Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. SB 402
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Health Policy (Harrell) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete lines 645 - 889
    4  and insert:
    5  the condition. If there is no resident representative or
    6  designee, or he or she cannot be located or is unresponsive, the
    7  facility shall arrange, with the appropriate health care
    8  provider, the necessary care and services to treat the
    9  condition.
   10         (9)(8) The Department of Children and Families may require
   11  an examination for supplemental security income and optional
   12  state supplementation recipients residing in facilities at any
   13  time and shall provide the examination whenever a resident’s
   14  condition requires it. Any facility administrator; personnel of
   15  the agency, the department, or the Department of Children and
   16  Families; or a representative of the State Long-Term Care
   17  Ombudsman Program who believes a resident needs to be evaluated
   18  shall notify the resident’s case manager, who shall take
   19  appropriate action. A report of the examination findings must
   20  shall be provided to the resident’s case manager and the
   21  facility administrator to help the administrator meet his or her
   22  responsibilities under subsection (1).
   23         (9)A terminally ill resident who no longer meets the
   24  criteria for continued residency may remain in the facility if
   25  the arrangement is mutually agreeable to the resident and the
   26  facility; additional care is rendered through a licensed
   27  hospice, and the resident is under the care of a physician who
   28  agrees that the physical needs of the resident are being met.
   29         (10) Facilities licensed to provide extended congregate
   30  care services shall promote aging in place by determining
   31  appropriateness of continued residency based on a comprehensive
   32  review of the resident’s physical and functional status; the
   33  ability of the facility, family members, friends, or any other
   34  pertinent individuals or agencies to provide the care and
   35  services required; and documentation that a written service plan
   36  consistent with facility policy has been developed and
   37  implemented to ensure that the resident’s needs and preferences
   38  are addressed.
   39         (11)No resident who requires 24-hour nursing supervision,
   40  except for a resident who is an enrolled hospice patient
   41  pursuant to part IV of chapter 400, shall be retained in a
   42  facility licensed under this part.
   43         Section 9. Paragraphs (a) and (k) of subsection (1) and
   44  subsection (3) of section 429.28, Florida Statutes, are amended
   45  to read:
   46         429.28 Resident bill of rights.—
   47         (1) No resident of a facility shall be deprived of any
   48  civil or legal rights, benefits, or privileges guaranteed by
   49  law, the Constitution of the State of Florida, or the
   50  Constitution of the United States as a resident of a facility.
   51  Every resident of a facility shall have the right to:
   52         (a) Live in a safe and decent living environment, free from
   53  abuse, and neglect, and exploitation.
   54         (k) At least 45 days’ notice of relocation or termination
   55  of residency from the facility unless, for medical reasons, the
   56  resident is certified by a physician to require an emergency
   57  relocation to a facility providing a more skilled level of care
   58  or the resident engages in a pattern of conduct that is harmful
   59  or offensive to other residents. In the case of a resident who
   60  has been adjudicated mentally incapacitated, the guardian shall
   61  be given at least 45 days’ notice of a nonemergency relocation
   62  or residency termination. Reasons for relocation must shall be
   63  set forth in writing and provided to the resident or the
   64  resident’s legal representative. In order for a facility to
   65  terminate the residency of an individual without notice as
   66  provided herein, the facility shall show good cause in a court
   67  of competent jurisdiction.
   68         (3)(a) The agency shall conduct a survey to determine
   69  whether the facility is complying with this section general
   70  compliance with facility standards and compliance with
   71  residents’ rights as a prerequisite to initial licensure or
   72  licensure renewal. The agency shall adopt rules for uniform
   73  standards and criteria that will be used to determine compliance
   74  with facility standards and compliance with residents’ rights.
   75         (b) In order to determine whether the facility is
   76  adequately protecting residents’ rights, the licensure renewal
   77  biennial survey must shall include private informal
   78  conversations with a sample of residents and consultation with
   79  the ombudsman council in the district in which the facility is
   80  located to discuss residents’ experiences within the facility.
   81         Section 10. Section 429.41, Florida Statutes, is amended to
   82  read:
   83         429.41 Rules establishing standards.—
   84         (1) It is the intent of the Legislature that rules
   85  published and enforced pursuant to this section shall include
   86  criteria by which a reasonable and consistent quality of
   87  resident care and quality of life may be ensured and the results
   88  of such resident care may be demonstrated. Such rules shall also
   89  promote ensure a safe and sanitary environment that is
   90  residential and noninstitutional in design or nature and may
   91  allow for technological advances in the provision of care,
   92  safety, and security, including the use of devices, equipment,
   93  and other security measures related to wander management,
   94  emergency response, staff risk management, and the general
   95  safety and security of residents, staff, and the facility. It is
   96  further intended that reasonable efforts be made to accommodate
   97  the needs and preferences of residents to enhance the quality of
   98  life in a facility. Uniform firesafety standards for assisted
   99  living facilities shall be established by the State Fire Marshal
  100  pursuant to s. 633.206. The agency may adopt rules to administer
  101  part II of chapter 408. In order to provide safe and sanitary
  102  facilities and the highest quality of resident care
  103  accommodating the needs and preferences of residents, The
  104  agency, in consultation with the Department of Children and
  105  Families and the Department of Health, shall adopt rules,
  106  policies, and procedures to administer this part, which must
  107  include reasonable and fair minimum standards in relation to:
  108         (a) The requirements for and maintenance and the sanitary
  109  condition of facilities, not in conflict with, or duplicative
  110  of, rules adopted pursuant to s. 381.006(16) and s. 381.0072 and
  111  standards established under chapter 553 and s. 633.206, relating
  112  to a safe and decent living environment, including furnishings
  113  for resident bedrooms or sleeping areas, locking devices, linens
  114  plumbing, heating, cooling, lighting, ventilation, living space,
  115  and other housing conditions relating to hazards, which will
  116  promote ensure the health, safety, and welfare comfort of
  117  residents suitable to the size of the structure. The rules must
  118  clearly delineate the respective responsibilities of the
  119  agency’s licensure and survey staff and the county health
  120  departments and ensure that inspections are not duplicative. The
  121  agency may collect fees for food service inspections conducted
  122  by county health departments and may transfer such fees to the
  123  Department of Health.
  124         1.Firesafety evacuation capability determination.—An
  125  evacuation capability evaluation for initial licensure shall be
  126  conducted within 6 months after the date of licensure.
  127         2.Firesafety requirements.—
  128         a.The National Fire Protection Association, Life Safety
  129  Code, NFPA 101 and 101A, current editions, shall be used in
  130  determining the uniform firesafety code adopted by the State
  131  Fire Marshal for assisted living facilities, pursuant to s.
  132  633.206.
  133         b.A local government or a utility may charge fees only in
  134  an amount not to exceed the actual expenses incurred by the
  135  local government or the utility relating to the installation and
  136  maintenance of an automatic fire sprinkler system in a licensed
  137  assisted living facility structure.
  138         c.All licensed facilities must have an annual fire
  139  inspection conducted by the local fire marshal or authority
  140  having jurisdiction.
  141         d.An assisted living facility that is issued a building
  142  permit or certificate of occupancy before July 1, 2016, may at
  143  its option and after notifying the authority having
  144  jurisdiction, remain under the provisions of the 1994 and 1995
  145  editions of the National Fire Protection Association, Life
  146  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  147  remain under such provisions may make repairs, modernizations,
  148  renovations, or additions to, or rehabilitate, the facility in
  149  compliance with NFPA 101, 1994 edition, and may utilize the
  150  alternative approaches to life safety in compliance with NFPA
  151  101A, 1995 edition. However, a facility for which a building
  152  permit or certificate of occupancy is issued before July 1,
  153  2016, that undergoes Level III building alteration or
  154  rehabilitation, as defined in the Florida Building Code, or
  155  seeks to utilize features not authorized under the 1994 or 1995
  156  editions of the Life Safety Code must thereafter comply with all
  157  aspects of the uniform firesafety standards established under s.
  158  633.206, and the Florida Fire Prevention Code, in effect for
  159  assisted living facilities as adopted by the State Fire Marshal.
  160         3.Resident elopement requirements.—Facilities are required
  161  to conduct a minimum of two resident elopement prevention and
  162  response drills per year. All administrators and direct care
  163  staff must participate in the drills, which shall include a
  164  review of procedures to address resident elopement. Facilities
  165  must document the implementation of the drills and ensure that
  166  the drills are conducted in a manner consistent with the
  167  facility’s resident elopement policies and procedures.
  168         (b) The preparation and annual update of a comprehensive
  169  emergency management plan. Such standards must be included in
  170  the rules adopted by the agency after consultation with the
  171  Division of Emergency Management. At a minimum, the rules must
  172  provide for plan components that address emergency evacuation
  173  transportation; adequate sheltering arrangements; postdisaster
  174  activities, including provision of emergency power, food, and
  175  water; postdisaster transportation; supplies; staffing;
  176  emergency equipment; individual identification of residents and
  177  transfer of records; communication with families; and responses
  178  to family inquiries. The comprehensive emergency management plan
  179  is subject to review and approval by the county local emergency
  180  management agency. During its review, the county local emergency
  181  management agency shall ensure that the following agencies, at a
  182  minimum, are given the opportunity to review the plan: the
  183  Department of Health, the Agency for Health Care Administration,
  184  and the Division of Emergency Management. Also, appropriate
  185  volunteer organizations must be given the opportunity to review
  186  the plan. The county local emergency management agency shall
  187  complete its review within 60 days and either approve the plan
  188  or advise the facility of necessary revisions. A facility must
  189  submit a comprehensive emergency management plan to the county
  190  emergency management agency within 30 days after issuance of a
  191  license.
  192         (c) The number, training, and qualifications of all
  193  personnel having responsibility for the care of residents. The
  194  rules must require adequate staff to provide for the safety of
  195  all residents. Facilities licensed for 17 or more residents are
  196  required to maintain an alert staff for 24 hours per day.
  197         (d)All sanitary conditions within the facility and its
  198  surroundings which will ensure the health and comfort of
  199  residents. The rules must clearly delineate the responsibilities
  200  of the agency’s licensure and survey staff, the county health
  201  departments, and the local authority having jurisdiction over
  202  firesafety and ensure that inspections are not duplicative. The
  203  agency may collect fees for food service inspections conducted
  204  by the county health departments and transfer such fees to the
  205  Department of Health.
  206         (d)(e) License application and license renewal, transfer of
  207  ownership, proper management of resident funds and personal
  208  property, surety bonds, resident contracts, refund policies,
  209  financial ability to operate, and facility and staff records.
  210         (e)(f) Inspections, complaint investigations, moratoriums,
  211  classification of deficiencies, levying and enforcement of
  212  penalties, and use of income from fees and fines.
  213         (f)(g) The enforcement of the resident bill of rights
  214  specified in s. 429.28.
  215         (g)(h) The care and maintenance of residents provided by
  216  the facility, which must include, but is not limited to:
  217         1. The supervision of residents;
  218         2. The provision of personal services;
  219         3. The provision of, or arrangement for, social and leisure
  220  activities;
  221         4. The assistance in making arrangements arrangement for
  222  appointments and transportation to appropriate medical, dental,
  223  nursing, or mental health services, as needed by residents;
  224         5. The management of medication stored within the facility
  225  and as needed by residents;
  226         6. The dietary nutritional needs of residents;
  227         7. Resident records; and
  228         8. Internal risk management and quality assurance.
  229         (h)(i) Facilities holding a limited nursing, extended
  230  congregate care, or limited mental health license.
  231         (i)(j) The establishment of specific criteria to define
  232  appropriateness of resident admission and continued residency in
  233  a facility holding a standard, limited nursing, extended
  234  congregate care, and limited mental health license.
  235         (j)(k) The use of physical or chemical restraints. The use
  236  of geriatric chairs or Posey restraints is prohibited. Other
  237  physical restraints may be used in accordance with agency rules
  238  when ordered is limited to half-bed rails as prescribed and
  239  documented by the resident’s physician and consented to by with
  240  the consent of the resident or, if applicable, the resident’s
  241  representative or designee or the resident’s surrogate,
  242  guardian, or attorney in fact. Such rules must specify
  243  requirements for care planning, staff monitoring, and periodic
  244  review by a physician. The use of chemical restraints is limited
  245  to prescribed dosages of medications authorized by the
  246  resident’s physician and must be consistent with the resident’s
  247  diagnosis. Residents who are receiving medications that can
  248  serve as chemical restraints must be evaluated by their
  249  physician at least annually to assess:
  250         1. The continued need for the medication.
  251         2. The level of the medication in the resident’s blood.
  252         3. The need for adjustments in the prescription.
  253         (k)(l) The establishment of specific resident elopement
  254  drill requirements, policies, and procedures on resident
  256  ================= T I T L E  A M E N D M E N T ================
  257  And the title is amended as follows:
  258         Delete line 45
  259  and insert:
  260         circumstances; requiring the facility to arrange for
  261         necessary care and services if no resident
  262         representative or designee is available or responsive;
  263         removing provisions relating to the