Florida Senate - 2015                        COMMITTEE AMENDMENT
       Bill No. CS for SB 382
       
       
       
       
       
       
                                Ì377856XÎ377856                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/16/2015           .                                
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       The Committee on Appropriations (Garcia) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 394.4574, Florida Statutes, is amended
    6  to read:
    7         394.4574 Department Responsibilities for coordination of
    8  services for a mental health resident who resides in an assisted
    9  living facility that holds a limited mental health license.—
   10         (1) As used in this section, the term “mental health
   11  resident,for purposes of this section, means an individual who
   12  receives social security disability income due to a mental
   13  disorder as determined by the Social Security Administration or
   14  receives supplemental security income due to a mental disorder
   15  as determined by the Social Security Administration and receives
   16  optional state supplementation.
   17         (2) Medicaid managed care plans are responsible for
   18  Medicaid-enrolled mental health residents, and managing entities
   19  under contract with the department are responsible for mental
   20  health residents who are not enrolled in a Medicaid health plan.
   21  A Medicaid managed care plan or a managing entity shall The
   22  department must ensure that:
   23         (a) A mental health resident has been assessed by a
   24  psychiatrist, clinical psychologist, clinical social worker, or
   25  psychiatric nurse, or an individual who is supervised by one of
   26  these professionals, and determined to be appropriate to reside
   27  in an assisted living facility. The documentation must be
   28  provided to the administrator of the facility within 30 days
   29  after the mental health resident has been admitted to the
   30  facility. An evaluation completed upon discharge from a state
   31  mental hospital meets the requirements of this subsection
   32  related to appropriateness for placement as a mental health
   33  resident if it was completed within 90 days before prior to
   34  admission to the facility.
   35         (b) A cooperative agreement, as required in s. 429.075, is
   36  developed by between the mental health care services provider
   37  that serves a mental health resident and the administrator of
   38  the assisted living facility with a limited mental health
   39  license in which the mental health resident is living. Any
   40  entity that provides Medicaid prepaid health plan services shall
   41  ensure the appropriate coordination of health care services with
   42  an assisted living facility in cases where a Medicaid recipient
   43  is both a member of the entity’s prepaid health plan and a
   44  resident of the assisted living facility. If the entity is at
   45  risk for Medicaid targeted case management and behavioral health
   46  services, the entity shall inform the assisted living facility
   47  of the procedures to follow should an emergent condition arise.
   48         (c) The community living support plan, as defined in s.
   49  429.02, has been prepared by a mental health resident and his or
   50  her a mental health case manager of that resident in
   51  consultation with the administrator of the facility or the
   52  administrator’s designee. The plan must be completed and
   53  provided to the administrator of the assisted living facility
   54  with a limited mental health license in which the mental health
   55  resident lives upon the resident’s admission. The support plan
   56  and the agreement may be in one document. The agency may not
   57  cite an assisted living facility for not possessing a resident’s
   58  community living support plan if the facility can document that
   59  it has requested the plan for that resident.
   60         (d) The assisted living facility with a limited mental
   61  health license is provided with documentation that the
   62  individual meets the definition of a mental health resident.
   63         (e) The mental health services provider assigns a case
   64  manager to each mental health resident for whom the entity is
   65  responsible who lives in an assisted living facility with a
   66  limited mental health license. The case manager shall coordinate
   67  is responsible for coordinating the development of and
   68  implementation of the community living support plan defined in
   69  s. 429.02. The plan must be updated at least annually, or when
   70  there is a significant change in the resident’s behavioral
   71  health status, such as an inpatient admission or a change in
   72  medication, level of service, or residence. Each case manager
   73  shall keep a record of the date and time of any face-to-face
   74  interaction with the resident and make the record available to
   75  the responsible entity for inspection. The record must be
   76  retained for at least 2 years after the date of the most recent
   77  interaction.
   78         (f)Adequate and consistent monitoring and enforcement of
   79  community living support plans and cooperative agreements are
   80  conducted by the resident’s case manager.
   81         (g) Concerns are reported to the appropriate regulatory
   82  oversight organization if a regulated provider fails to deliver
   83  appropriate services or otherwise acts in a manner that has the
   84  potential to result in harm to the resident.
   85         (3) The Secretary of Children and Families, in consultation
   86  with the Agency for Health Care Administration, shall annually
   87  require each district administrator to develop, with community
   88  input, a detailed annual plan that demonstrates detailed plans
   89  that demonstrate how the district will ensure the provision of
   90  state-funded mental health and substance abuse treatment
   91  services to residents of assisted living facilities that hold a
   92  limited mental health license. This plan These plans must be
   93  consistent with the substance abuse and mental health district
   94  plan developed pursuant to s. 394.75 and must address case
   95  management services; access to consumer-operated drop-in
   96  centers; access to services during evenings, weekends, and
   97  holidays; supervision of the clinical needs of the residents;
   98  and access to emergency psychiatric care.
   99         Section 2. Subsection (1) of section 400.0074, Florida
  100  Statutes, is amended, and paragraph (h) is added to subsection
  101  (2) of that section, to read:
  102         400.0074 Local ombudsman council onsite administrative
  103  assessments.—
  104         (1) In addition to any specific investigation conducted
  105  pursuant to a complaint, the local council shall conduct, at
  106  least annually, an onsite administrative assessment of each
  107  nursing home, assisted living facility, and adult family-care
  108  home within its jurisdiction. This administrative assessment
  109  must be comprehensive in nature and must shall focus on factors
  110  affecting residents’ the rights, health, safety, and welfare of
  111  the residents. Each local council is encouraged to conduct a
  112  similar onsite administrative assessment of each additional
  113  long-term care facility within its jurisdiction.
  114         (2) An onsite administrative assessment conducted by a
  115  local council shall be subject to the following conditions:
  116         (h) Upon completion of an administrative assessment, the
  117  local council shall conduct an exit consultation with the
  118  facility administrator or administrator’s designee to discuss
  119  issues and concerns in areas affecting residents’ rights,
  120  health, safety, and welfare and, if needed, make recommendations
  121  for improvement.
  122         Section 3. Subsection (2) of section 400.0078, Florida
  123  Statutes, is amended to read:
  124         400.0078 Citizen access to State Long-Term Care Ombudsman
  125  Program services.—
  126         (2) Every resident or representative of a resident shall
  127  receive, Upon admission to a long-term care facility, each
  128  resident or representative of a resident must receive
  129  information regarding the purpose of the State Long-Term Care
  130  Ombudsman Program, the statewide toll-free telephone number for
  131  receiving complaints, information that retaliatory action cannot
  132  be taken against a resident for presenting grievances or for
  133  exercising any other resident right, and other relevant
  134  information regarding how to contact the program. Each resident
  135  or his or her representative Residents or their representatives
  136  must be furnished additional copies of this information upon
  137  request.
  138         Section 4. Paragraph (c) of subsection (4) of section
  139  409.212, Florida Statutes, is amended to read:
  140         409.212 Optional supplementation.—
  141         (4) In addition to the amount of optional supplementation
  142  provided by the state, a person may receive additional
  143  supplementation from third parties to contribute to his or her
  144  cost of care. Additional supplementation may be provided under
  145  the following conditions:
  146         (c) The additional supplementation shall not exceed four
  147  two times the provider rate recognized under the optional state
  148  supplementation program.
  149         Section 5. Subsection (13) of section 429.02, Florida
  150  Statutes, is amended to read:
  151         429.02 Definitions.—When used in this part, the term:
  152         (13) “Limited nursing services” means acts that may be
  153  performed by a person licensed under pursuant to part I of
  154  chapter 464 by persons licensed thereunder while carrying out
  155  their professional duties but limited to those acts which the
  156  department specifies by rule. Acts which may be specified by
  157  rule as allowable Limited nursing services shall be for persons
  158  who meet the admission criteria established by the department
  159  for assisted living facilities and shall not be complex enough
  160  to require 24-hour nursing supervision and may include such
  161  services as the application and care of routine dressings, and
  162  care of casts, braces, and splints.
  163         Section 6. Paragraphs (b) and (c) of subsection (3) of
  164  section 429.07, Florida Statutes, are amended to read:
  165         429.07 License required; fee.—
  166         (3) In addition to the requirements of s. 408.806, each
  167  license granted by the agency must state the type of care for
  168  which the license is granted. Licenses shall be issued for one
  169  or more of the following categories of care: standard, extended
  170  congregate care, limited nursing services, or limited mental
  171  health.
  172         (b) An extended congregate care license shall be issued to
  173  each facility that has been licensed as an assisted living
  174  facility for 2 or more years and that provides services
  175  facilities providing, directly or through contract, services
  176  beyond those authorized in paragraph (a), including services
  177  performed by persons licensed under part I of chapter 464 and
  178  supportive services, as defined by rule, to persons who would
  179  otherwise be disqualified from continued residence in a facility
  180  licensed under this part. An extended congregate care license
  181  may be issued to a facility that has a provisional extended
  182  congregate care license and meets the requirements for licensure
  183  under subparagraph 2. The primary purpose of extended congregate
  184  care services is to allow residents the option of remaining in a
  185  familiar setting from which they would otherwise be disqualified
  186  for continued residency as they become more impaired. A facility
  187  licensed to provide extended congregate care services may also
  188  admit an individual who exceeds the admission criteria for a
  189  facility with a standard license if the individual is determined
  190  appropriate for admission to the extended congregate care
  191  facility.
  192         1. In order for extended congregate care services to be
  193  provided, the agency must first determine that all requirements
  194  established in law and rule are met and must specifically
  195  designate, on the facility’s license, that such services may be
  196  provided and whether the designation applies to all or part of
  197  the facility. This Such designation may be made at the time of
  198  initial licensure or licensure renewal relicensure, or upon
  199  request in writing by a licensee under this part and part II of
  200  chapter 408. The notification of approval or the denial of the
  201  request shall be made in accordance with part II of chapter 408.
  202  Each existing facility that qualifies facilities qualifying to
  203  provide extended congregate care services must have maintained a
  204  standard license and may not have been subject to administrative
  205  sanctions during the previous 2 years, or since initial
  206  licensure if the facility has been licensed for less than 2
  207  years, for any of the following reasons:
  208         a. A class I or class II violation;
  209         b. Three or more repeat or recurring class III violations
  210  of identical or similar resident care standards from which a
  211  pattern of noncompliance is found by the agency;
  212         c. Three or more class III violations that were not
  213  corrected in accordance with the corrective action plan approved
  214  by the agency;
  215         d. Violation of resident care standards which results in
  216  requiring the facility to employ the services of a consultant
  217  pharmacist or consultant dietitian;
  218         e. Denial, suspension, or revocation of a license for
  219  another facility licensed under this part in which the applicant
  220  for an extended congregate care license has at least 25 percent
  221  ownership interest; or
  222         f. Imposition of a moratorium pursuant to this part or part
  223  II of chapter 408 or initiation of injunctive proceedings.
  224  
  225  The agency may deny or revoke a facility’s extended congregate
  226  care license if it fails to meet the criteria for an extended
  227  congregate care license as provided in this subparagraph.
  228         2.If an assisted living facility has been licensed for
  229  less than 2 years, the initial extended congregate care license
  230  must be provisional and may not exceed 6 months. The licensee
  231  shall notify the agency, in writing, when it admits at least one
  232  extended congregate care resident, after which an unannounced
  233  inspection shall be made to determine compliance with
  234  requirements of an extended congregate care license. A licensee
  235  that has a provisional extended congregate care license which
  236  demonstrates compliance with all of the requirements of an
  237  extended congregate care license during the inspection shall be
  238  issued an extended congregate care license. In addition to
  239  sanctions authorized under this part, if violations are found
  240  during the inspection and the licensee fails to demonstrate
  241  compliance with all assisted living requirements during a
  242  followup inspection, the licensee shall immediately suspend
  243  extended congregate care services, and the provisional extended
  244  congregate care license expires. The agency may extend the
  245  provisional license for not more than 1 month in order to
  246  complete a followup visit.
  247         3.2. A facility that is licensed to provide extended
  248  congregate care services shall maintain a written progress
  249  report on each person who receives services which describes the
  250  type, amount, duration, scope, and outcome of services that are
  251  rendered and the general status of the resident’s health. A
  252  registered nurse, or appropriate designee, representing the
  253  agency shall visit the facility at least twice a year quarterly
  254  to monitor residents who are receiving extended congregate care
  255  services and to determine if the facility is in compliance with
  256  this part, part II of chapter 408, and relevant rules. One of
  257  the visits may be in conjunction with the regular survey. The
  258  monitoring visits may be provided through contractual
  259  arrangements with appropriate community agencies. A registered
  260  nurse shall serve as part of the team that inspects the
  261  facility. The agency may waive one of the required yearly
  262  monitoring visits for a facility that has:
  263         a. Held an extended congregate care license for at least 24
  264  months; been licensed for at least 24 months to provide extended
  265  congregate care services, if, during the inspection, the
  266  registered nurse determines that extended congregate care
  267  services are being provided appropriately, and if the facility
  268  has
  269         b. No class I or class II violations and no uncorrected
  270  class III violations; and.
  271         c. No ombudsman council complaints that resulted in a
  272  citation for licensure The agency must first consult with the
  273  long-term care ombudsman council for the area in which the
  274  facility is located to determine if any complaints have been
  275  made and substantiated about the quality of services or care.
  276  The agency may not waive one of the required yearly monitoring
  277  visits if complaints have been made and substantiated.
  278         4.3. A facility that is licensed to provide extended
  279  congregate care services must:
  280         a. Demonstrate the capability to meet unanticipated
  281  resident service needs.
  282         b. Offer a physical environment that promotes a homelike
  283  setting, provides for resident privacy, promotes resident
  284  independence, and allows sufficient congregate space as defined
  285  by rule.
  286         c. Have sufficient staff available, taking into account the
  287  physical plant and firesafety features of the building, to
  288  assist with the evacuation of residents in an emergency.
  289         d. Adopt and follow policies and procedures that maximize
  290  resident independence, dignity, choice, and decisionmaking to
  291  permit residents to age in place, so that moves due to changes
  292  in functional status are minimized or avoided.
  293         e. Allow residents or, if applicable, a resident’s
  294  representative, designee, surrogate, guardian, or attorney in
  295  fact to make a variety of personal choices, participate in
  296  developing service plans, and share responsibility in
  297  decisionmaking.
  298         f. Implement the concept of managed risk.
  299         g. Provide, directly or through contract, the services of a
  300  person licensed under part I of chapter 464.
  301         h. In addition to the training mandated in s. 429.52,
  302  provide specialized training as defined by rule for facility
  303  staff.
  304         5.4. A facility that is licensed to provide extended
  305  congregate care services is exempt from the criteria for
  306  continued residency set forth in rules adopted under s. 429.41.
  307  A licensed facility must adopt its own requirements within
  308  guidelines for continued residency set forth by rule. However,
  309  the facility may not serve residents who require 24-hour nursing
  310  supervision. A licensed facility that provides extended
  311  congregate care services must also provide each resident with a
  312  written copy of facility policies governing admission and
  313  retention.
  314         5. The primary purpose of extended congregate care services
  315  is to allow residents, as they become more impaired, the option
  316  of remaining in a familiar setting from which they would
  317  otherwise be disqualified for continued residency. A facility
  318  licensed to provide extended congregate care services may also
  319  admit an individual who exceeds the admission criteria for a
  320  facility with a standard license, if the individual is
  321  determined appropriate for admission to the extended congregate
  322  care facility.
  323         6. Before the admission of an individual to a facility
  324  licensed to provide extended congregate care services, the
  325  individual must undergo a medical examination as provided in s.
  326  429.26(4) and the facility must develop a preliminary service
  327  plan for the individual.
  328         7. If When a facility can no longer provide or arrange for
  329  services in accordance with the resident’s service plan and
  330  needs and the facility’s policy, the facility must shall make
  331  arrangements for relocating the person in accordance with s.
  332  429.28(1)(k).
  333         8. Failure to provide extended congregate care services may
  334  result in denial of extended congregate care license renewal.
  335         (c) A limited nursing services license shall be issued to a
  336  facility that provides services beyond those authorized in
  337  paragraph (a) and as specified in this paragraph.
  338         1. In order for limited nursing services to be provided in
  339  a facility licensed under this part, the agency must first
  340  determine that all requirements established in law and rule are
  341  met and must specifically designate, on the facility’s license,
  342  that such services may be provided. This Such designation may be
  343  made at the time of initial licensure or licensure renewal
  344  relicensure, or upon request in writing by a licensee under this
  345  part and part II of chapter 408. Notification of approval or
  346  denial of such request shall be made in accordance with part II
  347  of chapter 408. An existing facility that qualifies facilities
  348  qualifying to provide limited nursing services must shall have
  349  maintained a standard license and may not have been subject to
  350  administrative sanctions that affect the health, safety, and
  351  welfare of residents for the previous 2 years or since initial
  352  licensure if the facility has been licensed for less than 2
  353  years.
  354         2. A facility Facilities that is are licensed to provide
  355  limited nursing services shall maintain a written progress
  356  report on each person who receives such nursing services. The,
  357  which report must describe describes the type, amount, duration,
  358  scope, and outcome of services that are rendered and the general
  359  status of the resident’s health. A registered nurse representing
  360  the agency shall visit the facility such facilities at least
  361  annually twice a year to monitor residents who are receiving
  362  limited nursing services and to determine if the facility is in
  363  compliance with applicable provisions of this part, part II of
  364  chapter 408, and related rules. The monitoring visits may be
  365  provided through contractual arrangements with appropriate
  366  community agencies. A registered nurse shall also serve as part
  367  of the team that inspects such facility. Visits may be in
  368  conjunction with other agency inspections. The agency may waive
  369  the required yearly monitoring visit for a facility that has:
  370         a. Had a limited nursing services license for at least 24
  371  months;
  372         b. No class I or class II violations and no uncorrected
  373  class III violations; and
  374         c. No ombudsman council complaints that resulted in a
  375  citation for licensure.
  376         3. A person who receives limited nursing services under
  377  this part must meet the admission criteria established by the
  378  agency for assisted living facilities. When a resident no longer
  379  meets the admission criteria for a facility licensed under this
  380  part, arrangements for relocating the person shall be made in
  381  accordance with s. 429.28(1)(k), unless the facility is licensed
  382  to provide extended congregate care services.
  383         Section 7. Section 429.075, Florida Statutes, is amended to
  384  read:
  385         429.075 Limited mental health license.—An assisted living
  386  facility that serves one three or more mental health residents
  387  must obtain a limited mental health license.
  388         (1) To obtain a limited mental health license, a facility
  389  must hold a standard license as an assisted living facility,
  390  must not have any current uncorrected deficiencies or
  391  violations, and must ensure that, within 6 months after
  392  receiving a limited mental health license, the facility
  393  administrator and the staff of the facility who are in direct
  394  contact with mental health residents must complete training of
  395  no less than 6 hours related to their duties. This Such
  396  designation may be made at the time of initial licensure or
  397  licensure renewal relicensure or upon request in writing by a
  398  licensee under this part and part II of chapter 408.
  399  Notification of approval or denial of such request shall be made
  400  in accordance with this part, part II of chapter 408, and
  401  applicable rules. This training must will be provided by or
  402  approved by the Department of Children and Families.
  403         (2) A facility that is Facilities licensed to provide
  404  services to mental health residents must shall provide
  405  appropriate supervision and staffing to provide for the health,
  406  safety, and welfare of such residents.
  407         (3) A facility that has a limited mental health license
  408  must:
  409         (a) Have a copy of each mental health resident’s community
  410  living support plan and the cooperative agreement with the
  411  mental health care services provider or provide written evidence
  412  that a request for the community living support plan and the
  413  cooperative agreement was sent to the Medicaid managed care plan
  414  or managing entity under contract with the Department of
  415  Children and Families within 72 hours after admission. The
  416  support plan and the agreement may be combined.
  417         (b) Have documentation that is provided by the Department
  418  of Children and Families that each mental health resident has
  419  been assessed and determined to be able to live in the community
  420  in an assisted living facility that has with a limited mental
  421  health license or provide written evidence that a request for
  422  documentation was sent to the department within 72 hours after
  423  admission.
  424         (c) Make the community living support plan available for
  425  inspection by the resident, the resident’s legal guardian or,
  426  the resident’s health care surrogate, and other individuals who
  427  have a lawful basis for reviewing this document.
  428         (d) Assist the mental health resident in carrying out the
  429  activities identified in the resident’s individual’s community
  430  living support plan.
  431         (4) A facility that has with a limited mental health
  432  license may enter into a cooperative agreement with a private
  433  mental health provider. For purposes of the limited mental
  434  health license, the private mental health provider may act as
  435  the case manager.
  436         Section 8. Section 429.14, Florida Statutes, is amended to
  437  read:
  438         429.14 Administrative penalties.—
  439         (1) In addition to the requirements of part II of chapter
  440  408, the agency may deny, revoke, and suspend any license issued
  441  under this part and impose an administrative fine in the manner
  442  provided in chapter 120 against a licensee for a violation of
  443  any provision of this part, part II of chapter 408, or
  444  applicable rules, or for any of the following actions by a
  445  licensee, for the actions of any person subject to level 2
  446  background screening under s. 408.809, or for the actions of any
  447  facility staff employee:
  448         (a) An intentional or negligent act seriously affecting the
  449  health, safety, or welfare of a resident of the facility.
  450         (b) A The determination by the agency that the owner lacks
  451  the financial ability to provide continuing adequate care to
  452  residents.
  453         (c) Misappropriation or conversion of the property of a
  454  resident of the facility.
  455         (d) Failure to follow the criteria and procedures provided
  456  under part I of chapter 394 relating to the transportation,
  457  voluntary admission, and involuntary examination of a facility
  458  resident.
  459         (e) A citation for of any of the following violations
  460  deficiencies as specified in s. 429.19:
  461         1. One or more cited class I violations deficiencies.
  462         2. Three or more cited class II violations deficiencies.
  463         3. Five or more cited class III violations deficiencies
  464  that have been cited on a single survey and have not been
  465  corrected within the times specified.
  466         (f) Failure to comply with the background screening
  467  standards of this part, s. 408.809(1), or chapter 435.
  468         (g) Violation of a moratorium.
  469         (h) Failure of the license applicant, the licensee during
  470  licensure renewal relicensure, or a licensee that holds a
  471  provisional license to meet the minimum license requirements of
  472  this part, or related rules, at the time of license application
  473  or renewal.
  474         (i) An intentional or negligent life-threatening act in
  475  violation of the uniform firesafety standards for assisted
  476  living facilities or other firesafety standards which that
  477  threatens the health, safety, or welfare of a resident of a
  478  facility, as communicated to the agency by the local authority
  479  having jurisdiction or the State Fire Marshal.
  480         (j) Knowingly operating any unlicensed facility or
  481  providing without a license any service that must be licensed
  482  under this chapter or chapter 400.
  483         (k) Any act constituting a ground upon which application
  484  for a license may be denied.
  485         (2) Upon notification by the local authority having
  486  jurisdiction or by the State Fire Marshal, the agency may deny
  487  or revoke the license of an assisted living facility that fails
  488  to correct cited fire code violations that affect or threaten
  489  the health, safety, or welfare of a resident of a facility.
  490         (3) The agency may deny or revoke a license of an to any
  491  applicant or controlling interest as defined in part II of
  492  chapter 408 which has or had a 25 percent 25-percent or greater
  493  financial or ownership interest in any other facility that is
  494  licensed under this part, or in any entity licensed by this
  495  state or another state to provide health or residential care, if
  496  that which facility or entity during the 5 years before prior to
  497  the application for a license closed due to financial inability
  498  to operate; had a receiver appointed or a license denied,
  499  suspended, or revoked; was subject to a moratorium; or had an
  500  injunctive proceeding initiated against it.
  501         (4) The agency shall deny or revoke the license of an
  502  assisted living facility if any of the following apply:
  503         (a)There are two moratoria, issued pursuant to this part
  504  or part II of chapter 408, within a 2-year period which are
  505  imposed by final order.
  506         (b)The facility is cited for two or more class I
  507  violations arising from unrelated circumstances during the same
  508  survey or investigation.
  509         (c)The facility is cited for two or more class I
  510  violations arising from separate surveys or investigations
  511  within a 2-year period that has two or more class I violations
  512  that are similar or identical to violations identified by the
  513  agency during a survey, inspection, monitoring visit, or
  514  complaint investigation occurring within the previous 2 years.
  515         (5) An action taken by the agency to suspend, deny, or
  516  revoke a facility’s license under this part or part II of
  517  chapter 408, in which the agency claims that the facility owner
  518  or an employee of the facility has threatened the health,
  519  safety, or welfare of a resident of the facility, shall be heard
  520  by the Division of Administrative Hearings of the Department of
  521  Management Services within 120 days after receipt of the
  522  facility’s request for a hearing, unless that time limitation is
  523  waived by both parties. The administrative law judge shall must
  524  render a decision within 30 days after receipt of a proposed
  525  recommended order.
  526         (6) As provided under s. 408.814, the agency shall impose
  527  an immediate moratorium on an assisted living facility that
  528  fails to provide the agency access to the facility or prohibits
  529  the agency from conducting a regulatory inspection. The licensee
  530  may not restrict agency staff in accessing and copying records
  531  or in conducting confidential interviews with facility staff or
  532  any individual who receives services from the facility. If
  533  requested by the facility, the agency must reimburse the
  534  facility for all reasonable costs related to the accessing and
  535  copying of records required under this subsection provide to the
  536  Division of Hotels and Restaurants of the Department of Business
  537  and Professional Regulation, on a monthly basis, a list of those
  538  assisted living facilities that have had their licenses denied,
  539  suspended, or revoked or that are involved in an appellate
  540  proceeding pursuant to s. 120.60 related to the denial,
  541  suspension, or revocation of a license.
  542         (7) Agency notification of a license suspension or
  543  revocation, or denial of a license renewal, shall be posted and
  544  visible to the public at the facility.
  545         (8) If a facility is required to relocate some or all of
  546  its residents due to agency action, that facility is exempt from
  547  the 45 days’ notice requirement imposed under s. 429.28(1)(k).
  548  This subsection does not exempt the facility from any deadline
  549  for corrective action set by the agency.
  550         Section 9. Paragraphs (a) and (b) of subsection (2) of
  551  section 429.178, Florida Statutes, are amended to read:
  552         429.178 Special care for persons with Alzheimer’s disease
  553  or other related disorders.—
  554         (2)(a) An individual who is employed by a facility that
  555  provides special care for residents who have with Alzheimer’s
  556  disease or other related disorders, and who has regular contact
  557  with such residents, must complete up to 4 hours of initial
  558  dementia-specific training developed or approved by the
  559  department. The training must shall be completed within 3 months
  560  after beginning employment and shall satisfy the core training
  561  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  562         (b) A direct caregiver who is employed by a facility that
  563  provides special care for residents who have with Alzheimer’s
  564  disease or other related disorders, and who provides direct care
  565  to such residents, must complete the required initial training
  566  and 4 additional hours of training developed or approved by the
  567  department. The training must shall be completed within 9 months
  568  after beginning employment and shall satisfy the core training
  569  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  570         Section 10. Paragraphs (e) and (f) are added to subsection
  571  (2) of section 429.19, Florida Statutes, to read:
  572         429.19 Violations; imposition of administrative fines;
  573  grounds.—
  574         (2) Each violation of this part and adopted rules shall be
  575  classified according to the nature of the violation and the
  576  gravity of its probable effect on facility residents. The agency
  577  shall indicate the classification on the written notice of the
  578  violation as follows:
  579         (e) Any fine imposed by the agency for a cited class I or
  580  class II violation must be doubled if the agency finds that such
  581  violation has not been corrected within six months of the
  582  citation being issued.
  583         (f)Regardless of the class of violation cited, instead of
  584  the fine amounts listed in paragraphs (a)-(d), the agency shall
  585  impose an administrative fine of $500 if a facility is found not
  586  to be in compliance with the background screening requirements
  587  as provided in s. 408.809.
  588         Section 11. Subsection (3) and paragraph (c) of subsection
  589  (4) of section 429.256, Florida Statutes, are amended to read:
  590         429.256 Assistance with self-administration of medication.—
  591         (3) Assistance with self-administration of medication
  592  includes:
  593         (a) Taking the medication, in its previously dispensed,
  594  properly labeled container, including an insulin syringe that is
  595  prefilled with the proper dosage by a pharmacist and an insulin
  596  pen that is prefilled by the manufacturer, from where it is
  597  stored, and bringing it to the resident.
  598         (b) In the presence of the resident, reading the label,
  599  opening the container, removing a prescribed amount of
  600  medication from the container, and closing the container.
  601         (c) Placing an oral dosage in the resident’s hand or
  602  placing the dosage in another container and helping the resident
  603  by lifting the container to his or her mouth.
  604         (d) Applying topical medications.
  605         (e) Returning the medication container to proper storage.
  606         (f) Keeping a record of when a resident receives assistance
  607  with self-administration under this section.
  608         (g) Assisting with the use of a nebulizer, including
  609  removing the cap of a nebulizer, opening the unit dose of
  610  nebulizer solution, and pouring the prescribed premeasured dose
  611  of medication into the dispensing cup of the nebulizer.
  612         (h) Using a glucometer to perform blood-glucose level
  613  checks.
  614         (i) Assisting with putting on and taking off antiembolism
  615  stockings.
  616         (j) Assisting with applying and removing an oxygen cannula,
  617  but not with titrating the prescribed oxygen settings.
  618         (k) Assisting with the use of a continuous positive airway
  619  pressure (CPAP) device, but not with titrating the prescribed
  620  setting of the device.
  621         (l) Assisting with measuring vital signs.
  622         (m) Assisting with colostomy bags.
  623         (4) Assistance with self-administration does not include:
  624         (c) Administration of medications through intermittent
  625  positive pressure breathing machines or a nebulizer.
  626         Section 12. Subsection (3) of section 429.27, Florida
  627  Statutes, is amended to read:
  628         429.27 Property and personal affairs of residents.—
  629         (3) A facility, upon mutual consent with the resident,
  630  shall provide for the safekeeping in the facility of personal
  631  effects not in excess of $500 and funds of the resident not in
  632  excess of $500 $200 cash, and shall keep complete and accurate
  633  records of all such funds and personal effects received. If a
  634  resident is absent from a facility for 24 hours or more, the
  635  facility may provide for the safekeeping of the resident’s
  636  personal effects in excess of $500.
  637         Section 13. Subsections (2), (5), and (6) of section
  638  429.28, Florida Statutes, are amended to read:
  639         429.28 Resident bill of rights.—
  640         (2) The administrator of a facility shall ensure that a
  641  written notice of the rights, obligations, and prohibitions set
  642  forth in this part is posted in a prominent place in each
  643  facility and read or explained to residents who cannot read. The
  644  This notice must shall include the name, address, and telephone
  645  numbers of the local ombudsman council, the and central abuse
  646  hotline, and, if when applicable, Disability Rights Florida the
  647  Advocacy Center for Persons with Disabilities, Inc., and the
  648  Florida local advocacy council, where complaints may be lodged.
  649  The notice must state that a complaint made to the Office of
  650  State Long-Term Care Ombudsman or a local long-term care
  651  ombudsman council, the names and identities of the residents
  652  involved in the complaint, and the identity of complainants are
  653  kept confidential pursuant to s. 400.0077 and that retaliatory
  654  action cannot be taken against a resident for presenting
  655  grievances or for exercising any other resident right. The
  656  facility must ensure a resident’s access to a telephone to call
  657  the local ombudsman council, central abuse hotline, and
  658  Disability Rights Florida Advocacy Center for Persons with
  659  Disabilities, Inc., and the Florida local advocacy council.
  660         (5) A No facility or employee of a facility may not serve
  661  notice upon a resident to leave the premises or take any other
  662  retaliatory action against any person who:
  663         (a) Exercises any right set forth in this section.
  664         (b) Appears as a witness in any hearing, inside or outside
  665  the facility.
  666         (c) Files a civil action alleging a violation of the
  667  provisions of this part or notifies a state attorney or the
  668  Attorney General of a possible violation of such provisions.
  669         (6) A Any facility that which terminates the residency of
  670  an individual who participated in activities specified in
  671  subsection (5) must shall show good cause in a court of
  672  competent jurisdiction. If good cause is not shown, the agency
  673  shall impose a fine of $2,500 in addition to any other penalty
  674  assessed against the facility.
  675         Section 14. Section 429.34, Florida Statutes, is amended to
  676  read:
  677         429.34 Right of entry and inspection.—
  678         (1) In addition to the requirements of s. 408.811, any duly
  679  designated officer or employee of the department, the Department
  680  of Children and Families, the Medicaid Fraud Control Unit of the
  681  Office of the Attorney General, the state or local fire marshal,
  682  or a member of the state or local long-term care ombudsman
  683  council has shall have the right to enter unannounced upon and
  684  into the premises of any facility licensed pursuant to this part
  685  in order to determine the state of compliance with the
  686  provisions of this part, part II of chapter 408, and applicable
  687  rules. Data collected by the state or local long-term care
  688  ombudsman councils or the state or local advocacy councils may
  689  be used by the agency in investigations involving violations of
  690  regulatory standards. A person specified in this section who
  691  knows or has reasonable cause to suspect that a vulnerable adult
  692  has been or is being abused, neglected, or exploited shall
  693  immediately report such knowledge or suspicion to the central
  694  abuse hotline pursuant to chapter 415.
  695         (2) The agency shall inspect each licensed assisted living
  696  facility at least once every 24 months to determine compliance
  697  with this chapter and related rules. If an assisted living
  698  facility is cited for one or more class I violations or two or
  699  more class II violations arising from separate surveys within a
  700  60-day period or due to unrelated circumstances during the same
  701  survey, the agency must conduct an additional licensure
  702  inspection within 6 months.
  703         Section 15. Subsection (2) of section 429.41, Florida
  704  Statutes, is amended to read:
  705         429.41 Rules establishing standards.—
  706         (2) In adopting any rules pursuant to this part, the
  707  department, in conjunction with the agency, shall make distinct
  708  standards for facilities based upon facility size; the types of
  709  care provided; the physical and mental capabilities and needs of
  710  residents; the type, frequency, and amount of services and care
  711  offered; and the staffing characteristics of the facility. Rules
  712  developed pursuant to this section may shall not restrict the
  713  use of shared staffing and shared programming in facilities that
  714  are part of retirement communities that provide multiple levels
  715  of care and otherwise meet the requirements of law and rule. If
  716  a continuing care facility licensed under chapter 651 or a
  717  retirement community offering multiple levels of care obtains a
  718  license pursuant to this chapter for a building or part of a
  719  building designated for independent living, staffing
  720  requirements established in rule apply only to residents who
  721  receive personal services, limited nursing services, or extended
  722  congregate care services under this part. Such facilities shall
  723  retain a log listing the names and unit number for residents
  724  receiving these services. The log must be available to surveyors
  725  upon request. Except for uniform firesafety standards, the
  726  department shall adopt by rule separate and distinct standards
  727  for facilities with 16 or fewer beds and for facilities with 17
  728  or more beds. The standards for facilities with 16 or fewer beds
  729  must shall be appropriate for a noninstitutional residential
  730  environment; however, provided that the structure may not be is
  731  no more than two stories in height and all persons who cannot
  732  exit the facility unassisted in an emergency must reside on the
  733  first floor. The department, in conjunction with the agency, may
  734  make other distinctions among types of facilities as necessary
  735  to enforce the provisions of this part. Where appropriate, the
  736  agency shall offer alternate solutions for complying with
  737  established standards, based on distinctions made by the
  738  department and the agency relative to the physical
  739  characteristics of facilities and the types of care offered
  740  therein.
  741         Section 16. Present subsections (1) through (11) of section
  742  429.52, Florida Statutes, are redesignated as subsections (2)
  743  through (12), respectively, a new subsection (1) is added to
  744  that section, and present subsections (5) and (9) of that
  745  section are amended, to read:
  746         429.52 Staff training and educational programs; core
  747  educational requirement.—
  748         (1) Effective October 1, 2015, each new assisted living
  749  facility employee who has not previously completed core training
  750  must attend a preservice orientation provided by the facility
  751  before interacting with residents. The preservice orientation
  752  must be at least 2 hours in duration and cover topics that help
  753  the employee provide responsible care and respond to the needs
  754  of facility residents. Upon completion, the employee and the
  755  administrator of the facility must sign a statement that the
  756  employee completed the required preservice orientation. The
  757  facility must keep the signed statement in the employee’s
  758  personnel record.
  759         (6)(5) Staff involved with the management of medications
  760  and assisting with the self-administration of medications under
  761  s. 429.256 must complete a minimum of 6 4 additional hours of
  762  training provided by a registered nurse, licensed pharmacist, or
  763  department staff. The department shall establish by rule the
  764  minimum requirements of this additional training.
  765         (10)(9) The training required by this section other than
  766  the preservice orientation must shall be conducted by persons
  767  registered with the department as having the requisite
  768  experience and credentials to conduct the training. A person
  769  seeking to register as a trainer must provide the department
  770  with proof of completion of the minimum core training education
  771  requirements, successful passage of the competency test
  772  established under this section, and proof of compliance with the
  773  continuing education requirement in subsection (5)(4).
  774         Section 17. Section 429.55, Florida Statutes, is created to
  775  read:
  776         429.55Consumer information website.—The Legislature finds
  777  that consumers need additional information on the quality of
  778  care and service in assisted living facilities in order to
  779  select the best facility for themselves or their loved ones.
  780  Therefore, the Agency for Health Care Administration shall
  781  create content that is easily accessible through the home page
  782  of the agency’s website either directly or indirectly through
  783  links to one or more other established websites of the agency’s
  784  choosing. The website must be searchable by facility name,
  785  license type, city, or zip code. By November 1, 2015, the agency
  786  shall include all content in its possession on the website and
  787  add content when received from facilities. At a minimum, the
  788  content must include:
  789         (1)Information on each licensed assisted living facility,
  790  including, but not limited to:
  791         (a)The name and address of the facility.
  792         (b)The name of the owner or operator of the facility.
  793         (c)The number and type of licensed beds in the facility.
  794         (d)The types of licenses held by the facility.
  795         (e)The facility’s license expiration date and status.
  796         (f)The total number of clients that the facility is
  797  licensed to serve and the most recently available occupancy
  798  levels.
  799         (g)The number of private and semiprivate rooms offered.
  800         (h)The bed-hold policy.
  801         (i)The religious affiliation, if any, of the assisted
  802  living facility.
  803         (j)The languages spoken by the staff.
  804         (k)Availability of nurses.
  805         (l)Forms of payment accepted, including, but not limited
  806  to, Medicaid, Medicaid long-term managed care, private
  807  insurance, health maintenance organization, United States
  808  Department of Veterans Affairs, CHAMPUS program, or workers’
  809  compensation coverage.
  810         (m)Indication if the licensee is operating under
  811  bankruptcy protection.
  812         (n)Recreational and other programs available.
  813         (o)Special care units or programs offered.
  814         (p)Whether the facility is a part of a retirement
  815  community that offers other services pursuant to this part or
  816  part III of this chapter, part II or part III of chapter 400, or
  817  chapter 651.
  818         (q)Links to the State Long-Term Care Ombudsman Program
  819  website and the program’s statewide toll-free telephone number.
  820         (r)Links to the websites of the providers.
  821         (s)Other relevant information that the agency currently
  822  collects.
  823         (2)Survey and violation information for the facility,
  824  including a list of the facility’s violations committed during
  825  the previous 60 months, which on July 1, 2015, may include
  826  violations committed on or after July 1, 2010. The list shall be
  827  updated monthly and include for each violation:
  828         (a)A summary of the violation, including all licensure,
  829  revisit, and complaint survey information, presented in a manner
  830  understandable by the general public.
  831         (b)Any sanctions imposed by final order.
  832         (c)The date the corrective action was confirmed by the
  833  agency.
  834         (3)Links to inspection reports that the agency has on
  835  file.
  836         (4)The agency may adopt rules to administer this section.
  837         Section 18. This act shall take effect July 1, 2015.
  838  
  839  ================= T I T L E  A M E N D M E N T ================
  840  And the title is amended as follows:
  841         Delete everything before the enacting clause
  842  and insert:
  843                        A bill to be entitled                      
  844         An act relating to assisted living facilities;
  845         amending s. 394.4574, F.S.; providing that Medicaid
  846         managed care plans are responsible for enrolled mental
  847         health residents; providing that managing entities
  848         under contract with the Department of Children and
  849         Families are responsible for mental health residents
  850         who are not enrolled with a Medicaid managed care
  851         plan; requiring that a community living support plan
  852         be completed and provided to the administrator of a
  853         facility within a specified period after the
  854         resident’s admission; restricting the agency from
  855         imposing a fine if the facility has requested the
  856         community living support plan; requiring that the
  857         community living support plan be updated when there is
  858         a significant change to the mental health resident’s
  859         behavioral health; requiring a mental health resident
  860         case manager to keep certain records of interactions
  861         with the resident and to make the records available
  862         for inspection; requiring retention of the records for
  863         a specified period; requiring the responsible entity
  864         to ensure monitoring and implementation of community
  865         living support plans and cooperative agreements;
  866         amending s. 400.0074, F.S.; requiring a local
  867         ombudsman council to conduct comprehensive onsite
  868         administrative assessments; requiring a local council
  869         to conduct an exit consultation with the facility
  870         administrator or administrator designee; amending s.
  871         400.0078, F.S.; requiring that a long-term care
  872         resident or resident representative be informed of
  873         resident immunity from retaliatory action for
  874         presenting grievances or exercising resident rights;
  875         amending s. 409.212, F.S.; increasing the cap on
  876         additional supplementation that a person may receive
  877         under certain conditions; amending s. 429.02, F.S.;
  878         revising the definition of the term “limited nursing
  879         services”; amending s. 429.07, F.S.; requiring that an
  880         extended congregate care license be issued to certain
  881         facilities licensed as assisted living facilities
  882         under certain circumstances and authorizing the
  883         issuance of such license if a specified condition is
  884         met; providing that the initial extended congregate
  885         care license is provisional under certain
  886         circumstances; requiring a licensee to notify the
  887         agency of acceptance of a resident who qualifies for
  888         extended congregate care services; requiring the
  889         agency to inspect the facility for compliance with
  890         license requirements; requiring the licensee to
  891         suspend extended congregate care services under
  892         certain circumstances; revising the frequency of
  893         monitoring visits to a facility by a registered nurse
  894         representing the agency; authorizing the agency to
  895         waive a required yearly monitoring visit under certain
  896         circumstances; authorizing the agency to deny or
  897         revoke a facility’s extended congregate care license;
  898         authorizing the agency to waive the required yearly
  899         monitoring visit for a facility that is licensed to
  900         provide limited nursing services under certain
  901         circumstances; amending s. 429.075, F.S.; requiring an
  902         assisted living facility that serves mental health
  903         residents to obtain a limited mental health license;
  904         requiring a limited mental health facility to provide
  905         written evidence that certain documentation was sent
  906         to the department within a specified period; amending
  907         s. 429.14, F.S.; requiring the agency to deny or
  908         revoke the license of an assisted living facility
  909         under certain circumstances; requiring the agency to
  910         impose an immediate moratorium on the license of an
  911         assisted living facility under certain circumstances;
  912         deleting a requirement that the agency provide a list
  913         of facilities with denied, suspended, or revoked
  914         licenses to the Department of Business and
  915         Professional Regulation; exempting a facility from the
  916         45-day notice requirement if it is required to
  917         relocate residents; amending s. 429.178, F.S.;
  918         conforming cross-references; amending s. 429.19, F.S.;
  919         requiring the agency to levy a fine for violations
  920         that are corrected before an inspection if
  921         noncompliance occurred within a specified period of
  922         time; requiring the agency to double fine amounts
  923         under certain circumstances; amending s. 429.256,
  924         F.S.; revising the term “assistance with self
  925         administration of medication” as it relates to the
  926         Assisted Living Facilities Act; amending s. 429.27,
  927         F.S.; revising the amount of cash for which a facility
  928         may provide safekeeping for a resident; amending s.
  929         429.28, F.S.; providing notice requirements regarding
  930         confidentiality of resident identity in a complaint
  931         made to the State Long-Term Care Ombudsman Program or
  932         a local long-term care ombudsman council and immunity
  933         from retaliatory action for presenting grievances or
  934         exercising resident rights; requiring the agency to
  935         adopt rules; providing a fine if a facility terminates
  936         an individual’s residency after the filing of a
  937         complaint if good cause is not shown for the
  938         termination; amending s. 429.34, F.S.; requiring
  939         certain persons to report elder abuse in assisted
  940         living facilities; requiring the agency to regularly
  941         inspect a licensed assisted living facility; requiring
  942         the agency to conduct periodic inspections; amending
  943         s. 429.41, F.S.; providing that certain staffing
  944         requirements apply only to residents in continuing
  945         care facilities who are receiving certain services;
  946         amending s. 429.52, F.S.; requiring each newly hired
  947         employee of an assisted living facility to attend a
  948         preservice orientation; requiring the employee and
  949         administrator to sign a statement of completion and
  950         keep the statement in the employee’s personnel record;
  951         requiring additional hours of training for assistance
  952         with medication; creating s. 429.55, F.S.; directing
  953         the agency to create an assisted living facility
  954         consumer information website; providing criteria for
  955         webpage content; providing content requirements;
  956         authorizing the agency to adopt rules; providing an
  957         effective date.