HB 787

1	A bill to be entitled
2	An act relating to nursing home facilities; amending
3	s. 400.021, F.S.; revising definitions of the terms
4	"geriatric outpatient clinic" and "resident care plan"
5	and defining the term "therapeutic spa services";
6	amending s. 400.141, F.S.; revising provisions
7	relating to facilities eligible to share programming
8	and staff; deleting requirements for the submission of
9	certain reports to the Agency for Health Care
10	Administration; creating s. 400.172, F.S.; providing
11	requirements for a nursing home facility operated by a
12	licensee that provides respite care services;
13	providing for rights of persons receiving respite care
14	in nursing home facilities; requiring a prospective
15	respite care recipient to provide certain information
16	to the nursing home facility; amending s. 400.141,
17	F.S.; revising provisions relating to other needed
18	services provided by licensed nursing home facilities,
19	including respite care, adult day, and therapeutic spa
20	services; amending s. 408.0435, F.S.; revising the
21	period of time allotted for approval of the nursing
22	home moratorium on a certificate of need for
23	additional community nursing home beds; amending s.
24	429.905, F.S.; defining the term "day" for purposes of
25	day care services provided to adults who are not
26	residents; amending s. 651.118, F.S.; providing a
27	funding limitation on sheltered nursing home beds used
28	to provide assisted living, rather than extended
29	congregate care services; authorizing certain sharing
30	of areas, services, and staff between such sheltered
31	beds and nursing home beds in those facilities;
32	providing an effective date.
33
34	WHEREAS, the Legislature recognizes that the use of nursing
35	homes has decreased over the past decade because of alternatives
36	that are now available to consumers, and
37	WHEREAS, nursing homes continue to be a valuable resource
38	and should be used to the fullest extent possible to provide
39	traditional nursing care to the most impaired persons as well as
40	providing services to frail or disabled persons who choose to
41	remain in the community or who may need a less skilled level of
42	care, and
43	WHEREAS, regulatory requirements should be flexible enough
44	to allow nursing homes to diversify but continue to include
45	sufficient protections to ensure the best care possible to
46	consumers, NOW, THEREFORE,
47
48	Be It Enacted by the Legislature of the State of Florida:
49
50	Section 1.  Subsections (8) and (16) of section 400.021,
51	Florida Statutes, are amended, and subsection (19) is added to
52	that section, to read:
53	400.021  Definitions.-When used in this part, unless the
54	context otherwise requires, the term:
55	(8)  "Geriatric outpatient clinic" means a site for
56	providing outpatient health care to persons 60 years of age or
57	older, which is staffed by a registered nurse, or a physician
58	assistant, or a licensed practical nurse under the direct
59	supervision of a registered nurse, advanced registered nurse
60	practitioner, physician assistant, or physician.
61	(16)  "Resident care plan" means a written plan developed,
62	maintained, and reviewed not less than quarterly by a registered
63	nurse, with participation from other facility staff and the
64	resident or his or her designee or legal representative, which
65	includes a comprehensive assessment of the needs of an
66	individual resident; the type and frequency of services required
67	to provide the necessary care for the resident to attain or
68	maintain the highest practicable physical, mental, and
69	psychosocial well-being; a listing of services provided within
70	or outside the facility to meet those needs; and an explanation
71	of service goals. The resident care plan must be signed by the
72	director of nursing or another registered nurse employed by the
73	facility to whom institutional responsibilities have been
74	delegated and by the resident, the resident's designee, or the
75	resident's legal representative. The facility may not use an
76	agency or temporary registered nurse to satisfy the foregoing
77	requirement and must document the institutional responsibilities
78	that have been delegated to the registered nurse.
79	(19)  "Therapeutic spa services" means bathing, nail, and
80	hair care services and other similar services related to
81	personal hygiene.
82	Section 2.  Paragraph (g) of subsection (1) of section
83	400.141, Florida Statutes, is amended to read:
84	400.141  Administration and management of nursing home
85	facilities.-
86	(1)  Every licensed facility shall comply with all
87	applicable standards and rules of the agency and shall:
88	(g)  If the facility has a standard license or is a Gold
89	Seal facility, exceeds the minimum required hours of licensed
90	nursing and certified nursing assistant direct care per resident
91	per day, and is part of a continuing care facility licensed
92	under chapter 651 or a retirement community that offers other
93	services pursuant to part III of this chapter or part I or part
94	III of chapter 429 on a single campus, be allowed to share
95	programming and staff. At the time of inspection and in the
96	semiannual report required pursuant to paragraph (o), a
97	continuing care facility or retirement community that uses this
98	option must demonstrate through staffing records that minimum
99	staffing requirements for the facility were met. Licensed nurses
100	and certified nursing assistants who work in the nursing home
101	facility may be used to provide services elsewhere on campus if
102	the facility exceeds the minimum number of direct care hours
103	required per resident per day and the total number of residents
104	receiving direct care services from a licensed nurse or a
105	certified nursing assistant does not cause the facility to
106	violate the staffing ratios required under s. 400.23(3)(a).
107	Compliance with the minimum staffing ratios must shall be based
108	on the total number of residents receiving direct care services,
109	regardless of where they reside on campus. If the facility
110	receives a conditional license, it may not share staff until the
111	conditional license status ends. This paragraph does not
112	restrict the agency's authority under federal or state law to
113	require additional staff if a facility is cited for deficiencies
114	in care which are caused by an insufficient number of certified
115	nursing assistants or licensed nurses. The agency may adopt
116	rules for the documentation necessary to determine compliance
117	with this provision.
118	Section 3.  Section 400.172, Florida Statutes, is created
119	to read:
120	400.172  Respite care provided in nursing home facilities.-
121	(1)  For each person admitted for respite care as
122	authorized under s. 400.141(1)(f), a nursing home facility
123	operated by a licensee must:
124	(a)  Have a written abbreviated plan of care that, at a
125	minimum, includes nutritional requirements, medication orders,
126	physician orders, nursing assessments, and dietary preferences.
127	The nursing or physician assessments may take the place of all
128	other assessments required for full-time residents.
129	(b)  Have a contract that, at a minimum, specifies the
130	services to be provided to a resident receiving respite care,
131	including charges for services, activities, equipment, emergency
132	medical services, and the administration of medications. If
133	multiple admissions for a single person for respite care are
134	anticipated, the original contract is valid for 1 year after the
135	date the contract is executed.
136	(c)  Ensure that each resident is released to his or her
137	caregiver or an individual designated in writing by the
138	caregiver.
139	(2)  A person admitted under the respite care program
140	shall:
141	(a)  Be exempt from department rules relating to the
142	discharge planning process.
143	(b)  Be covered by the residents' rights specified in s.
144	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
145	are not be considered trust funds subject to the requirements of
146	s. 400.022(1)(h) until the resident has been in the facility for
147	more than 14 consecutive days.
148	(c)  Be allowed to use his or her personal medications
149	during the respite stay if permitted by facility policy. The
150	facility must obtain a physician's order for the medications.
151	The caregiver may provide information regarding the medications
152	as part of the nursing assessment and that information must
153	agree with the physician's order. Medications shall be released
154	with the resident upon discharge in accordance with current
155	physician's orders.
156	(d)  Be entitled to reside in the facility for a total of
157	60 days within a contract year or for a total of 60 days within
158	a calendar year if the contract is for less than 12 months.
159	However, each single stay may not exceed 14 days. If a stay
160	exceeds 14 consecutive days, the facility must comply with all
161	assessment and care planning requirements applicable to nursing
162	home residents.
163	(e)  Reside in a licensed nursing home bed.
164	(3)  A prospective respite care resident must provide
165	medical information from a physician, physician assistant, or
166	nurse practitioner and any other information provided by the
167	primary caregiver required by the facility before or when the
168	person is admitted to receive respite care. The medical
169	information must include a physician's order for respite care
170	and proof of a physical examination by a licensed physician,
171	physician assistant, or nurse practitioner. The physician's
172	order and physical examination may be used to provide
173	intermittent respite care for up to 12 months after the date the
174	order is written.
175	(4)  The facility shall assume the duties of the primary
176	caregiver. To ensure continuity of care and services, the
177	resident may retain his or her personal physician and shall have
178	access to medically necessary services such as physical therapy,
179	occupational therapy, or speech therapy, as needed. The facility
180	shall arrange for transportation of the resident to these
181	services, if necessary.
182	Section 4.  Paragraph (f) of subsection (1) of section
183	400.141, Florida Statutes, is amended to read:
184	400.141  Administration and management of nursing home
185	facilities.-
186	(1)  Every licensed facility shall comply with all
187	applicable standards and rules of the agency and shall:
188	(f)  Be allowed and encouraged by the agency to provide
189	other needed services under certain conditions. If the facility
190	has a standard licensure status, and has had no class I or class
191	II deficiencies during the past 2 years or has been awarded a
192	Gold Seal under the program established in s. 400.235, it may be
193	encouraged by the agency to provide services, including, but not
194	limited to, respite, therapeutic spa, and adult day services to
195	nonresidents, which enable individuals to move in and out of the
196	facility. A facility is not subject to any additional licensure
197	requirements for providing these services. Respite care may be
198	offered to persons in need of short-term or temporary nursing
199	home services. Respite care must be provided in accordance with
200	this part and rules adopted by the agency. However, the agency
201	shall, by rule, adopt modified requirements for resident
202	assessment, resident care plans, resident contracts, physician
203	orders, and other provisions, as appropriate, for short-term or
204	temporary nursing home services. Providers of adult day services
205	must comply with the requirements of s. 429.905(2). The agency
206	shall allow for shared programming and staff in a facility which
207	meets minimum standards and offers services pursuant to this
208	paragraph, but, if the facility is cited for deficiencies in
209	patient care, may require additional staff and programs
210	appropriate to the needs of service recipients. A person who
211	receives respite care may not be counted as a resident of the
212	facility for purposes of the facility's licensed capacity unless
213	that person receives 24-hour respite care. A person receiving
214	either respite care for 24 hours or longer or adult day services
215	must be included when calculating minimum staffing for the
216	facility. Any costs and revenues generated by a nursing home
217	facility from nonresidential programs or services shall be
218	excluded from the calculations of Medicaid per diems for nursing
219	home institutional care reimbursement.
220	Section 5.  Subsection (1) of section 408.0435, Florida
221	Statutes, is amended to read:
222	408.0435  Moratorium on nursing home certificates of need.-
223	(1)  Notwithstanding the establishment of need as provided
224	for in this chapter, a certificate of need for additional
225	community nursing home beds may not be approved by the agency
226	until Medicaid managed care is implemented statewide pursuant to
227	ss. 409.961-409.985 or October 1, 2016, whichever is later
228	earlier.
229	Section 6.  Subsection (2) of section 429.905, Florida
230	Statutes, is amended to read:
231	429.905  Exemptions; monitoring of adult day care center
232	programs colocated with assisted living facilities or licensed
233	nursing home facilities.-
234	(2)  A licensed assisted living facility, a licensed
235	hospital, or a licensed nursing home facility may provide
236	services during the day which include, but are not limited to,
237	social, health, therapeutic, recreational, nutritional, and
238	respite services, to adults who are not residents. Such a
239	facility need not be licensed as an adult day care center;
240	however, the agency must monitor the facility during the regular
241	inspection and at least biennially to ensure adequate space and
242	sufficient staff. If an assisted living facility, a hospital, or
243	a nursing home holds itself out to the public as an adult day
244	care center, it must be licensed as such and meet all standards
245	prescribed by statute and rule. For the purpose of this
246	subsection, the term "day" means any portion of a 24-hour day.
247	Section 7.  Subsection (8) of section 651.118, Florida
248	Statutes, is amended to read:
249	651.118  Agency for Health Care Administration;
250	certificates of need; sheltered beds; community beds.-
251	(8)  A provider may petition the Agency for Health Care
252	Administration to use a designated number of sheltered nursing
253	home beds to provide assisted living extended congregate care as
254	defined in s. 429.02 if the beds are in a distinct area of the
255	nursing home which can be adapted to meet the requirements for
256	an assisted living facility as defined in s. 429.02 extended
257	congregate care. The provider may subsequently use such beds as
258	sheltered beds after notifying the agency of the intended
259	change. Any sheltered beds used to provide assisted living
260	extended congregate care pursuant to this subsection may not
261	qualify for funding under the Medicaid waiver. Any sheltered
262	beds used to provide assisted living extended congregate care
263	pursuant to this subsection may share common areas, services,
264	and staff with beds designated for nursing home care, provided
265	that all of the beds are under common ownership. For the
266	purposes of this subsection, fire and life safety codes
267	applicable to nursing home facilities shall apply.
268	Section 8.  This act shall take effect July 1, 2012.

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