HB 397

1	A bill to be entitled
2	An act relating to assisted living facilities;
3	creating the Florida Assisted Living Quality
4	Improvement Initiative Pilot Project; providing
5	purpose; providing definitions; limiting the pilot
6	project to specified area offices of the Agency for
7	Health Care Administration; providing for statewide
8	expansion of the pilot program on December 31, 2017,
9	unless repealed by the Legislature; providing criteria
10	for participation in the pilot project; providing
11	duties of the agency for implementation of the pilot
12	project; requiring the agency to use an electronic
13	data collection system for quality assurance;
14	providing for establishment of a data collection
15	workgroup and providing its duties; authorizing the
16	agency to establish a fee for facilities that use the
17	data collection system; providing system requirements;
18	providing for establishment of a monitoring workgroup
19	and providing its duties, including a report to the
20	Governor and Legislature; providing for development,
21	in collaboration with the Medicaid Fraud Unit, of an
22	interagency task force to conduct investigations of
23	certain facilities and revoke licenses, suspend
24	payments, and relocate residents for substantial
25	noncompliance or failure to provide adequate care;
26	authorizing the agency to impose a fine for transfers
27	or discharges from a hospital to an assisted living
28	facility that do not meet certain standards; providing
29	for development and implementation of a statewide
30	administrator certification program; requiring an
31	assisted living facility to employ a certified
32	administrator as a condition for continued licensure;
33	providing requirements for and limitations on
34	certified administrators; requiring the administrator
35	of a licensed facility that is eligible to participate
36	in the pilot project to notify the agency when the
37	facility enrolls in the pilot project; requiring each
38	facility, before enrollment, to execute a memorandum
39	of agreement that includes a provision authorizing the
40	agency to terminate the facility's participation in
41	the pilot project; prohibiting a facility from
42	challenging or appealing the agency's decision under
43	ch. 120, F.S.; providing for annual open enrollment;
44	providing that a facility's enrollment in the pilot
45	project does not prohibit the facility from seeking
46	alternative accreditation; requiring the agency to
47	establish quality improvement teams; providing for the
48	composition and duties of a quality improvement team;
49	providing conditions for a quality improvement team to
50	terminate the operation of an assisted living
51	facility; providing for the resumption of inspections
52	by the agency if a facility's participation in the
53	pilot project is terminated; requiring compliance with
54	agency rules before an assisted living facility may be
55	reenrolled in the pilot project; requiring the agency
56	to approve or reject a facility's request for
57	termination of participation in the pilot project;
58	requiring that the facility be subject to survey,
59	inspection, and monitoring visits by the agency;
60	providing that reports and documents generated by a
61	quality improvement team may not be used in certain
62	tort actions; authorizing the Department of Elderly
63	Affairs to adopt rules and impose fees and
64	requirements for providers of core training; providing
65	educational requirements for assisted living facility
66	administrators; providing an effective date.
67
68	Be It Enacted by the Legislature of the State of Florida:
69
70	Section 1.  Florida Assisted Living Quality Improvement
71	Initiative Pilot Project.-
72	(1)  The Florida Assisted Living Quality Improvement
73	Initiative Pilot Project is created to identify best practices
74	for providing care to residents of licensed assisted living
75	facilities, improve regulatory oversight and protection of
76	residents, promote increased information sharing, collaboration,
77	and implementation of best practices by frontline caregivers,
78	and develop, in collaboration with the facility, a quality
79	improvement plan to reduce the need for institutional care.
80	(2)  As used in this section, the term:
81	(a)  "Agency" means the Agency for Health Care
82	Administration.
83	(b)  "Department" means the Department of Elderly Affairs.
84	(3)  The pilot project shall be limited to 150 facilities
85	in each of agency areas 4, 5, 6, 8, and 11. The pilot project
86	shall expand statewide on December 31, 2017, unless repealed by
87	the Legislature. A facility is eligible to participate in the
88	pilot project if the facility has not been cited for a class I
89	or class II violation and has no more than five uncorrected
90	class III violations on the prior two annual surveys and on any
91	survey that resulted from a complaint.
92	(4)  To implement the pilot project, the agency shall,
93	within funds appropriated:
94	(a)  Establish an enrollment process and a timeline for
95	implementation of the pilot project.
96	(b)  Establish a method to measure facility improvement and
97	collect data with respect to critical factors that affect
98	quality of care and occupancy rates.
99	(c)  Use electronic means to collect data on facility
100	quality assurance.
101	(d)  Establish a data collection workgroup to develop
102	criteria for a request for proposal to implement a statewide
103	data collection system. The request for proposal must specify
104	the data elements that the data collection system must capture
105	and how the data will be used to track quality of care and
106	occupancy rates. The agency may reallocate funding within its
107	budget to implement the system in the pilot project areas. An
108	assisted living facility that receives Medicaid funding must use
109	the data collection system. The agency may establish a fee for
110	users of the data collection system. The agency shall require
111	that the data collection system:
112	1.  Be compatible with changes in long-term care resulting
113	from Medicaid reform enacted by the Federal Government.
114	2.  Permit user access from all parts of the system of care
115	associated with licensed assisted living facilities that receive
116	Medicaid funding.
117	3.  Permit frontline caregivers to collect defined data
118	elements that indicate a change in a resident's condition and
119	employ intuitive technology to forecast patient care needs and
120	trends in facility quality improvement.
121	4.  Provide online training videos to improve the skills of
122	frontline caregivers. A training provider may make online
123	training material available via the statewide data collection
124	system. Training shall be provided on a subscription basis and
125	shall include online competency examinations for caregivers. The
126	system shall verify the identity of the subscriber and the
127	amount of time the subscriber participates in online training.
128	This information shall be made available to the agency through
129	electronic means.
130	5.  Include specialized training for staff who care for
131	adults with mental illness, which shall include aggression
132	control training, information regarding involuntary commitment
133	procedures under the Baker Act, how to recognize a change in
134	mental condition, use of psychiatric medications, how to manage
135	difficult behaviors of adults with mental illness, and other
136	training in services provided by the state mental health
137	services delivery system.
138	6.  Include a technical interface between a mental health
139	provider and an assisted living facility if the provider and the
140	facility have established a cooperative agreement, as defined in
141	s. 429.02(8), Florida Statutes. The interface shall permit a
142	mental health case manager to review client information and care
143	trends associated with residents of an assisted living facility.
144	A case manager shall record any face-to-face contact with a
145	resident and update the community living support plan in real
146	time when changes are needed. The agency survey staff and the
147	department shall have access to this information for agency
148	monitoring purposes.
149	(e)  Establish a monitoring workgroup, to be comprised of
150	representatives of state agencies that regulate assisted living
151	facilities, owners of assisted living facilities, and other
152	interested parties, to:
153	1.  Develop a request for information, establish
154	requirements for certification, and approve proposed fees by
155	July 1, 2013.
156	2.  Review survey forms, the inspection process, and how
157	compliance is determined to ensure the safety and protection of
158	residents who reside in a licensed assisted living facility.
159	3.  Develop a streamlined regulatory oversight system.
160	4.  Monitor the implementation of the pilot project.
161	5.  Propose specific changes to implement a cost-effective
162	oversight system for assisted living facilities.
163	6.  Establish a plan that uses an abbreviated survey
164	process to enable agency surveyors to concentrate on facilities
165	that require greater oversight and that includes appropriately
166	trained lead assisted living facility surveyors.
167	7.  Submit a report of its findings to the Governor, the
168	President of the Senate, and the Speaker of the House of
169	Representatives by January 1, 2013.
170	(f)  In collaboration with the Medicaid Fraud Control Unit,
171	develop an interagency task force to investigate facilities that
172	have failed to improve care for residents, are suspected of
173	operating without a license, or have been subject to fines or
174	other sanctions. The agency shall be the lead agency and shall
175	schedule random onsite inspections of such facilities to
176	evaluate compliance with assisted living facility standards and
177	Medicaid rules. The task force may revoke a facility's license
178	if substantial noncompliance is found. The task force may
179	suspend payments to the facility and relocate residents who are
180	not receiving appropriate care.
181	(g)  Review discharge plans for a patient who is being
182	transferred from a hospital to an assisted living facility,
183	require the hospital to complete a health assessment of the
184	patient signed by a licensed health care professional prior to
185	discharge, and provide a copy of the assessment to the
186	administrator of the assisted living facility before the patient
187	is discharged. The agency shall levy a $500 fine for each
188	transfer or discharge from a hospital that fails to meet the
189	requirements of this paragraph.
190	(h)  Work with private-sector providers of certification to
191	develop and implement a statewide administrator certification
192	program. Each certified assisted living facility administrator
193	must pass a competency examination every 4 years and is
194	responsible for renewing the certification. An assisted living
195	facility must employ a certified administrator as a condition
196	for continued licensure. A certified assisted living facility
197	administrator may not supervise more than three facilities. The
198	certification must be posted in a visible place in the facility.
199	Each facility must have a certified administrator on call at all
200	times.
201	(5)  The administrator of a licensed facility that is
202	eligible to participate in the pilot project shall notify the
203	agency when the facility agrees to enroll in the pilot project.
204	Enrollment in the pilot project is voluntary but may be required
205	if the agency determines that enrollment in the pilot project is
206	necessary to improve the quality of care offered by the
207	facility. The agency shall enroll the first 150 eligible
208	facilities in each authorized agency area that seek enrollment.
209	Before enrollment, each facility must execute a memorandum of
210	agreement with the agency that includes a provision authorizing
211	the agency to terminate the facility's participation in the
212	pilot project at will. The agency's decision to terminate a
213	facility's participation in the pilot project may not be
214	challenged or appealed under chapter 120, Florida Statutes.
215	(6)  The open enrollment period to participate in the pilot
216	project begins January 1 and ends March 1 each year. A
217	facility's enrollment in the pilot project does not prohibit the
218	facility from seeking alternative accreditation from a
219	recognized health care accreditation organization, such as the
220	Commission on Accreditation of Rehabilitative Facilities or the
221	Joint Commission.
222	(7)  The agency, within funds appropriated by the
223	Legislature, shall establish an assisted living facility quality
224	improvement team in each pilot project area for the purpose of
225	evaluating and improving the quality of facilities participating
226	in the pilot project.
227	(a)  A quality improvement team shall include:
228	1.  An agency lead surveyor who has received training
229	relating to the requirements for providing care to residents of
230	an assisted living facility, who shall head the team.
231	2.  A quality improvement specialist who has professional
232	expertise or a background in working with behavioral health
233	needs or elder and aging needs.
234	3.  A registered nurse.
235	4.  A licensed dietician.
236	5.  If the facility being evaluated is an assisted living
237	facility with a limited mental health license is being
238	evaluated, a mental health professional.
239	(b)  A quality improvement team shall:
240	1.  Establish criteria for quality improvement plans, which
241	shall include an evaluation of the plan based upon client access
242	to adequate care, provision of personal services and support,
243	adequate documentation and reporting of client information,
244	supervision and training of the staff and residents, and
245	compliance with physical plant and safety standards that promote
246	independence and dignity for facility residents.
247	2.  Evaluate the progress of the facility in meeting the
248	goals of the quality improvement plan.
249	3.  Conduct an annual assessment and followup visits as
250	needed to monitor the progress of the facility in meeting the
251	goals of the quality improvement plan.
252	4.  Consult with the owner and administrator of the
253	facility in meeting plan requirements, create electronic systems
254	to monitor compliance with agency rules, ensure that training
255	standards established under s. 429.52, Florida Statutes, are
256	met, and work to help ensure an adequate system of care that
257	provides access to community-based services that would improve
258	the care of the residents and the conditions in the facility.
259	5.  Maintain records of the assessments and ongoing efforts
260	to assist the facility in meeting quality improvement goals.
261	6.  Use electronic means to capture data and generate
262	reports relating to compliance with the quality improvement
263	plan.
264	(8)  A quality improvement team may terminate a facility
265	that has failed to meet the goals of the plan from the pilot
266	project after reasonable efforts are made to seek cooperation
267	and assistance from the owner and the administrator of the
268	facility. If a facility is terminated under these conditions,
269	the facility's participation in the pilot project is
270	automatically terminated.
271	(9)  If a facility's participation in the pilot project is
272	terminated, the quality improvement team shall notify the
273	Division of Health Quality Assurance of the agency, and that
274	facility shall be subject to the survey, inspection, and
275	monitoring visits conducted under s. 408.811, Florida Statutes.
276	The facility is not eligible to reenroll in the pilot project
277	until the agency has certified that the facility is in
278	substantial compliance with agency rules.
279	(10)  A facility may terminate its participation in the
280	pilot project, and the agency shall require the facility to be
281	subject to the survey, inspection, and monitoring visits
282	conducted pursuant to s. 408.811, Florida Statutes. If such
283	termination is sought, the facility administrator shall notify
284	the agency area office in writing and specify the reasons the
285	facility seeks to terminate its participation in the pilot
286	project. The agency shall approve or reject the request under
287	the terms and conditions of the memorandum of agreement
288	completed by the facility before enrolling in the pilot project.
289	(11)  Reports and documents generated by a quality
290	improvement team may not be used in any tort action sought
291	against the licenseholder of an enrolled facility.
292	(12)  The Department of Elderly Affairs may adopt rules,
293	impose fees, and provide requirements necessary to certify
294	providers that seek to offer the assisted living facility staff
295	core training. The department shall review the total number of
296	hours required for completion of core training, which shall be
297	at least 40 hours. The department may charge a fee for core
298	training and revoke certification for core trainers that fail to
299	meet requirements as established under department rule. Fees
300	imposed under this subsection may not, in the aggregate, exceed
301	the costs necessary to adequately administer the certification
302	process for providers of core training.
303	(13)  An assisted living facility administrator must
304	complete a minimum of 40 hours in the core training program,
305	have a minimum of 5 years' administrative experience at a
306	licensed assisted living facility, or have a 4-year
307	baccalaureate degree from an accredited college or university.
308	An administrator must obtain 8 hours of continuing education in
309	areas that relate to the number and type of residents served at
310	the assisted living facility. The administrator may enroll in
311	online education courses or other accredited programs that offer
312	continuing education units, class credits, or a department-
313	approved curriculum by an assisted living core training
314	provider.
315	Section 2.  This act shall take effect July 1, 2012.

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