Florida Senate - 2015                       CS for CS for SB 382
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senators Sobel and Gaetz
       
       
       
       
       576-04239-15                                           2015382c2
    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         managed care plans are responsible for enrolled mental
    5         health residents; providing that managing entities
    6         under contract with the Department of Children and
    7         Families are responsible for mental health residents
    8         who are not enrolled with a Medicaid managed care
    9         plan; requiring that a community living support plan
   10         be completed and provided to the administrator of a
   11         facility within a specified period after the
   12         resident’s admission; restricting the agency from
   13         imposing a fine if the facility has requested the
   14         community living support plan; requiring that the
   15         community living support plan be updated when there is
   16         a significant change to the mental health resident’s
   17         behavioral health; requiring a mental health resident
   18         case manager to keep certain records of interactions
   19         with the resident and to make the records available
   20         for inspection; requiring retention of the records for
   21         a specified period; requiring the responsible entity
   22         to ensure monitoring and implementation of community
   23         living support plans and cooperative agreements;
   24         amending s. 400.0074, F.S.; requiring a local
   25         ombudsman council to conduct comprehensive onsite
   26         administrative assessments; requiring a local council
   27         to conduct an exit consultation with the facility
   28         administrator or administrator designee; amending s.
   29         400.0078, F.S.; requiring that a long-term care
   30         resident or resident representative be informed of
   31         resident immunity from retaliatory action for
   32         presenting grievances or exercising resident rights;
   33         amending s. 409.212, F.S.; increasing the cap on
   34         additional supplementation that a person may receive
   35         under certain conditions; amending s. 429.02, F.S.;
   36         revising the definition of the term “limited nursing
   37         services”; amending s. 429.07, F.S.; requiring that an
   38         extended congregate care license be issued to certain
   39         facilities licensed as assisted living facilities
   40         under certain circumstances and authorizing the
   41         issuance of such a license if a specified condition is
   42         met; providing that the initial extended congregate
   43         care license is provisional under certain
   44         circumstances; requiring a licensee to notify the
   45         agency of acceptance of a resident who qualifies for
   46         extended congregate care services; requiring the
   47         agency to inspect the facility for compliance with
   48         license requirements; requiring the licensee to
   49         suspend extended congregate care services under
   50         certain circumstances; revising the frequency of
   51         monitoring visits to a facility by a registered nurse
   52         representing the agency; authorizing the agency to
   53         waive a required yearly monitoring visit under certain
   54         circumstances; authorizing the agency to deny or
   55         revoke a facility’s extended congregate care license;
   56         authorizing the agency to waive the required yearly
   57         monitoring visit for a facility that is licensed to
   58         provide limited nursing services under certain
   59         circumstances; amending s. 429.075, F.S.; requiring an
   60         assisted living facility that serves mental health
   61         residents to obtain a limited mental health license;
   62         requiring a limited mental health facility to provide
   63         written evidence that certain documentation was sent
   64         to the department within a specified period; amending
   65         s. 429.14, F.S.; requiring the agency to deny or
   66         revoke the license of an assisted living facility
   67         under certain circumstances; requiring the agency to
   68         impose an immediate moratorium on the license of an
   69         assisted living facility under certain circumstances;
   70         deleting a requirement that the agency provide a list
   71         of facilities with denied, suspended, or revoked
   72         licenses to the Department of Business and
   73         Professional Regulation; exempting a facility from the
   74         45-day notice requirement if it is required to
   75         relocate residents; amending s. 429.178, F.S.;
   76         conforming cross-references; amending s. 429.19, F.S.;
   77         requiring the agency to levy a fine for violations
   78         that are corrected before an inspection if
   79         noncompliance occurred within a specified period of
   80         time; requiring the agency to double fine amounts
   81         under certain circumstances; amending s. 429.256,
   82         F.S.; revising the term “assistance with self
   83         administration of medication” as it relates to the
   84         Assisted Living Facilities Act; amending s. 429.27,
   85         F.S.; revising the amount of cash for which a facility
   86         may provide safekeeping for a resident; amending s.
   87         429.28, F.S.; providing notice requirements regarding
   88         confidentiality of resident identity in a complaint
   89         made to the State Long-Term Care Ombudsman Program or
   90         a local long-term care ombudsman council and immunity
   91         from retaliatory action for presenting grievances or
   92         exercising resident rights; requiring the agency to
   93         adopt rules; providing a fine if a facility terminates
   94         an individual’s residency after the filing of a
   95         complaint if good cause is not shown for the
   96         termination; amending s. 429.34, F.S.; requiring
   97         certain persons to report elder abuse in assisted
   98         living facilities; requiring the agency to regularly
   99         inspect a licensed assisted living facility; requiring
  100         the agency to conduct periodic inspections; amending
  101         s. 429.41, F.S.; providing that certain staffing
  102         requirements apply only to residents in continuing
  103         care facilities who are receiving certain services;
  104         amending s. 429.52, F.S.; requiring each newly hired
  105         employee of an assisted living facility to attend a
  106         preservice orientation; requiring the employee and
  107         administrator to sign a statement of completion and
  108         keep the statement in the employee’s personnel record;
  109         requiring additional hours of training for assistance
  110         with medication; creating s. 429.55, F.S.; directing
  111         the agency to create an assisted living facility
  112         consumer information website; providing criteria for
  113         webpage content; providing content requirements;
  114         authorizing the agency to adopt rules; providing an
  115         effective date.
  116          
  117  Be It Enacted by the Legislature of the State of Florida:
  118  
  119         Section 1. Section 394.4574, Florida Statutes, is amended
  120  to read:
  121         394.4574 Department Responsibilities for coordination of
  122  services for a mental health resident who resides in an assisted
  123  living facility that holds a limited mental health license.—
  124         (1) As used in this section, the term “mental health
  125  resident,for purposes of this section, means an individual who
  126  receives social security disability income due to a mental
  127  disorder as determined by the Social Security Administration or
  128  receives supplemental security income due to a mental disorder
  129  as determined by the Social Security Administration and receives
  130  optional state supplementation.
  131         (2) Medicaid managed care plans are responsible for
  132  Medicaid-enrolled mental health residents, and managing entities
  133  under contract with the department are responsible for mental
  134  health residents who are not enrolled in a Medicaid health plan.
  135  A Medicaid managed care plan or a managing entity shall The
  136  department must ensure that:
  137         (a) A mental health resident has been assessed by a
  138  psychiatrist, clinical psychologist, clinical social worker, or
  139  psychiatric nurse, or an individual who is supervised by one of
  140  these professionals, and determined to be appropriate to reside
  141  in an assisted living facility. The documentation must be
  142  provided to the administrator of the facility within 30 days
  143  after the mental health resident has been admitted to the
  144  facility. An evaluation completed upon discharge from a state
  145  mental hospital meets the requirements of this subsection
  146  related to appropriateness for placement as a mental health
  147  resident if it was completed within 90 days before prior to
  148  admission to the facility.
  149         (b) A cooperative agreement, as required in s. 429.075, is
  150  developed by between the mental health care services provider
  151  that serves a mental health resident and the administrator of
  152  the assisted living facility with a limited mental health
  153  license in which the mental health resident is living. Any
  154  entity that provides Medicaid prepaid health plan services shall
  155  ensure the appropriate coordination of health care services with
  156  an assisted living facility in cases where a Medicaid recipient
  157  is both a member of the entity’s prepaid health plan and a
  158  resident of the assisted living facility. If the entity is at
  159  risk for Medicaid targeted case management and behavioral health
  160  services, the entity shall inform the assisted living facility
  161  of the procedures to follow should an emergent condition arise.
  162         (c) The community living support plan, as defined in s.
  163  429.02, has been prepared by a mental health resident and his or
  164  her a mental health case manager of that resident in
  165  consultation with the administrator of the facility or the
  166  administrator’s designee. The plan must be completed and
  167  provided to the administrator of the assisted living facility
  168  with a limited mental health license in which the mental health
  169  resident lives upon the resident’s admission. The support plan
  170  and the agreement may be in one document. The agency may not
  171  cite an assisted living facility for not possessing a resident’s
  172  community living support plan if the facility can document that
  173  it has requested the plan for that resident.
  174         (d) The assisted living facility with a limited mental
  175  health license is provided with documentation that the
  176  individual meets the definition of a mental health resident.
  177         (e) The mental health services provider assigns a case
  178  manager to each mental health resident for whom the entity is
  179  responsible who lives in an assisted living facility with a
  180  limited mental health license. The case manager shall coordinate
  181  is responsible for coordinating the development of and
  182  implementation of the community living support plan defined in
  183  s. 429.02. The plan must be updated at least annually, or when
  184  there is a significant change in the resident’s behavioral
  185  health status, such as an inpatient admission or a change in
  186  medication, level of service, or residence. Each case manager
  187  shall keep a record of the date and time of any face-to-face
  188  interaction with the resident and make the record available to
  189  the responsible entity for inspection. The record must be
  190  retained for at least 2 years after the date of the most recent
  191  interaction.
  192         (f)Adequate and consistent monitoring and enforcement of
  193  community living support plans and cooperative agreements are
  194  conducted by the resident’s case manager.
  195         (g) Concerns are reported to the appropriate regulatory
  196  oversight organization if a regulated provider fails to deliver
  197  appropriate services or otherwise acts in a manner that has the
  198  potential to result in harm to the resident.
  199         (3) The Secretary of Children and Families, in consultation
  200  with the Agency for Health Care Administration, shall annually
  201  require each district administrator to develop, with community
  202  input, a detailed annual plan that demonstrates detailed plans
  203  that demonstrate how the district will ensure the provision of
  204  state-funded mental health and substance abuse treatment
  205  services to residents of assisted living facilities that hold a
  206  limited mental health license. This plan These plans must be
  207  consistent with the substance abuse and mental health district
  208  plan developed pursuant to s. 394.75 and must address case
  209  management services; access to consumer-operated drop-in
  210  centers; access to services during evenings, weekends, and
  211  holidays; supervision of the clinical needs of the residents;
  212  and access to emergency psychiatric care.
  213         Section 2. Subsection (1) of section 400.0074, Florida
  214  Statutes, is amended, and paragraph (h) is added to subsection
  215  (2) of that section, to read:
  216         400.0074 Local ombudsman council onsite administrative
  217  assessments.—
  218         (1) In addition to any specific investigation conducted
  219  pursuant to a complaint, the local council shall conduct, at
  220  least annually, an onsite administrative assessment of each
  221  nursing home, assisted living facility, and adult family-care
  222  home within its jurisdiction. This administrative assessment
  223  must be comprehensive in nature and must shall focus on factors
  224  affecting residents’ the rights, health, safety, and welfare of
  225  the residents. Each local council is encouraged to conduct a
  226  similar onsite administrative assessment of each additional
  227  long-term care facility within its jurisdiction.
  228         (2) An onsite administrative assessment conducted by a
  229  local council shall be subject to the following conditions:
  230         (h) Upon completion of an administrative assessment, the
  231  local council shall conduct an exit consultation with the
  232  facility administrator or administrator’s designee to discuss
  233  issues and concerns in areas affecting residents’ rights,
  234  health, safety, and welfare and, if needed, make recommendations
  235  for improvement.
  236         Section 3. Subsection (2) of section 400.0078, Florida
  237  Statutes, is amended to read:
  238         400.0078 Citizen access to State Long-Term Care Ombudsman
  239  Program services.—
  240         (2) Every resident or representative of a resident shall
  241  receive, Upon admission to a long-term care facility, each
  242  resident or representative of a resident must receive
  243  information regarding the purpose of the State Long-Term Care
  244  Ombudsman Program, the statewide toll-free telephone number for
  245  receiving complaints, information that retaliatory action cannot
  246  be taken against a resident for presenting grievances or for
  247  exercising any other resident right, and other relevant
  248  information regarding how to contact the program. Each resident
  249  or his or her representative Residents or their representatives
  250  must be furnished additional copies of this information upon
  251  request.
  252         Section 4. Paragraph (c) of subsection (4) of section
  253  409.212, Florida Statutes, is amended to read:
  254         409.212 Optional supplementation.—
  255         (4) In addition to the amount of optional supplementation
  256  provided by the state, a person may receive additional
  257  supplementation from third parties to contribute to his or her
  258  cost of care. Additional supplementation may be provided under
  259  the following conditions:
  260         (c) The additional supplementation shall not exceed four
  261  two times the provider rate recognized under the optional state
  262  supplementation program.
  263         Section 5. Subsection (13) of section 429.02, Florida
  264  Statutes, is amended to read:
  265         429.02 Definitions.—When used in this part, the term:
  266         (13) “Limited nursing services” means acts that may be
  267  performed by a person licensed under pursuant to part I of
  268  chapter 464 by persons licensed thereunder while carrying out
  269  their professional duties but limited to those acts which the
  270  department specifies by rule. Acts which may be specified by
  271  rule as allowable Limited nursing services shall be for persons
  272  who meet the admission criteria established by the department
  273  for assisted living facilities and shall not be complex enough
  274  to require 24-hour nursing supervision and may include such
  275  services as the application and care of routine dressings, and
  276  care of casts, braces, and splints.
  277         Section 6. Paragraphs (b) and (c) of subsection (3) of
  278  section 429.07, Florida Statutes, are amended to read:
  279         429.07 License required; fee.—
  280         (3) In addition to the requirements of s. 408.806, each
  281  license granted by the agency must state the type of care for
  282  which the license is granted. Licenses shall be issued for one
  283  or more of the following categories of care: standard, extended
  284  congregate care, limited nursing services, or limited mental
  285  health.
  286         (b) An extended congregate care license shall be issued to
  287  each facility that has been licensed as an assisted living
  288  facility for 2 or more years and that provides services
  289  facilities providing, directly or through contract, services
  290  beyond those authorized in paragraph (a), including services
  291  performed by persons licensed under part I of chapter 464 and
  292  supportive services, as defined by rule, to persons who would
  293  otherwise be disqualified from continued residence in a facility
  294  licensed under this part. An extended congregate care license
  295  may be issued to a facility that has a provisional extended
  296  congregate care license and meets the requirements for licensure
  297  under subparagraph 2. The primary purpose of extended congregate
  298  care services is to allow residents the option of remaining in a
  299  familiar setting from which they would otherwise be disqualified
  300  for continued residency as they become more impaired. A facility
  301  licensed to provide extended congregate care services may also
  302  admit an individual who exceeds the admission criteria for a
  303  facility with a standard license if the individual is determined
  304  appropriate for admission to the extended congregate care
  305  facility.
  306         1. In order for extended congregate care services to be
  307  provided, the agency must first determine that all requirements
  308  established in law and rule are met and must specifically
  309  designate, on the facility’s license, that such services may be
  310  provided and whether the designation applies to all or part of
  311  the facility. This Such designation may be made at the time of
  312  initial licensure or licensure renewal relicensure, or upon
  313  request in writing by a licensee under this part and part II of
  314  chapter 408. The notification of approval or the denial of the
  315  request shall be made in accordance with part II of chapter 408.
  316  Each existing facility that qualifies facilities qualifying to
  317  provide extended congregate care services must have maintained a
  318  standard license and may not have been subject to administrative
  319  sanctions during the previous 2 years, or since initial
  320  licensure if the facility has been licensed for less than 2
  321  years, for any of the following reasons:
  322         a. A class I or class II violation;
  323         b. Three or more repeat or recurring class III violations
  324  of identical or similar resident care standards from which a
  325  pattern of noncompliance is found by the agency;
  326         c. Three or more class III violations that were not
  327  corrected in accordance with the corrective action plan approved
  328  by the agency;
  329         d. Violation of resident care standards which results in
  330  requiring the facility to employ the services of a consultant
  331  pharmacist or consultant dietitian;
  332         e. Denial, suspension, or revocation of a license for
  333  another facility licensed under this part in which the applicant
  334  for an extended congregate care license has at least 25 percent
  335  ownership interest; or
  336         f. Imposition of a moratorium pursuant to this part or part
  337  II of chapter 408 or initiation of injunctive proceedings.
  338  
  339  The agency may deny or revoke a facility’s extended congregate
  340  care license if it fails to meet the criteria for an extended
  341  congregate care license as provided in this subparagraph.
  342         2.If an assisted living facility has been licensed for
  343  less than 2 years, the initial extended congregate care license
  344  must be provisional and may not exceed 6 months. The licensee
  345  shall notify the agency, in writing, when it admits at least one
  346  extended congregate care resident, after which an unannounced
  347  inspection shall be made to determine compliance with
  348  requirements of an extended congregate care license. A licensee
  349  that has a provisional extended congregate care license which
  350  demonstrates compliance with all of the requirements of an
  351  extended congregate care license during the inspection shall be
  352  issued an extended congregate care license. In addition to
  353  sanctions authorized under this part, if violations are found
  354  during the inspection and the licensee fails to demonstrate
  355  compliance with all assisted living requirements during a
  356  followup inspection, the licensee shall immediately suspend
  357  extended congregate care services, and the provisional extended
  358  congregate care license expires. The agency may extend the
  359  provisional license for not more than 1 month in order to
  360  complete a followup visit.
  361         3.2. A facility that is licensed to provide extended
  362  congregate care services shall maintain a written progress
  363  report on each person who receives services which describes the
  364  type, amount, duration, scope, and outcome of services that are
  365  rendered and the general status of the resident’s health. A
  366  registered nurse, or appropriate designee, representing the
  367  agency shall visit the facility at least twice a year quarterly
  368  to monitor residents who are receiving extended congregate care
  369  services and to determine if the facility is in compliance with
  370  this part, part II of chapter 408, and relevant rules. One of
  371  the visits may be in conjunction with the regular survey. The
  372  monitoring visits may be provided through contractual
  373  arrangements with appropriate community agencies. A registered
  374  nurse shall serve as part of the team that inspects the
  375  facility. The agency may waive one of the required yearly
  376  monitoring visits for a facility that has:
  377         a. Held an extended congregate care license for at least 24
  378  months; been licensed for at least 24 months to provide extended
  379  congregate care services, if, during the inspection, the
  380  registered nurse determines that extended congregate care
  381  services are being provided appropriately, and if the facility
  382  has
  383         b. No class I or class II violations and no uncorrected
  384  class III violations; and.
  385         c. No ombudsman council complaints that resulted in a
  386  citation for licensure The agency must first consult with the
  387  long-term care ombudsman council for the area in which the
  388  facility is located to determine if any complaints have been
  389  made and substantiated about the quality of services or care.
  390  The agency may not waive one of the required yearly monitoring
  391  visits if complaints have been made and substantiated.
  392         4.3. A facility that is licensed to provide extended
  393  congregate care services must:
  394         a. Demonstrate the capability to meet unanticipated
  395  resident service needs.
  396         b. Offer a physical environment that promotes a homelike
  397  setting, provides for resident privacy, promotes resident
  398  independence, and allows sufficient congregate space as defined
  399  by rule.
  400         c. Have sufficient staff available, taking into account the
  401  physical plant and firesafety features of the building, to
  402  assist with the evacuation of residents in an emergency.
  403         d. Adopt and follow policies and procedures that maximize
  404  resident independence, dignity, choice, and decisionmaking to
  405  permit residents to age in place, so that moves due to changes
  406  in functional status are minimized or avoided.
  407         e. Allow residents or, if applicable, a resident’s
  408  representative, designee, surrogate, guardian, or attorney in
  409  fact to make a variety of personal choices, participate in
  410  developing service plans, and share responsibility in
  411  decisionmaking.
  412         f. Implement the concept of managed risk.
  413         g. Provide, directly or through contract, the services of a
  414  person licensed under part I of chapter 464.
  415         h. In addition to the training mandated in s. 429.52,
  416  provide specialized training as defined by rule for facility
  417  staff.
  418         5.4. A facility that is licensed to provide extended
  419  congregate care services is exempt from the criteria for
  420  continued residency set forth in rules adopted under s. 429.41.
  421  A licensed facility must adopt its own requirements within
  422  guidelines for continued residency set forth by rule. However,
  423  the facility may not serve residents who require 24-hour nursing
  424  supervision. A licensed facility that provides extended
  425  congregate care services must also provide each resident with a
  426  written copy of facility policies governing admission and
  427  retention.
  428         5. The primary purpose of extended congregate care services
  429  is to allow residents, as they become more impaired, the option
  430  of remaining in a familiar setting from which they would
  431  otherwise be disqualified for continued residency. A facility
  432  licensed to provide extended congregate care services may also
  433  admit an individual who exceeds the admission criteria for a
  434  facility with a standard license, if the individual is
  435  determined appropriate for admission to the extended congregate
  436  care facility.
  437         6. Before the admission of an individual to a facility
  438  licensed to provide extended congregate care services, the
  439  individual must undergo a medical examination as provided in s.
  440  429.26(4) and the facility must develop a preliminary service
  441  plan for the individual.
  442         7. If When a facility can no longer provide or arrange for
  443  services in accordance with the resident’s service plan and
  444  needs and the facility’s policy, the facility must shall make
  445  arrangements for relocating the person in accordance with s.
  446  429.28(1)(k).
  447         8. Failure to provide extended congregate care services may
  448  result in denial of extended congregate care license renewal.
  449         (c) A limited nursing services license shall be issued to a
  450  facility that provides services beyond those authorized in
  451  paragraph (a) and as specified in this paragraph.
  452         1. In order for limited nursing services to be provided in
  453  a facility licensed under this part, the agency must first
  454  determine that all requirements established in law and rule are
  455  met and must specifically designate, on the facility’s license,
  456  that such services may be provided. This Such designation may be
  457  made at the time of initial licensure or licensure renewal
  458  relicensure, or upon request in writing by a licensee under this
  459  part and part II of chapter 408. Notification of approval or
  460  denial of such request shall be made in accordance with part II
  461  of chapter 408. An existing facility that qualifies facilities
  462  qualifying to provide limited nursing services must shall have
  463  maintained a standard license and may not have been subject to
  464  administrative sanctions that affect the health, safety, and
  465  welfare of residents for the previous 2 years or since initial
  466  licensure if the facility has been licensed for less than 2
  467  years.
  468         2. A facility Facilities that is are licensed to provide
  469  limited nursing services shall maintain a written progress
  470  report on each person who receives such nursing services. The,
  471  which report must describe describes the type, amount, duration,
  472  scope, and outcome of services that are rendered and the general
  473  status of the resident’s health. A registered nurse representing
  474  the agency shall visit the facility such facilities at least
  475  annually twice a year to monitor residents who are receiving
  476  limited nursing services and to determine if the facility is in
  477  compliance with applicable provisions of this part, part II of
  478  chapter 408, and related rules. The monitoring visits may be
  479  provided through contractual arrangements with appropriate
  480  community agencies. A registered nurse shall also serve as part
  481  of the team that inspects such facility. Visits may be in
  482  conjunction with other agency inspections. The agency may waive
  483  the required yearly monitoring visit for a facility that has:
  484         a. Had a limited nursing services license for at least 24
  485  months;
  486         b. No class I or class II violations and no uncorrected
  487  class III violations; and
  488         c. No ombudsman council complaints that resulted in a
  489  citation for licensure.
  490         3. A person who receives limited nursing services under
  491  this part must meet the admission criteria established by the
  492  agency for assisted living facilities. When a resident no longer
  493  meets the admission criteria for a facility licensed under this
  494  part, arrangements for relocating the person shall be made in
  495  accordance with s. 429.28(1)(k), unless the facility is licensed
  496  to provide extended congregate care services.
  497         Section 7. Section 429.075, Florida Statutes, is amended to
  498  read:
  499         429.075 Limited mental health license.—An assisted living
  500  facility that serves one three or more mental health residents
  501  must obtain a limited mental health license.
  502         (1) To obtain a limited mental health license, a facility
  503  must hold a standard license as an assisted living facility,
  504  must not have any current uncorrected deficiencies or
  505  violations, and must ensure that, within 6 months after
  506  receiving a limited mental health license, the facility
  507  administrator and the staff of the facility who are in direct
  508  contact with mental health residents must complete training of
  509  no less than 6 hours related to their duties. This Such
  510  designation may be made at the time of initial licensure or
  511  licensure renewal relicensure or upon request in writing by a
  512  licensee under this part and part II of chapter 408.
  513  Notification of approval or denial of such request shall be made
  514  in accordance with this part, part II of chapter 408, and
  515  applicable rules. This training must will be provided by or
  516  approved by the Department of Children and Families.
  517         (2) A facility that is Facilities licensed to provide
  518  services to mental health residents must shall provide
  519  appropriate supervision and staffing to provide for the health,
  520  safety, and welfare of such residents.
  521         (3) A facility that has a limited mental health license
  522  must:
  523         (a) Have a copy of each mental health resident’s community
  524  living support plan and the cooperative agreement with the
  525  mental health care services provider or provide written evidence
  526  that a request for the community living support plan and the
  527  cooperative agreement was sent to the Medicaid managed care plan
  528  or managing entity under contract with the Department of
  529  Children and Families within 72 hours after admission. The
  530  support plan and the agreement may be combined.
  531         (b) Have documentation that is provided by the Department
  532  of Children and Families that each mental health resident has
  533  been assessed and determined to be able to live in the community
  534  in an assisted living facility that has with a limited mental
  535  health license or provide written evidence that a request for
  536  documentation was sent to the department within 72 hours after
  537  admission.
  538         (c) Make the community living support plan available for
  539  inspection by the resident, the resident’s legal guardian or,
  540  the resident’s health care surrogate, and other individuals who
  541  have a lawful basis for reviewing this document.
  542         (d) Assist the mental health resident in carrying out the
  543  activities identified in the resident’s individual’s community
  544  living support plan.
  545         (4) A facility that has with a limited mental health
  546  license may enter into a cooperative agreement with a private
  547  mental health provider. For purposes of the limited mental
  548  health license, the private mental health provider may act as
  549  the case manager.
  550         Section 8. Section 429.14, Florida Statutes, is amended to
  551  read:
  552         429.14 Administrative penalties.—
  553         (1) In addition to the requirements of part II of chapter
  554  408, the agency may deny, revoke, and suspend any license issued
  555  under this part and impose an administrative fine in the manner
  556  provided in chapter 120 against a licensee for a violation of
  557  any provision of this part, part II of chapter 408, or
  558  applicable rules, or for any of the following actions by a
  559  licensee, for the actions of any person subject to level 2
  560  background screening under s. 408.809, or for the actions of any
  561  facility staff employee:
  562         (a) An intentional or negligent act seriously affecting the
  563  health, safety, or welfare of a resident of the facility.
  564         (b) A The determination by the agency that the owner lacks
  565  the financial ability to provide continuing adequate care to
  566  residents.
  567         (c) Misappropriation or conversion of the property of a
  568  resident of the facility.
  569         (d) Failure to follow the criteria and procedures provided
  570  under part I of chapter 394 relating to the transportation,
  571  voluntary admission, and involuntary examination of a facility
  572  resident.
  573         (e) A citation for of any of the following violations
  574  deficiencies as specified in s. 429.19:
  575         1. One or more cited class I violations deficiencies.
  576         2. Three or more cited class II violations deficiencies.
  577         3. Five or more cited class III violations deficiencies
  578  that have been cited on a single survey and have not been
  579  corrected within the times specified.
  580         (f) Failure to comply with the background screening
  581  standards of this part, s. 408.809(1), or chapter 435.
  582         (g) Violation of a moratorium.
  583         (h) Failure of the license applicant, the licensee during
  584  licensure renewal relicensure, or a licensee that holds a
  585  provisional license to meet the minimum license requirements of
  586  this part, or related rules, at the time of license application
  587  or renewal.
  588         (i) An intentional or negligent life-threatening act in
  589  violation of the uniform firesafety standards for assisted
  590  living facilities or other firesafety standards which that
  591  threatens the health, safety, or welfare of a resident of a
  592  facility, as communicated to the agency by the local authority
  593  having jurisdiction or the State Fire Marshal.
  594         (j) Knowingly operating any unlicensed facility or
  595  providing without a license any service that must be licensed
  596  under this chapter or chapter 400.
  597         (k) Any act constituting a ground upon which application
  598  for a license may be denied.
  599         (2) Upon notification by the local authority having
  600  jurisdiction or by the State Fire Marshal, the agency may deny
  601  or revoke the license of an assisted living facility that fails
  602  to correct cited fire code violations that affect or threaten
  603  the health, safety, or welfare of a resident of a facility.
  604         (3) The agency may deny or revoke a license of an to any
  605  applicant or controlling interest as defined in part II of
  606  chapter 408 which has or had a 25 percent 25-percent or greater
  607  financial or ownership interest in any other facility that is
  608  licensed under this part, or in any entity licensed by this
  609  state or another state to provide health or residential care, if
  610  that which facility or entity during the 5 years before prior to
  611  the application for a license closed due to financial inability
  612  to operate; had a receiver appointed or a license denied,
  613  suspended, or revoked; was subject to a moratorium; or had an
  614  injunctive proceeding initiated against it.
  615         (4) The agency shall deny or revoke the license of an
  616  assisted living facility if any of the following apply:
  617         (a)There are two moratoria, issued pursuant to this part
  618  or part II of chapter 408, within a 2-year period which are
  619  imposed by final order.
  620         (b)The facility is cited for two or more class I
  621  violations arising from unrelated circumstances during the same
  622  survey or investigation.
  623         (c)The facility is cited for two or more class I
  624  violations arising from separate surveys or investigations
  625  within a 2-year period that has two or more class I violations
  626  that are similar or identical to violations identified by the
  627  agency during a survey, inspection, monitoring visit, or
  628  complaint investigation occurring within the previous 2 years.
  629         (5) An action taken by the agency to suspend, deny, or
  630  revoke a facility’s license under this part or part II of
  631  chapter 408, in which the agency claims that the facility owner
  632  or an employee of the facility has threatened the health,
  633  safety, or welfare of a resident of the facility, shall be heard
  634  by the Division of Administrative Hearings of the Department of
  635  Management Services within 120 days after receipt of the
  636  facility’s request for a hearing, unless that time limitation is
  637  waived by both parties. The administrative law judge shall must
  638  render a decision within 30 days after receipt of a proposed
  639  recommended order.
  640         (6) As provided under s. 408.814, the agency shall impose
  641  an immediate moratorium on an assisted living facility that
  642  fails to provide the agency access to the facility or prohibits
  643  the agency from conducting a regulatory inspection. The licensee
  644  may not restrict agency staff in accessing and copying records
  645  or in conducting confidential interviews with facility staff or
  646  any individual who receives services from the facility. If
  647  requested by the facility, the agency must reimburse the
  648  facility for all reasonable costs related to the accessing and
  649  copying of records required under this subsection provide to the
  650  Division of Hotels and Restaurants of the Department of Business
  651  and Professional Regulation, on a monthly basis, a list of those
  652  assisted living facilities that have had their licenses denied,
  653  suspended, or revoked or that are involved in an appellate
  654  proceeding pursuant to s. 120.60 related to the denial,
  655  suspension, or revocation of a license.
  656         (7) Agency notification of a license suspension or
  657  revocation, or denial of a license renewal, shall be posted and
  658  visible to the public at the facility.
  659         (8) If a facility is required to relocate some or all of
  660  its residents due to agency action, that facility is exempt from
  661  the 45 days’ notice requirement imposed under s. 429.28(1)(k).
  662  This subsection does not exempt the facility from any deadline
  663  for corrective action set by the agency.
  664         Section 9. Paragraphs (a) and (b) of subsection (2) of
  665  section 429.178, Florida Statutes, are amended to read:
  666         429.178 Special care for persons with Alzheimer’s disease
  667  or other related disorders.—
  668         (2)(a) An individual who is employed by a facility that
  669  provides special care for residents who have with Alzheimer’s
  670  disease or other related disorders, and who has regular contact
  671  with such residents, must complete up to 4 hours of initial
  672  dementia-specific training developed or approved by the
  673  department. The training must shall be completed within 3 months
  674  after beginning employment and shall satisfy the core training
  675  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  676         (b) A direct caregiver who is employed by a facility that
  677  provides special care for residents who have with Alzheimer’s
  678  disease or other related disorders, and who provides direct care
  679  to such residents, must complete the required initial training
  680  and 4 additional hours of training developed or approved by the
  681  department. The training must shall be completed within 9 months
  682  after beginning employment and shall satisfy the core training
  683  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  684         Section 10. Paragraphs (e) and (f) are added to subsection
  685  (2) of section 429.19, Florida Statutes, to read:
  686         429.19 Violations; imposition of administrative fines;
  687  grounds.—
  688         (2) Each violation of this part and adopted rules shall be
  689  classified according to the nature of the violation and the
  690  gravity of its probable effect on facility residents. The agency
  691  shall indicate the classification on the written notice of the
  692  violation as follows:
  693         (e) Any fine imposed by the agency for a cited class I or
  694  class II violation must be doubled if the agency finds that such
  695  violation has not been corrected within six months of the
  696  citation being issued.
  697         (f)Regardless of the class of violation cited, instead of
  698  the fine amounts listed in paragraphs (a)-(d), the agency shall
  699  impose an administrative fine of $500 if a facility is found not
  700  to be in compliance with the background screening requirements
  701  as provided in s. 408.809.
  702         Section 11. Subsection (3) and paragraph (c) of subsection
  703  (4) of section 429.256, Florida Statutes, are amended to read:
  704         429.256 Assistance with self-administration of medication.—
  705         (3) Assistance with self-administration of medication
  706  includes:
  707         (a) Taking the medication, in its previously dispensed,
  708  properly labeled container, including an insulin syringe that is
  709  prefilled with the proper dosage by a pharmacist and an insulin
  710  pen that is prefilled by the manufacturer, from where it is
  711  stored, and bringing it to the resident.
  712         (b) In the presence of the resident, reading the label,
  713  opening the container, removing a prescribed amount of
  714  medication from the container, and closing the container.
  715         (c) Placing an oral dosage in the resident’s hand or
  716  placing the dosage in another container and helping the resident
  717  by lifting the container to his or her mouth.
  718         (d) Applying topical medications.
  719         (e) Returning the medication container to proper storage.
  720         (f) Keeping a record of when a resident receives assistance
  721  with self-administration under this section.
  722         (g) Assisting with the use of a nebulizer, including
  723  removing the cap of a nebulizer, opening the unit dose of
  724  nebulizer solution, and pouring the prescribed premeasured dose
  725  of medication into the dispensing cup of the nebulizer.
  726         (h) Using a glucometer to perform blood-glucose level
  727  checks.
  728         (i) Assisting with putting on and taking off antiembolism
  729  stockings.
  730         (j) Assisting with applying and removing an oxygen cannula,
  731  but not with titrating the prescribed oxygen settings.
  732         (k) Assisting with the use of a continuous positive airway
  733  pressure (CPAP) device, but not with titrating the prescribed
  734  setting of the device.
  735         (l) Assisting with measuring vital signs.
  736         (m) Assisting with colostomy bags.
  737         (4) Assistance with self-administration does not include:
  738         (c) Administration of medications through intermittent
  739  positive pressure breathing machines or a nebulizer.
  740         Section 12. Subsection (3) of section 429.27, Florida
  741  Statutes, is amended to read:
  742         429.27 Property and personal affairs of residents.—
  743         (3) A facility, upon mutual consent with the resident,
  744  shall provide for the safekeeping in the facility of personal
  745  effects not in excess of $500 and funds of the resident not in
  746  excess of $500 $200 cash, and shall keep complete and accurate
  747  records of all such funds and personal effects received. If a
  748  resident is absent from a facility for 24 hours or more, the
  749  facility may provide for the safekeeping of the resident’s
  750  personal effects in excess of $500.
  751         Section 13. Subsections (2), (5), and (6) of section
  752  429.28, Florida Statutes, are amended to read:
  753         429.28 Resident bill of rights.—
  754         (2) The administrator of a facility shall ensure that a
  755  written notice of the rights, obligations, and prohibitions set
  756  forth in this part is posted in a prominent place in each
  757  facility and read or explained to residents who cannot read. The
  758  This notice must shall include the name, address, and telephone
  759  numbers of the local ombudsman council, the and central abuse
  760  hotline, and, if when applicable, Disability Rights Florida the
  761  Advocacy Center for Persons with Disabilities, Inc., and the
  762  Florida local advocacy council, where complaints may be lodged.
  763  The notice must state that a complaint made to the Office of
  764  State Long-Term Care Ombudsman or a local long-term care
  765  ombudsman council, the names and identities of the residents
  766  involved in the complaint, and the identity of complainants are
  767  kept confidential pursuant to s. 400.0077 and that retaliatory
  768  action cannot be taken against a resident for presenting
  769  grievances or for exercising any other resident right. The
  770  facility must ensure a resident’s access to a telephone to call
  771  the local ombudsman council, central abuse hotline, and
  772  Disability Rights Florida Advocacy Center for Persons with
  773  Disabilities, Inc., and the Florida local advocacy council.
  774         (5) A No facility or employee of a facility may not serve
  775  notice upon a resident to leave the premises or take any other
  776  retaliatory action against any person who:
  777         (a) Exercises any right set forth in this section.
  778         (b) Appears as a witness in any hearing, inside or outside
  779  the facility.
  780         (c) Files a civil action alleging a violation of the
  781  provisions of this part or notifies a state attorney or the
  782  Attorney General of a possible violation of such provisions.
  783         (6) A Any facility that which terminates the residency of
  784  an individual who participated in activities specified in
  785  subsection (5) must shall show good cause in a court of
  786  competent jurisdiction. If good cause is not shown, the agency
  787  shall impose a fine of $2,500 in addition to any other penalty
  788  assessed against the facility.
  789         Section 14. Section 429.34, Florida Statutes, is amended to
  790  read:
  791         429.34 Right of entry and inspection.—
  792         (1) In addition to the requirements of s. 408.811, any duly
  793  designated officer or employee of the department, the Department
  794  of Children and Families, the Medicaid Fraud Control Unit of the
  795  Office of the Attorney General, the state or local fire marshal,
  796  or a member of the state or local long-term care ombudsman
  797  council has shall have the right to enter unannounced upon and
  798  into the premises of any facility licensed pursuant to this part
  799  in order to determine the state of compliance with the
  800  provisions of this part, part II of chapter 408, and applicable
  801  rules. Data collected by the state or local long-term care
  802  ombudsman councils or the state or local advocacy councils may
  803  be used by the agency in investigations involving violations of
  804  regulatory standards. A person specified in this section who
  805  knows or has reasonable cause to suspect that a vulnerable adult
  806  has been or is being abused, neglected, or exploited shall
  807  immediately report such knowledge or suspicion to the central
  808  abuse hotline pursuant to chapter 415.
  809         (2) The agency shall inspect each licensed assisted living
  810  facility at least once every 24 months to determine compliance
  811  with this chapter and related rules. If an assisted living
  812  facility is cited for one or more class I violations or two or
  813  more class II violations arising from separate surveys within a
  814  60-day period or due to unrelated circumstances during the same
  815  survey, the agency must conduct an additional licensure
  816  inspection within 6 months.
  817         Section 15. Subsection (2) of section 429.41, Florida
  818  Statutes, is amended to read:
  819         429.41 Rules establishing standards.—
  820         (2) In adopting any rules pursuant to this part, the
  821  department, in conjunction with the agency, shall make distinct
  822  standards for facilities based upon facility size; the types of
  823  care provided; the physical and mental capabilities and needs of
  824  residents; the type, frequency, and amount of services and care
  825  offered; and the staffing characteristics of the facility. Rules
  826  developed pursuant to this section may shall not restrict the
  827  use of shared staffing and shared programming in facilities that
  828  are part of retirement communities that provide multiple levels
  829  of care and otherwise meet the requirements of law and rule. If
  830  a continuing care facility licensed under chapter 651 or a
  831  retirement community offering multiple levels of care obtains a
  832  license pursuant to this chapter for a building or part of a
  833  building designated for independent living, staffing
  834  requirements established in rule apply only to residents who
  835  receive personal services, limited nursing services, or extended
  836  congregate care services under this part. Such facilities shall
  837  retain a log listing the names and unit number for residents
  838  receiving these services. The log must be available to surveyors
  839  upon request. Except for uniform firesafety standards, the
  840  department shall adopt by rule separate and distinct standards
  841  for facilities with 16 or fewer beds and for facilities with 17
  842  or more beds. The standards for facilities with 16 or fewer beds
  843  must shall be appropriate for a noninstitutional residential
  844  environment; however, provided that the structure may not be is
  845  no more than two stories in height and all persons who cannot
  846  exit the facility unassisted in an emergency must reside on the
  847  first floor. The department, in conjunction with the agency, may
  848  make other distinctions among types of facilities as necessary
  849  to enforce the provisions of this part. Where appropriate, the
  850  agency shall offer alternate solutions for complying with
  851  established standards, based on distinctions made by the
  852  department and the agency relative to the physical
  853  characteristics of facilities and the types of care offered
  854  therein.
  855         Section 16. Present subsections (1) through (11) of section
  856  429.52, Florida Statutes, are redesignated as subsections (2)
  857  through (12), respectively, a new subsection (1) is added to
  858  that section, and present subsections (5) and (9) of that
  859  section are amended, to read:
  860         429.52 Staff training and educational programs; core
  861  educational requirement.—
  862         (1) Effective October 1, 2015, each new assisted living
  863  facility employee who has not previously completed core training
  864  must attend a preservice orientation provided by the facility
  865  before interacting with residents. The preservice orientation
  866  must be at least 2 hours in duration and cover topics that help
  867  the employee provide responsible care and respond to the needs
  868  of facility residents. Upon completion, the employee and the
  869  administrator of the facility must sign a statement that the
  870  employee completed the required preservice orientation. The
  871  facility must keep the signed statement in the employee’s
  872  personnel record.
  873         (6)(5) Staff involved with the management of medications
  874  and assisting with the self-administration of medications under
  875  s. 429.256 must complete a minimum of 6 4 additional hours of
  876  training provided by a registered nurse, licensed pharmacist, or
  877  department staff. The department shall establish by rule the
  878  minimum requirements of this additional training.
  879         (10)(9) The training required by this section other than
  880  the preservice orientation must shall be conducted by persons
  881  registered with the department as having the requisite
  882  experience and credentials to conduct the training. A person
  883  seeking to register as a trainer must provide the department
  884  with proof of completion of the minimum core training education
  885  requirements, successful passage of the competency test
  886  established under this section, and proof of compliance with the
  887  continuing education requirement in subsection (5)(4).
  888         Section 17. Section 429.55, Florida Statutes, is created to
  889  read:
  890         429.55Consumer information website.—The Legislature finds
  891  that consumers need additional information on the quality of
  892  care and service in assisted living facilities in order to
  893  select the best facility for themselves or their loved ones.
  894  Therefore, the Agency for Health Care Administration shall
  895  create content that is easily accessible through the home page
  896  of the agency’s website either directly or indirectly through
  897  links to one or more other established websites of the agency’s
  898  choosing. The website must be searchable by facility name,
  899  license type, city, or zip code. By November 1, 2015, the agency
  900  shall include all content in its possession on the website and
  901  add content when received from facilities. At a minimum, the
  902  content must include:
  903         (1)Information on each licensed assisted living facility,
  904  including, but not limited to:
  905         (a)The name and address of the facility.
  906         (b)The name of the owner or operator of the facility.
  907         (c)The number and type of licensed beds in the facility.
  908         (d)The types of licenses held by the facility.
  909         (e)The facility’s license expiration date and status.
  910         (f)The total number of clients that the facility is
  911  licensed to serve and the most recently available occupancy
  912  levels.
  913         (g)The number of private and semiprivate rooms offered.
  914         (h)The bed-hold policy.
  915         (i)The religious affiliation, if any, of the assisted
  916  living facility.
  917         (j)The languages spoken by the staff.
  918         (k)Availability of nurses.
  919         (l)Forms of payment accepted, including, but not limited
  920  to, Medicaid, Medicaid long-term managed care, private
  921  insurance, health maintenance organization, United States
  922  Department of Veterans Affairs, CHAMPUS program, or workers’
  923  compensation coverage.
  924         (m)Indication if the licensee is operating under
  925  bankruptcy protection.
  926         (n)Recreational and other programs available.
  927         (o)Special care units or programs offered.
  928         (p)Whether the facility is a part of a retirement
  929  community that offers other services pursuant to this part or
  930  part III of this chapter, part II or part III of chapter 400, or
  931  chapter 651.
  932         (q)Links to the State Long-Term Care Ombudsman Program
  933  website and the program’s statewide toll-free telephone number.
  934         (r)Links to the websites of the providers.
  935         (s)Other relevant information that the agency currently
  936  collects.
  937         (2)Survey and violation information for the facility,
  938  including a list of the facility’s violations committed during
  939  the previous 60 months, which on July 1, 2015, may include
  940  violations committed on or after July 1, 2010. The list shall be
  941  updated monthly and include for each violation:
  942         (a)A summary of the violation, including all licensure,
  943  revisit, and complaint survey information, presented in a manner
  944  understandable by the general public.
  945         (b)Any sanctions imposed by final order.
  946         (c)The date the corrective action was confirmed by the
  947  agency.
  948         (3)Links to inspection reports that the agency has on
  949  file.
  950         (4)The agency may adopt rules to administer this section.
  951         Section 18. This act shall take effect July 1, 2015.