Florida Senate - 2014         (PROPOSED COMMITTEE BILL) SPB 7000
       
       
        
       FOR CONSIDERATION By the Committee on Children, Families, and
       Elder Affairs
       
       
       
       
       586-00373A-14                                         20147000__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 394.4574, F.S.; providing that Medicaid
    4         prepaid behavioral health plans are responsible for
    5         enrolled mental health residents; providing that
    6         managing entities under contract with the Department
    7         of Children and Families are responsible for mental
    8         health residents who are not enrolled with a Medicaid
    9         prepaid behavioral health plan; deleting a provision
   10         to conform to changes made by the act; requiring that
   11         the community living support plan be completed and
   12         provided to the administrator of a facility upon the
   13         mental health resident’s admission; requiring the
   14         community living support plan to be updated when there
   15         is a significant change to the mental health
   16         resident’s behavioral health; requiring the case
   17         manager assigned to a mental health resident of an
   18         assisted living facility that holds a limited mental
   19         health license to keep a record of the date and time
   20         of face-to-face interactions with the resident and to
   21         make the record available to the responsible entity
   22         for inspection; requiring that the record be
   23         maintained for a specified time; requiring the
   24         responsible entity to ensure that there is adequate
   25         and consistent monitoring and enforcement of community
   26         living support plans and cooperative agreements and
   27         that concerns are reported to the appropriate
   28         regulatory oversight organization under certain
   29         circumstances; amending s. 400.0074, F.S.; requiring
   30         that an administrative assessment conducted by a local
   31         council be comprehensive in nature and focus on
   32         factors affecting the rights, health, safety, and
   33         welfare of nursing home residents; requiring a local
   34         council to conduct an exit consultation with the
   35         facility administrator or administrator designee to
   36         discuss issues and concerns in areas affecting the
   37         rights, health, safety, and welfare of residents and
   38         make recommendations for improvement; amending s.
   39         400.0078, F.S.; requiring that a resident or a
   40         representative of a resident of a long-term care
   41         facility be informed that retaliatory action cannot be
   42         taken against a resident for presenting grievances or
   43         for exercising any other resident right; amending s.
   44         429.02, F.S.; conforming a cross-reference; providing
   45         a definition; amending s. 429.07, F.S.; requiring that
   46         an extended congregate care license be issued to
   47         certain facilities that have been licensed as assisted
   48         living facilities under certain circumstances and
   49         authorizing the issuance of such license if a
   50         specified condition is met; providing the purpose of
   51         an extended congregate care license; providing that
   52         the initial extended congregate care license of an
   53         assisted living facility is provisional under certain
   54         circumstances; requiring a licensee to notify the
   55         Agency for Health Care Administration if it accepts a
   56         resident who qualifies for extended congregate care
   57         services; requiring the agency to inspect the facility
   58         for compliance with the requirements of an extended
   59         congregate care license; requiring the issuance of an
   60         extended congregate care license under certain
   61         circumstances; requiring the licensee to immediately
   62         suspend extended congregate care services under
   63         certain circumstances; requiring a registered nurse
   64         representing the agency to visit the facility at least
   65         twice a year, rather than quarterly, to monitor
   66         residents who are receiving extended congregate care
   67         services; authorizing the agency to waive one of the
   68         required yearly monitoring visits under certain
   69         circumstances; authorizing the agency to deny or
   70         revoke a facility’s extended congregate care license;
   71         requiring a registered nurse representing the agency
   72         to visit the facility at least annually, rather than
   73         twice a year, to monitor residents who are receiving
   74         limited nursing services; providing that such
   75         monitoring visits may be conducted in conjunction with
   76         other agency inspections; authorizing the agency to
   77         waive the required yearly monitoring visit for a
   78         facility that is licensed to provide limited nursing
   79         services under certain circumstances; amending s.
   80         429.075, F.S.; requiring an assisted living facility
   81         that serves one or more mental health residents to
   82         obtain a limited mental health license; amending s.
   83         429.14, F.S.; revising the circumstances under which
   84         the agency may deny, revoke, or suspend the license of
   85         an assisted living facility and impose an
   86         administrative fine; requiring the agency to deny or
   87         revoke the license of an assisted living facility
   88         under certain circumstances; requiring the agency to
   89         impose an immediate moratorium on the license of an
   90         assisted living facility under certain circumstances;
   91         deleting a provision requiring the agency to provide a
   92         list of facilities with denied, suspended, or revoked
   93         licenses to the Department of Business and
   94         Professional Regulation; exempting a facility from the
   95         45-day notice requirement if it is required to
   96         relocate some or all of its residents; amending s.
   97         429.178, F.S.; conforming cross-references; amending
   98         s. 429.19, F.S.; revising the amounts and uses of
   99         administrative fines; requiring the agency to levy a
  100         fine for violations that are corrected before an
  101         inspection if noncompliance occurred within a
  102         specified period of time; deleting factors that the
  103         agency is required to consider in determining
  104         penalties and fines; amending s. 429.256, F.S.;
  105         revising the term “assistance with self-administration
  106         of medication” as it relates to the Assisted Living
  107         Facilities Act; amending s. 429.28, F.S.; providing
  108         notice requirements to inform facility residents that
  109         the identity of the resident and complainant in any
  110         complaint made to the State Long-Term Care Ombudsman
  111         Program or a local long-term care ombudsman council is
  112         confidential and that retaliatory action cannot be
  113         taken against a resident for presenting grievances or
  114         for exercising any other resident right; requiring
  115         that a facility that terminates an individual’s
  116         residency after the filing of a complaint be fined if
  117         good cause is not shown for the termination; amending
  118         s. 429.34, F.S.; requiring certain persons to report
  119         elder abuse in assisted living facilities; requiring
  120         the agency to regularly inspect every licensed
  121         assisted living facility; requiring the agency to
  122         conduct more frequent inspections under certain
  123         circumstances; requiring the licensee to pay a fee for
  124         the cost of additional inspections; requiring the
  125         agency to annually adjust the fee; amending s. 429.41,
  126         F.S.; providing that certain staffing requirements
  127         apply only to residents in continuing care facilities
  128         who are receiving the relevant service; amending s.
  129         429.52, F.S.; requiring each newly hired employee of
  130         an assisted living facility to attend a preservice
  131         orientation provided by the assisted living facility;
  132         requiring the employee and administrator to sign an
  133         affidavit upon completion of the preservice
  134         orientation; requiring the assisted living facility to
  135         maintain the signed affidavit in the employee’s work
  136         file; conforming a cross-reference; creating s.
  137         429.55, F.S.; providing that a facility may apply for
  138         a flexible bed license; requiring a facility that has
  139         a flexible bed license to keep a log, specify certain
  140         information in a flexible bed contract, and retain
  141         certain records; requiring a licensed flexible bed
  142         facility to provide state surveyors with access to the
  143         log and certain independent living units; authorizing
  144         state surveyors to interview certain residents;
  145         providing that a flexible bed license does not
  146         preclude a resident from obtaining certain services;
  147         requiring the Office of Program Policy Analysis and
  148         Government Accountability to study the reliability of
  149         facility surveys and submit to the Governor and the
  150         Legislature its findings and recommendations;
  151         requiring the agency to implement a rating system of
  152         assisted living facilities by a specified date, adopt
  153         rules, and create content for the agency’s website
  154         that makes available to consumers information
  155         regarding assisted living facilities; providing
  156         criteria for the content; providing an effective date.
  157          
  158  Be It Enacted by the Legislature of the State of Florida:
  159  
  160         Section 1. Section 394.4574, Florida Statutes, is amended
  161  to read:
  162         394.4574 Department Responsibilities for coordination of
  163  services for a mental health resident who resides in an assisted
  164  living facility that holds a limited mental health license.—
  165         (1) As used in this section, the term “mental health
  166  resident” “mental health resident,” for purposes of this
  167  section, means an individual who receives social security
  168  disability income due to a mental disorder as determined by the
  169  Social Security Administration or receives supplemental security
  170  income due to a mental disorder as determined by the Social
  171  Security Administration and receives optional state
  172  supplementation.
  173         (2) Medicaid prepaid behavioral health plans are
  174  responsible for enrolled mental health residents, and managing
  175  entities under contract with the department are responsible for
  176  mental health residents who are not enrolled with a Medicaid
  177  prepaid behavioral health plan. A Medicaid prepaid behavioral
  178  health plan or a managing entity, as appropriate, shall The
  179  department must ensure that:
  180         (a) A mental health resident has been assessed by a
  181  psychiatrist, clinical psychologist, clinical social worker, or
  182  psychiatric nurse, or an individual who is supervised by one of
  183  these professionals, and determined to be appropriate to reside
  184  in an assisted living facility. The documentation must be
  185  provided to the administrator of the facility within 30 days
  186  after the mental health resident has been admitted to the
  187  facility. An evaluation completed upon discharge from a state
  188  mental hospital meets the requirements of this subsection
  189  related to appropriateness for placement as a mental health
  190  resident if it was completed within 90 days before prior to
  191  admission to the facility.
  192         (b) A cooperative agreement, as required in s. 429.075, is
  193  developed by between the mental health care services provider
  194  that serves a mental health resident and the administrator of
  195  the assisted living facility with a limited mental health
  196  license in which the mental health resident is living. Any
  197  entity that provides Medicaid prepaid health plan services shall
  198  ensure the appropriate coordination of health care services with
  199  an assisted living facility in cases where a Medicaid recipient
  200  is both a member of the entity’s prepaid health plan and a
  201  resident of the assisted living facility. If the entity is at
  202  risk for Medicaid targeted case management and behavioral health
  203  services, the entity shall inform the assisted living facility
  204  of the procedures to follow should an emergent condition arise.
  205         (c) The community living support plan, as defined in s.
  206  429.02, has been prepared by a mental health resident and his or
  207  her a mental health case manager of that resident in
  208  consultation with the administrator of the facility or the
  209  administrator’s designee. The plan must be completed and
  210  provided to the administrator of the assisted living facility
  211  with a limited mental health license in which the mental health
  212  resident lives upon the resident’s admission. The support plan
  213  and the agreement may be in one document.
  214         (d) The assisted living facility with a limited mental
  215  health license is provided with documentation that the
  216  individual meets the definition of a mental health resident.
  217         (e) The mental health services provider assigns a case
  218  manager to each mental health resident for whom the entity is
  219  responsible who lives in an assisted living facility with a
  220  limited mental health license. The case manager shall coordinate
  221  is responsible for coordinating the development of and
  222  implementation of the community living support plan defined in
  223  s. 429.02. The plan must be updated at least annually, or when
  224  there is a significant change in the resident’s behavioral
  225  health status, such as an inpatient admission or a change in
  226  medication, level of service, or residence. Each case manager
  227  shall keep a record of the date and time of any face-to-face
  228  interaction with the resident and make the record available to
  229  the responsible entity for inspection. The record must be
  230  retained for at least 2 years after the date of the most recent
  231  interaction.
  232         (f)Adequate and consistent monitoring and enforcement of
  233  community living support plans and cooperative agreements are
  234  conducted by the resident’s case manager.
  235         (g) Concerns are reported to the appropriate regulatory
  236  oversight organization if a regulated provider fails to deliver
  237  appropriate services or otherwise acts in a manner that has the
  238  potential to result in harm to the resident.
  239         (3) The Secretary of Children and Families Family Services,
  240  in consultation with the Agency for Health Care Administration,
  241  shall annually require each district administrator to develop,
  242  with community input, a detailed annual plan that demonstrates
  243  detailed plans that demonstrate how the district will ensure the
  244  provision of state-funded mental health and substance abuse
  245  treatment services to residents of assisted living facilities
  246  that hold a limited mental health license. This plan These plans
  247  must be consistent with the substance abuse and mental health
  248  district plan developed pursuant to s. 394.75 and must address
  249  case management services; access to consumer-operated drop-in
  250  centers; access to services during evenings, weekends, and
  251  holidays; supervision of the clinical needs of the residents;
  252  and access to emergency psychiatric care.
  253         Section 2. Subsection (1) of section 400.0074, Florida
  254  Statutes, is amended, and paragraph (h) is added to subsection
  255  (2) of that section, to read:
  256         400.0074 Local ombudsman council onsite administrative
  257  assessments.—
  258         (1) In addition to any specific investigation conducted
  259  pursuant to a complaint, the local council shall conduct, at
  260  least annually, an onsite administrative assessment of each
  261  nursing home, assisted living facility, and adult family-care
  262  home within its jurisdiction. This administrative assessment
  263  must be comprehensive in nature and must shall focus on factors
  264  affecting residents’ the rights, health, safety, and welfare of
  265  the residents. Each local council is encouraged to conduct a
  266  similar onsite administrative assessment of each additional
  267  long-term care facility within its jurisdiction.
  268         (2) An onsite administrative assessment conducted by a
  269  local council shall be subject to the following conditions:
  270         (h) The local council shall conduct an exit consultation
  271  with the facility administrator or administrator designee to
  272  discuss issues and concerns in areas affecting residents’
  273  rights, health, safety, and welfare and, if needed, make
  274  recommendations for improvement.
  275         Section 3. Subsection (2) of section 400.0078, Florida
  276  Statutes, is amended to read:
  277         400.0078 Citizen access to State Long-Term Care Ombudsman
  278  Program services.—
  279         (2) Every resident or representative of a resident shall
  280  receive, Upon admission to a long-term care facility, each
  281  resident or representative of a resident must receive
  282  information regarding the purpose of the State Long-Term Care
  283  Ombudsman Program, the statewide toll-free telephone number for
  284  receiving complaints, information that retaliatory action cannot
  285  be taken against a resident for presenting grievances or for
  286  exercising any other resident right, and other relevant
  287  information regarding how to contact the program. Each resident
  288  or his or her representative Residents or their representatives
  289  must be furnished additional copies of this information upon
  290  request.
  291         Section 4. Subsection (11) of section 429.02, Florida
  292  Statutes, is amended, present subsections (12) through (26) of
  293  that section are redesignated as subsections (13) through (27),
  294  respectively, and a new subsection (12) is added to that
  295  section, to read:
  296         429.02 Definitions.—When used in this part, the term:
  297         (11) “Extended congregate care” means acts beyond those
  298  authorized in subsection (17) which (16) that may be performed
  299  by persons licensed under pursuant to part I of chapter 464 by
  300  persons licensed thereunder while carrying out their
  301  professional duties, and other supportive services which may be
  302  specified by rule. The purpose of such services is to enable
  303  residents to age in place in a residential environment despite
  304  mental or physical limitations that might otherwise disqualify
  305  them from residency in a facility licensed under this part.
  306         (12) “Flexible bed” means a licensed bed designated to
  307  allow a continuing care facility licensed under chapter 651 or a
  308  retirement community that offers other services pursuant to this
  309  part in addition to nursing home, home health, or adult day care
  310  services licensed under this chapter or chapter 400 on a single
  311  campus to provide assisted living services for up to 15 percent
  312  of independent living residents residing in residential units
  313  designated for independent living on the campus. A flexible bed
  314  allows a resident who needs personal care services, but who does
  315  not require a secure care setting, to age in place. A flexible
  316  bed is reserved for individuals who have been a contract holder
  317  of a facility licensed under chapter 651 or a resident of a
  318  retirement community for at least 6 months.
  319         Section 5. Paragraphs (b) and (c) of subsection (3) of
  320  section 429.07, Florida Statutes, are amended to read:
  321         429.07 License required; fee.—
  322         (3) In addition to the requirements of s. 408.806, each
  323  license granted by the agency must state the type of care for
  324  which the license is granted. Licenses shall be issued for one
  325  or more of the following categories of care: standard, extended
  326  congregate care, limited nursing services, or limited mental
  327  health.
  328         (b) An extended congregate care license shall be issued to
  329  each facility that has been licensed as an assisted living
  330  facility for 2 or more years and that provides services
  331  facilities providing, directly or through contract, services
  332  beyond those authorized in paragraph (a), including services
  333  performed by persons licensed under part I of chapter 464 and
  334  supportive services, as defined by rule, to persons who would
  335  otherwise be disqualified from continued residence in a facility
  336  licensed under this part. An extended congregate care license
  337  may be issued to a facility that has a provisional extended
  338  congregate care license and meets the requirements for licensure
  339  under subparagraph 2. The primary purpose of extended congregate
  340  care services is to allow residents the option of remaining in a
  341  familiar setting from which they would otherwise be disqualified
  342  for continued residency as they become more impaired. A facility
  343  licensed to provide extended congregate care services may also
  344  admit an individual who exceeds the admission criteria for a
  345  facility with a standard license, if he or she is determined
  346  appropriate for admission to the extended congregate care
  347  facility.
  348         1. In order for extended congregate care services to be
  349  provided, the agency must first determine that all requirements
  350  established in law and rule are met and must specifically
  351  designate, on the facility’s license, that such services may be
  352  provided and whether the designation applies to all or part of
  353  the facility. This Such designation may be made at the time of
  354  initial licensure or relicensure, or upon request in writing by
  355  a licensee under this part and part II of chapter 408. The
  356  notification of approval or the denial of the request shall be
  357  made in accordance with part II of chapter 408. Each existing
  358  facility that qualifies facilities qualifying to provide
  359  extended congregate care services must have maintained a
  360  standard license and may not have been subject to administrative
  361  sanctions during the previous 2 years, or since initial
  362  licensure if the facility has been licensed for less than 2
  363  years, for any of the following reasons:
  364         a. A class I or class II violation;
  365         b. Three or more repeat or recurring class III violations
  366  of identical or similar resident care standards from which a
  367  pattern of noncompliance is found by the agency;
  368         c. Three or more class III violations that were not
  369  corrected in accordance with the corrective action plan approved
  370  by the agency;
  371         d. Violation of resident care standards which results in
  372  requiring the facility to employ the services of a consultant
  373  pharmacist or consultant dietitian;
  374         e. Denial, suspension, or revocation of a license for
  375  another facility licensed under this part in which the applicant
  376  for an extended congregate care license has at least 25 percent
  377  ownership interest; or
  378         f. Imposition of a moratorium pursuant to this part or part
  379  II of chapter 408 or initiation of injunctive proceedings.
  380  
  381  The agency may deny or revoke a facility’s extended congregate
  382  care license for not meeting the criteria for an extended
  383  congregate care license as provided in this subparagraph.
  384         2.If an assisted living facility has been licensed for
  385  less than 2 years but meets all other licensure requirements for
  386  an extended congregate care license, it shall be issued a
  387  provisional extended congregate care license for a period of 6
  388  months. Within the first 3 months after the provisional license
  389  is issued, the licensee shall notify the agency when it has
  390  admitted an extended congregate care resident, after which an
  391  unannounced inspection shall be made to determine compliance
  392  with requirements of an extended congregate care license. If the
  393  licensee demonstrates compliance with all of the requirements of
  394  an extended congregate care license during the inspection, the
  395  licensee shall be issued an extended congregate care license. In
  396  addition to sanctions authorized under this part, if violations
  397  are found during the inspection and the licensee fails to
  398  demonstrate compliance with all assisted living requirements
  399  during a followup inspection, the licensee shall immediately
  400  suspend extended congregate care services, and the provisional
  401  extended congregate care license expires.
  402         3.2. A facility that is licensed to provide extended
  403  congregate care services shall maintain a written progress
  404  report on each person who receives services which describes the
  405  type, amount, duration, scope, and outcome of services that are
  406  rendered and the general status of the resident’s health. A
  407  registered nurse, or appropriate designee, representing the
  408  agency shall visit the facility at least twice a year quarterly
  409  to monitor residents who are receiving extended congregate care
  410  services and to determine if the facility is in compliance with
  411  this part, part II of chapter 408, and relevant rules. One of
  412  the visits may be in conjunction with the regular survey. The
  413  monitoring visits may be provided through contractual
  414  arrangements with appropriate community agencies. A registered
  415  nurse shall serve as part of the team that inspects the
  416  facility. The agency may waive one of the required yearly
  417  monitoring visits for a facility that has:
  418         a. Held an extended congregate care license for at least 24
  419  months; been licensed for at least 24 months to provide extended
  420  congregate care services, if, during the inspection, the
  421  registered nurse determines that extended congregate care
  422  services are being provided appropriately, and if the facility
  423  has
  424         b. No class I or class II violations and no uncorrected
  425  class III violations; and.
  426         c. No confirmed ombudsman council complaints that resulted
  427  in a citation for licensure The agency must first consult with
  428  the long-term care ombudsman council for the area in which the
  429  facility is located to determine if any complaints have been
  430  made and substantiated about the quality of services or care.
  431  The agency may not waive one of the required yearly monitoring
  432  visits if complaints have been made and substantiated.
  433         4.3. A facility that is licensed to provide extended
  434  congregate care services must:
  435         a. Demonstrate the capability to meet unanticipated
  436  resident service needs.
  437         b. Offer a physical environment that promotes a homelike
  438  setting, provides for resident privacy, promotes resident
  439  independence, and allows sufficient congregate space as defined
  440  by rule.
  441         c. Have sufficient staff available, taking into account the
  442  physical plant and firesafety features of the building, to
  443  assist with the evacuation of residents in an emergency.
  444         d. Adopt and follow policies and procedures that maximize
  445  resident independence, dignity, choice, and decisionmaking to
  446  permit residents to age in place, so that moves due to changes
  447  in functional status are minimized or avoided.
  448         e. Allow residents or, if applicable, a resident’s
  449  representative, designee, surrogate, guardian, or attorney in
  450  fact to make a variety of personal choices, participate in
  451  developing service plans, and share responsibility in
  452  decisionmaking.
  453         f. Implement the concept of managed risk.
  454         g. Provide, directly or through contract, the services of a
  455  person licensed under part I of chapter 464.
  456         h. In addition to the training mandated in s. 429.52,
  457  provide specialized training as defined by rule for facility
  458  staff.
  459         5.4. A facility that is licensed to provide extended
  460  congregate care services is exempt from the criteria for
  461  continued residency set forth in rules adopted under s. 429.41.
  462  A licensed facility must adopt its own requirements within
  463  guidelines for continued residency set forth by rule. However,
  464  the facility may not serve residents who require 24-hour nursing
  465  supervision. A licensed facility that provides extended
  466  congregate care services must also provide each resident with a
  467  written copy of facility policies governing admission and
  468  retention.
  469         5. The primary purpose of extended congregate care services
  470  is to allow residents, as they become more impaired, the option
  471  of remaining in a familiar setting from which they would
  472  otherwise be disqualified for continued residency. A facility
  473  licensed to provide extended congregate care services may also
  474  admit an individual who exceeds the admission criteria for a
  475  facility with a standard license, if the individual is
  476  determined appropriate for admission to the extended congregate
  477  care facility.
  478         6. Before the admission of an individual to a facility
  479  licensed to provide extended congregate care services, the
  480  individual must undergo a medical examination as provided in s.
  481  429.26(4) and the facility must develop a preliminary service
  482  plan for the individual.
  483         7. If When a facility can no longer provide or arrange for
  484  services in accordance with the resident’s service plan and
  485  needs and the facility’s policy, the facility must shall make
  486  arrangements for relocating the person in accordance with s.
  487  429.28(1)(k).
  488         8. Failure to provide extended congregate care services may
  489  result in denial of extended congregate care license renewal.
  490         (c) A limited nursing services license shall be issued to a
  491  facility that provides services beyond those authorized in
  492  paragraph (a) and as specified in this paragraph.
  493         1. In order for limited nursing services to be provided in
  494  a facility licensed under this part, the agency must first
  495  determine that all requirements established in law and rule are
  496  met and must specifically designate, on the facility’s license,
  497  that such services may be provided. This Such designation may be
  498  made at the time of initial licensure or licensure renewal
  499  relicensure, or upon request in writing by a licensee under this
  500  part and part II of chapter 408. Notification of approval or
  501  denial of such request shall be made in accordance with part II
  502  of chapter 408. An existing facility that qualifies facilities
  503  qualifying to provide limited nursing services must shall have
  504  maintained a standard license and may not have been subject to
  505  administrative sanctions that affect the health, safety, and
  506  welfare of residents for the previous 2 years or since initial
  507  licensure if the facility has been licensed for less than 2
  508  years.
  509         2. A facility Facilities that is are licensed to provide
  510  limited nursing services shall maintain a written progress
  511  report on each person who receives such nursing services. The,
  512  which report must describe describes the type, amount, duration,
  513  scope, and outcome of services that are rendered and the general
  514  status of the resident’s health. A registered nurse representing
  515  the agency shall visit the facility such facilities at least
  516  annually twice a year to monitor residents who are receiving
  517  limited nursing services and to determine if the facility is in
  518  compliance with applicable provisions of this part, part II of
  519  chapter 408, and related rules. The monitoring visits may be
  520  provided through contractual arrangements with appropriate
  521  community agencies. A registered nurse shall also serve as part
  522  of the team that inspects such facility. Visits may be in
  523  conjunction with other agency inspections. The agency may waive
  524  the required yearly monitoring visit for a facility that has:
  525         a. Had a limited nursing services license for at least 24
  526  months;
  527         b. No class I or class II violations and no uncorrected
  528  class III violations; and
  529         c. No confirmed ombudsman council complaints that resulted
  530  in a citation for licensure.
  531         3. A person who receives limited nursing services under
  532  this part must meet the admission criteria established by the
  533  agency for assisted living facilities. When a resident no longer
  534  meets the admission criteria for a facility licensed under this
  535  part, arrangements for relocating the person shall be made in
  536  accordance with s. 429.28(1)(k), unless the facility is licensed
  537  to provide extended congregate care services.
  538         Section 6. Section 429.075, Florida Statutes, is amended to
  539  read:
  540         429.075 Limited mental health license.—An assisted living
  541  facility that serves one three or more mental health residents
  542  must obtain a limited mental health license.
  543         (1) To obtain a limited mental health license, a facility
  544  must hold a standard license as an assisted living facility,
  545  must not have any current uncorrected deficiencies or
  546  violations, and must ensure that, within 6 months after
  547  receiving a limited mental health license, the facility
  548  administrator and the staff of the facility who are in direct
  549  contact with mental health residents must complete training of
  550  no less than 6 hours related to their duties. This Such
  551  designation may be made at the time of initial licensure or
  552  relicensure or upon request in writing by a licensee under this
  553  part and part II of chapter 408. Notification of approval or
  554  denial of such request shall be made in accordance with this
  555  part, part II of chapter 408, and applicable rules. This
  556  training must will be provided by or approved by the Department
  557  of Children and Families Family Services.
  558         (2) A facility that is Facilities licensed to provide
  559  services to mental health residents must shall provide
  560  appropriate supervision and staffing to provide for the health,
  561  safety, and welfare of such residents.
  562         (3) A facility that has a limited mental health license
  563  must:
  564         (a) Have a copy of each mental health resident’s community
  565  living support plan and the cooperative agreement with the
  566  mental health care services provider. The support plan and the
  567  agreement may be combined.
  568         (b) Have documentation that is provided by the Department
  569  of Children and Families Family Services that each mental health
  570  resident has been assessed and determined to be able to live in
  571  the community in an assisted living facility that has with a
  572  limited mental health license.
  573         (c) Make the community living support plan available for
  574  inspection by the resident, the resident’s legal guardian or,
  575  the resident’s health care surrogate, and other individuals who
  576  have a lawful basis for reviewing this document.
  577         (d) Assist the mental health resident in carrying out the
  578  activities identified in the individual’s community living
  579  support plan.
  580         (4) A facility that has with a limited mental health
  581  license may enter into a cooperative agreement with a private
  582  mental health provider. For purposes of the limited mental
  583  health license, the private mental health provider may act as
  584  the case manager.
  585         Section 7. Section 429.14, Florida Statutes, is amended to
  586  read:
  587         429.14 Administrative penalties.—
  588         (1) In addition to the requirements of part II of chapter
  589  408, the agency may deny, revoke, and suspend any license issued
  590  under this part and impose an administrative fine in the manner
  591  provided in chapter 120 against a licensee for a violation of
  592  any provision of this part, part II of chapter 408, or
  593  applicable rules, or for any of the following actions by a
  594  licensee, for the actions of any person subject to level 2
  595  background screening under s. 408.809, or for the actions of any
  596  facility staff employee:
  597         (a) An intentional or negligent act seriously affecting the
  598  health, safety, or welfare of a resident of the facility.
  599         (b) A The determination by the agency that the owner lacks
  600  the financial ability to provide continuing adequate care to
  601  residents.
  602         (c) Misappropriation or conversion of the property of a
  603  resident of the facility.
  604         (d) Failure to follow the criteria and procedures provided
  605  under part I of chapter 394 relating to the transportation,
  606  voluntary admission, and involuntary examination of a facility
  607  resident.
  608         (e) A citation for of any of the following violations
  609  deficiencies as specified in s. 429.19:
  610         1. One or more cited class I violations deficiencies.
  611         2. Three or more cited class II violations deficiencies.
  612         3. Five or more cited class III violations deficiencies
  613  that have been cited on a single survey and have not been
  614  corrected within the times specified.
  615         (f) Failure to comply with the background screening
  616  standards of this part, s. 408.809(1), or chapter 435.
  617         (g) Violation of a moratorium.
  618         (h) Failure of the license applicant, the licensee during
  619  relicensure, or a licensee that holds a provisional license to
  620  meet the minimum license requirements of this part, or related
  621  rules, at the time of license application or renewal.
  622         (i) An intentional or negligent life-threatening act in
  623  violation of the uniform firesafety standards for assisted
  624  living facilities or other firesafety standards which that
  625  threatens the health, safety, or welfare of a resident of a
  626  facility, as communicated to the agency by the local authority
  627  having jurisdiction or the State Fire Marshal.
  628         (j) Knowingly operating any unlicensed facility or
  629  providing without a license any service that must be licensed
  630  under this chapter or chapter 400.
  631         (k) Any act constituting a ground upon which application
  632  for a license may be denied.
  633         (2) Upon notification by the local authority having
  634  jurisdiction or by the State Fire Marshal, the agency may deny
  635  or revoke the license of an assisted living facility that fails
  636  to correct cited fire code violations that affect or threaten
  637  the health, safety, or welfare of a resident of a facility.
  638         (3) The agency may deny or revoke a license of an to any
  639  applicant or controlling interest as defined in part II of
  640  chapter 408 which has or had a 25 percent 25-percent or greater
  641  financial or ownership interest in any other facility that is
  642  licensed under this part, or in any entity licensed by this
  643  state or another state to provide health or residential care, if
  644  that which facility or entity during the 5 years prior to the
  645  application for a license closed due to financial inability to
  646  operate; had a receiver appointed or a license denied,
  647  suspended, or revoked; was subject to a moratorium; or had an
  648  injunctive proceeding initiated against it.
  649         (4) The agency shall deny or revoke the license of an
  650  assisted living facility if:
  651         (a)There are two moratoria, issued pursuant to this part
  652  or part II of chapter 408, within a 2-year period which are
  653  imposed by final order;
  654         (b)The facility is cited for two or more class I
  655  violations arising from unrelated circumstances during the same
  656  survey or investigation; or
  657         (c)The facility is cited for two or more class I
  658  violations arising from separate surveys or investigations
  659  within a 2-year period that has two or more class I violations
  660  that are similar or identical to violations identified by the
  661  agency during a survey, inspection, monitoring visit, or
  662  complaint investigation occurring within the previous 2 years.
  663         (5) An action taken by the agency to suspend, deny, or
  664  revoke a facility’s license under this part or part II of
  665  chapter 408, in which the agency claims that the facility owner
  666  or an employee of the facility has threatened the health,
  667  safety, or welfare of a resident of the facility, must be heard
  668  by the Division of Administrative Hearings of the Department of
  669  Management Services within 120 days after receipt of the
  670  facility’s request for a hearing, unless that time limitation is
  671  waived by both parties. The administrative law judge shall must
  672  render a decision within 30 days after receipt of a proposed
  673  recommended order.
  674         (6) As provided under s. 408.814, the agency shall impose
  675  an immediate moratorium on an assisted living facility that
  676  fails to provide the agency access to the facility or prohibits
  677  the agency from conducting a regulatory inspection. The licensee
  678  may not restrict agency staff in accessing and copying records
  679  or in conducting confidential interviews with facility staff or
  680  any individual who receives services from the facility provide
  681  to the Division of Hotels and Restaurants of the Department of
  682  Business and Professional Regulation, on a monthly basis, a list
  683  of those assisted living facilities that have had their licenses
  684  denied, suspended, or revoked or that are involved in an
  685  appellate proceeding pursuant to s. 120.60 related to the
  686  denial, suspension, or revocation of a license.
  687         (7) Agency notification of a license suspension or
  688  revocation, or denial of a license renewal, shall be posted and
  689  visible to the public at the facility.
  690         (8) If a facility is required to relocate some or all of
  691  its residents due to agency action, that facility is exempt from
  692  the 45-days’ notice requirement imposed under s. 429.28(1)(k).
  693  This subsection does not exempt the facility from any deadlines
  694  for corrective action set by the agency.
  695         Section 8. Paragraphs (a) and (b) of subsection (2) of
  696  section 429.178, Florida Statutes, are amended to read:
  697         429.178 Special care for persons with Alzheimer’s disease
  698  or other related disorders.—
  699         (2)(a) An individual who is employed by a facility that
  700  provides special care for residents who have with Alzheimer’s
  701  disease or other related disorders, and who has regular contact
  702  with such residents, must complete up to 4 hours of initial
  703  dementia-specific training developed or approved by the
  704  department. The training must shall be completed within 3 months
  705  after beginning employment and satisfy shall satisfy the core
  706  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  707         (b) A direct caregiver who is employed by a facility that
  708  provides special care for residents with Alzheimer’s disease or
  709  other related disorders, and who provides direct care to such
  710  residents, must complete the required initial training and 4
  711  additional hours of training developed or approved by the
  712  department. The training must shall be completed within 9 months
  713  after beginning employment and satisfy shall satisfy the core
  714  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  715         Section 9. Section 429.19, Florida Statutes, is amended to
  716  read:
  717         429.19 Violations; imposition of administrative fines;
  718  grounds.—
  719         (1) In addition to the requirements of part II of chapter
  720  408, the agency shall impose an administrative fine in the
  721  manner provided in chapter 120 for the violation of any
  722  provision of this part, part II of chapter 408, and applicable
  723  rules by an assisted living facility, for the actions of any
  724  person subject to level 2 background screening under s. 408.809,
  725  for the actions of any facility employee, or for an intentional
  726  or negligent act seriously affecting the health, safety, or
  727  welfare of a resident of the facility.
  728         (2) Each violation of this part and adopted rules must
  729  shall be classified according to the nature of the violation and
  730  the gravity of its probable effect on facility residents. The
  731  agency shall indicate the classification on the written notice
  732  of the violation as follows:
  733         (a) Class “I” violations are defined in s. 408.813. The
  734  agency shall impose an administrative fine of $7,500 for each a
  735  cited class I violation in a facility that is licensed for fewer
  736  than 100 beds at the time of the violation in an amount not less
  737  than $5,000 and not exceeding $10,000 for each violation. The
  738  agency shall impose an administrative fine of $11,250 for each
  739  cited class I violation in a facility that is licensed for 100
  740  or more beds at the time of the violation. If the noncompliance
  741  occurred within the prior 12 months, the fine must be levied for
  742  violations that are corrected before an inspection.
  743         (b) Class “II” violations are defined in s. 408.813. The
  744  agency shall impose an administrative fine of $3,000 for each a
  745  cited class II violation in a facility that is licensed for
  746  fewer than 100 beds at the time of the violation in an amount
  747  not less than $1,000 and not exceeding $5,000 for each
  748  violation. The agency shall impose an administrative fine of
  749  $4,500 for each cited class II violation in a facility that is
  750  licensed for 100 or more beds at the time of the violation.
  751         (c) Class “III” violations are defined in s. 408.813. The
  752  agency shall impose an administrative fine of $750 for each a
  753  cited class III violation in a facility that is licensed for
  754  fewer than 100 beds at the time of the violation in an amount
  755  not less than $500 and not exceeding $1,000 for each violation.
  756  The agency shall impose an administrative fine of $1,125 for
  757  each cited class III violation in a facility that is licensed
  758  for 100 or more beds at the time of the violation.
  759         (d) Class “IV” violations are defined in s. 408.813. The
  760  agency shall impose an administrative fine of $150 for each a
  761  cited class IV violation in a facility that is licensed for
  762  fewer than 100 beds at the time of the violation in an amount
  763  not less than $100 and not exceeding $200 for each violation.
  764  The agency shall impose an administrative fine of $225 for each
  765  cited class IV violation in a facility that is licensed for 100
  766  or more beds at the time of the violation.
  767         (e) Any fine imposed for a class I violation or a class II
  768  violation must be doubled if a facility was previously cited for
  769  one or more class I or class II violations during the agency’s
  770  last licensure inspection or any inspection or complaint
  771  investigation since the last licensure inspection.
  772         (f) Notwithstanding s. 408.813(2)(c) and (d) and s.
  773  408.832, a fine must be imposed for each class III or class IV
  774  violation, regardless of correction, if a facility was
  775  previously cited for one or more class III or class IV
  776  violations during the agency’s last licensure inspection or any
  777  inspection or complaint investigation since the last licensure
  778  inspection for the same regulatory violation. A fine imposed for
  779  class III or class IV violations must be doubled if a facility
  780  was previously cited for one or more class III or class IV
  781  violations during the agency’s last two licensure inspections
  782  for the same regulatory violation.
  783         (g) Regardless of the class of violation cited, instead of
  784  the fine amounts listed in paragraphs (a)-(d), the agency shall
  785  impose an administrative fine of $500 if a facility is found not
  786  to be in compliance with the background screening requirements
  787  as provided in s. 408.809.
  788         (3) For purposes of this section, in determining if a
  789  penalty is to be imposed and in fixing the amount of the fine,
  790  the agency shall consider the following factors:
  791         (a) The gravity of the violation, including the probability
  792  that death or serious physical or emotional harm to a resident
  793  will result or has resulted, the severity of the action or
  794  potential harm, and the extent to which the provisions of the
  795  applicable laws or rules were violated.
  796         (b) Actions taken by the owner or administrator to correct
  797  violations.
  798         (c) Any previous violations.
  799         (d) The financial benefit to the facility of committing or
  800  continuing the violation.
  801         (e) The licensed capacity of the facility.
  802         (3)(4) Each day of continuing violation after the date
  803  established by the agency fixed for correction termination of
  804  the violation, as ordered by the agency, constitutes an
  805  additional, separate, and distinct violation.
  806         (4)(5)An Any action taken to correct a violation shall be
  807  documented in writing by the owner or administrator of the
  808  facility and verified through followup visits by agency
  809  personnel. The agency may impose a fine and, in the case of an
  810  owner-operated facility, revoke or deny a facility’s license
  811  when a facility administrator fraudulently misrepresents action
  812  taken to correct a violation.
  813         (5)(6)A Any facility whose owner fails to apply for a
  814  change-of-ownership license in accordance with part II of
  815  chapter 408 and operates the facility under the new ownership is
  816  subject to a fine of $5,000.
  817         (6)(7) In addition to any administrative fines imposed, the
  818  agency may assess a survey fee, equal to the lesser of one half
  819  of the facility’s biennial license and bed fee or $500, to cover
  820  the cost of conducting initial complaint investigations that
  821  result in the finding of a violation that was the subject of the
  822  complaint or monitoring visits conducted under s. 429.28(3)(c)
  823  to verify the correction of the violations.
  824         (7)(8) During an inspection, the agency shall make a
  825  reasonable attempt to discuss each violation with the owner or
  826  administrator of the facility, prior to written notification.
  827         (8)(9) The agency shall develop and disseminate an annual
  828  list of all facilities sanctioned or fined for violations of
  829  state standards, the number and class of violations involved,
  830  the penalties imposed, and the current status of cases. The list
  831  shall be disseminated, at no charge, to the Department of
  832  Elderly Affairs, the Department of Health, the Department of
  833  Children and Families Family Services, the Agency for Persons
  834  with Disabilities, the area agencies on aging, the Florida
  835  Statewide Advocacy Council, and the state and local ombudsman
  836  councils. The Department of Children and Families Family
  837  Services shall disseminate the list to service providers under
  838  contract to the department who are responsible for referring
  839  persons to a facility for residency. The agency may charge a fee
  840  commensurate with the cost of printing and postage to other
  841  interested parties requesting a copy of this list. This
  842  information may be provided electronically or through the
  843  agency’s website Internet site.
  844         Section 10. Subsection (3) and paragraph (c) of subsection
  845  (4) of section 429.256, Florida Statutes, are amended to read:
  846         429.256 Assistance with self-administration of medication.—
  847         (3) Assistance with self-administration of medication
  848  includes:
  849         (a) Taking the medication, in its previously dispensed,
  850  properly labeled container, including an insulin syringe that is
  851  prefilled with the proper dosage by a pharmacist and an insulin
  852  pen that is prefilled by the manufacturer, from where it is
  853  stored, and bringing it to the resident.
  854         (b) In the presence of the resident, reading the label,
  855  opening the container, removing a prescribed amount of
  856  medication from the container, and closing the container,
  857  including removing the cap of a nebulizer, opening the unit dose
  858  of nebulizer solution, and pouring the prescribed premeasured
  859  dose of medication into the dispensing cup of the nebulizer.
  860         (c) Placing an oral dosage in the resident’s hand or
  861  placing the dosage in another container and helping the resident
  862  by lifting the container to his or her mouth.
  863         (d) Applying topical medications.
  864         (e) Returning the medication container to proper storage.
  865         (f) Keeping a record of when a resident receives assistance
  866  with self-administration under this section.
  867         (g) Assisting with the use of a nebulizer.
  868         (h) Using a glucometer to perform blood-glucose level
  869  checks.
  870         (i) Assisting with putting on and taking off antiembolism
  871  stockings.
  872         (j) Assisting with applying and removing an oxygen cannula.
  873         (k) Assisting with the use of a continuous positive airway
  874  pressure (CPAP) device.
  875         (l) Assisting with measuring vital signs.
  876         (m) Assisting with colostomy bags.
  877         (4) Assistance with self-administration does not include:
  878         (c) Administration of medications through intermittent
  879  positive pressure breathing machines or a nebulizer.
  880         Section 11. Subsections (2), (5), and (6) of section
  881  429.28, Florida Statutes, are amended to read:
  882         429.28 Resident bill of rights.—
  883         (2) The administrator of a facility shall ensure that a
  884  written notice of the rights, obligations, and prohibitions set
  885  forth in this part is posted in a prominent place in each
  886  facility and read or explained to residents who cannot read. The
  887  This notice must shall include the name, address, and telephone
  888  numbers of the local ombudsman council, the and central abuse
  889  hotline, and, if when applicable, Disability Rights Florida the
  890  Advocacy Center for Persons with Disabilities, Inc., and the
  891  Florida local advocacy council, where complaints may be lodged.
  892  The notice must state that a complaint made to the Office of
  893  State Long-Term Care Ombudsman or a local long-term care
  894  ombudsman council, the names and identities of the residents
  895  involved in the complaint, and the identity of complainants are
  896  kept confidential pursuant to s. 400.0077 and that retaliatory
  897  action cannot be taken against a resident for presenting
  898  grievances or for exercising any other resident right. The
  899  facility must ensure a resident’s access to a telephone to call
  900  the local ombudsman council, central abuse hotline, and
  901  Disability Rights Florida Advocacy Center for Persons with
  902  Disabilities, Inc., and the Florida local advocacy council.
  903         (5) A No facility or employee of a facility may not serve
  904  notice upon a resident to leave the premises or take any other
  905  retaliatory action against any person who:
  906         (a) Exercises any right set forth in this section.
  907         (b) Appears as a witness in any hearing, inside or outside
  908  the facility.
  909         (c) Files a civil action alleging a violation of the
  910  provisions of this part or notifies a state attorney or the
  911  Attorney General of a possible violation of such provisions.
  912         (6) A Any facility that which terminates the residency of
  913  an individual who participated in activities specified in
  914  subsection (5) must shall show good cause in a court of
  915  competent jurisdiction. If good cause is not shown, the agency
  916  shall impose a fine of $2,500 in addition to any other penalty
  917  assessed against the facility.
  918         Section 12. Section 429.34, Florida Statutes, is amended to
  919  read:
  920         429.34 Right of entry and inspection.—
  921         (1) In addition to the requirements of s. 408.811, any duly
  922  designated officer or employee of the department, the Department
  923  of Children and Families Family Services, the Medicaid Fraud
  924  Control Unit of the Office of the Attorney General, the state or
  925  local fire marshal, or a member of the state or local long-term
  926  care ombudsman council has shall have the right to enter
  927  unannounced upon and into the premises of any facility licensed
  928  pursuant to this part in order to determine the state of
  929  compliance with the provisions of this part, part II of chapter
  930  408, and applicable rules. Data collected by the state or local
  931  long-term care ombudsman councils or the state or local advocacy
  932  councils may be used by the agency in investigations involving
  933  violations of regulatory standards. A person specified in this
  934  section who knows or has reasonable cause to suspect that a
  935  vulnerable adult has been or is being abused, neglected, or
  936  exploited shall immediately report such knowledge or suspicion
  937  to the central abuse hotline pursuant to chapter 415.
  938         (2) The agency shall inspect each licensed assisted living
  939  facility at least once every 24 months to determine compliance
  940  with this chapter and related rules. If an assisted living
  941  facility is cited for one or more class I violations or two or
  942  more class II violations arising from separate surveys within a
  943  60-day period or due to unrelated circumstances during the same
  944  survey, the agency must conduct an additional licensure
  945  inspection within 6 months. In addition to any fines imposed on
  946  the facility under s. 429.19, the licensee shall pay a fee for
  947  the cost of the additional inspection equivalent to the standard
  948  assisted living facility license and per-bed fees, without
  949  exception for beds designated for recipients of optional state
  950  supplementation. The agency shall adjust the fee in accordance
  951  with s. 408.805.
  952         Section 13. Subsection (2) of section 429.41, Florida
  953  Statutes, is amended to read:
  954         429.41 Rules establishing standards.—
  955         (2) In adopting any rules pursuant to this part, the
  956  department, in conjunction with the agency, shall make distinct
  957  standards for facilities based upon facility size; the types of
  958  care provided; the physical and mental capabilities and needs of
  959  residents; the type, frequency, and amount of services and care
  960  offered; and the staffing characteristics of the facility. Rules
  961  developed pursuant to this section may shall not restrict the
  962  use of shared staffing and shared programming in facilities that
  963  are part of retirement communities that provide multiple levels
  964  of care and otherwise meet the requirements of law and rule. If
  965  a continuing care facility licensed under chapter 651 or a
  966  retirement community offering multiple levels of care authorizes
  967  assisted living services in a building or part of a building
  968  designated for independent living, staffing requirements
  969  established in rule apply only to residents who have contracted
  970  for, and are receiving, assisted living services. If a facility
  971  uses flexible beds, staffing requirements established in rule
  972  apply only to residents receiving services through the flexible
  973  bed license provided for by department rule. Except for uniform
  974  firesafety standards, the department shall adopt by rule
  975  separate and distinct standards for facilities with 16 or fewer
  976  beds and for facilities with 17 or more beds. The standards for
  977  facilities with 16 or fewer beds must shall be appropriate for a
  978  noninstitutional residential environment;, however, provided
  979  that the structure may not be is no more than two stories in
  980  height and all persons who cannot exit the facility unassisted
  981  in an emergency must reside on the first floor. The department,
  982  in conjunction with the agency, may make other distinctions
  983  among types of facilities as necessary to enforce the provisions
  984  of this part. Where appropriate, the agency shall offer
  985  alternate solutions for complying with established standards,
  986  based on distinctions made by the department and the agency
  987  relative to the physical characteristics of facilities and the
  988  types of care offered therein.
  989         Section 14. Present subsections (1) through (11) of section
  990  429.52, Florida Statutes, are renumbered as subsections (2)
  991  through (12), respectively, a new subsection (1) is added to
  992  that section, and present subsection (9) of that section is
  993  amended, to read:
  994         429.52 Staff training and educational programs; core
  995  educational requirement.—
  996         (1) Effective October 1, 2014, each new assisted living
  997  facility employee who has not previously completed core training
  998  must attend a preservice orientation provided by the facility
  999  before interacting with residents. The preservice orientation
 1000  must be at least 2 hours in duration and cover topics that help
 1001  the employee provide responsible care and respond to the needs
 1002  of facility residents. Upon completion, the employee and the
 1003  administrator of the facility must sign an affidavit stating
 1004  that the employee completed the required preservice orientation.
 1005  The facility must keep the affidavit in the employee’s work
 1006  file.
 1007         (10)(9) The training required by this section must shall be
 1008  conducted by persons registered with the department as having
 1009  the requisite experience and credentials to conduct the
 1010  training. A person seeking to register as a trainer must provide
 1011  the department with proof of completion of the minimum core
 1012  training education requirements, successful passage of the
 1013  competency test established under this section, and proof of
 1014  compliance with the continuing education requirement in
 1015  subsection (5) (4).
 1016         Section 15. Section 429.55, Florida Statutes, is created to
 1017  read:
 1018         429.55Facilities licensed for flexible beds.—
 1019         (1) Beginning January 1, 2015, a facility may apply for a
 1020  flexible bed license.
 1021         (2)A facility that has a flexible bed license shall:
 1022         (a) Retain a log that lists the name of each resident who
 1023  has contracted for and is receiving assisted living services in
 1024  flexible bed living units, the unit number in which the resident
 1025  resides, the date the contract for the services commenced, the
 1026  date that services ended in the flexible bed living unit if
 1027  applicable, and documentation to demonstrate that minimum
 1028  staffing standards are met;
 1029         (b) Specify in the flexible bed contract the process that
 1030  will be used to determine when a resident is no longer eligible
 1031  for services provided through the flexible bed license. This
 1032  contract for services must also outline if the delivery of
 1033  services in a flexible bed living unit will be covered under the
 1034  existing residency agreement or will require a fee for service
 1035  payment; and
 1036         (c) Retain each flexible bed contract for 5 years after the
 1037  assisted living services end. All other records must be retained
 1038  for at least 2 years from the date of termination of the
 1039  services.
 1040         (3) Upon request, a facility that has a flexible bed
 1041  license must provide state surveyors with access to the log
 1042  described in paragraph (2)(a). State surveyors shall also have
 1043  access to independent living units occupied by residents who are
 1044  receiving services through the flexible bed license at the time
 1045  of any survey. State surveyors may interview any resident who
 1046  has received services through the flexible bed license since the
 1047  last biennial survey, but who is no longer receiving such
 1048  services.
 1049         (4) A flexible bed license does not preclude a resident who
 1050  lives in a building that has such a license from obtaining home
 1051  health services in accordance with the policies of the facility.
 1052         Section 16. The Legislature finds that consistent
 1053  regulation of assisted living facilities benefits residents and
 1054  operators of such facilities. To determine whether surveys are
 1055  consistent between surveys and surveyors, the Office of Program
 1056  Policy Analysis and Government Accountability (OPPAGA) shall
 1057  conduct a study of intersurveyor reliability for assisted living
 1058  facilities. By November 1, 2014, OPPAGA shall report its
 1059  findings to the Governor, the President of the Senate, and the
 1060  Speaker of the House of Representatives and make any
 1061  recommendations for improving intersurveyor reliability.
 1062         Section 17. The Legislature finds that consumers need
 1063  additional information on the quality of care and service in
 1064  assisted living facilities in order to select the best facility
 1065  for themselves or their loved ones. Therefore, the Agency for
 1066  Health Care Administration shall:
 1067         (1)Implement a rating system for assisted living
 1068  facilities by November 1, 2014. The agency shall adopt rules to
 1069  administer this subsection.
 1070         (2) By January 1, 2015, create content that is easily
 1071  accessible through the front page of the agency’s website. At a
 1072  minimum, the content must include:
 1073         (a)Information on each licensed assisted living facility,
 1074  including, but not limited to:
 1075         1.The name and address of the facility.
 1076         2.The number and type of licensed beds in the facility.
 1077         3.The types of licenses held by the facility.
 1078         4.The facility’s license expiration date and status.
 1079         5.Other relevant information that the agency currently
 1080  collects.
 1081         (b) A list of the facility’s violations, including, for
 1082  each violation:
 1083         1. A summary of the violation which is presented in a
 1084  manner understandable by the general public;
 1085         2. Any sanctions imposed by final order; and
 1086         3. A summary of any corrective action taken by the
 1087  facility.
 1088         (c) Links to inspection reports that the agency has on
 1089  file.
 1090         (d)A monitored comment page, maintained by the agency,
 1091  which allows members of the public to anonymously comment on
 1092  assisted living facilities that are licensed to operate in this
 1093  state. This comment page must, at a minimum, allow members of
 1094  the public to post comments on their experiences with, or
 1095  observations of, an assisted living facility and to review other
 1096  people’s comments. Comments posted to the agency’s comment page
 1097  may not contain profanity and are intended to provide meaningful
 1098  feedback about the assisted living facility. The agency shall
 1099  review comments for profane content before the comments are
 1100  posted to the page. A controlling interest, as defined in s.
 1101  408.803, Florida Statutes, in an assisted living facility, or an
 1102  employee or owner of an assisted living facility, is prohibited
 1103  from posting comments on the page, except that a controlling
 1104  interest, employee, or owner may respond to comments on the
 1105  page, and the agency shall ensure that the responses are
 1106  identified as being from a representative of the facility.
 1107         Section 18. This act shall take effect July 1, 2014.