CS for CS for SB 382                             First Engrossed
       
       
       
       
       
       
       
       
       2015382e1
       
    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 for Health Care Administration to
   78         impose a fine if a facility is not in compliance with
   79         certain background screening requirements; amending s.
   80         429.256, F.S.; revising the term “assistance with
   81         self-administration of medication” as it relates to
   82         the Assisted Living Facilities Act; amending s.
   83         429.27, F.S.; revising the amount of cash for which a
   84         facility may provide safekeeping for a resident;
   85         amending s. 429.28, F.S.; providing notice
   86         requirements regarding confidentiality of resident
   87         identity in a complaint made to the State Long-Term
   88         Care Ombudsman Program or a local long-term care
   89         ombudsman council and immunity from retaliatory action
   90         for presenting grievances or exercising resident
   91         rights; requiring the agency to adopt rules; providing
   92         a fine if a facility terminates an individual’s
   93         residency after the filing of a complaint if good
   94         cause is not shown for the termination; amending s.
   95         429.34, F.S.; requiring certain persons to report
   96         elder abuse in assisted living facilities; requiring
   97         the agency to regularly inspect a licensed assisted
   98         living facility; requiring the agency to conduct
   99         periodic inspections; amending s. 429.41, F.S.;
  100         providing that certain staffing requirements apply
  101         only to residents in continuing care facilities who
  102         are receiving certain services; amending s. 429.52,
  103         F.S.; requiring each newly hired employee of an
  104         assisted living facility to attend a preservice
  105         orientation; requiring the employee and administrator
  106         to sign a statement of completion and keep the
  107         statement in the employee’s personnel record;
  108         requiring additional hours of training for assistance
  109         with medication; creating s. 429.55, F.S.; directing
  110         the agency to create an assisted living facility
  111         consumer information website; providing criteria for
  112         webpage content; providing content requirements;
  113         authorizing the agency to adopt rules; providing an
  114         effective date.
  115          
  116  Be It Enacted by the Legislature of the State of Florida:
  117  
  118         Section 1. Section 394.4574, Florida Statutes, is amended
  119  to read:
  120         394.4574 Department Responsibilities for coordination of
  121  services for a mental health resident who resides in an assisted
  122  living facility that holds a limited mental health license.—
  123         (1) As used in this section, the term “mental health
  124  resident,for purposes of this section, means an individual who
  125  receives social security disability income due to a mental
  126  disorder as determined by the Social Security Administration or
  127  receives supplemental security income due to a mental disorder
  128  as determined by the Social Security Administration and receives
  129  optional state supplementation.
  130         (2) Medicaid managed care plans are responsible for
  131  Medicaid-enrolled mental health residents, and managing entities
  132  under contract with the department are responsible for mental
  133  health residents who are not enrolled in a Medicaid health plan.
  134  A Medicaid managed care plan or a managing entity shall The
  135  department must ensure that:
  136         (a) A mental health resident has been assessed by a
  137  psychiatrist, clinical psychologist, clinical social worker, or
  138  psychiatric nurse, or an individual who is supervised by one of
  139  these professionals, and determined to be appropriate to reside
  140  in an assisted living facility. The documentation must be
  141  provided to the administrator of the facility within 30 days
  142  after the mental health resident has been admitted to the
  143  facility. An evaluation completed upon discharge from a state
  144  mental hospital meets the requirements of this subsection
  145  related to appropriateness for placement as a mental health
  146  resident if it was completed within 90 days before prior to
  147  admission to the facility.
  148         (b) A cooperative agreement, as required in s. 429.075, is
  149  developed by between the mental health care services provider
  150  that serves a mental health resident and the administrator of
  151  the assisted living facility with a limited mental health
  152  license in which the mental health resident is living. Any
  153  entity that provides Medicaid prepaid health plan services shall
  154  ensure the appropriate coordination of health care services with
  155  an assisted living facility in cases where a Medicaid recipient
  156  is both a member of the entity’s prepaid health plan and a
  157  resident of the assisted living facility. If the entity is at
  158  risk for Medicaid targeted case management and behavioral health
  159  services, the entity shall inform the assisted living facility
  160  of the procedures to follow should an emergent condition arise.
  161         (c) The community living support plan, as defined in s.
  162  429.02, has been prepared by a mental health resident and his or
  163  her a mental health case manager of that resident in
  164  consultation with the administrator of the facility or the
  165  administrator’s designee. The plan must be completed and
  166  provided to the administrator of the assisted living facility
  167  with a limited mental health license in which the mental health
  168  resident lives upon the resident’s admission. The support plan
  169  and the agreement may be in one document. The agency may not
  170  cite an assisted living facility for not possessing a resident’s
  171  community living support plan if the facility can document that
  172  it has requested the plan for that resident.
  173         (d) The assisted living facility with a limited mental
  174  health license is provided with documentation that the
  175  individual meets the definition of a mental health resident.
  176         (e) The mental health services provider assigns a case
  177  manager to each mental health resident for whom the entity is
  178  responsible who lives in an assisted living facility with a
  179  limited mental health license. The case manager shall coordinate
  180  is responsible for coordinating the development of and
  181  implementation of the community living support plan defined in
  182  s. 429.02. The plan must be updated at least annually, or when
  183  there is a significant change in the resident’s behavioral
  184  health status. Each case manager shall keep a record of the date
  185  and time of any face-to-face interaction with the resident and
  186  make the record available to the responsible entity for
  187  inspection. The record must be retained for at least 2 years
  188  after the date of the most recent interaction.
  189         (f)Adequate and consistent monitoring and enforcement of
  190  community living support plans and cooperative agreements are
  191  conducted by the resident’s case manager.
  192         (g) Concerns are reported to the appropriate regulatory
  193  oversight organization if a regulated provider fails to deliver
  194  appropriate services or otherwise acts in a manner that has the
  195  potential to result in harm to the resident.
  196         (3) The Secretary of Children and Families, in consultation
  197  with the Agency for Health Care Administration, shall annually
  198  require each district administrator to develop, with community
  199  input, a detailed annual plan that demonstrates detailed plans
  200  that demonstrate how the district will ensure the provision of
  201  state-funded mental health and substance abuse treatment
  202  services to residents of assisted living facilities that hold a
  203  limited mental health license. This plan These plans must be
  204  consistent with the substance abuse and mental health district
  205  plan developed pursuant to s. 394.75 and must address case
  206  management services; access to consumer-operated drop-in
  207  centers; access to services during evenings, weekends, and
  208  holidays; supervision of the clinical needs of the residents;
  209  and access to emergency psychiatric care.
  210         Section 2. Subsection (1) of section 400.0074, Florida
  211  Statutes, is amended, and paragraph (h) is added to subsection
  212  (2) of that section, to read:
  213         400.0074 Local ombudsman council onsite administrative
  214  assessments.—
  215         (1) In addition to any specific investigation conducted
  216  pursuant to a complaint, the local council shall conduct, at
  217  least annually, an onsite administrative assessment of each
  218  nursing home, assisted living facility, and adult family-care
  219  home within its jurisdiction. This administrative assessment
  220  must be comprehensive in nature and must shall focus on factors
  221  affecting residents’ the rights, health, safety, and welfare of
  222  the residents. Each local council is encouraged to conduct a
  223  similar onsite administrative assessment of each additional
  224  long-term care facility within its jurisdiction.
  225         (2) An onsite administrative assessment conducted by a
  226  local council shall be subject to the following conditions:
  227         (h) Upon completion of an administrative assessment, the
  228  local council shall conduct an exit consultation with the
  229  facility administrator or administrator’s designee to discuss
  230  issues and concerns in areas affecting residents’ rights,
  231  health, safety, and welfare and, if needed, make recommendations
  232  for improvement.
  233         Section 3. Subsection (2) of section 400.0078, Florida
  234  Statutes, is amended to read:
  235         400.0078 Citizen access to State Long-Term Care Ombudsman
  236  Program services.—
  237         (2) Every resident or representative of a resident shall
  238  receive, Upon admission to a long-term care facility, each
  239  resident or representative of a resident must receive
  240  information regarding the purpose of the State Long-Term Care
  241  Ombudsman Program, the statewide toll-free telephone number for
  242  receiving complaints, information that retaliatory action cannot
  243  be taken against a resident for presenting grievances or for
  244  exercising any other resident right, and other relevant
  245  information regarding how to contact the program. Each resident
  246  or his or her representative Residents or their representatives
  247  must be furnished additional copies of this information upon
  248  request.
  249         Section 4. Paragraph (c) of subsection (4) of section
  250  409.212, Florida Statutes, is amended to read:
  251         409.212 Optional supplementation.—
  252         (4) In addition to the amount of optional supplementation
  253  provided by the state, a person may receive additional
  254  supplementation from third parties to contribute to his or her
  255  cost of care. Additional supplementation may be provided under
  256  the following conditions:
  257         (c) The additional supplementation shall not exceed four
  258  two times the provider rate recognized under the optional state
  259  supplementation program.
  260         Section 5. Subsection (13) of section 429.02, Florida
  261  Statutes, is amended to read:
  262         429.02 Definitions.—When used in this part, the term:
  263         (13) “Limited nursing services” means acts that may be
  264  performed by a person licensed under pursuant to part I of
  265  chapter 464 by persons licensed thereunder while carrying out
  266  their professional duties but limited to those acts which the
  267  department specifies by rule. Acts which may be specified by
  268  rule as allowable Limited nursing services shall be for persons
  269  who meet the admission criteria established by the department
  270  for assisted living facilities and shall not be complex enough
  271  to require 24-hour nursing supervision and may include such
  272  services as the application and care of routine dressings, and
  273  care of casts, braces, and splints.
  274         Section 6. Paragraphs (b) and (c) of subsection (3) of
  275  section 429.07, Florida Statutes, are amended to read:
  276         429.07 License required; fee.—
  277         (3) In addition to the requirements of s. 408.806, each
  278  license granted by the agency must state the type of care for
  279  which the license is granted. Licenses shall be issued for one
  280  or more of the following categories of care: standard, extended
  281  congregate care, limited nursing services, or limited mental
  282  health.
  283         (b) An extended congregate care license shall be issued to
  284  each facility that has been licensed as an assisted living
  285  facility for 2 or more years and that provides services
  286  facilities providing, directly or through contract, services
  287  beyond those authorized in paragraph (a), including services
  288  performed by persons licensed under part I of chapter 464 and
  289  supportive services, as defined by rule, to persons who would
  290  otherwise be disqualified from continued residence in a facility
  291  licensed under this part. An extended congregate care license
  292  may be issued to a facility that has a provisional extended
  293  congregate care license and meets the requirements for licensure
  294  under subparagraph 2. The primary purpose of extended congregate
  295  care services is to allow residents the option of remaining in a
  296  familiar setting from which they would otherwise be disqualified
  297  for continued residency as they become more impaired. A facility
  298  licensed to provide extended congregate care services may also
  299  admit an individual who exceeds the admission criteria for a
  300  facility with a standard license if the individual is determined
  301  appropriate for admission to the extended congregate care
  302  facility.
  303         1. In order for extended congregate care services to be
  304  provided, the agency must first determine that all requirements
  305  established in law and rule are met and must specifically
  306  designate, on the facility’s license, that such services may be
  307  provided and whether the designation applies to all or part of
  308  the facility. This Such designation may be made at the time of
  309  initial licensure or licensure renewal relicensure, or upon
  310  request in writing by a licensee under this part and part II of
  311  chapter 408. The notification of approval or the denial of the
  312  request shall be made in accordance with part II of chapter 408.
  313  Each existing facility that qualifies facilities qualifying to
  314  provide extended congregate care services must have maintained a
  315  standard license and may not have been subject to administrative
  316  sanctions during the previous 2 years, or since initial
  317  licensure if the facility has been licensed for less than 2
  318  years, for any of the following reasons:
  319         a. A class I or class II violation;
  320         b. Three or more repeat or recurring class III violations
  321  of identical or similar resident care standards from which a
  322  pattern of noncompliance is found by the agency;
  323         c. Three or more class III violations that were not
  324  corrected in accordance with the corrective action plan approved
  325  by the agency;
  326         d. Violation of resident care standards which results in
  327  requiring the facility to employ the services of a consultant
  328  pharmacist or consultant dietitian;
  329         e. Denial, suspension, or revocation of a license for
  330  another facility licensed under this part in which the applicant
  331  for an extended congregate care license has at least 25 percent
  332  ownership interest; or
  333         f. Imposition of a moratorium pursuant to this part or part
  334  II of chapter 408 or initiation of injunctive proceedings.
  335  
  336  The agency may deny or revoke a facility’s extended congregate
  337  care license if it fails to meet the criteria for an extended
  338  congregate care license as provided in this subparagraph.
  339         2.If an assisted living facility has been licensed for
  340  less than 2 years, the initial extended congregate care license
  341  must be provisional and may not exceed 6 months. The licensee
  342  shall notify the agency, in writing, when it admits at least one
  343  extended congregate care resident, after which an unannounced
  344  inspection shall be made to determine compliance with
  345  requirements of an extended congregate care license. A licensee
  346  that has a provisional extended congregate care license which
  347  demonstrates compliance with all of the requirements of an
  348  extended congregate care license during the inspection shall be
  349  issued an extended congregate care license. In addition to
  350  sanctions authorized under this part, if violations are found
  351  during the inspection and the licensee fails to demonstrate
  352  compliance with all assisted living requirements during a
  353  followup inspection, the licensee shall immediately suspend
  354  extended congregate care services, and the provisional extended
  355  congregate care license expires. The agency may extend the
  356  provisional license for not more than 1 month in order to
  357  complete a followup visit.
  358         3.2. A facility that is licensed to provide extended
  359  congregate care services shall maintain a written progress
  360  report on each person who receives services which describes the
  361  type, amount, duration, scope, and outcome of services that are
  362  rendered and the general status of the resident’s health. A
  363  registered nurse, or appropriate designee, representing the
  364  agency shall visit the facility at least twice a year quarterly
  365  to monitor residents who are receiving extended congregate care
  366  services and to determine if the facility is in compliance with
  367  this part, part II of chapter 408, and relevant rules. One of
  368  the visits may be in conjunction with the regular survey. The
  369  monitoring visits may be provided through contractual
  370  arrangements with appropriate community agencies. A registered
  371  nurse shall serve as part of the team that inspects the
  372  facility. The agency may waive one of the required yearly
  373  monitoring visits for a facility that has:
  374         a. Held an extended congregate care license for at least 24
  375  months; been licensed for at least 24 months to provide extended
  376  congregate care services, if, during the inspection, the
  377  registered nurse determines that extended congregate care
  378  services are being provided appropriately, and if the facility
  379  has
  380         b. No class I or class II violations and no uncorrected
  381  class III violations; and.
  382         c. No ombudsman council complaints that resulted in a
  383  citation for licensure The agency must first consult with the
  384  long-term care ombudsman council for the area in which the
  385  facility is located to determine if any complaints have been
  386  made and substantiated about the quality of services or care.
  387  The agency may not waive one of the required yearly monitoring
  388  visits if complaints have been made and substantiated.
  389         4.3. A facility that is licensed to provide extended
  390  congregate care services must:
  391         a. Demonstrate the capability to meet unanticipated
  392  resident service needs.
  393         b. Offer a physical environment that promotes a homelike
  394  setting, provides for resident privacy, promotes resident
  395  independence, and allows sufficient congregate space as defined
  396  by rule.
  397         c. Have sufficient staff available, taking into account the
  398  physical plant and firesafety features of the building, to
  399  assist with the evacuation of residents in an emergency.
  400         d. Adopt and follow policies and procedures that maximize
  401  resident independence, dignity, choice, and decisionmaking to
  402  permit residents to age in place, so that moves due to changes
  403  in functional status are minimized or avoided.
  404         e. Allow residents or, if applicable, a resident’s
  405  representative, designee, surrogate, guardian, or attorney in
  406  fact to make a variety of personal choices, participate in
  407  developing service plans, and share responsibility in
  408  decisionmaking.
  409         f. Implement the concept of managed risk.
  410         g. Provide, directly or through contract, the services of a
  411  person licensed under part I of chapter 464.
  412         h. In addition to the training mandated in s. 429.52,
  413  provide specialized training as defined by rule for facility
  414  staff.
  415         5.4. A facility that is licensed to provide extended
  416  congregate care services is exempt from the criteria for
  417  continued residency set forth in rules adopted under s. 429.41.
  418  A licensed facility must adopt its own requirements within
  419  guidelines for continued residency set forth by rule. However,
  420  the facility may not serve residents who require 24-hour nursing
  421  supervision. A licensed facility that provides extended
  422  congregate care services must also provide each resident with a
  423  written copy of facility policies governing admission and
  424  retention.
  425         5. The primary purpose of extended congregate care services
  426  is to allow residents, as they become more impaired, the option
  427  of remaining in a familiar setting from which they would
  428  otherwise be disqualified for continued residency. A facility
  429  licensed to provide extended congregate care services may also
  430  admit an individual who exceeds the admission criteria for a
  431  facility with a standard license, if the individual is
  432  determined appropriate for admission to the extended congregate
  433  care facility.
  434         6. Before the admission of an individual to a facility
  435  licensed to provide extended congregate care services, the
  436  individual must undergo a medical examination as provided in s.
  437  429.26(4) and the facility must develop a preliminary service
  438  plan for the individual.
  439         7. If When a facility can no longer provide or arrange for
  440  services in accordance with the resident’s service plan and
  441  needs and the facility’s policy, the facility must shall make
  442  arrangements for relocating the person in accordance with s.
  443  429.28(1)(k).
  444         8. Failure to provide extended congregate care services may
  445  result in denial of extended congregate care license renewal.
  446         (c) A limited nursing services license shall be issued to a
  447  facility that provides services beyond those authorized in
  448  paragraph (a) and as specified in this paragraph.
  449         1. In order for limited nursing services to be provided in
  450  a facility licensed under this part, the agency must first
  451  determine that all requirements established in law and rule are
  452  met and must specifically designate, on the facility’s license,
  453  that such services may be provided. This Such designation may be
  454  made at the time of initial licensure or licensure renewal
  455  relicensure, or upon request in writing by a licensee under this
  456  part and part II of chapter 408. Notification of approval or
  457  denial of such request shall be made in accordance with part II
  458  of chapter 408. An existing facility that qualifies facilities
  459  qualifying to provide limited nursing services must shall have
  460  maintained a standard license and may not have been subject to
  461  administrative sanctions that affect the health, safety, and
  462  welfare of residents for the previous 2 years or since initial
  463  licensure if the facility has been licensed for less than 2
  464  years.
  465         2. A facility Facilities that is are licensed to provide
  466  limited nursing services shall maintain a written progress
  467  report on each person who receives such nursing services. The,
  468  which report must describe describes the type, amount, duration,
  469  scope, and outcome of services that are rendered and the general
  470  status of the resident’s health. A registered nurse representing
  471  the agency shall visit the facility such facilities at least
  472  annually twice a year to monitor residents who are receiving
  473  limited nursing services and to determine if the facility is in
  474  compliance with applicable provisions of this part, part II of
  475  chapter 408, and related rules. The monitoring visits may be
  476  provided through contractual arrangements with appropriate
  477  community agencies. A registered nurse shall also serve as part
  478  of the team that inspects such facility. Visits may be in
  479  conjunction with other agency inspections. The agency may waive
  480  the required yearly monitoring visit for a facility that has:
  481         a. Had a limited nursing services license for at least 24
  482  months;
  483         b. No class I or class II violations and no uncorrected
  484  class III violations; and
  485         c. No ombudsman council complaints that resulted in a
  486  citation for licensure.
  487         3. A person who receives limited nursing services under
  488  this part must meet the admission criteria established by the
  489  agency for assisted living facilities. When a resident no longer
  490  meets the admission criteria for a facility licensed under this
  491  part, arrangements for relocating the person shall be made in
  492  accordance with s. 429.28(1)(k), unless the facility is licensed
  493  to provide extended congregate care services.
  494         Section 7. Section 429.075, Florida Statutes, is amended to
  495  read:
  496         429.075 Limited mental health license.—An assisted living
  497  facility that serves one three or more mental health residents
  498  must obtain a limited mental health license.
  499         (1) To obtain a limited mental health license, a facility
  500  must hold a standard license as an assisted living facility,
  501  must not have any current uncorrected deficiencies or
  502  violations, and must ensure that, within 6 months after
  503  receiving a limited mental health license, the facility
  504  administrator and the staff of the facility who are in direct
  505  contact with mental health residents must complete training of
  506  no less than 6 hours related to their duties. This Such
  507  designation may be made at the time of initial licensure or
  508  licensure renewal relicensure or upon request in writing by a
  509  licensee under this part and part II of chapter 408.
  510  Notification of approval or denial of such request shall be made
  511  in accordance with this part, part II of chapter 408, and
  512  applicable rules. This training must will be provided by or
  513  approved by the Department of Children and Families.
  514         (2) A facility that is Facilities licensed to provide
  515  services to mental health residents must shall provide
  516  appropriate supervision and staffing to provide for the health,
  517  safety, and welfare of such residents.
  518         (3) A facility that has a limited mental health license
  519  must:
  520         (a) Have a copy of each mental health resident’s community
  521  living support plan and the cooperative agreement with the
  522  mental health care services provider or provide written evidence
  523  that a request for the community living support plan and the
  524  cooperative agreement was sent to the Medicaid managed care plan
  525  or managing entity under contract with the Department of
  526  Children and Families within 72 hours after admission. The
  527  support plan and the agreement may be combined.
  528         (b) Have documentation that is provided by the Department
  529  of Children and Families that each mental health resident has
  530  been assessed and determined to be able to live in the community
  531  in an assisted living facility that has with a limited mental
  532  health license or provide written evidence that a request for
  533  documentation was sent to the department within 72 hours after
  534  admission.
  535         (c) Make the community living support plan available for
  536  inspection by the resident, the resident’s legal guardian or,
  537  the resident’s health care surrogate, and other individuals who
  538  have a lawful basis for reviewing this document.
  539         (d) Assist the mental health resident in carrying out the
  540  activities identified in the resident’s individual’s community
  541  living support plan.
  542         (4) A facility that has with a limited mental health
  543  license may enter into a cooperative agreement with a private
  544  mental health provider. For purposes of the limited mental
  545  health license, the private mental health provider may act as
  546  the case manager.
  547         Section 8. Section 429.14, Florida Statutes, is amended to
  548  read:
  549         429.14 Administrative penalties.—
  550         (1) In addition to the requirements of part II of chapter
  551  408, the agency may deny, revoke, and suspend any license issued
  552  under this part and impose an administrative fine in the manner
  553  provided in chapter 120 against a licensee for a violation of
  554  any provision of this part, part II of chapter 408, or
  555  applicable rules, or for any of the following actions by a
  556  licensee, for the actions of any person subject to level 2
  557  background screening under s. 408.809, or for the actions of any
  558  facility staff employee:
  559         (a) An intentional or negligent act seriously affecting the
  560  health, safety, or welfare of a resident of the facility.
  561         (b) A The determination by the agency that the owner lacks
  562  the financial ability to provide continuing adequate care to
  563  residents.
  564         (c) Misappropriation or conversion of the property of a
  565  resident of the facility.
  566         (d) Failure to follow the criteria and procedures provided
  567  under part I of chapter 394 relating to the transportation,
  568  voluntary admission, and involuntary examination of a facility
  569  resident.
  570         (e) A citation for of any of the following violations
  571  deficiencies as specified in s. 429.19:
  572         1. One or more cited class I violations deficiencies.
  573         2. Three or more cited class II violations deficiencies.
  574         3. Five or more cited class III violations deficiencies
  575  that have been cited on a single survey and have not been
  576  corrected within the times specified.
  577         (f) Failure to comply with the background screening
  578  standards of this part, s. 408.809(1), or chapter 435.
  579         (g) Violation of a moratorium.
  580         (h) Failure of the license applicant, the licensee during
  581  licensure renewal relicensure, or a licensee that holds a
  582  provisional license to meet the minimum license requirements of
  583  this part, or related rules, at the time of license application
  584  or renewal.
  585         (i) An intentional or negligent life-threatening act in
  586  violation of the uniform firesafety standards for assisted
  587  living facilities or other firesafety standards which that
  588  threatens the health, safety, or welfare of a resident of a
  589  facility, as communicated to the agency by the local authority
  590  having jurisdiction or the State Fire Marshal.
  591         (j) Knowingly operating any unlicensed facility or
  592  providing without a license any service that must be licensed
  593  under this chapter or chapter 400.
  594         (k) Any act constituting a ground upon which application
  595  for a license may be denied.
  596         (2) Upon notification by the local authority having
  597  jurisdiction or by the State Fire Marshal, the agency may deny
  598  or revoke the license of an assisted living facility that fails
  599  to correct cited fire code violations that affect or threaten
  600  the health, safety, or welfare of a resident of a facility.
  601         (3) The agency may deny or revoke a license of an to any
  602  applicant or controlling interest as defined in part II of
  603  chapter 408 which has or had a 25 percent 25-percent or greater
  604  financial or ownership interest in any other facility that is
  605  licensed under this part, or in any entity licensed by this
  606  state or another state to provide health or residential care, if
  607  that which facility or entity during the 5 years before prior to
  608  the application for a license closed due to financial inability
  609  to operate; had a receiver appointed or a license denied,
  610  suspended, or revoked; was subject to a moratorium; or had an
  611  injunctive proceeding initiated against it.
  612         (4) The agency shall deny or revoke the license of an
  613  assisted living facility if any of the following apply:
  614         (a)There are two moratoria, issued pursuant to this part
  615  or part II of chapter 408, within a 2-year period which are
  616  imposed by final order.
  617         (b)The facility is cited for two or more class I
  618  violations arising from unrelated circumstances during the same
  619  survey or investigation.
  620         (c)The facility is cited for two or more class I
  621  violations arising from separate surveys or investigations
  622  within a 2-year period that has two or more class I violations
  623  that are similar or identical to violations identified by the
  624  agency during a survey, inspection, monitoring visit, or
  625  complaint investigation occurring within the previous 2 years.
  626         (5) An action taken by the agency to suspend, deny, or
  627  revoke a facility’s license under this part or part II of
  628  chapter 408, in which the agency claims that the facility owner
  629  or an employee of the facility has threatened the health,
  630  safety, or welfare of a resident of the facility, shall be heard
  631  by the Division of Administrative Hearings of the Department of
  632  Management Services within 120 days after receipt of the
  633  facility’s request for a hearing, unless that time limitation is
  634  waived by both parties. The administrative law judge shall must
  635  render a decision within 30 days after receipt of a proposed
  636  recommended order.
  637         (6) As provided under s. 408.814, the agency shall impose
  638  an immediate moratorium on an assisted living facility that
  639  fails to provide the agency access to the facility or prohibits
  640  the agency from conducting a regulatory inspection. The licensee
  641  may not restrict agency staff in accessing and copying records,
  642  at the agency’s expense, or in conducting confidential
  643  interviews with facility staff or any individual who receives
  644  services from the facility provide to the Division of Hotels and
  645  Restaurants of the Department of Business and Professional
  646  Regulation, on a monthly basis, a list of those assisted living
  647  facilities that have had their licenses denied, suspended, or
  648  revoked or that are involved in an appellate proceeding pursuant
  649  to s. 120.60 related to the denial, suspension, or revocation of
  650  a license.
  651         (7) Agency notification of a license suspension or
  652  revocation, or denial of a license renewal, shall be posted and
  653  visible to the public at the facility.
  654         (8) If a facility is required to relocate some or all of
  655  its residents due to agency action, that facility is exempt from
  656  the 45 days’ notice requirement imposed under s. 429.28(1)(k).
  657  This subsection does not exempt the facility from any deadline
  658  for corrective action set by the agency.
  659         Section 9. Paragraphs (a) and (b) of subsection (2) of
  660  section 429.178, Florida Statutes, are amended to read:
  661         429.178 Special care for persons with Alzheimer’s disease
  662  or other related disorders.—
  663         (2)(a) An individual who is employed by a facility that
  664  provides special care for residents who have with Alzheimer’s
  665  disease or other related disorders, and who has regular contact
  666  with such residents, must complete up to 4 hours of initial
  667  dementia-specific training developed or approved by the
  668  department. The training must shall be completed within 3 months
  669  after beginning employment and shall satisfy the core training
  670  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  671         (b) A direct caregiver who is employed by a facility that
  672  provides special care for residents who have with Alzheimer’s
  673  disease or other related disorders, and who provides direct care
  674  to such residents, must complete the required initial training
  675  and 4 additional hours of training developed or approved by the
  676  department. The training must shall be completed within 9 months
  677  after beginning employment and shall satisfy the core training
  678  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  679         Section 10. Paragraph (e) is added to subsection (2) of
  680  section 429.19, Florida Statutes, to read:
  681         429.19 Violations; imposition of administrative fines;
  682  grounds.—
  683         (2) Each violation of this part and adopted rules shall be
  684  classified according to the nature of the violation and the
  685  gravity of its probable effect on facility residents. The agency
  686  shall indicate the classification on the written notice of the
  687  violation as follows:
  688         (e) Regardless of the class of violation cited, instead of
  689  the fine amounts listed in paragraphs (a)-(d), the agency shall
  690  impose an administrative fine of $500 if a facility is found not
  691  to be in compliance with the background screening requirements
  692  as provided in s. 408.809.
  693         Section 11. Subsection (3) and paragraph (c) of subsection
  694  (4) of section 429.256, Florida Statutes, are amended to read:
  695         429.256 Assistance with self-administration of medication.—
  696         (3) Assistance with self-administration of medication
  697  includes:
  698         (a) Taking the medication, in its previously dispensed,
  699  properly labeled container, including an insulin syringe that is
  700  prefilled with the proper dosage by a pharmacist and an insulin
  701  pen that is prefilled by the manufacturer, from where it is
  702  stored, and bringing it to the resident.
  703         (b) In the presence of the resident, reading the label,
  704  opening the container, removing a prescribed amount of
  705  medication from the container, and closing the container.
  706         (c) Placing an oral dosage in the resident’s hand or
  707  placing the dosage in another container and helping the resident
  708  by lifting the container to his or her mouth.
  709         (d) Applying topical medications.
  710         (e) Returning the medication container to proper storage.
  711         (f) Keeping a record of when a resident receives assistance
  712  with self-administration under this section.
  713         (g) Assisting with the use of a nebulizer, including
  714  removing the cap of a nebulizer, opening the unit dose of
  715  nebulizer solution, and pouring the prescribed premeasured dose
  716  of medication into the dispensing cup of the nebulizer.
  717         (h) Using a glucometer to perform blood-glucose level
  718  checks.
  719         (i) Assisting with putting on and taking off antiembolism
  720  stockings.
  721         (j) Assisting with applying and removing an oxygen cannula,
  722  but not with titrating the prescribed oxygen settings.
  723         (k) Assisting with the use of a continuous positive airway
  724  pressure (CPAP) device, but not with titrating the prescribed
  725  setting of the device.
  726         (l) Assisting with measuring vital signs.
  727         (m) Assisting with colostomy bags.
  728         (4) Assistance with self-administration does not include:
  729         (c) Administration of medications through intermittent
  730  positive pressure breathing machines or a nebulizer.
  731         Section 12. Subsection (3) of section 429.27, Florida
  732  Statutes, is amended to read:
  733         429.27 Property and personal affairs of residents.—
  734         (3) A facility, upon mutual consent with the resident,
  735  shall provide for the safekeeping in the facility of personal
  736  effects not in excess of $500 and funds of the resident not in
  737  excess of $500 $200 cash, and shall keep complete and accurate
  738  records of all such funds and personal effects received. If a
  739  resident is absent from a facility for 24 hours or more, the
  740  facility may provide for the safekeeping of the resident’s
  741  personal effects in excess of $500.
  742         Section 13. Subsections (2), (5), and (6) and paragraph (a)
  743  of subsection (3) of section 429.28, Florida Statutes, are
  744  amended to read:
  745         429.28 Resident bill of rights.—
  746         (2) The administrator of a facility shall ensure that a
  747  written notice of the rights, obligations, and prohibitions set
  748  forth in this part is posted in a prominent place in each
  749  facility and read or explained to residents who cannot read. The
  750  This notice must shall include the name, address, and telephone
  751  numbers of the local ombudsman council, the and central abuse
  752  hotline, and, if when applicable, Disability Rights Florida the
  753  Advocacy Center for Persons with Disabilities, Inc., and the
  754  Florida local advocacy council, where complaints may be lodged.
  755  The notice must state that a complaint made to the Office of
  756  State Long-Term Care Ombudsman or a local long-term care
  757  ombudsman council, the names and identities of the residents
  758  involved in the complaint, and the identity of complainants are
  759  kept confidential pursuant to s. 400.0077 and that retaliatory
  760  action cannot be taken against a resident for presenting
  761  grievances or for exercising any other resident right. The
  762  facility must ensure a resident’s access to a telephone to call
  763  the local ombudsman council, central abuse hotline, and
  764  Disability Rights Florida Advocacy Center for Persons with
  765  Disabilities, Inc., and the Florida local advocacy council.
  766         (3)(a) The agency shall conduct a survey to determine
  767  general compliance with facility standards and compliance with
  768  residents’ rights as a prerequisite to initial licensure or
  769  licensure renewal. The agency shall adopt rules in consultation
  770  with the department for uniform standards and criteria that will
  771  be used to determine compliance with facility standards and
  772  residents’ rights.
  773         (5) A No facility or employee of a facility may not serve
  774  notice upon a resident to leave the premises or take any other
  775  retaliatory action against any person who:
  776         (a) Exercises any right set forth in this section.
  777         (b) Appears as a witness in any hearing, inside or outside
  778  the facility.
  779         (c) Files a civil action alleging a violation of the
  780  provisions of this part or notifies a state attorney or the
  781  Attorney General of a possible violation of such provisions.
  782         (6) A Any facility that which terminates the residency of
  783  an individual who participated in activities specified in
  784  subsection (5) must shall show good cause in a court of
  785  competent jurisdiction. If good cause is not shown, the agency
  786  shall impose a fine of $2,500 in addition to any other penalty
  787  assessed against the facility.
  788         Section 14. Section 429.34, Florida Statutes, is amended to
  789  read:
  790         429.34 Right of entry and inspection.—
  791         (1) In addition to the requirements of s. 408.811, any duly
  792  designated officer or employee of the department, the Department
  793  of Children and Families, the Medicaid Fraud Control Unit of the
  794  Office of the Attorney General, the state or local fire marshal,
  795  or a member of the state or local long-term care ombudsman
  796  council has shall have the right to enter unannounced upon and
  797  into the premises of any facility licensed pursuant to this part
  798  in order to determine the state of compliance with the
  799  provisions of this part, part II of chapter 408, and applicable
  800  rules. Data collected by the state or local long-term care
  801  ombudsman councils or the state or local advocacy councils may
  802  be used by the agency in investigations involving violations of
  803  regulatory standards. A person specified in this section who
  804  knows or has reasonable cause to suspect that a vulnerable adult
  805  has been or is being abused, neglected, or exploited shall
  806  immediately report such knowledge or suspicion to the central
  807  abuse hotline pursuant to chapter 415.
  808         (2) The agency shall inspect each licensed assisted living
  809  facility at least once every 24 months to determine compliance
  810  with this chapter and related rules. If an assisted living
  811  facility is cited for one or more class I violations or two or
  812  more class II violations arising from separate surveys within a
  813  60-day period or due to unrelated circumstances during the same
  814  survey, the agency must conduct an additional licensure
  815  inspection within 6 months.
  816         Section 15. Subsection (2) of section 429.41, Florida
  817  Statutes, is amended to read:
  818         429.41 Rules establishing standards.—
  819         (2) In adopting any rules pursuant to this part, the
  820  department, in conjunction with the agency, shall make distinct
  821  standards for facilities based upon facility size; the types of
  822  care provided; the physical and mental capabilities and needs of
  823  residents; the type, frequency, and amount of services and care
  824  offered; and the staffing characteristics of the facility. Rules
  825  developed pursuant to this section may shall not restrict the
  826  use of shared staffing and shared programming in facilities that
  827  are part of retirement communities that provide multiple levels
  828  of care and otherwise meet the requirements of law and rule. If
  829  a continuing care facility licensed under chapter 651 or a
  830  retirement community offering multiple levels of care obtains a
  831  license pursuant to this chapter for a building or part of a
  832  building designated for independent living, staffing
  833  requirements established in rule apply only to residents who
  834  receive personal services, limited nursing services, or extended
  835  congregate care services under this part. Such facilities shall
  836  retain a log listing the names and unit number for residents
  837  receiving these services. The log must be available to surveyors
  838  upon request. Except for uniform firesafety standards, the
  839  department shall adopt by rule separate and distinct standards
  840  for facilities with 16 or fewer beds and for facilities with 17
  841  or more beds. The standards for facilities with 16 or fewer beds
  842  must shall be appropriate for a noninstitutional residential
  843  environment; however, provided that the structure may not be is
  844  no more than two stories in height and all persons who cannot
  845  exit the facility unassisted in an emergency must reside on the
  846  first floor. The department, in conjunction with the agency, may
  847  make other distinctions among types of facilities as necessary
  848  to enforce the provisions of this part. Where appropriate, the
  849  agency shall offer alternate solutions for complying with
  850  established standards, based on distinctions made by the
  851  department and the agency relative to the physical
  852  characteristics of facilities and the types of care offered
  853  therein.
  854         Section 16. Present subsections (1) through (11) of section
  855  429.52, Florida Statutes, are redesignated as subsections (2)
  856  through (12), respectively, a new subsection (1) is added to
  857  that section, and present subsections (5) and (9) of that
  858  section are amended, to read:
  859         429.52 Staff training and educational programs; core
  860  educational requirement.—
  861         (1) Effective October 1, 2015, each new assisted living
  862  facility employee who has not previously completed core training
  863  must attend a preservice orientation provided by the facility
  864  before interacting with residents. The preservice orientation
  865  must be at least 2 hours in duration and cover topics that help
  866  the employee provide responsible care and respond to the needs
  867  of facility residents. Upon completion, the employee and the
  868  administrator of the facility must sign a statement that the
  869  employee completed the required preservice orientation. The
  870  facility must keep the signed statement in the employee’s
  871  personnel record.
  872         (6)(5) Staff involved with the management of medications
  873  and assisting with the self-administration of medications under
  874  s. 429.256 must complete a minimum of 6 4 additional hours of
  875  training provided by a registered nurse, licensed pharmacist, or
  876  department staff. The department shall establish by rule the
  877  minimum requirements of this additional training.
  878         (10)(9) The training required by this section other than
  879  the preservice orientation must shall be conducted by persons
  880  registered with the department as having the requisite
  881  experience and credentials to conduct the training. A person
  882  seeking to register as a trainer must provide the department
  883  with proof of completion of the minimum core training education
  884  requirements, successful passage of the competency test
  885  established under this section, and proof of compliance with the
  886  continuing education requirement in subsection (5)(4).
  887         Section 17. Section 429.55, Florida Statutes, is created to
  888  read:
  889         429.55Consumer information website.—The Legislature finds
  890  that consumers need additional information on the quality of
  891  care and service in assisted living facilities in order to
  892  select the best facility for themselves or their loved ones.
  893  Therefore, the Agency for Health Care Administration shall
  894  create a content link that is easily accessible and prominently
  895  displayed on the home page of the agency’s website to provide
  896  consumer information on assisted living facilities. The website
  897  must be searchable by facility name, license type, city, or zip
  898  code. By November 1, 2015, the agency shall include all content
  899  in its possession on the website and add content when received
  900  from facilities. At a minimum, the content must include:
  901         (1)Information on each licensed assisted living facility,
  902  including, but not limited to:
  903         (a)The name and address of the facility.
  904         (b)The name of the owner or operator of the facility.
  905         (c)The number and type of licensed beds in the facility.
  906         (d)The types of licenses held by the facility.
  907         (e)The facility’s license expiration date and status.
  908         (f)The total number of clients that the facility is
  909  licensed to serve and the most recently available occupancy
  910  levels.
  911         (g)The number of private and semiprivate rooms offered.
  912         (h)The bed-hold policy.
  913         (i)The religious affiliation, if any, of the assisted
  914  living facility.
  915         (j)The languages spoken by the staff.
  916         (k)Availability of nurses.
  917         (l)Forms of payment accepted, including, but not limited
  918  to, Medicaid, Medicaid long-term managed care, private
  919  insurance, health maintenance organization, United States
  920  Department of Veterans Affairs, CHAMPUS program, or workers’
  921  compensation coverage.
  922         (m)Indication if the licensee is operating under
  923  bankruptcy protection.
  924         (n)Recreational and other programs available.
  925         (o)Special care units or programs offered.
  926         (p)Whether the facility is a part of a retirement
  927  community that offers other services pursuant to this part or
  928  part III of this chapter, part II or part III of chapter 400, or
  929  chapter 651.
  930         (q)Links to the State Long-Term Care Ombudsman Program
  931  website and the program’s statewide toll-free telephone number.
  932         (r)Links to the websites of the providers.
  933         (s)Other relevant information that the agency currently
  934  collects.
  935         (2)Survey and violation information for the facility,
  936  including a list of the facility’s violations committed during
  937  the previous 60 months, which on July 1, 2015, may include
  938  violations committed on or after July 1, 2010. The list shall be
  939  updated monthly and include for each violation:
  940         (a)A summary of the violation, including all licensure,
  941  revisit, and complaint survey information, presented in a manner
  942  understandable by the general public.
  943         (b)Any sanctions imposed by final order.
  944         (c)The date the corrective action was confirmed by the
  945  agency.
  946         (3)Links to inspection reports that the agency has on
  947  file.
  948         (4)The agency may adopt rules to administer this section.
  949         Section 18. This act shall take effect July 1, 2015.