Florida Senate - 2012 SENATOR AMENDMENT
Bill No. CS for SB 2074
Barcode 296574
LEGISLATIVE ACTION
Senate . House
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Floor: WD .
03/09/2012 03:47 PM .
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Senator Garcia moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 394.4574, Florida Statutes, is amended
6 to read:
7 394.4574 Department responsibilities for a mental health
8 resident who resides in an assisted living facility that holds a
9 limited mental health license.—
10 (1) The term “mental health resident,” for purposes of this
11 section, means an individual who receives social security
12 disability income due to a mental disorder as determined by the
13 Social Security Administration or receives supplemental security
14 income due to a mental disorder as determined by the Social
15 Security Administration and receives optional state
16 supplementation.
17 (2) The department must ensure that:
18 (a) A mental health resident has been assessed by a
19 psychiatrist, clinical psychologist, clinical social worker, or
20 psychiatric nurse, or an individual who is supervised by one of
21 these professionals, and determined to be appropriate to reside
22 in an assisted living facility. The documentation must be
23 provided to the administrator of the facility within 30 days
24 after the mental health resident has been admitted to the
25 facility. An evaluation completed upon discharge from a state
26 mental hospital meets the requirements of this subsection
27 related to appropriateness for placement as a mental health
28 resident if it was completed within 90 days prior to admission
29 to the facility.
30 (b) A cooperative agreement, as required in s. 429.0751
31 429.075, is developed between the mental health care services
32 provider that serves a mental health resident and the
33 administrator of the assisted living facility with a limited
34 mental health license in which the mental health resident is
35 living. Any entity that provides Medicaid prepaid health plan
36 services shall ensure the appropriate coordination of health
37 care services with an assisted living facility in cases where a
38 Medicaid recipient is both a member of the entity’s prepaid
39 health plan and a resident of the assisted living facility. If
40 the entity is at risk for Medicaid targeted case management and
41 behavioral health services, the entity shall inform the assisted
42 living facility of the procedures to follow should an emergent
43 condition arise.
44 (c) The community living support plan, as defined in s.
45 429.02, has been prepared by a mental health resident and a
46 mental health case manager of that resident in consultation with
47 the administrator of the facility or the administrator’s
48 designee. The plan must be provided to the administrator of the
49 assisted living facility with a limited mental health license in
50 which the mental health resident lives. The support plan and the
51 agreement may be in one document.
52 (d) The assisted living facility with a limited mental
53 health license is provided with documentation that the
54 individual meets the definition of a mental health resident.
55 (e) The mental health services provider assigns a case
56 manager to each mental health resident who lives in an assisted
57 living facility with a limited mental health license. The case
58 manager is responsible for coordinating the development of and
59 implementation of the community living support plan defined in
60 s. 429.02. The plan must be updated as needed, but at least
61 annually, to ensure that the ongoing needs of the residents are
62 addressed.
63
64 The department shall adopt rules to implement the community
65 living support plans and cooperative agreements established
66 under this section.
67 (3) A Medicaid prepaid health plan shall ensure the
68 appropriate coordination of health care services with an
69 assisted living facility when a Medicaid recipient is both a
70 member of the entity’s prepaid health plan and a resident of the
71 assisted living facility. If the Medicaid prepaid health plan is
72 responsible for Medicaid-targeted case management and behavioral
73 health services, the plan shall inform the assisted living
74 facility of the procedures to follow when an emergent condition
75 arises.
76 (4) The department shall include in contracts with mental
77 health service providers provisions that require the service
78 provider to assign a case manager for a mental health resident,
79 prepare a community living support plan, enter into a
80 cooperative agreement with the assisted living facility, and
81 otherwise comply with the provisions of this section. The
82 department shall establish and impose contract penalties for
83 mental health service providers under contract with the
84 department that fail to comply with this section.
85 (5) The Agency for Health Care Administration shall include
86 in contracts with Medicaid prepaid health plans provisions that
87 require the mental health service provider to prepare a
88 community living support plan, enter into a cooperative
89 agreement with the assisted living facility, and otherwise
90 comply with the provisions of this section. The agency shall
91 also establish and impose contract penalties for Medicaid
92 prepaid health plans that fail to comply with this section.
93 (6) The department shall enter into an interagency
94 agreement with the Agency for Health Care Administration that
95 delineates their respective responsibilities and procedures for
96 enforcing the requirements of this section with respect to
97 assisted living facilities and mental health service providers.
98 (7)(3) The Secretary of Children and Family Services, in
99 consultation with the Agency for Health Care Administration,
100 shall annually require each district administrator to develop,
101 with community input, detailed plans that demonstrate how the
102 district will ensure the provision of state-funded mental health
103 and substance abuse treatment services to residents of assisted
104 living facilities that hold a limited mental health license.
105 These plans must be consistent with the substance abuse and
106 mental health district plan developed pursuant to s. 394.75 and
107 must address case management services; access to consumer
108 operated drop-in centers; access to services during evenings,
109 weekends, and holidays; supervision of the clinical needs of the
110 residents; and access to emergency psychiatric care.
111 Section 2. Subsection (1) of section 395.002, Florida
112 Statutes, is amended to read:
113 395.002 Definitions.—As used in this chapter:
114 (1) “Accrediting organizations” means national
115 accreditation organizations that are approved by the Centers for
116 Medicare and Medicaid Services and whose standards incorporate
117 comparable licensure regulations required by the state the Joint
118 Commission on Accreditation of Healthcare Organizations, the
119 American Osteopathic Association, the Commission on
120 Accreditation of Rehabilitation Facilities, and the
121 Accreditation Association for Ambulatory Health Care, Inc.
122 Section 3. Section 395.1051, Florida Statutes, is amended
123 to read:
124 395.1051 Duty to notify patients.—
125 (1) An appropriately trained person designated by each
126 licensed facility shall inform each patient, or an individual
127 identified pursuant to s. 765.401(1), in person about adverse
128 incidents that result in serious harm to the patient.
129 Notification of outcomes of care that result in harm to the
130 patient under this section does shall not constitute an
131 acknowledgment or admission of liability and may not, nor can it
132 be introduced as evidence.
133 (2) A hospital must provide notice to all obstetrical
134 physicians with privileges at the hospital at least 120 days
135 before the hospital closes an obstetrics department or ceases to
136 provide obstetrical services.
137 Section 4. Paragraph (b) of subsection (1) of section
138 395.1055, Florida Statutes, is amended to read:
139 395.1055 Rules and enforcement.—
140 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
141 and 120.54 to implement the provisions of this part, which shall
142 include reasonable and fair minimum standards for ensuring that:
143 (b) Infection control, housekeeping, sanitary conditions,
144 and medical record procedures that will adequately protect
145 patient care and safety are established and implemented. These
146 procedures shall require housekeeping and sanitation staff to
147 wear masks and gloves when cleaning patient rooms, to disinfect
148 environmental surfaces in patient rooms in accordance with the
149 time instructions on the label of the disinfectant used by the
150 hospital, and to document compliance with this paragraph. The
151 agency may impose an administrative fine for each day that a
152 violation of this paragraph occurs.
153 Section 5. Subsection (2) of section 400.0078, Florida
154 Statutes, is amended to read:
155 400.0078 Citizen access to State Long-Term Care Ombudsman
156 Program services.—
157 (2) Every resident or representative of a resident shall
158 receive, Upon admission to a long-term care facility, each
159 resident or representative of a resident must receive
160 information regarding:
161 (a)1. The purpose of the State Long-Term Care Ombudsman
162 Program;,
163 2. The statewide toll-free telephone number for receiving
164 complaints;,
165 3. The residents rights under s. 429.28, including
166 information that retaliatory action cannot be taken against a
167 resident for presenting grievances or for exercising any other
168 of these rights; and
169 4. Other relevant information regarding how to contact the
170 program.
171 (b) Residents or their representatives must be furnished
172 additional copies of this information upon request.
173 Section 6. Subsection (3) of section 408.05, Florida
174 Statutes, is amended to read:
175 408.05 Florida Center for Health Information and Policy
176 Analysis.—
177 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—The agency
178 shall collect, compile, analyze, and distribute In order to
179 produce comparable and uniform health information and
180 statistics. Such information shall be used for developing the
181 development of policy recommendations, evaluating program and
182 provider performance, and facilitating the independent and
183 collaborative quality improvement activities of providers,
184 payors, and others involved in the delivery of health services.
185 The agency shall perform the following functions:
186 (a) Coordinate the activities of state agencies involved in
187 the design and implementation of the comprehensive health
188 information system.
189 (b) Undertake research, development, and evaluation
190 respecting the comprehensive health information system.
191 (c) Review the statistical activities of state agencies to
192 ensure that they are consistent with the comprehensive health
193 information system.
194 (d) Develop written agreements with local, state, and
195 federal agencies for the sharing of health-care-related data or
196 using the facilities and services of such agencies. State
197 agencies, local health councils, and other agencies under state
198 contract shall assist the center in obtaining, compiling, and
199 transferring health-care-related data maintained by state and
200 local agencies. Written agreements must specify the types,
201 methods, and periodicity of data exchanges and specify the types
202 of data that will be transferred to the center.
203 (e) Establish by rule the types of data collected,
204 compiled, processed, used, or shared. Decisions regarding center
205 data sets should be made based on consultation with the State
206 Consumer Health Information and Policy Advisory Council and
207 other public and private users regarding the types of data which
208 should be collected and their uses. The center shall establish
209 standardized means for collecting health information and
210 statistics under laws and rules administered by the agency.
211 (f) Establish minimum health-care-related data sets which
212 are necessary on a continuing basis to fulfill the collection
213 requirements of the center and which shall be used by state
214 agencies in collecting and compiling health-care-related data.
215 The agency shall periodically review ongoing health care data
216 collections of the Department of Health and other state agencies
217 to determine if the collections are being conducted in
218 accordance with the established minimum sets of data.
219 (g) Establish advisory standards to ensure the quality of
220 health statistical and epidemiological data collection,
221 processing, and analysis by local, state, and private
222 organizations.
223 (h) Prescribe standards for the publication of health-care
224 related data reported pursuant to this section which ensure the
225 reporting of accurate, valid, reliable, complete, and comparable
226 data. Such standards should include advisory warnings to users
227 of the data regarding the status and quality of any data
228 reported by or available from the center.
229 (i) Prescribe standards for the maintenance and
230 preservation of the center’s data. This should include methods
231 for archiving data, retrieval of archived data, and data editing
232 and verification.
233 (j) Ensure that strict quality control measures are
234 maintained for the dissemination of data through publications,
235 studies, or user requests.
236 (k) Develop, in conjunction with the State Consumer Health
237 Information and Policy Advisory Council, and implement a long
238 range plan for making available health care quality measures and
239 financial data that will allow consumers to compare health care
240 services. The health care quality measures and financial data
241 the agency must make available shall include, but is not limited
242 to, pharmaceuticals, physicians, health care facilities, and
243 health plans and managed care entities. The agency shall update
244 the plan and report on the status of its implementation
245 annually. The agency shall also make the plan and status report
246 available to the public on its Internet website. As part of the
247 plan, the agency shall identify the process and timeframes for
248 implementation, any barriers to implementation, and
249 recommendations of changes in the law that may be enacted by the
250 Legislature to eliminate the barriers. As preliminary elements
251 of the plan, the agency shall:
252 1. Make available patient-safety indicators, inpatient
253 quality indicators, and performance outcome and patient charge
254 data collected from health care facilities pursuant to s.
255 408.061(1)(a) and (2). The terms “patient-safety indicators” and
256 “inpatient quality indicators” shall be as defined by the
257 Centers for Medicare and Medicaid Services, the National Quality
258 Forum, the Joint Commission on Accreditation of Healthcare
259 Organizations, the Agency for Healthcare Research and Quality,
260 the Centers for Disease Control and Prevention, or a similar
261 national entity that establishes standards to measure the
262 performance of health care providers, or by other states. The
263 agency shall determine which conditions, procedures, health care
264 quality measures, and patient charge data to disclose based upon
265 input from the council. When determining which conditions and
266 procedures are to be disclosed, the council and the agency shall
267 consider variation in costs, variation in outcomes, and
268 magnitude of variations and other relevant information. When
269 determining which health care quality measures to disclose, the
270 agency:
271 a. Shall consider such factors as volume of cases; average
272 patient charges; average length of stay; complication rates;
273 mortality rates; and infection rates, among others, which shall
274 be adjusted for case mix and severity, if applicable.
275 b. May consider such additional measures that are adopted
276 by the Centers for Medicare and Medicaid Studies, National
277 Quality Forum, the Joint Commission on Accreditation of
278 Healthcare Organizations, the Agency for Healthcare Research and
279 Quality, Centers for Disease Control and Prevention, or a
280 similar national entity that establishes standards to measure
281 the performance of health care providers, or by other states.
282
283 When determining which patient charge data to disclose, the
284 agency shall include such measures as the average of
285 undiscounted charges on frequently performed procedures and
286 preventive diagnostic procedures, the range of procedure charges
287 from highest to lowest, average net revenue per adjusted patient
288 day, average cost per adjusted patient day, and average cost per
289 admission, among others.
290 2. Make available performance measures, benefit design, and
291 premium cost data from health plans licensed pursuant to chapter
292 627 or chapter 641. The agency shall determine which health care
293 quality measures and member and subscriber cost data to
294 disclose, based upon input from the council. When determining
295 which data to disclose, the agency shall consider information
296 that may be required by either individual or group purchasers to
297 assess the value of the product, which may include membership
298 satisfaction, quality of care, current enrollment or membership,
299 coverage areas, accreditation status, premium costs, plan costs,
300 premium increases, range of benefits, copayments and
301 deductibles, accuracy and speed of claims payment, credentials
302 of physicians, number of providers, names of network providers,
303 and hospitals in the network. Health plans shall make available
304 to the agency any such data or information that is not currently
305 reported to the agency or the office.
306 3. Determine the method and format for public disclosure of
307 data reported pursuant to this paragraph. The agency shall make
308 its determination based upon input from the State Consumer
309 Health Information and Policy Advisory Council. At a minimum,
310 the data shall be made available on the agency’s Internet
311 website in a manner that allows consumers to conduct an
312 interactive search that allows them to view and compare the
313 information for specific providers. The website must include
314 such additional information as is determined necessary to ensure
315 that the website enhances informed decisionmaking among
316 consumers and health care purchasers, which shall include, at a
317 minimum, appropriate guidance on how to use the data and an
318 explanation of why the data may vary from provider to provider.
319 4. Publish on its website undiscounted charges for no fewer
320 than 150 of the most commonly performed adult and pediatric
321 procedures, including outpatient, inpatient, diagnostic, and
322 preventative procedures.
323 (l) Assist quality improvement collaboratives by releasing
324 information to the providers, payors, or entities representing
325 and working on behalf of providers and payors. The agency shall
326 release such data, which is deemed necessary for the
327 administration of the Medicaid program, to quality improvement
328 collaboratives for evaluation of the incidence of potentially
329 preventable events.
330 Section 7. Subsection (31) is added to section 408.802,
331 Florida Statutes, to read:
332 408.802 Applicability.—The provisions of this part apply to
333 the provision of services that require licensure as defined in
334 this part and to the following entities licensed, registered, or
335 certified by the agency, as described in chapters 112, 383, 390,
336 394, 395, 400, 429, 440, 483, and 765:
337 (31) Assisted living facility administrators, as provided
338 under part I of chapter 429.
339 Section 8. Subsection (29) is added to section 408.820,
340 Florida Statutes, to read:
341 408.820 Exemptions.—Except as prescribed in authorizing
342 statutes, the following exemptions shall apply to specified
343 requirements of this part:
344 (29) Assisted living facility administrators, as provided
345 under part I of chapter 429, are exempt from ss. 408.806(7),
346 408.810(4)-(10), and 408.811.
347 Section 9. Paragraph (c) of subsection (4) of section
348 409.212, Florida Statutes, is amended to read:
349 409.212 Optional supplementation.—
350 (4) In addition to the amount of optional supplementation
351 provided by the state, a person may receive additional
352 supplementation from third parties to contribute to his or her
353 cost of care. Additional supplementation may be provided under
354 the following conditions:
355 (c) The additional supplementation shall not exceed four
356 two times the provider rate recognized under the optional state
357 supplementation program.
358 Section 10. Section 409.986, Florida Statutes, is created
359 to read:
360 409.986 Quality adjustments to Medicaid rates.—
361 (1) As used in this section, the term:
362 (a) “Expected rate” means the risk-adjusted rate for each
363 provider that accounts for the severity of illness, diagnosis
364 related groups, and the age of a patient.
365 (b) “Hospital-acquired infections” means infections not
366 present and without evidence of incubation at the time of
367 admission to a hospital.
368 (c) “Observed rate” means the actual number for each
369 provider of potentially preventable events divided by the number
370 of cases in which potentially preventable events may have
371 occurred.
372 (d) “Potentially preventable admission” means an admission
373 of a person to a hospital that might have reasonably been
374 prevented with adequate access to ambulatory care or health care
375 coordination.
376 (e) “Potentially preventable ancillary service” means a
377 health care service provided or ordered by a physician or other
378 health care provider to supplement or support the evaluation or
379 treatment of a patient, including a diagnostic test, laboratory
380 test, therapy service, or radiology service, that may not be
381 reasonably necessary for the provision of quality health care or
382 treatment.
383 (f) “Potentially preventable complication” means a harmful
384 event or negative outcome with respect to a person, including an
385 infection or surgical complication, that:
386 1. Occurs after the person’s admission to a hospital; and
387 2. May have resulted from the care, lack of care, or
388 treatment provided during the hospital stay rather than from a
389 natural progression of an underlying disease.
390 (g) “Potentially preventable emergency department visit”
391 means treatment of a person in a hospital emergency room or
392 freestanding emergency medical care facility for a condition
393 that does not require or should not have required emergency
394 medical attention because the condition can or could have been
395 treated or prevented by a physician or other health care
396 provider in a nonemergency setting.
397 (h) “Potentially preventable event” means a potentially
398 preventable admission, a potentially preventable ancillary
399 service, a potentially preventable complication, a potentially
400 preventable emergency department visit, a potentially
401 preventable readmission, or a combination of those events.
402 (i) “Potentially preventable readmission” means a return
403 hospitalization of a person within 15 days that may have
404 resulted from deficiencies in the care or treatment provided to
405 the person during a previous hospital stay or from deficiencies
406 in posthospital discharge followup. The term does not include a
407 hospital readmission necessitated by the occurrence of unrelated
408 events after the discharge. The term includes the readmission of
409 a person to a hospital for:
410 1. The same condition or procedure for which the person was
411 previously admitted;
412 2. An infection or other complication resulting from care
413 previously provided; or
414 3. A condition or procedure that indicates that a surgical
415 intervention performed during a previous admission was
416 unsuccessful in achieving the anticipated outcome.
417 (j) “Quality improvement collaboration” means a structured
418 process involving multiple providers and subject matter experts
419 to focus on a specific aspect of quality care in order to
420 analyze past performance and plan, implement, and evaluate
421 specific improvement methods.
422 (2) The agency shall establish and implement methodologies
423 to adjust Medicaid payment rates for hospitals, nursing homes,
424 and managed care plans based on evidence of improved patient
425 outcomes. Payment adjustments shall be dependent on
426 consideration of specific outcome measures for each provider
427 category, documented activities by providers to improve
428 performance, and evidence of significant improvement over time.
429 Measurement of outcomes shall include appropriate risk
430 adjustments, exclude cases that cannot be determined to be
431 preventable, and waive adjustments for providers with too few
432 cases to calculate reliable rates.
433 (a) Performance-based payment adjustments may be made up to
434 1 percent of each qualified provider’s rate for hospital
435 inpatient services, hospital outpatient services, nursing home
436 care, and the plan-specific capitation rate for prepaid health
437 plans. Adjustments for activities to improve performance may be
438 made up to 0.25 percent based on evidence of a provider’s
439 engagement in activities specified in this section.
440 (b) Outcome measures shall be established for a base year,
441 which may be state fiscal year 2010-2011 or a more recent 12
442 month period.
443 (3) Methodologies established pursuant to this section
444 shall use existing databases, including Medicaid claims,
445 encounter data compiled pursuant to s. 409.9122(14), and
446 hospital discharge data compiled pursuant to s. 408.061(1)(a).
447 To the extent possible, the agency shall use methods for
448 determining outcome measures in use by other payors.
449 (4) The agency shall seek any necessary federal approval
450 for the performance payment system and implement the system in
451 state fiscal year 2015-2016.
452 (5) The agency may appoint a technical advisory panel for
453 each provider category in order to solicit advice and
454 recommendations during the development and implementation of the
455 performance payment system.
456 (6) The performance payment system for hospitals shall
457 apply to general hospitals as defined in s. 395.002. The outcome
458 measures used to allocate positive payment adjustments shall
459 consist of one or more potentially preventable events such as
460 potentially preventable readmissions and potentially preventable
461 complications.
462 (a) For each 12-month period after the base year, the
463 agency shall determine the expected rate and the observed rate
464 for specific outcome indicators for each hospital. The
465 difference between the expected and observed rates shall be used
466 to establish a performance rate for each hospital. Hospitals
467 shall be ranked based on performance rates.
468 (b) For at least the first three rate-setting periods after
469 the performance payment system is implemented, a positive
470 payment adjustment shall be made to hospitals in the top 10
471 percentiles, based on their performance rates, and the 10
472 hospitals with the best year-to-year improvement among those
473 hospitals that did not rank in the top 10 percentiles. After the
474 third period of performance payment, the agency may replace the
475 criteria specified in this subsection with quantified benchmarks
476 for determining which providers qualify for positive payment
477 adjustments.
478 (c) Quality improvement activities that may earn positive
479 payment adjustments include:
480 1. Complying with requirements that reduce hospital
481 acquired infections pursuant to s. 395.1055(1)(b); or
482 2. Actively engaging in a quality improvement collaboration
483 that focuses on reducing potentially preventable admissions,
484 potentially preventable readmissions, or hospital-acquired
485 infections.
486 (7) The performance payment system for skilled nursing
487 facilities shall apply to facilities licensed pursuant to part
488 II of chapter 400 with current Medicaid provider service
489 agreements. The agency, after consultation with the technical
490 advisory panel established in subsection (5), shall select
491 outcome measures to be used to allocate positive payment
492 adjustments. The outcome measures shall be consistent with the
493 federal Quality Assurance and Performance Improvement
494 requirements and include one or more of the following clinical
495 care areas: pressure sores, falls, or hospitalizations.
496 (a) For each 12-month period after the base year, the
497 agency shall determine the expected rate and the observed rate
498 for specific outcome indicators for each skilled nursing
499 facility. The difference between the expected and observed rates
500 shall be used to establish a performance rate for each skilled
501 nursing facility. Facilities shall be ranked based on
502 performance rates.
503 (b) For at least the first three rate-setting periods after
504 the performance payment system is implemented, a positive
505 payment adjustment shall be made to facilities in the top three
506 percentiles, based on their performance rates, and the 10
507 facilities with the best year-to-year improvement among
508 facilities that did not rank in the top three percentiles. After
509 the third period of performance payment, the agency may replace
510 the criteria specified in this subsection with quantified
511 benchmarks for determining which facilities qualify for positive
512 payment adjustments.
513 (c) Quality improvement activities that may earn positive
514 payment adjustments include:
515 1. Actively engaging in a comprehensive fall-prevention
516 program.
517 2. Actively engaging in a quality improvement collaboration
518 that focuses on reducing potentially preventable hospital
519 admissions or reducing the percentage of residents with pressure
520 ulcers that are new or worsened.
521 (8) A performance payment system shall apply to all managed
522 care plans. The outcome measures used to allocate positive
523 payment adjustments shall consist of one or more potentially
524 preventable events, such as potentially preventable initial
525 hospital admissions, potentially preventable emergency
526 department visits, or potentially preventable ancillary
527 services.
528 (a) For each 12-month period after the base year, the
529 agency shall determine the expected rate and the observed rate
530 for specific outcome indicators for each managed care plan. The
531 difference between the expected and observed rates shall be used
532 to establish a performance rate for each plan. Managed care
533 plans shall be ranked based on performance rates.
534 (b) For at least the first three rate-setting periods after
535 the performance payment system is implemented, a positive
536 payment adjustment shall be made to the top 10 managed care
537 plans. After the third period during which the performance
538 payment system is implemented, the agency may replace the
539 criteria specified in this subsection with quantified benchmarks
540 for determining which plans qualify for positive payment
541 adjustments.
542 (9) Payment adjustments made pursuant to this section may
543 not result in expenditures that exceed the amounts appropriated
544 in the General Appropriations Act for hospitals, nursing homes,
545 and managed care plans.
546 Section 11. Paragraph (a) of subsection (1) of section
547 415.1034, Florida Statutes, is amended to read:
548 415.1034 Mandatory reporting of abuse, neglect, or
549 exploitation of vulnerable adults; mandatory reports of death.—
550 (1) MANDATORY REPORTING.—
551 (a) Any person, including, but not limited to, any:
552 1. A physician, osteopathic physician, medical examiner,
553 chiropractic physician, nurse, paramedic, emergency medical
554 technician, or hospital personnel engaged in the admission,
555 examination, care, or treatment of vulnerable adults;
556 2. A health professional or mental health professional
557 other than one listed in subparagraph 1.;
558 3. A practitioner who relies solely on spiritual means for
559 healing;
560 4. Nursing home staff; assisted living facility staff;
561 adult day care center staff; adult family-care home staff;
562 social worker; or other professional adult care, residential, or
563 institutional staff;
564 5. A state, county, or municipal criminal justice employee
565 or law enforcement officer;
566 6. An employee of the Department of Business and
567 Professional Regulation conducting inspections of public lodging
568 establishments under s. 509.032;
569 7. A Florida advocacy council member or long-term care
570 ombudsman council member; or
571 8. A bank, savings and loan, or credit union officer,
572 trustee, or employee; or
573 9. An employee or agent of a state or local agency who has
574 regulatory responsibilities over or who provides services to
575 persons residing in a state-licensed assisted living facility,
576
577 who knows, or has reasonable cause to suspect, that a vulnerable
578 adult has been or is being abused, neglected, or exploited must
579 shall immediately report such knowledge or suspicion to the
580 central abuse hotline.
581 Section 12. Subsections (7) and (8) of section 429.02,
582 Florida Statutes, are amended to read:
583 429.02 Definitions.—When used in this part, the term:
584 (7) “Community living support plan” means a written
585 document prepared by a mental health resident and the resident’s
586 mental health case manager in consultation with the
587 administrator of an assisted living facility with a limited
588 mental health license or the administrator’s designee. A copy
589 must be provided to the administrator. The plan must include
590 information about the supports, services, and special needs of
591 the resident which enable the resident to live in the assisted
592 living facility and a method by which facility staff can
593 recognize and respond to the signs and symptoms particular to
594 that resident which indicate the need for professional services.
595 (8) “Cooperative agreement” means a written statement of
596 understanding between a mental health care provider and the
597 administrator of the assisted living facility with a limited
598 mental health license in which a mental health resident is
599 living. The agreement must specify directions for accessing
600 emergency and after-hours care for the mental health resident. A
601 single cooperative agreement may service all mental health
602 residents who are clients of the same mental health care
603 provider.
604 Section 13. Subsection (1) and paragraphs (b) and (c) of
605 subsection (3) of section 429.07, Florida Statutes, are amended
606 to read:
607 429.07 License required; fee.—
608 (1) The requirements of part II of chapter 408 apply to the
609 provision of services that require licensure pursuant to this
610 part and part II of chapter 408 and to entities licensed by or
611 applying for such licensure from the agency pursuant to this
612 part. A license issued by the agency is required in order to
613 operate an assisted living facility in this state. Effective
614 July 1, 2013, an assisted living facility may not operate in
615 this state unless the facility is under the management of an
616 assisted living facility administrator licensed pursuant to s.
617 429.50.
618 (3) In addition to the requirements of s. 408.806, each
619 license granted by the agency must state the type of care for
620 which the license is granted. Licenses shall be issued for one
621 or more of the following categories of care: standard, extended
622 congregate care, limited nursing services, or limited mental
623 health.
624 (b) An extended congregate care license shall be issued to
625 facilities providing, directly or through contract, services
626 beyond those authorized in paragraph (a), including services
627 performed by persons licensed under part I of chapter 464 and
628 supportive services, as defined by rule, to persons who would
629 otherwise be disqualified from continued residence in a facility
630 licensed under this part.
631 1. In order for extended congregate care services to be
632 provided, the agency must first determine that all requirements
633 established in law and rule are met and must specifically
634 designate, on the facility’s license, that such services may be
635 provided and whether the designation applies to all or part of
636 the facility. Such designation may be made at the time of
637 initial licensure or relicensure, or upon request in writing by
638 a licensee under this part and part II of chapter 408. The
639 notification of approval or the denial of the request shall be
640 made in accordance with part II of chapter 408. Existing
641 facilities qualifying to provide extended congregate care
642 services must have maintained a standard license and may not
643 have been subject to administrative sanctions during the
644 previous 2 years, or since initial licensure if the facility has
645 been licensed for less than 2 years, for any of the following
646 reasons:
647 a. A class I or class II violation;
648 b. Three or more repeat or recurring class III violations
649 of identical or similar resident care standards from which a
650 pattern of noncompliance is found by the agency;
651 c. Three or more class III violations that were not
652 corrected in accordance with the corrective action plan approved
653 by the agency;
654 d. Violation of resident care standards which results in
655 requiring the facility to employ the services of a consultant
656 pharmacist or consultant dietitian;
657 e. Denial, suspension, or revocation of a license for
658 another facility licensed under this part in which the applicant
659 for an extended congregate care license has at least 25 percent
660 ownership interest; or
661 f. Imposition of a moratorium pursuant to this part or part
662 II of chapter 408 or initiation of injunctive proceedings.
663 2. A facility that is licensed to provide extended
664 congregate care services shall maintain a written progress
665 report on each person who receives services which describes the
666 type, amount, duration, scope, and outcome of services that are
667 rendered and the general status of the resident’s health. A
668 registered nurse, or appropriate designee, representing the
669 agency shall visit the facility at least once a year quarterly
670 to monitor residents who are receiving extended congregate care
671 services and to determine if the facility is in compliance with
672 this part, part II of chapter 408, and relevant rules. One of
673 the visits may be in conjunction with the regular survey. The
674 monitoring visits may be provided through contractual
675 arrangements with appropriate community agencies. A registered
676 nurse shall serve as part of the team that inspects the
677 facility. The agency may waive a one of the required yearly
678 monitoring visit visits for a facility that has been licensed
679 for at least 24 months to provide extended congregate care
680 services, if, during the inspection, the registered nurse
681 determines that extended congregate care services are being
682 provided appropriately, and if the facility has no:
683 a. Class I or class II violations and no uncorrected class
684 III violations;
685 b. Citations for a licensure violation which resulted from
686 referrals by the ombudsman to the agency; or
687 c. Citation for a licensure violation which resulted from
688 complaints to the agency. The agency must first consult with the
689 long-term care ombudsman council for the area in which the
690 facility is located to determine if any complaints have been
691 made and substantiated about the quality of services or care.
692 The agency may not waive one of the required yearly monitoring
693 visits if complaints have been made and substantiated.
694 3. A facility that is licensed to provide extended
695 congregate care services must:
696 a. Demonstrate the capability to meet unanticipated
697 resident service needs.
698 b. Offer a physical environment that promotes a homelike
699 setting, provides for resident privacy, promotes resident
700 independence, and allows sufficient congregate space as defined
701 by rule.
702 c. Have sufficient staff available, taking into account the
703 physical plant and firesafety features of the building, to
704 assist with the evacuation of residents in an emergency.
705 d. Adopt and follow policies and procedures that maximize
706 resident independence, dignity, choice, and decisionmaking to
707 permit residents to age in place, so that moves due to changes
708 in functional status are minimized or avoided.
709 e. Allow residents or, if applicable, a resident’s
710 representative, designee, surrogate, guardian, or attorney in
711 fact to make a variety of personal choices, participate in
712 developing service plans, and share responsibility in
713 decisionmaking.
714 f. Implement the concept of managed risk.
715 g. Provide, directly or through contract, the services of a
716 person licensed under part I of chapter 464.
717 h. In addition to the training mandated in s. 429.52,
718 provide specialized training as defined by rule for facility
719 staff.
720 4. A facility that is licensed to provide extended
721 congregate care services is exempt from the criteria for
722 continued residency set forth in rules adopted under s. 429.41.
723 A licensed facility must adopt its own requirements within
724 guidelines for continued residency set forth by rule. However,
725 the facility may not serve residents who require 24-hour nursing
726 supervision. A licensed facility that provides extended
727 congregate care services must also provide each resident with a
728 written copy of facility policies governing admission and
729 retention.
730 5. The primary purpose of extended congregate care services
731 is to allow residents, as they become more impaired, the option
732 of remaining in a familiar setting from which they would
733 otherwise be disqualified for continued residency. A facility
734 licensed to provide extended congregate care services may also
735 admit an individual who exceeds the admission criteria for a
736 facility with a standard license, if the individual is
737 determined appropriate for admission to the extended congregate
738 care facility.
739 6. Before the admission of an individual to a facility
740 licensed to provide extended congregate care services, the
741 individual must undergo a medical examination as provided in s.
742 429.26(4) and the facility must develop a preliminary service
743 plan for the individual.
744 7. When a facility can no longer provide or arrange for
745 services in accordance with the resident’s service plan and
746 needs and the facility’s policy, the facility shall make
747 arrangements for relocating the person in accordance with s.
748 429.28(1)(k).
749 8. Failure to provide extended congregate care services may
750 result in denial of extended congregate care license renewal.
751 (c) A limited nursing services license shall be issued to a
752 facility that provides services beyond those authorized in
753 paragraph (a) and as specified in this paragraph.
754 1. In order for limited nursing services to be provided in
755 a facility licensed under this part, the agency must first
756 determine that all requirements established in law and rule are
757 met and must specifically designate, on the facility’s license,
758 that such services may be provided. Such designation may be made
759 at the time of initial licensure or relicensure, or upon request
760 in writing by a licensee under this part and part II of chapter
761 408. Notification of approval or denial of such request shall be
762 made in accordance with part II of chapter 408. Existing
763 facilities qualifying to provide limited nursing services shall
764 have maintained a standard license and may not have been subject
765 to administrative sanctions that affect the health, safety, and
766 welfare of residents for the previous 2 years or since initial
767 licensure if the facility has been licensed for less than 2
768 years.
769 2. Facilities that are licensed to provide limited nursing
770 services shall maintain a written progress report on each person
771 who receives such nursing services, which report describes the
772 type, amount, duration, scope, and outcome of services that are
773 rendered and the general status of the resident’s health. A
774 registered nurse representing the agency shall visit such
775 facilities at least once twice a year to monitor residents who
776 are receiving limited nursing services and to determine if the
777 facility is in compliance with applicable provisions of this
778 part, part II of chapter 408, and related rules. The monitoring
779 visits may be provided through contractual arrangements with
780 appropriate community agencies. A registered nurse shall also
781 serve as part of the team that inspects such facility. The
782 agency may waive a monitoring visit for a facility that has been
783 licensed for at least 24 months to provide limited nursing
784 services and if the facility has no:
785 a. Class I or class II violations and no uncorrected class
786 III violations;
787 b. Citations for a licensure violation which resulted from
788 referrals by the ombudsman to the agency; or
789 c. Citation for a licensure violation which resulted from
790 complaints to the agency.
791 3. A person who receives limited nursing services under
792 this part must meet the admission criteria established by the
793 agency for assisted living facilities. When a resident no longer
794 meets the admission criteria for a facility licensed under this
795 part, arrangements for relocating the person shall be made in
796 accordance with s. 429.28(1)(k), unless the facility is licensed
797 to provide extended congregate care services.
798 Section 14. Section 429.075, Florida Statutes, is amended
799 to read:
800 429.075 Limited mental health license.—In order to serve
801 three or more mental health residents, an assisted living
802 facility that serves three or more mental health residents must
803 obtain a limited mental health license.
804 (1) To obtain a limited mental health license, a facility:
805 (a) Must hold a standard license as an assisted living
806 facility; and,
807 (b) Must not have been subject to administrative sanctions
808 during the previous 2 years, or since initial licensure if the
809 assisted living facility has been licensed for less than 2
810 years, for any of the following reasons:
811 1. One or more class I violations imposed by final agency
812 action;
813 2. Three or more class II violations imposed by final
814 agency action;
815 3. Ten or more class III violations that were not corrected
816 in accordance with s. 408.811(4);
817 4. Denial, suspension, or revocation of a license for
818 another assisted living facility licensed under this part in
819 which the license applicant had at least a 25-percent ownership
820 interest; or
821 5. Imposition of a moratorium pursuant to this part or part
822 II of chapter 408 or initiation of injunctive proceedings. any
823 current uncorrected deficiencies or violations, and must ensure
824 that,
825 (2) Within 6 months after receiving a limited mental health
826 license, the facility administrator and the staff of the
827 facility who are in direct contact with mental health residents
828 must complete training of no less than 6 hours related to their
829 duties. This training shall be approved by the Department of
830 Children and Family Services. A training provider may charge a
831 reasonable fee for the training.
832 (3) Application for a limited mental health license Such
833 designation may be made at the time of initial licensure or
834 relicensure or upon request in writing by a licensee under this
835 part and part II of chapter 408. Notification of approval or
836 denial of the license such request shall be made in accordance
837 with this part, part II of chapter 408, and applicable rules.
838 This training will be provided by or approved by the Department
839 of Children and Family Services.
840 (4)(2) Facilities licensed to provide services to mental
841 health residents shall provide appropriate supervision and
842 staffing to provide for the health, safety, and welfare of such
843 residents.
844 (3) A facility that has a limited mental health license
845 must:
846 (a) Have a copy of each mental health resident’s community
847 living support plan and the cooperative agreement with the
848 mental health care services provider. The support plan and the
849 agreement may be combined.
850 (b) Have documentation that is provided by the Department
851 of Children and Family Services that each mental health resident
852 has been assessed and determined to be able to live in the
853 community in an assisted living facility with a limited mental
854 health license.
855 (c) Make the community living support plan available for
856 inspection by the resident, the resident’s legal guardian, the
857 resident’s health care surrogate, and other individuals who have
858 a lawful basis for reviewing this document.
859 (d) Assist the mental health resident in carrying out the
860 activities identified in the individual’s community living
861 support plan.
862 (4) A facility with a limited mental health license may
863 enter into a cooperative agreement with a private mental health
864 provider. For purposes of the limited mental health license, the
865 private mental health provider may act as the case manager.
866 Section 15. Section 429.0751, Florida Statutes, is created
867 to read:
868 429.0751 Mental health residents.—An assisted living
869 facility that has one or more mental health residents must:
870 (1) Enter into a cooperative agreement with the mental
871 health care service provider responsible for providing services
872 to the mental health resident, including a mental health care
873 service provider responsible for providing private pay services
874 to the mental health resident, to ensure coordination of care.
875 (2) Consult with the mental health case manager and the
876 mental health resident in the development of a community living
877 support plan and maintain a copy of each mental health
878 resident’s community living support plan.
879 (3) Make the community living support plan available for
880 inspection by the resident, the resident’s legal guardian, the
881 resident’s health care surrogate, and other individuals who have
882 a lawful basis for reviewing this document.
883 (4) Assist the mental health resident in carrying out the
884 activities identified in the individual’s community living
885 support plan.
886 (5) Have documentation that is provided by the Department
887 of Children and Family Services that each mental health resident
888 has been assessed and determined to be able to live in the
889 community in an assisted living facility.
890 Section 16. Paragraphs (a) and (b) of subsection (2) of
891 section 429.178, Florida Statutes, are amended to read:
892 429.178 Special care for persons with Alzheimer’s disease
893 or other related disorders.—
894 (2)(a) An individual who is employed by a facility that
895 provides special care for residents with Alzheimer’s disease or
896 other related disorders, and who has regular contact with such
897 residents, must complete up to 4 hours of initial dementia
898 specific training developed or approved by the department. The
899 training shall be completed within 3 months after beginning
900 employment and shall satisfy the core training requirements of
901 s. 429.52(2)(d) 429.52(2)(g).
902 (b) A direct caregiver who is employed by a facility that
903 provides special care for residents with Alzheimer’s disease or
904 other related disorders, and who provides direct care to such
905 residents, must complete the required initial training and 4
906 additional hours of training developed or approved by the
907 department. The training shall be completed within 9 months
908 after beginning employment and shall satisfy the core training
909 requirements of s. 429.52(2)(d) 429.52(2)(g).
910 Section 17. Subsection (2) of section 429.19, Florida
911 Statutes, is amended to read:
912 429.19 Violations; imposition of administrative fines;
913 grounds.—
914 (2) Each violation of this part and adopted rules shall be
915 classified according to the nature of the violation and the
916 gravity of its probable effect on facility residents.
917 (a) The agency shall indicate the classification on the
918 written notice of the violation as follows:
919 1.(a) Class “I” violations are defined in s. 408.813. The
920 agency shall issue a citation regardless of correction. The
921 agency shall impose an administrative fine for a cited class I
922 violation in an amount not less than $5,000 and not exceeding
923 $10,000 for each violation.
924 2.(b) Class “II” violations are defined in s. 408.813. The
925 agency may issue a citation regardless of correction. The agency
926 shall impose an administrative fine for a cited class II
927 violation in an amount not less than $1,000 and not exceeding
928 $5,000 for each violation.
929 3.(c) Class “III” violations are defined in s. 408.813. The
930 agency shall impose an administrative fine for a cited class III
931 violation in an amount not less than $500 and not exceeding
932 $1,000 for each violation.
933 4.(d) Class “IV” violations are defined in s. 408.813. The
934 agency shall impose an administrative fine for a cited class IV
935 violation in an amount not less than $100 and not exceeding $200
936 for each violation.
937 (b) In lieu of the penalties provided in paragraph (a), the
938 agency shall impose a $10,000 penalty for a violation that
939 results in the death of a resident.
940 (c) Notwithstanding paragraph (a), if the assisted living
941 facility is cited for a class I or class II violation and within
942 24 months the facility is cited for another class I or class II
943 violation, the agency shall double the fine for the subsequent
944 violation if the violation is in the same class as the previous
945 violation.
946 Section 18. Section 429.195, Florida Statutes, is amended
947 to read:
948 429.195 Rebates prohibited; penalties.—
949 (1) It is unlawful for any assisted living facility
950 licensed under this part to contract or promise to pay or
951 receive any commission, bonus, kickback, or rebate or engage in
952 any split-fee arrangement in any form whatsoever with any
953 person, health care provider, or health care facility as
954 provided in s. 817.505 physician, surgeon, organization, agency,
955 or person, either directly or indirectly, for residents referred
956 to an assisted living facility licensed under this part. A
957 facility may employ or contract with persons to market the
958 facility, provided the employee or contract provider clearly
959 indicates that he or she represents the facility. A person or
960 agency independent of the facility may provide placement or
961 referral services for a fee to individuals seeking assistance in
962 finding a suitable facility; however, any fee paid for placement
963 or referral services must be paid by the individual looking for
964 a facility, not by the facility.
965 (2) This section does not apply to:
966 (a) Any individual employed by the assisted living facility
967 or with whom the facility contracts to market the facility if
968 the individual clearly indicates that he or she works with or
969 for the facility.
970 (b) Payments by an assisted living facility to a referral
971 service that provides information, consultation, or referrals to
972 consumers to assist them in finding appropriate care or housing
973 options for seniors or disabled adults, if such referred
974 consumers are not Medicaid recipients.
975 (c) A resident of an assisted living facility who refers to
976 the assisted living facility a friend, family member, or other
977 individual with whom the resident has a personal relationship,
978 in which case the assisted living facility may provide a
979 monetary reward to the resident for making such referral.
980 (3)(2) A violation of this section shall be considered
981 patient brokering and is punishable as provided in s. 817.505.
982 Section 19. Paragraph (j) is added to subsection (3) of
983 section 817.505, Florida Statutes, to read:
984 817.505 Patient brokering prohibited; exceptions;
985 penalties.—
986 (3) This section shall not apply to:
987 (j) Any payment permitted under s. 429.195(2).
988 Section 20. Section 429.231, Florida Statutes, is created
989 to read:
990 429.231 Advisory council; membership; duties.—
991 (1) The department shall establish an advisory council to
992 review the facts and circumstances of unexpected deaths in
993 assisted living facilities and of elopements that result in harm
994 to a resident. The purpose of this review is to:
995 (a) Achieve a greater understanding of the causes and
996 contributing factors of the unexpected deaths and elopements.
997 (b) Identify any gaps, deficiencies, or problems in the
998 delivery of services to the residents.
999 (2) Based on the review, the advisory council shall make
1000 recommendations for:
1001 (a) Industry best practices that could be used to prevent
1002 unexpected deaths and elopements.
1003 (b) Training and educational requirements for employees and
1004 administrators of assisted living facilities.
1005 (c) Changes in the law, rules, or other policies to prevent
1006 unexpected deaths and elopements.
1007 (3) The advisory council shall prepare an annual
1008 statistical report on the incidence and causes of unexpected
1009 deaths in assisted living facilities and of elopements that
1010 result in harm to residents during the prior calendar year. The
1011 advisory council shall submit a copy of the report by December
1012 31 of each year to the Governor, the President of the Senate,
1013 and the Speaker of the House of Representatives. The report may
1014 make recommendations for state action, including specific
1015 policy, procedural, regulatory, or statutory changes, and any
1016 other recommended preventive action.
1017 (4) The advisory council shall consist of the following
1018 members:
1019 (a) The Secretary of Elderly Affairs, or a designee, who
1020 shall be the chair.
1021 (b) The Secretary of Health Care Administration, or a
1022 designee.
1023 (c) The Secretary of Children and Family Services, or a
1024 designee.
1025 (d) The State Long-Term Care Ombudsman, or a designee.
1026 (e) The following members, selected by the Governor:
1027 1. An owner or administrator of an assisted living facility
1028 with fewer than 17 beds.
1029 2. An owner or administrator of an assisted living facility
1030 with 17 or more beds.
1031 3. An owner or administrator of an assisted living facility
1032 with a limited mental health license.
1033 4. A representative from each of three statewide
1034 associations that represent assisted living facilities.
1035 5. A resident of an assisted living facility.
1036 (5) The advisory council shall meet at the call of the
1037 chair, but at least twice each calendar year. The chair may
1038 appoint ad hoc committees as necessary to carry out the duties
1039 of the council.
1040 (6) The members of the advisory council selected by the
1041 Governor shall be appointed to staggered terms of office which
1042 may not exceed 2 years. Members are eligible for reappointment.
1043 (7) Members of the advisory council shall serve without
1044 compensation, but are entitled to reimbursement for per diem and
1045 travel expenses incurred in the performance of their duties as
1046 provided in s. 112.061 and to the extent that funds are
1047 available.
1048 Section 21. Section 429.34, Florida Statutes, is amended to
1049 read:
1050 429.34 Right of entry and inspection.—
1051 (1) In addition to the requirements of s. 408.811, any duly
1052 designated officer or employee of the department, the Department
1053 of Children and Family Services, the Medicaid Fraud Control Unit
1054 of the Office of the Attorney General, the state or local fire
1055 marshal, or a member of the state or local long-term care
1056 ombudsman council may shall have the right to enter unannounced
1057 upon and into the premises of any facility licensed pursuant to
1058 this part in order to determine the state of compliance with the
1059 provisions of this part, part II of chapter 408, and applicable
1060 rules. Data collected by the state or local long-term care
1061 ombudsman councils or the state or local advocacy councils may
1062 be used by the agency in investigations involving violations of
1063 regulatory standards.
1064 (2) In accordance with s. 408.811, every 24 months the
1065 agency shall conduct at least one unannounced inspection to
1066 determine compliance with this part, part II of chapter 408, and
1067 applicable rules. If the assisted living facility is accredited
1068 by the Joint Commission, the Council on Accreditation, or the
1069 Commission on Accreditation of Rehabilitation Facilities, the
1070 agency may conduct inspections less frequently, but in no event
1071 less than once every 5 years.
1072 (a) Two additional inspections shall be conducted every 6
1073 months for the next year if the assisted living facility has
1074 been cited for a class I violation or two or more class II
1075 violations arising from separate inspections within a 60-day
1076 period. In addition to any fines imposed on an assisted living
1077 facility under s. 429.19, the agency shall assess a fee of $69
1078 per bed for each of the additional two inspections, not to
1079 exceed $12,000 per inspection.
1080 (b) The agency shall verify through subsequent inspections
1081 that any violation identified during an inspection is corrected.
1082 However, the agency may verify the correction of a class III or
1083 class IV violation unrelated to resident rights or resident care
1084 without reinspection if the facility submits adequate written
1085 documentation that the violation has been corrected.
1086 Section 22. Section 429.50, Florida Statutes, is created to
1087 read:
1088 429.50 Assisted living facility administrator;
1089 qualifications; licensure; fees; continuing education.—
1090 (1) The requirements of part II of chapter 408 apply to the
1091 provision of services that require licensure pursuant to this
1092 section. Effective July 1, 2013, an assisted living facility
1093 administrator must have a license issued by the agency.
1094 (2) To be eligible to be licensed as an assisted living
1095 facility administrator, an applicant must provide proof of a
1096 current and valid assisted living facility administrator
1097 certification and complete background screening pursuant to s.
1098 429.174.
1099 (3) Notwithstanding subsection (2), the agency may grant an
1100 initial license to an applicant who:
1101 (a)1. Has been employed as an assisted living facility
1102 administrator for 2 of the 5 years immediately preceding July 1,
1103 2013, or who is employed as an assisted living facility
1104 administrator on June 1, 2013;
1105 2. Is in compliance with the continuing education
1106 requirements in this part;
1107 3. Within 2 years before the initial application for an
1108 assisted living facility administrator license, has not been the
1109 administrator of an assisted living facility when a Class I or
1110 Class II violation occurred for which the facility was cited by
1111 final agency action; and
1112 4. Has completed background screening pursuant to s.
1113 429.174; or
1114 (b) Is licensed in accordance with part II of chapter 468,
1115 is in compliance with the continuing education requirements in
1116 part II of chapter 468, and has completed background screening
1117 pursuant to s. 429.174.
1118 (4) An assisted living facility administrator certification
1119 must be issued by a third-party credentialing entity under
1120 contract with the agency, and, for the initial certification,
1121 the entity must certify that the individual:
1122 (a) Is at least 21 years old.
1123 (b) Has completed 30 hours of core training and 10 hours of
1124 supplemental training as described in s. 429.52.
1125 (c) Has passed the competency test described in s. 429.52
1126 with a minimum score of 80.
1127 (d) Has otherwise met the requirements of this part.
1128 (5) The agency shall contract with one or more third-party
1129 credentialing entities for the purpose of certifying assisted
1130 living facility administrators. A third-party credentialing
1131 entity must be a nonprofit organization that has met nationally
1132 recognized standards for developing and administering
1133 professional certification programs. The contract must require
1134 that a third-party credentialing entity:
1135 (a) Develop a competency test as described in s. 429.52(7).
1136 (b) Maintain an Internet-based database, accessible to the
1137 public, of all persons holding an assisted living facility
1138 administrator certification.
1139 (c) Require continuing education consistent with s. 429.52
1140 and, at least, biennial certification renewal for persons
1141 holding an assisted living facility administrator certification.
1142 (6) The license shall be renewed biennially.
1143 (7) The fees for licensure shall be $150 for the initial
1144 licensure and $150 for each licensure renewal.
1145 (8) A licensed assisted living facility administrator must
1146 complete continuing education described in s. 429.52 for a
1147 minimum of 18 hours every 2 years.
1148 (9) The agency shall deny or revoke the license if the
1149 applicant or licensee:
1150 (a) Was the assisted living facility administrator of
1151 record for an assisted living facility licensed by the agency
1152 under this chapter, part II of chapter 408, or applicable rules,
1153 when the facility was cited for violations that resulted in
1154 denial or revocation of a license; or
1155 (b) Has a final agency action for unlicensed activity
1156 pursuant to this chapter, part II of chapter 408, or applicable
1157 rules.
1158 (10) The agency may deny or revoke the license if the
1159 applicant or licensee was the assisted living facility
1160 administrator of record for an assisted living facility licensed
1161 by the agency under this chapter, part II of chapter 408, or
1162 applicable rules, when the facility was cited for violations
1163 within the previous 3 years that resulted in a resident’s death.
1164 (11) The agency may adopt rules as necessary to administer
1165 this section.
1166 Section 23. For the purpose of staggering license
1167 expiration dates, the Agency for Health Care Administration may
1168 issue a license for less than a 2-year period for assisted
1169 living facility administrator licensure as authorized in this
1170 act. The agency shall charge a prorated licensure fee for this
1171 shortened period. This section and the authority granted under
1172 this section expire December 31, 2013.
1173 Section 24. Effective January 1, 2013, section 429.52,
1174 Florida Statutes, is amended to read:
1175 429.52 Staff, administrator, and administrator license
1176 applicant training and educational programs; core educational
1177 requirement.—
1178 (1) Administrators, applicants to become administrators,
1179 and other assisted living facility staff must meet minimum
1180 training and education requirements established by the
1181 Department of Elderly Affairs by rule. This training and
1182 education is intended to assist facilities to appropriately
1183 respond to the needs of residents, to maintain resident care and
1184 facility standards, and to meet licensure requirements.
1185 (2) For assisted living facility staff other than
1186 administrators, The department shall establish a competency test
1187 and a minimum required score to indicate successful completion
1188 of the training and educational requirements. The competency
1189 test must be developed by the department in conjunction with the
1190 agency and providers. the required training and education, which
1191 may be provided as inservice training, must cover at least the
1192 following topics:
1193 (a) Reporting major incidents and reporting adverse
1194 incidents State law and rules relating to assisted living
1195 facilities.
1196 (b) Resident rights and identifying and reporting abuse,
1197 neglect, and exploitation.
1198 (c) Emergency procedures, including firesafety and resident
1199 elopement response policies and procedures Special needs of
1200 elderly persons, persons with mental illness, and persons with
1201 developmental disabilities and how to meet those needs.
1202 (d) General information on interacting with individuals
1203 with Alzheimer’s disease and related disorders Nutrition and
1204 food service, including acceptable sanitation practices for
1205 preparing, storing, and serving food.
1206 (e) Medication management, recordkeeping, and proper
1207 techniques for assisting residents with self-administered
1208 medication.
1209 (f) Firesafety requirements, including fire evacuation
1210 drill procedures and other emergency procedures.
1211 (g) Care of persons with Alzheimer’s disease and related
1212 disorders.
1213 (3) Effective January 1, 2004, a new facility administrator
1214 must complete the required training and education, including the
1215 competency test, within a reasonable time after being employed
1216 as an administrator, as determined by the department. Failure to
1217 do so is a violation of this part and subjects the violator to
1218 an administrative fine as prescribed in s. 429.19.
1219 Administrators licensed in accordance with part II of chapter
1220 468 are exempt from this requirement. Other licensed
1221 professionals may be exempted, as determined by the department
1222 by rule.
1223 (4) Administrators are required to participate in
1224 continuing education for a minimum of 12 contact hours every 2
1225 years.
1226 (3)(5) Staff involved with the management of medications
1227 and assisting with the self-administration of medications under
1228 s. 429.256 must complete a minimum of 4 additional hours of
1229 training provided by a registered nurse, licensed pharmacist, or
1230 department staff. The department shall establish by rule the
1231 minimum requirements of this additional training.
1232 (6) Other facility staff shall participate in training
1233 relevant to their job duties as specified by rule of the
1234 department.
1235 (4)(7) If the department or the agency determines that
1236 there are problems in a facility that could be reduced through
1237 specific staff training or education beyond that already
1238 required under this section, the department or the agency may
1239 require, and provide, or cause to be provided, the training or
1240 education of any personal care staff in the facility.
1241 (5) The department, in consultation with the agency, the
1242 Department of Children and Family Services, and stakeholders,
1243 shall approve a standardized core training curriculum that must
1244 be completed by an applicant for licensure as an assisted living
1245 facility administrator. The curriculum must be offered in
1246 English and Spanish and timely updated to reflect changes in the
1247 law, rules, and best practices. The required training must
1248 cover, at a minimum, the following topics:
1249 (a) State law and rules relating to assisted living
1250 facilities.
1251 (b) Residents’ rights and procedures for identifying and
1252 reporting abuse, neglect, and exploitation.
1253 (c) Special needs of elderly persons, persons who have
1254 mental illnesses, and persons who have developmental
1255 disabilities and how to meet those needs.
1256 (d) Nutrition and food service, including acceptable
1257 sanitation practices for preparing, storing, and serving food.
1258 (e) Medication management, recordkeeping, and proper
1259 techniques for assisting residents who self-administer
1260 medication.
1261 (f) Firesafety requirements, including procedures for fire
1262 evacuation drills and other emergency procedures.
1263 (g) Care of persons who have Alzheimer’s disease and
1264 related disorders.
1265 (h) Elopement prevention.
1266 (i) Aggression and behavior management, deescalation
1267 techniques, and proper protocols and procedures of the Baker Act
1268 as provided in part I of chapter 394.
1269 (j) Do-not-resuscitate orders.
1270 (k) Infection control.
1271 (l) Admission, continuing residency, and best practices in
1272 the assisted living industry.
1273 (m) Phases of care and interacting with residents.
1274 (6) The department, in consultation with the agency, the
1275 Department of Children and Family Services, and stakeholders,
1276 shall approve a supplemental training curriculum consisting of
1277 topics related to extended congregate care, limited mental
1278 health, and business operations, including human resources,
1279 financial management, and supervision of staff, which must be
1280 completed by an applicant for licensure as an assisted living
1281 facility administrator.
1282 (7) The department shall approve a competency test for
1283 applicants for licensure as an assisted living facility
1284 administrator which tests the individual’s comprehension of the
1285 training required in subsections (5) and (6). The competency
1286 test must be reviewed annually and timely updated to reflect
1287 changes in the law, rules, and best practices. The competency
1288 test must be offered in English and Spanish and may be made
1289 available through testing centers.
1290 (8) The department, in consultation with the agency and
1291 stakeholders, shall approve curricula for continuing education
1292 for administrators and staff members of an assisted living
1293 facility. Continuing education shall include topics similar to
1294 that of the core training required for staff members and
1295 applicants for licensure as assisted living facility
1296 administrators. Continuing education may be offered through
1297 online courses, and any fees associated with the online service
1298 shall be borne by the licensee or the assisted living facility.
1299 Required continuing education must, at a minimum, cover the
1300 following topics:
1301 (a) Elopement prevention.
1302 (b) Deescalation techniques.
1303 (c) Phases of care and interacting with residents.
1304 (9) The training required by this section shall be
1305 conducted by:
1306 (a) Any Florida College System institution;
1307 (b) Any nonpublic postsecondary educational institution
1308 licensed or exempted from licensure pursuant to chapter 1005; or
1309 (c) Any statewide association that contracts with the
1310 department to provide training. The department may specify
1311 minimum trainer qualifications in the contract. For the purposes
1312 of this section, the term “statewide association” means any
1313 statewide entity which represents and provides technical
1314 assistance to assisted living facilities.
1315 (10) Assisted living facility trainers shall keep a record
1316 of individuals who complete training and shall, within 30 days
1317 after the individual completes the course, electronically submit
1318 the record to the agency and to all third-party credentialing
1319 entities under contract with the agency pursuant to s.
1320 429.50(5).
1321 (11) The department shall adopt rules as necessary to
1322 administer this section.
1323 (8) The department shall adopt rules related to these
1324 training requirements, the competency test, necessary
1325 procedures, and competency test fees and shall adopt or contract
1326 with another entity to develop a curriculum, which shall be used
1327 as the minimum core training requirements. The department shall
1328 consult with representatives of stakeholder associations and
1329 agencies in the development of the curriculum.
1330 (9) The training required by this section shall be
1331 conducted by persons registered with the department as having
1332 the requisite experience and credentials to conduct the
1333 training. A person seeking to register as a trainer must provide
1334 the department with proof of completion of the minimum core
1335 training education requirements, successful passage of the
1336 competency test established under this section, and proof of
1337 compliance with the continuing education requirement in
1338 subsection (4).
1339 (10) A person seeking to register as a trainer must also:
1340 (a) Provide proof of completion of a 4-year degree from an
1341 accredited college or university and must have worked in a
1342 management position in an assisted living facility for 3 years
1343 after being core certified;
1344 (b) Have worked in a management position in an assisted
1345 living facility for 5 years after being core certified and have
1346 1 year of teaching experience as an educator or staff trainer
1347 for persons who work in assisted living facilities or other
1348 long-term care settings;
1349 (c) Have been previously employed as a core trainer for the
1350 department; or
1351 (d) Meet other qualification criteria as defined in rule,
1352 which the department is authorized to adopt.
1353 (11) The department shall adopt rules to establish trainer
1354 registration requirements.
1355 Section 25. Section 429.54, Florida Statutes, is amended to
1356 read:
1357 429.54 Collection of information; local subsidy;
1358 interagency communication.—
1359 (1) To enable the department to collect the information
1360 requested by the Legislature regarding the actual cost of
1361 providing room, board, and personal care in assisted living
1362 facilities, the department may is authorized to conduct field
1363 visits and audits of facilities as may be necessary. The owners
1364 of randomly sampled facilities shall submit such reports,
1365 audits, and accountings of cost as the department may require by
1366 rule; however, provided that such reports, audits, and
1367 accountings may not be more than shall be the minimum necessary
1368 to implement the provisions of this subsection section. Any
1369 facility selected to participate in the study shall cooperate
1370 with the department by providing cost of operation information
1371 to interviewers.
1372 (2) Local governments or organizations may contribute to
1373 the cost of care of local facility residents by further
1374 subsidizing the rate of state-authorized payment to such
1375 facilities. Implementation of local subsidy shall require
1376 departmental approval and may shall not result in reductions in
1377 the state supplement.
1378 (3) Subject to the availability of funds, the agency, the
1379 department, the Department of Children and Family Services, and
1380 the Agency for Persons with Disabilities shall develop or modify
1381 electronic systems of communication among state-supported
1382 automated systems to ensure that relevant information pertaining
1383 to the regulation of assisted living facilities and assisted
1384 living facility staff is timely and effectively communicated
1385 among agencies in order to facilitate the protection of
1386 residents.
1387 Section 26. For fiscal year 2012-2013, 8 full-time
1388 equivalent positions, with associated salary rate of 324,962,
1389 are authorized and the sum of $554,399 in recurring funds from
1390 the Health Care Trust Fund of the Agency for Health Care
1391 Administration are appropriated to the Agency for Health Care
1392 Administration for the purpose of carrying out the regulatory
1393 activities provided in this act.
1394 Section 27. Except as otherwise expressly provided in this
1395 act, this act shall take effect July 1, 2012.
1396
1397
1398 ================= T I T L E A M E N D M E N T ================
1399 And the title is amended as follows:
1400 Delete everything before the enacting clause
1401 and insert:
1402 A bill to be entitled
1403 An act relating to quality improvement initiatives for
1404 entities regulated by the Agency for Health Care
1405 Administration; amending s. 394.4574, F.S.; providing
1406 responsibilities of the Department of Children and
1407 Family Services and mental health service providers
1408 for mental health residents who reside in assisted
1409 living facilities; directing the agency to impose
1410 contract penalties on Medicaid prepaid health plans
1411 under specified circumstances; directing the
1412 department to impose contract penalties on mental
1413 health service providers under specified
1414 circumstances; directing the department and the agency
1415 to enter into an interagency agreement for the
1416 enforcement of their respective responsibilities and
1417 procedures related thereto; amending s. 395.002, F.S.;
1418 revising the definition of the term “accrediting
1419 organizations”; amending s. 395.1051, F.S.; requiring
1420 a hospital to provide notice to all obstetrical
1421 physicians with privileges at that hospital within a
1422 specified period of time before the hospital closes an
1423 obstetrics department or ceases to provide obstetrical
1424 services; amending s. 395.1055, F.S.; revising
1425 provisions relating to agency rules regarding
1426 standards for infection control, housekeeping, and
1427 sanitary conditions in a hospital; requiring
1428 housekeeping and sanitation staff to employ and
1429 document compliance with specified cleaning and
1430 disinfecting procedures; authorizing imposition of
1431 administrative fines for noncompliance; amending s.
1432 400.0078, F.S.; requiring specified information
1433 regarding the confidentiality of complaints to the
1434 State Long-Term Care Ombudsman Program to be provided
1435 to residents of a long-term care facility upon
1436 admission to the facility; amending s. 408.05, F.S.;
1437 directing the agency to collect, compile, analyze, and
1438 distribute specified health care information for
1439 specified uses; providing for the agency to release
1440 data necessary for the administration of the Medicaid
1441 program to quality improvement collaboratives for
1442 specified purposes; amending s. 408.802, F.S.;
1443 providing that the provisions of part II of ch. 408,
1444 F.S., the Health Care Licensing Procedures Act, apply
1445 to assisted living facility administrators; amending
1446 s. 408.820, F.S.; exempting assisted living facility
1447 administrators from specified provisions of part II of
1448 ch. 408, F.S., the Health Care Licensing Procedures
1449 Act; amending s. 409.212, F.S.; increasing a
1450 limitation on additional supplementation a person who
1451 receives optional supplementation may receive;
1452 creating s. 409.986, F.S.; providing definitions;
1453 directing the agency to establish and implement
1454 methodologies to adjust Medicaid rates for hospitals,
1455 nursing homes, and managed care plans; providing
1456 criteria for and limits on the amount of Medicaid
1457 payment rate adjustments; directing the agency to seek
1458 federal approval to implement a performance payment
1459 system; providing for implementation of the system in
1460 fiscal year 2015-2016; authorizing the agency to
1461 appoint a technical advisory panel; providing
1462 applicability of the performance payment system to
1463 general hospitals, skilled nursing facilities, and
1464 managed care plans and providing criteria therefor;
1465 amending s. 415.1034, F.S.; providing that specified
1466 persons who have regulatory responsibilities over or
1467 provide services to persons residing in certain
1468 facilities must report suspected incidents of abuse to
1469 the central abuse hotline; amending s. 429.02, F.S.;
1470 revising definitions applicable to the Assisted Living
1471 Facilities Act; amending s. 429.07, F.S.; requiring
1472 that an assisted living facility be under the
1473 management of a licensed assisted living facility
1474 administrator; providing for a reduced number of
1475 monitoring visits for an assisted living facility that
1476 is licensed to provide extended congregate care
1477 services under specified circumstances; providing for
1478 a reduced number of monitoring visits for an assisted
1479 living facility that is licensed to provide limited
1480 nursing services under specified circumstances;
1481 amending s. 429.075, F.S.; providing additional
1482 requirements for a limited mental health license;
1483 removing specified assisted living facility
1484 requirements; authorizing a training provider to
1485 charge a fee for the training required of facility
1486 administrators and staff; revising provisions for
1487 application for a limited mental health license;
1488 creating s. 429.0751, F.S.; providing requirements for
1489 an assisted living facility that has mental health
1490 residents; requiring the assisted living facility to
1491 enter into a cooperative agreement with a mental
1492 health care service provider; providing for the
1493 development of a community living support plan;
1494 specifying who may have access to the plan; requiring
1495 documentation of mental health resident assessments;
1496 amending s. 429.178, F.S.; conforming cross
1497 references; amending s. 429.19, F.S.; providing fines
1498 and penalties for specified violations by an assisted
1499 living facility; amending s. 429.195, F.S.; revising
1500 applicability of prohibitions on rebates provided by
1501 an assisted living facility for certain referrals;
1502 amending s. 817.505, F.S.; providing an exception from
1503 prohibitions relating to patient brokering; creating
1504 s. 429.231, F.S.; directing the Department of Elderly
1505 Affairs to create an advisory council to review the
1506 facts and circumstances of unexpected deaths in
1507 assisted living facilities and of elopements that
1508 result in harm to a resident; providing duties;
1509 providing for appointment and terms of members;
1510 providing for meetings; requiring a report; providing
1511 for per diem and travel expenses; amending s. 429.34,
1512 F.S.; providing a schedule for the inspection of
1513 assisted living facilities; providing exceptions;
1514 providing for fees for additional inspections after
1515 specified violations; creating s. 429.50, F.S.;
1516 prohibiting a person from performing the duties of an
1517 assisted living facility administrator without a
1518 license; providing qualifications for licensure;
1519 providing requirements for the issuance of assisted
1520 living facility administrator certifications;
1521 providing agency responsibilities; providing
1522 exceptions; providing license and license renewal
1523 fees; providing grounds for revocation or denial of
1524 licensure; providing rulemaking authority; authorizing
1525 the agency to issue a temporary license to an assisted
1526 living facility administrator under certain conditions
1527 and for a specified period of time; amending s.
1528 429.52, F.S.; providing training, competency testing,
1529 and continuing education requirements for assisted
1530 living facility administrators and license applicants;
1531 specifying entities that may provide training;
1532 providing a definition; requiring assisted living
1533 facility trainers to keep certain training records and
1534 submit those records to the agency; providing
1535 rulemaking authority; amending s. 429.54, F.S.;
1536 requiring the Agency for Health Care Administration,
1537 the Department of Elderly Affairs, the Department of
1538 Children and Family Services, and the Agency for
1539 Persons with Disabilities to develop or modify
1540 electronic information systems and other systems to
1541 ensure efficient communication regarding regulation of
1542 assisted living facilities, subject to the
1543 availability of funds; providing an appropriation and
1544 authorizing positions; providing effective dates.
1545