Florida Senate - 2018                                     SB 724
       By Senator Garcia
       36-00586-18                                            2018724__
    1                        A bill to be entitled                      
    2         An act relating to hospice care; amending s. 400.6005,
    3         F.S.; revising legislative findings and intent;
    4         amending s. 400.601, F.S.; redefining the term
    5         “hospice”; defining the terms “hospice program” and
    6         “seriously ill”; amending s. 400.609, F.S.; clarifying
    7         provisions relating to hospice services; creating s.
    8         400.6093, F.S.; authorizing hospices, or providers
    9         operating under contract with a hospice, to provide
   10         palliative care to seriously ill patients and their
   11         family members; providing construction; amending s.
   12         400.6095, F.S.; making technical changes; providing an
   13         effective date.
   15  Be It Enacted by the Legislature of the State of Florida:
   17         Section 1. Section 400.6005, Florida Statutes, is amended
   18  to read:
   19         400.6005 Legislative findings and intent.—The Legislature
   20  finds that a terminally ill patient individuals and their
   21  families, who is are no longer pursuing curative medical
   22  treatment and the patient’s family, should have the opportunity
   23  to select a support system that allows permits the patient to
   24  exercise maximum independence and dignity during the final days
   25  of life. The Legislature also finds that a seriously ill patient
   26  and the patient’s family should have the opportunity to select a
   27  support system that provides palliative care and supportive care
   28  and allows the patient to exercise maximum independence while
   29  receiving such care. The Legislature finds that hospice care
   30  provides a cost-effective and less intrusive form of medical
   31  care while meeting the social, psychological, and spiritual
   32  needs of terminally ill and seriously ill patients and their
   33  families. The intent of this part is to provide for the
   34  development, establishment, and enforcement of basic standards
   35  to ensure the safe and adequate care of persons receiving
   36  hospice services.
   37         Section 2. Section 400.601, Florida Statutes, is amended to
   38  read:
   39         400.601 Definitions.—As used in this part, the term:
   40         (1) “Agency” means the Agency for Health Care
   41  Administration.
   42         (2) “Department” means the Department of Elderly Affairs.
   43         (3) “Hospice” means a centrally administered corporation or
   44  a limited liability company that provides a continuum of
   45  palliative care and supportive care for a the terminally ill
   46  patient and his or her family.
   47         (4) “Hospice care team” means an interdisciplinary team of
   48  qualified professionals and volunteers who, in consultation with
   49  a the patient, the patient’s family, and the patient’s primary
   50  or attending physician, collectively assess, coordinate, and
   51  provide the appropriate palliative care and supportive care to
   52  hospice patients and their families.
   53         (5) “Hospice program” means a program offered by a hospice
   54  which provides a continuum of palliative care and supportive
   55  care for a patient and his or her family.
   56         (6)(5) “Hospice residential unit” means a homelike living
   57  facility, other than a facility licensed under other parts of
   58  this chapter, under chapter 395, or under chapter 429, which
   59  that is operated by a hospice for the benefit of its patients
   60  and is considered by a patient who lives there to be his or her
   61  primary residence.
   62         (7)(6) “Hospice services” means items and services
   63  furnished to a terminally ill patient and family by a hospice,
   64  or by others under arrangements with such a program, in a place
   65  of temporary or permanent residence used as the patient’s home
   66  for the purpose of maintaining the patient at home; or, if the
   67  patient needs short-term institutionalization, the services are
   68  shall be furnished in cooperation with those contracted
   69  institutions or in the hospice inpatient facility.
   70         (8)(7) “Palliative care” means services or interventions
   71  furnished to a seriously ill patient and family which are not
   72  curative but are provided for the reduction or abatement of pain
   73  and human suffering.
   74         (9)(8) “Patient” means the terminally ill or seriously ill
   75  individual receiving hospice services from a hospice.
   76         (10)(9) “Plan of care” means a written assessment by the
   77  hospice of each patient’s and family’s needs and preferences,
   78  and the services to be provided by the hospice to meet those
   79  needs.
   80         (11) “Seriously ill” means that the person has a life
   81  threatening medical condition that may be irreversible and may
   82  continue indefinitely, and which may be managed through
   83  palliative care.
   84         (12)(10) “Terminally ill” means that the patient has a
   85  medical prognosis that his or her life expectancy is 1 year or
   86  less if the illness runs its normal course.
   87         Section 3. Section 400.609, Florida Statutes, is amended to
   88  read:
   89         400.609 Hospice services.—Each hospice shall provide a
   90  continuum of hospice services which affords afford the
   91  terminally ill patient and the family of the patient a range of
   92  service delivery which can be tailored to specific needs and
   93  preferences of the terminally ill patient and family at any
   94  point in time throughout the length of care for the terminally
   95  ill patient and during the bereavement period. These services
   96  must be available 24 hours a day, 7 days a week, and must
   97  include:
   98         (1) SERVICES.—
   99         (a) The hospice care team shall directly provide the
  100  following core services: nursing services, social work services,
  101  pastoral or counseling services, dietary counseling, and
  102  bereavement counseling services. Physician services may be
  103  provided by the hospice directly or through contract. A hospice
  104  may also use contracted staff if necessary to supplement hospice
  105  employees in order to meet the needs of patients during periods
  106  of peak patient loads or under extraordinary circumstances.
  107         (b) Each hospice must also provide or arrange for such
  108  additional services as are needed to meet the palliative and
  109  support needs of the patient and family. These services may
  110  include, but are not limited to, physical therapy, occupational
  111  therapy, speech therapy, massage therapy, home health aide
  112  services, infusion therapy, provision of medical supplies and
  113  durable medical equipment, day care, homemaker and chore
  114  services, and funeral services.
  115         (2) HOSPICE HOME CARE.—Hospice care and services provided
  116  in a private home shall be the primary form of care. The goal of
  117  hospice home care shall be to provide adequate training and
  118  support to encourage self-sufficiency and allow patients and
  119  families to maintain the patient comfortably at home for as long
  120  as possible. The services of the hospice home care program shall
  121  be of the highest quality and shall be provided by the hospice
  122  care team.
  123         (3) HOSPICE RESIDENTIAL CARE.—Hospice care and services, to
  124  the extent practicable and compatible with the needs and
  125  preferences of the patient, may be provided by the hospice care
  126  team to a patient living in an assisted living facility, adult
  127  family-care home, nursing home, hospice residential unit or
  128  facility, or other nondomestic place of permanent or temporary
  129  residence. A resident or patient living in an assisted living
  130  facility, adult family-care home, nursing home, or other
  131  facility subject to state licensing who has been admitted to a
  132  hospice program shall be considered a hospice patient, and the
  133  hospice program shall be responsible for coordinating and
  134  ensuring the delivery of hospice care and services to such
  135  person pursuant to the standards and requirements of this part
  136  and rules adopted under this part.
  137         (4) HOSPICE INPATIENT CARE.—The inpatient component of care
  138  is a short-term adjunct to hospice home care and hospice
  139  residential care and shall be used only for pain control,
  140  symptom management, or respite care. The total number of
  141  inpatient days for all hospice patients in any 12-month period
  142  may not exceed 20 percent of the total number of hospice days
  143  for all the hospice patients of the licensed hospice. Hospice
  144  inpatient care shall be under the direct administration of the
  145  hospice, whether the inpatient facility is a freestanding
  146  hospice facility or part of a facility licensed pursuant to
  147  chapter 395 or part II of this chapter. The facility or rooms
  148  within a facility used for the hospice inpatient component of
  149  care shall be arranged, administered, and managed in such a
  150  manner as to provide privacy, dignity, comfort, warmth, and
  151  safety for the terminally ill patient and the family. Every
  152  possible accommodation must be made to create as homelike an
  153  atmosphere as practicable. To facilitate overnight family
  154  visitation within the facility, rooms must be limited to no more
  155  than double occupancy; and, whenever possible, both occupants
  156  must be hospice patients. There must be a continuum of care and
  157  a continuity of caregivers between the hospice home program and
  158  the inpatient aspect of care to the extent practicable and
  159  compatible with the preferences of the patient and his or her
  160  family. Fees charged for hospice inpatient care, whether
  161  provided directly by the hospice or through contract, must be
  162  made available upon request to the Agency for Health Care
  163  Administration. The hours for daily operation and the location
  164  of the place where the services are provided must be determined,
  165  to the extent practicable, by the accessibility of such services
  166  to the patients and families served by the hospice.
  167         (5) BEREAVEMENT COUNSELING.—The hospice bereavement program
  168  must be a comprehensive program, under professional supervision,
  169  that provides a continuum of formal and informal supportive
  170  services to the family for a minimum of 1 year after the
  171  patient’s death. This subsection does not constitute an
  172  additional exemption from chapter 490 or chapter 491.
  173         Section 4. Section 400.6093, Florida Statutes, is created
  174  to read:
  175         400.6093 Community palliative care services.—A hospice may
  176  provide palliative care to a seriously ill patient and his or
  177  her family members. Such palliative care may be provided to
  178  manage the side effects of treatment for a progressive disease
  179  or medical or surgical condition. Such care may be provided
  180  directly by the hospice or by other providers under contract
  181  with the hospice. This section does not preclude the provision
  182  of palliative care to seriously ill patients or their family
  183  members by any other health care provider or health care
  184  facility otherwise authorized to provide such care. This section
  185  does not mandate or prescribe additional Medicaid coverage.
  186         Section 5. Subsections (1) and (2) of section 400.6095,
  187  Florida Statutes, are amended to read:
  188         400.6095 Patient admission; assessment; plan of care;
  189  discharge; death.—
  190         (1) Each hospice shall make its services available to all
  191  terminally ill patients persons and their families without
  192  regard to age, gender, national origin, sexual orientation,
  193  disability, diagnosis, cost of therapy, ability to pay, or life
  194  circumstances. A hospice may shall not impose any value or
  195  belief system on its patients or their families and shall
  196  respect the values and belief systems of its patients and their
  197  families.
  198         (2) Admission of a terminally ill patient to a hospice
  199  program shall be made upon a diagnosis and prognosis of terminal
  200  illness by a physician licensed pursuant to chapter 458 or
  201  chapter 459 and must shall be dependent on the expressed request
  202  and informed consent of the patient.
  203         Section 6. This act shall take effect July 1, 2018.