Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. SB 474
Ì4795709Î479570
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/27/2017 .
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The Committee on Health Policy (Grimsley) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 400.6005, Florida Statutes, is amended
6 to read:
7 400.6005 Legislative findings and intent.—The Legislature
8 finds that a terminally ill patient individuals and their
9 families, who is are no longer pursuing curative medical
10 treatment and the patient’s family, should have the opportunity
11 to select a support system that allows permits the patient to
12 exercise maximum independence and dignity during the final days
13 of life. The Legislature also finds that a seriously ill patient
14 and the patient’s family should have the opportunity to select a
15 support system that provides palliative care and supportive care
16 and allows the patient to exercise maximum independence while
17 receiving such care. The Legislature finds that hospice care
18 provides a cost-effective and less intrusive form of medical
19 care while meeting the social, psychological, and spiritual
20 needs of terminally ill and seriously ill patients and their
21 families. The intent of this part is to provide for the
22 development, establishment, and enforcement of basic standards
23 to ensure the safe and adequate care of persons receiving
24 hospice services.
25 Section 2. Section 400.601, Florida Statutes, is amended to
26 read:
27 400.601 Definitions.—As used in this part, the term:
28 (1) “Agency” means the Agency for Health Care
29 Administration.
30 (2) “Department” means the Department of Elderly Affairs.
31 (3) “Hospice” means a centrally administered corporation or
32 a limited liability company that provides a continuum of
33 palliative care and supportive care for a the terminally ill
34 patient and his or her family.
35 (4) “Hospice care team” means an interdisciplinary team of
36 qualified professionals and volunteers who, in consultation with
37 a the patient, the patient’s family, and the patient’s primary
38 or attending physician, collectively assess, coordinate, and
39 provide the appropriate palliative care and supportive care to
40 hospice patients and their families.
41 (5) “Hospice program” means a program offered by a hospice
42 which provides a continuum of palliative care and supportive
43 care for a patient and his or her family.
44 (6)(5) “Hospice residential unit” means a homelike living
45 facility, other than a facility licensed under other parts of
46 this chapter, under chapter 395, or under chapter 429, which
47 that is operated by a hospice for the benefit of its patients
48 and is considered by a patient who lives there to be his or her
49 primary residence.
50 (7)(6) “Hospice services” means items and services
51 furnished to a terminally ill patient and family by a hospice,
52 or by others under arrangements with such a program, in a place
53 of temporary or permanent residence used as the patient’s home
54 for the purpose of maintaining the patient at home; or, if the
55 patient needs short-term institutionalization, the services
56 shall be furnished in cooperation with those contracted
57 institutions or in the hospice inpatient facility.
58 (8)(7) “Palliative care” means services or interventions
59 furnished to a seriously ill patient and family which are not
60 curative but are provided for the reduction or abatement of pain
61 and human suffering.
62 (9)(8) “Patient” means the terminally or seriously ill
63 individual receiving hospice services from a hospice.
64 (10)(9) “Plan of care” means a written assessment by the
65 hospice of each patient’s and family’s needs and preferences,
66 and the services to be provided by the hospice to meet those
67 needs.
68 (11) “Seriously ill” means that the person has a life
69 threatening medical condition that may be irreversible and may
70 continue indefinitely, and such condition may be managed through
71 palliative care.
72 (12)(10) “Terminally ill” means that the patient has a
73 medical prognosis that his or her life expectancy is 1 year or
74 less if the illness runs its normal course.
75 Section 3. Section 400.60501, Florida Statutes, is amended
76 to read:
77 400.60501 Outcome measures; adoption of federal quality
78 measures; public reporting national initiatives; annual report.—
79 (1) No later than December 31, 2019 2007, the department of
80 Elderly Affairs, in conjunction with the agency for Health Care
81 Administration, shall develop adopt the national hospice outcome
82 measures in 42 C.F.R. part 418 to determine the quality and
83 effectiveness of hospice care for hospices licensed in the
84 state. At a minimum, these outcome measures shall include a
85 requirement that 50 percent of patients who report severe pain
86 on a 0-to-10 scale must report a reduction to 5 or less by the
87 end of the 4th day of care on the hospice program.
88 (2) For hospices licensed in the state, The department of
89 Elderly Affairs, in conjunction with the agency for Health Care
90 Administration, shall:
91 (a) Make available to the public the national hospice
92 outcome measures in a format that is comprehensible by a
93 layperson and that allows a consumer to compare such measures of
94 one or more hospices. Consider and adopt national initiatives,
95 such as those developed by the national hospice and Palliative
96 Care Organization, to set benchmarks for measuring the quality
97 of hospice care provided in the state.
98 (b) Develop an annual report that analyzes and evaluates
99 the information collected under this act and any other data
100 collection or reporting provisions of law.
101 Section 4. Section 400.609, Florida Statutes, is amended to
102 read:
103 400.609 Hospice services.—Each hospice shall provide a
104 continuum of hospice services which affords afford the
105 terminally ill patient and the family of the patient a range of
106 service delivery which can be tailored to specific needs and
107 preferences of the terminally ill patient and family at any
108 point in time throughout the length of care for the terminally
109 ill patient and during the bereavement period. These services
110 must be available 24 hours a day, 7 days a week, and must
111 include:
112 (1) SERVICES.—
113 (a) The hospice care team shall directly provide the
114 following core services: nursing services, social work services,
115 pastoral or counseling services, dietary counseling, and
116 bereavement counseling services. Physician services may be
117 provided by the hospice directly or through contract. A hospice
118 may also use contracted staff if necessary to supplement hospice
119 employees in order to meet the needs of patients during periods
120 of peak patient loads or under extraordinary circumstances.
121 (b) Each hospice must also provide or arrange for such
122 additional services as are needed to meet the palliative and
123 support needs of the patient and family. These services may
124 include, but are not limited to, physical therapy, occupational
125 therapy, speech therapy, massage therapy, home health aide
126 services, infusion therapy, provision of medical supplies and
127 durable medical equipment, day care, homemaker and chore
128 services, and funeral services.
129 (2) HOSPICE HOME CARE.—Hospice care and services provided
130 in a private home shall be the primary form of care. The goal of
131 hospice home care shall be to provide adequate training and
132 support to encourage self-sufficiency and allow patients and
133 families to maintain the patient comfortably at home for as long
134 as possible. The services of the hospice home care program shall
135 be of the highest quality and shall be provided by the hospice
136 care team.
137 (3) HOSPICE RESIDENTIAL CARE.—Hospice care and services, to
138 the extent practicable and compatible with the needs and
139 preferences of the patient, may be provided by the hospice care
140 team to a patient living in an assisted living facility, adult
141 family-care home, nursing home, hospice residential unit or
142 facility, or other nondomestic place of permanent or temporary
143 residence. A resident or patient living in an assisted living
144 facility, adult family-care home, nursing home, or other
145 facility subject to state licensing who has been admitted to a
146 hospice program shall be considered a hospice patient, and the
147 hospice program shall be responsible for coordinating and
148 ensuring the delivery of hospice care and services to such
149 person pursuant to the standards and requirements of this part
150 and rules adopted under this part.
151 (4) HOSPICE INPATIENT CARE.—The inpatient component of care
152 is a short-term adjunct to hospice home care and hospice
153 residential care and shall be used only for pain control,
154 symptom management, or respite care. The total number of
155 inpatient days for all hospice patients in any 12-month period
156 may not exceed 20 percent of the total number of hospice days
157 for all the hospice patients of the licensed hospice. Hospice
158 inpatient care shall be under the direct administration of the
159 hospice, whether the inpatient facility is a freestanding
160 hospice facility or part of a facility licensed pursuant to
161 chapter 395 or part II of this chapter. The facility or rooms
162 within a facility used for the hospice inpatient component of
163 care shall be arranged, administered, and managed in such a
164 manner as to provide privacy, dignity, comfort, warmth, and
165 safety for the terminally ill patient and the family. Every
166 possible accommodation must be made to create as homelike an
167 atmosphere as practicable. To facilitate overnight family
168 visitation within the facility, rooms must be limited to no more
169 than double occupancy; and, whenever possible, both occupants
170 must be hospice patients. There must be a continuum of care and
171 a continuity of caregivers between the hospice home program and
172 the inpatient aspect of care to the extent practicable and
173 compatible with the preferences of the patient and his or her
174 family. Fees charged for hospice inpatient care, whether
175 provided directly by the hospice or through contract, must be
176 made available upon request to the Agency for Health Care
177 Administration. The hours for daily operation and the location
178 of the place where the services are provided must be determined,
179 to the extent practicable, by the accessibility of such services
180 to the patients and families served by the hospice.
181 (5) BEREAVEMENT COUNSELING.—The hospice bereavement program
182 must be a comprehensive program, under professional supervision,
183 that provides a continuum of formal and informal supportive
184 services to the family for a minimum of 1 year after the
185 patient’s death. This subsection does not constitute an
186 additional exemption from chapter 490 or chapter 491.
187 Section 5. Section 400.6093, Florida Statutes, is created
188 to read:
189 400.6093 Community palliative care services.—A hospice may
190 provide palliative care to a seriously ill patient and his or
191 her family members. Such palliative care may be provided to
192 manage the side effects of treatment for a progressive disease
193 or medical or surgical condition. Such care may also be provided
194 directly by the hospice or by other providers under contract
195 with the hospice. This section does not preclude the provision
196 of palliative care to seriously ill patients or their family
197 members by any other health care provider or health care
198 facility otherwise authorized to provide such care. This section
199 does not mandate or prescribe additional Medicaid coverage.
200 Section 6. Subsections (1) and (2) of section 400.6095,
201 Florida Statutes, are amended to read:
202 400.6095 Patient admission; assessment; plan of care;
203 discharge; death.—
204 (1) Each hospice shall make its services available to all
205 terminally ill patients persons and their families without
206 regard to age, gender, national origin, sexual orientation,
207 disability, diagnosis, cost of therapy, ability to pay, or life
208 circumstances. A hospice may shall not impose any value or
209 belief system on its patients or their families and shall
210 respect the values and belief systems of its patients and their
211 families.
212 (2) Admission of a terminally ill patient to a hospice
213 program shall be made upon a diagnosis and prognosis of terminal
214 illness by a physician licensed pursuant to chapter 458 or
215 chapter 459 and must shall be dependent on the expressed request
216 and informed consent of the patient.
217 Section 7. Section 400.6096, Florida Statutes, is created
218 to read:
219 400.6096 Disposal of prescribed controlled substances
220 following the death of a patient in the home.—
221 (1) A hospice physician, nurse, or social worker is
222 authorized to assist in the disposal of a controlled substance
223 prescribed to a patient at the time of the patient’s death
224 pursuant to the disposal regulations in 21 C.F.R. s. 1317.
225 (2) A hospice that assists in the disposal of a prescribed
226 controlled substance found in the patient’s home at the time of
227 the patient’s death must establish a written policy, procedure,
228 or system for acceptable disposal methods.
229 (3) A hospice physician, nurse, or social worker, upon the
230 patient’s death and with the permission of a family member or a
231 caregiver of the patient, may assist in the disposal of an
232 unused controlled substance prescribed to the patient, pursuant
233 to the written policy, procedure, or system established under
234 subsection (2).
235 (4) The prescribed controlled substance disposal procedure
236 must be carried out in the patient’s home. Hospice staff and
237 volunteers are not authorized to remove a prescribed controlled
238 substance from the patient’s home.
239 Section 8. Section 400.611, Florida Statutes, is amended to
240 read:
241 400.611 Interdisciplinary records of care; confidentiality;
242 release of records.—
243 (1) A hospice shall maintain an up-to-date,
244 interdisciplinary record of care being given and patient and
245 family status shall be kept. Records shall contain pertinent
246 past and current medical, nursing, social, and other therapeutic
247 information and such other information that is necessary for the
248 safe and adequate care of the patient. Notations regarding all
249 aspects of care for the patient and family shall be made in the
250 record. When services are terminated, the record shall show the
251 date and reason for termination.
252 (2) Patient records shall be retained for a period of 5 6
253 years after termination of hospice services, unless otherwise
254 provided by law. In the case of a patient who is a minor, the 5
255 6-year period shall begin on the date the patient reaches or
256 would have reached the age of majority.
257 (3) The interdisciplinary record of patient records of care
258 and billing records are confidential.
259 (4) A hospice may not release a patient’s interdisciplinary
260 record or any portion thereof, unless the person requesting the
261 information provides to the hospice:
262 (a) A patient authorization executed by the patient; or
263 legal guardian has given express written informed consent;
264 (b) If the patient is incapacitated, a patient
265 authorization executed before the patient’s death by the
266 patient’s then acting legal guardian, health care surrogate,
267 health care proxy, or agent under power of attorney;
268 (c) A court order appointing the person as the
269 administrator, curator, executor, or personal representative of
270 the patient’s estate with authority to obtain the patient’s
271 medical records;
272 (d) If a judicial appointment has not been made pursuant to
273 paragraph (c), a last will that is self-proved under s. 732.503
274 and designates the person to act as the patient’s personal
275 representative; or
276 (e) An order by a court of competent jurisdiction to
277 release the interdisciplinary record to the person has so
278 ordered; or
279 (c) A state or federal agency, acting under its statutory
280 authority, requires submission of aggregate statistical data.
281 Any information obtained from patient records by a state agency
282 pursuant to its statutory authority is confidential and exempt
283 from the provisions of s. 119.07(1).
284 (5) For purposes of this section, the term “patient
285 authorization” means an unrevoked written statement by the
286 patient, or an oral statement made by the patient which has been
287 reduced to writing in the patient’s interdisciplinary record of
288 care, or, in the case of an incapacitated patient, by the
289 patient’s then acting legal guardian, health care surrogate,
290 agent under a power of attorney, or health care proxy giving the
291 patient’s permission to release the interdisciplinary record to
292 a person requesting the record.
293 (6) A hospice must release requested aggregate patient
294 statistical data to a state or federal agency acting under its
295 statutory authority. Any information obtained from patient
296 records by a state agency pursuant to its statutory authority is
297 confidential and exempt from s. 119.07(1).
298 Section 9. This act shall take effect July 1, 2017.
299
300 ================= T I T L E A M E N D M E N T ================
301 And the title is amended as follows:
302 Delete everything before the enacting clause
303 and insert:
304 A bill to be entitled
305 An act relating to hospice care; amending s. 400.6005,
306 F.S.; revising legislative findings and intent;
307 amending s. 400.601, F.S.; redefining the term
308 “hospice”; defining the terms “hospice program” and
309 “seriously ill”; amending s. 400.60501, F.S.;
310 requiring the Department of Elderly Affairs, in
311 conjunction with the Agency for Health Care
312 Administration, to adopt national hospice outcome
313 measures by a specified date and to make such measures
314 available to the public; amending s. 400.609;
315 clarifying provisions relating to hospice services;
316 creating s. 400.6093, F.S.; authorizing hospices, or
317 providers operating under contract with a hospice, to
318 provide palliative care to seriously ill persons and
319 their family members; providing construction; amending
320 s. 400.6095, F.S.; making technical changes; creating
321 s. 400.6096, F.S.; authorizing certain hospice
322 personnel to assist in the disposal of certain
323 prescribed controlled substances; requiring a hospice
324 that chooses to assist in the disposal of certain
325 prescribed controlled substances to establish
326 policies, procedures, and systems for the disposal;
327 authorizing a hospice physician, nurse, or social
328 worker to assist in the disposals of certain
329 prescribed controlled substances; providing
330 requirements for such disposals; amending s. 400.611,
331 F.S.; requiring a hospice to maintain an up-to-date
332 interdisciplinary record of care; revising the patient
333 records retention period; providing for the
334 confidentiality of the interdisciplinary record of
335 patient care; specifying to whom and under what
336 conditions a hospice may release a patient’s
337 interdisciplinary record of care; defining a term;
338 requiring a hospice to release patient statistical
339 data to certain agencies; specifying that information
340 from patient records is confidential and exempt from
341 certain provisions; providing an effective date.