an alternative to or in conjunction with an
3008 administrative action against a provider, the agency may request
3009 a plan of corrective action that demonstrates a good faith
3010 effort to remedy each violation by a specific date, subject to
3011 the approval of the agency.
3012 Section 74. Section 429.915, Florida Statutes, is amended
3013 to read:
3014 429.915 Conditional license.—In addition to the license
3015 categories available in part II of chapter 408, the agency may
3016 issue a conditional license to an applicant for license renewal
3017 or change of ownership if the applicant fails to meet all
3018 standards and requirements for licensure. A conditional license
3019 issued under this subsection must be limited to a specific
3020 period not exceeding 6 months, as determined by the agency, and
3021 must be accompanied by an approved plan of correction.
3022 Section 75. Paragraphs (b) and (g) of subsection (3) of
3023 section 430.80, Florida Statutes, are amended to read:
3024 430.80 Implementation of a teaching nursing home pilot
3025 project.—
3026 (3) To be designated as a teaching nursing home, a nursing
3027 home licensee must, at a minimum:
3028 (b) Participate in a nationally recognized accreditation
3029 program and hold a valid accreditation, such as the
3030 accreditation awarded by the Joint Commission on Accreditation
3031 of Healthcare Organizations, or, at the time of initial
3032 designation, possess a Gold Seal Award as conferred by the state
3033 on its licensed nursing home;
3034 (g) Maintain insurance coverage pursuant to s.
3035 400.141(1)(q)(s) or proof of financial responsibility in a
3036 minimum amount of $750,000. Such proof of financial
3037 responsibility may include:
3038 1. Maintaining an escrow account consisting of cash or
3039 assets eligible for deposit in accordance with s. 625.52; or
3040 2. Obtaining and maintaining pursuant to chapter 675 an
3041 unexpired, irrevocable, nontransferable and nonassignable letter
3042 of credit issued by any bank or savings association organized
3043 and existing under the laws of this state or any bank or savings
3044 association organized under the laws of the United States that
3045 has its principal place of business in this state or has a
3046 branch office which is authorized to receive deposits in this
3047 state. The letter of credit shall be used to satisfy the
3048 obligation of the facility to the claimant upon presentment of a
3049 final judgment indicating liability and awarding damages to be
3050 paid by the facility or upon presentment of a settlement
3051 agreement signed by all parties to the agreement when such final
3052 judgment or settlement is a result of a liability claim against
3053 the facility.
3054 Section 76. Paragraph (d) of subsection (9) of section
3055 440.102, Florida Statutes, is repealed.
3056 Section 77. Paragraph (a) of subsection (2) of section
3057 440.13, Florida Statutes, is amended to read:
3058 440.13 Medical services and supplies; penalty for
3059 violations; limitations.—
3060 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3061 (a) Subject to the limitations specified elsewhere in this
3062 chapter, the employer shall furnish to the employee such
3063 medically necessary remedial treatment, care, and attendance for
3064 such period as the nature of the injury or the process of
3065 recovery may require, which is in accordance with established
3066 practice parameters and protocols of treatment as provided for
3067 in this chapter, including medicines, medical supplies, durable
3068 medical equipment, orthoses, prostheses, and other medically
3069 necessary apparatus. Remedial treatment, care, and attendance,
3070 including work-hardening programs or pain-management programs
3071 accredited by the Commission on Accreditation of Rehabilitation
3072 Facilities or the Joint Commission on the Accreditation of
3073 Health Organizations or pain-management programs affiliated with
3074 medical schools, shall be considered as covered treatment only
3075 when such care is given based on a referral by a physician as
3076 defined in this chapter. Medically necessary treatment, care,
3077 and attendance does not include chiropractic services in excess
3078 of 24 treatments or rendered 12 weeks beyond the date of the
3079 initial chiropractic treatment, whichever comes first, unless
3080 the carrier authorizes additional treatment or the employee is
3081 catastrophically injured.
3082
3083 Failure of the carrier to timely comply with this subsection
3084 shall be a violation of this chapter and the carrier shall be
3085 subject to penalties as provided for in s. 440.525.
3086 Section 78. Section 483.294, Florida Statutes, is amended
3087 to read:
3088 483.294 Inspection of centers.—In accordance with s.
3089 408.811, the agency shall biennially, at least once annually,
3090 inspect the premises and operations of all centers subject to
3091 licensure under this part.
3092 Section 79. Subsection (4) is added to section 626.9541,
3093 Florida Statutes, to read:
3094 626.9541 Unfair methods of competition and unfair or
3095 deceptive acts or practices defined; alternative rates of
3096 payment; wellness programs.—
3097 (4) WELLNESS PROGRAMS.—An insurer issuing a group or
3098 individual health benefit plan may offer a voluntary wellness or
3099 health-improvement program that allows for rewards or
3100 incentives, including, but not limited to, merchandise, gift
3101 cards, debit cards, premium discounts or rebates, contributions
3102 towards a member’s health savings account, modifications to
3103 copayment, deductible, or coinsurance amounts, or any
3104 combination of these incentives, to encourage or reward
3105 participation in the program. The health plan member may be
3106 required to provide verification, such as a statement from his
3107 or her physician, that a medical condition makes it unreasonably
3108 difficult or medically inadvisable for the individual to
3109 participate in the wellness program. Any reward or incentive
3110 established under this subsection is not an insurance benefit
3111 and does not violate this section. This subsection does not
3112 prohibit an insurer from offering incentives or rewards to
3113 members for adherence to wellness or health improvement programs
3114 if otherwise allowed by state or federal law. Notwithstanding
3115 any provision of this subsection, no insurer, nor its agent, may
3116 use any incentive authorized by this subsection for the purpose
3117 of redirecting patients from one health care insurance plan to
3118 another.
3119 Section 80. Subsection (1) of section 627.645, Florida
3120 Statutes, is amended to read:
3121 627.645 Denial of health insurance claims restricted.—
3122 (1) No claim for payment under a health insurance policy or
3123 self-insured program of health benefits for treatment, care, or
3124 services in a licensed hospital which is accredited by the Joint
3125 Commission on the Accreditation of Hospitals, the American
3126 Osteopathic Association, or the Commission on the Accreditation
3127 of Rehabilitative Facilities shall be denied because such
3128 hospital lacks major surgical facilities and is primarily of a
3129 rehabilitative nature, if such rehabilitation is specifically
3130 for treatment of physical disability.
3131 Section 81. Paragraph (c) of subsection (2) of section
3132 627.668, Florida Statutes, is amended to read:
3133 627.668 Optional coverage for mental and nervous disorders
3134 required; exception.—
3135 (2) Under group policies or contracts, inpatient hospital
3136 benefits, partial hospitalization benefits, and outpatient
3137 benefits consisting of durational limits, dollar amounts,
3138 deductibles, and coinsurance factors shall not be less favorable
3139 than for physical illness generally, except that:
3140 (c) Partial hospitalization benefits shall be provided
3141 under the direction of a licensed physician. For purposes of
3142 this part, the term “partial hospitalization services” is
3143 defined as those services offered by a program accredited by the
3144 Joint Commission on Accreditation of Hospitals (JCAH) or in
3145 compliance with equivalent standards. Alcohol rehabilitation
3146 programs accredited by the Joint Commission on Accreditation of
3147 Hospitals or approved by the state and licensed drug abuse
3148 rehabilitation programs shall also be qualified providers under
3149 this section. In any benefit year, if partial hospitalization
3150 services or a combination of inpatient and partial
3151 hospitalization are utilized, the total benefits paid for all
3152 such services shall not exceed the cost of 30 days of inpatient
3153 hospitalization for psychiatric services, including physician
3154 fees, which prevail in the community in which the partial
3155 hospitalization services are rendered. If partial
3156 hospitalization services benefits are provided beyond the limits
3157 set forth in this paragraph, the durational limits, dollar
3158 amounts, and coinsurance factors thereof need not be the same as
3159 those applicable to physical illness generally.
3160 Section 82. Subsection (3) of section 627.669, Florida
3161 Statutes, is amended to read:
3162 627.669 Optional coverage required for substance abuse
3163 impaired persons; exception.—
3164 (3) The benefits provided under this section shall be
3165 applicable only if treatment is provided by, or under the
3166 supervision of, or is prescribed by, a licensed physician or
3167 licensed psychologist and if services are provided in a program
3168 accredited by the Joint Commission on Accreditation of Hospitals
3169 or approved by the state.
3170 Section 83. Paragraph (a) of subsection (1) of section
3171 627.736, Florida Statutes, is amended to read:
3172 627.736 Required personal injury protection benefits;
3173 exclusions; priority; claims.—
3174 (1) REQUIRED BENEFITS.—Every insurance policy complying
3175 with the security requirements of s. 627.733 shall provide
3176 personal injury protection to the named insured, relatives
3177 residing in the same household, persons operating the insured
3178 motor vehicle, passengers in such motor vehicle, and other
3179 persons struck by such motor vehicle and suffering bodily injury
3180 while not an occupant of a self-propelled vehicle, subject to
3181 the provisions of subsection (2) and paragraph (4)(e), to a
3182 limit of $10,000 for loss sustained by any such person as a
3183 result of bodily injury, sickness, disease, or death arising out
3184 of the ownership, maintenance, or use of a motor vehicle as
3185 follows:
3186 (a) Medical benefits.—Eighty percent of all reasonable
3187 expenses for medically necessary medical, surgical, X-ray,
3188 dental, and rehabilitative services, including prosthetic
3189 devices, and medically necessary ambulance, hospital, and
3190 nursing services. However, the medical benefits shall provide
3191 reimbursement only for such services and care that are lawfully
3192 provided, supervised, ordered, or prescribed by a physician
3193 licensed under chapter 458 or chapter 459, a dentist licensed
3194 under chapter 466, or a chiropractic physician licensed under
3195 chapter 460 or that are provided by any of the following persons
3196 or entities:
3197 1. A hospital or ambulatory surgical center licensed under
3198 chapter 395.
3199 2. A person or entity licensed under ss. 401.2101-401.45
3200 that provides emergency transportation and treatment.
3201 3. An entity wholly owned by one or more physicians
3202 licensed under chapter 458 or chapter 459, chiropractic
3203 physicians licensed under chapter 460, or dentists licensed
3204 under chapter 466 or by such practitioner or practitioners and
3205 the spouse, parent, child, or sibling of that practitioner or
3206 those practitioners.
3207 4. An entity wholly owned, directly or indirectly, by a
3208 hospital or hospitals.
3209 5. A health care clinic licensed under ss. 400.990-400.995
3210 that is:
3211 a. Accredited by the Joint Commission on Accreditation of
3212 Healthcare Organizations, the American Osteopathic Association,
3213 the Commission on Accreditation of Rehabilitation Facilities, or
3214 the Accreditation Association for Ambulatory Health Care, Inc.;
3215 or
3216 b. A health care clinic that:
3217 (I) Has a medical director licensed under chapter 458,
3218 chapter 459, or chapter 460;
3219 (II) Has been continuously licensed for more than 3 years
3220 or is a publicly traded corporation that issues securities
3221 traded on an exchange registered with the United States
3222 Securities and Exchange Commission as a national securities
3223 exchange; and
3224 (III) Provides at least four of the following medical
3225 specialties:
3226 (A) General medicine.
3227 (B) Radiography.
3228 (C) Orthopedic medicine.
3229 (D) Physical medicine.
3230 (E) Physical therapy.
3231 (F) Physical rehabilitation.
3232 (G) Prescribing or dispensing outpatient prescription
3233 medication.
3234 (H) Laboratory services.
3235
3236 The Financial Services Commission shall adopt by rule the form
3237 that must be used by an insurer and a health care provider
3238 specified in subparagraph 3., subparagraph 4., or subparagraph
3239 5. to document that the health care provider meets the criteria
3240 of this paragraph, which rule must include a requirement for a
3241 sworn statement or affidavit.
3242
3243 Only insurers writing motor vehicle liability insurance in this
3244 state may provide the required benefits of this section, and no
3245 such insurer shall require the purchase of any other motor
3246 vehicle coverage other than the purchase of property damage
3247 liability coverage as required by s. 627.7275 as a condition for
3248 providing such required benefits. Insurers may not require that
3249 property damage liability insurance in an amount greater than
3250 $10,000 be purchased in conjunction with personal injury
3251 protection. Such insurers shall make benefits and required
3252 property damage liability insurance coverage available through
3253 normal marketing channels. Any insurer writing motor vehicle
3254 liability insurance in this state who fails to comply with such
3255 availability requirement as a general business practice shall be
3256 deemed to have violated part IX of chapter 626, and such
3257 violation shall constitute an unfair method of competition or an
3258 unfair or deceptive act or practice involving the business of
3259 insurance; and any such insurer committing such violation shall
3260 be subject to the penalties afforded in such part, as well as
3261 those which may be afforded elsewhere in the insurance code.
3262 Section 84. Subsection (12) of section 641.495, Florida
3263 Statutes, is amended to read:
3264 641.495 Requirements for issuance and maintenance of
3265 certificate.—
3266 (12) The provisions of part I of chapter 395 do not apply
3267 to a health maintenance organization that, on or before January
3268 1, 1991, provides not more than 10 outpatient holding beds for
3269 short-term and hospice-type patients in an ambulatory care
3270 facility for its members, provided that such health maintenance
3271 organization maintains current accreditation by the Joint
3272 Commission on Accreditation of Health Care Organizations, the
3273 Accreditation Association for Ambulatory Health Care, or the
3274 National Committee for Quality Assurance.
3275 Section 85. Subsection (13) of section 651.118, Florida
3276 Statutes, is amended to read:
3277 651.118 Agency for Health Care Administration; certificates
3278 of need; sheltered beds; community beds.—
3279 (13) Residents, as defined in this chapter, are not
3280 considered new admissions for the purpose of s.
3281 400.141(1)(n)(o)1.d.
3282 Section 86. Subsection (2) of section 766.1015, Florida
3283 Statutes, is amended to read:
3284 766.1015 Civil immunity for members of or consultants to
3285 certain boards, committees, or other entities.—
3286 (2) Such committee, board, group, commission, or other
3287 entity must be established in accordance with state law or in
3288 accordance with requirements of the Joint Commission on
3289 Accreditation of Healthcare Organizations, established and duly
3290 constituted by one or more public or licensed private hospitals
3291 or behavioral health agencies, or established by a governmental
3292 agency. To be protected by this section, the act, decision,
3293 omission, or utterance may not be made or done in bad faith or
3294 with malicious intent.
3295 Section 87. Subsection (4) of section 766.202, Florida
3296 Statutes, is amended to read:
3297 766.202 Definitions; ss. 766.201-766.212.—As used in ss.
3298 766.201-766.212, the term:
3299 (4) “Health care provider” means any hospital, ambulatory
3300 surgical center, or mobile surgical facility as defined and
3301 licensed under chapter 395; a birth center licensed under
3302 chapter 383; any person licensed under chapter 458, chapter 459,
3303 chapter 460, chapter 461, chapter 462, chapter 463, part I of
3304 chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3305 or chapter 486; a clinical lab licensed under chapter 483; a
3306 health maintenance organization certificated under part I of
3307 chapter 641; a blood bank; a plasma center; an industrial
3308 clinic; a renal dialysis facility; or a professional association
3309 partnership, corporation, joint venture, or other association
3310 for professional activity by health care providers.
3311 Section 88. This act shall take effect July 1, 2011.