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 directory and title amendments)
    3         Delete lines 381 - 554
    4  and insert:
    5         (3) Licensed facilities shall provide within 1 business day
    6  after the occurrence of an adverse incident, by electronic mail,
    7  facsimile, or United States mail, a preliminary report to the
    8  agency on all adverse incidents specified under this section.
    9  The report must include information regarding the identity of
   10  the affected resident, the type of adverse incident, and the
   11  result status of the facility’s investigation of the incident.
   12         (4) Licensed facilities shall provide within 15 days, by
   13  electronic mail, facsimile, or United States mail, a full report
   14  to the agency on all adverse incidents specified in this
   15  section. The report must include the results of the facility’s
   16  investigation into the adverse incident.
   17         (5) The agency shall send, by electronic mail, reminders to
   18  the facility’s administrator and other specified facility
   19  contacts 3 business days before the deadline for the submission
   20  of the full report. If the facility determines that the event is
   21  not an adverse incident, the facility must withdraw the
   22  preliminary report. Until 3 business days after the agency
   23  provides the reminder, facilities shall not be subject to any
   24  administrative or other action for failing to file a full report
   25  if the facility determined that the event was not an adverse
   26  incident after filing the preliminary report. Each facility
   27  shall report monthly to the agency any liability claim filed
   28  against it. The report must include the name of the resident,
   29  the dates of the incident leading to the claim, if applicable,
   30  and the type of injury or violation of rights alleged to have
   31  occurred. This report is not discoverable in any civil or
   32  administrative action, except in such actions brought by the
   33  agency to enforce the provisions of this part.
   34         (9) The adverse incident reports and preliminary adverse
   35  incident reports required under this section are confidential as
   36  provided by law and are not discoverable or admissible in any
   37  civil or administrative action, except in disciplinary
   38  proceedings by the agency or appropriate regulatory board.
   39         Section 6. Subsection (4) of section 429.255, Florida
   40  Statutes, is amended to read:
   41         429.255 Use of personnel; emergency care.—
   42         (4) Facility staff may withhold or withdraw cardiopulmonary
   43  resuscitation or the use of an automated external defibrillator
   44  if presented with an order not to resuscitate executed pursuant
   45  to s. 401.45. The agency shall adopt rules providing for the
   46  implementation of such orders. Facility staff and facilities may
   47  not be subject to criminal prosecution or civil liability, nor
   48  be considered to have engaged in negligent or unprofessional
   49  conduct, for withholding or withdrawing cardiopulmonary
   50  resuscitation or use of an automated external defibrillator
   51  pursuant to such an order and rules adopted by the agency. The
   52  absence of an order not to resuscitate executed pursuant to s.
   53  401.45 does not preclude a physician from withholding or
   54  withdrawing cardiopulmonary resuscitation or use of an automated
   55  external defibrillator as otherwise permitted by law.
   56         Section 7. Subsection (2), paragraph (b) of subsection (3),
   57  and paragraphs (e), (f), and (g) of subsection (4) of section
   58  429.256, Florida Statutes, are amended to read:
   59         429.256 Assistance with self-administration of medication.—
   60         (2) Residents who are capable of self-administering their
   61  own medications without assistance shall be encouraged and
   62  allowed to do so. However, an unlicensed person may, consistent
   63  with a dispensed prescription’s label or the package directions
   64  of an over-the-counter medication, assist a resident whose
   65  condition is medically stable with the self-administration of
   66  routine, regularly scheduled medications that are intended to be
   67  self-administered. Assistance with self-medication by an
   68  unlicensed person may occur only upon a documented request by,
   69  and the written informed consent of, a resident or the
   70  resident’s surrogate, guardian, or attorney in fact. For the
   71  purposes of this section, self-administered medications include
   72  both legend and over-the-counter oral dosage forms, topical
   73  dosage forms, transdermal patches, and topical ophthalmic, otic,
   74  and nasal dosage forms including solutions, suspensions, sprays,
   75  and inhalers.
   76         (3) Assistance with self-administration of medication
   77  includes:
   78         (b) In the presence of the resident, confirming that the
   79  medication is intended for that resident, orally advising the
   80  resident of the medication name and purpose reading the label,
   81  opening the container, removing a prescribed amount of
   82  medication from the container, and closing the container.
   83         (4) Assistance with self-administration does not include:
   84         (e) The use of irrigations or debriding agents used in the
   85  treatment of a skin condition.
   86         (f) Assisting with rectal, urethral, or vaginal
   87  preparations.
   88         (g) Assisting with medications ordered by the physician or
   89  health care professional with prescriptive authority to be given
   90  “as needed,” unless the order is written with specific
   91  parameters that preclude independent judgment on the part of the
   92  unlicensed person, and at the request of a competent resident
   93  requesting the medication is aware of his or her need for the
   94  medication and understands the purpose for taking the
   95  medication.
   96         Section 8. Section 429.26, Florida Statutes, is amended to
   97  read:
   98         429.26 Appropriateness of placements; examinations of
   99  residents.—
  100         (1) The owner or administrator of a facility is responsible
  101  for determining the appropriateness of admission of an
  102  individual to the facility and for determining the continued
  103  appropriateness of residence of an individual in the facility. A
  104  determination must shall be based upon an evaluation assessment
  105  of the strengths, needs, and preferences of the resident, a
  106  medical examination, the care and services offered or arranged
  107  for by the facility in accordance with facility policy, and any
  108  limitations in law or rule related to admission criteria or
  109  continued residency for the type of license held by the facility
  110  under this part. The following criteria apply to the
  111  determination of appropriateness for admission and continued
  112  residency of an individual in a facility:
  113         (a) A facility may admit or retain a resident who receives
  114  a health care service or treatment that is designed to be
  115  provided within a private residential setting if all
  116  requirements for providing that service or treatment are met by
  117  the facility or a third party.
  118         (b) A facility may admit or retain a resident who requires
  119  the use of assistive devices.
  120         (c) A facility may admit or retain an individual receiving
  121  hospice services if the arrangement is agreed to by the facility
  122  and the resident, additional care is provided by a licensed
  123  hospice, and the resident is under the care of a physician who
  124  agrees that the physical needs of the resident can be met at the
  125  facility. The resident must have a plan of care which delineates
  126  how the facility and the hospice will meet the scheduled and
  127  unscheduled needs of the resident.
  128         (d)1. Except for a resident who is admitted to hospice as
  129  provided in paragraph (c), a facility may not admit or retain a
  130  resident who is bedridden or who requires 24-hour nursing
  131  supervision. For purposes of this paragraph, the term
  132  “bedridden” means that a resident is confined to a bed because
  133  of the inability to:
  134         a.Move, turn, or reposition without total physical
  135  assistance;
  136         b.Transfer to a chair or wheelchair without total physical
  137  assistance; or
  138         c.Sit safely in a chair or wheelchair without personal
  139  assistance or a physical restraint.
  140         2.A resident may continue to reside in a facility if,
  141  during residency, he or she is bedridden for no more than 7
  142  consecutive days.
  143         3.If a facility is licensed to provide extended congregate
  144  care, a resident may continue to reside in a facility if, during
  145  residency, he or she is bedridden for no more than 14
  146  consecutive days.
  147         (2) A resident may not be moved from one facility to
  148  another without consultation with and agreement from the
  149  resident or, if applicable, the resident’s representative or
  150  designee or the resident’s family, guardian, surrogate, or
  151  attorney in fact. In the case of a resident who has been placed
  152  by the department or the Department of Children and Families,
  153  the administrator must notify the appropriate contact person in
  154  the applicable department.
  155         (3)(2) A physician, physician assistant, or advanced
  156  practice registered nurse practitioner who is employed by an
  157  assisted living facility to provide an initial examination for
  158  admission purposes may not have financial interests interest in
  159  the facility.
  160         (4)(3) Persons licensed under part I of chapter 464 who are
  161  employed by or under contract with a facility shall, on a
  162  routine basis or at least monthly, perform a nursing assessment
  163  of the residents for whom they are providing nursing services
  164  ordered by a physician, except administration of medication, and
  165  shall document such assessment, including any substantial
  166  changes in a resident’s status which may necessitate relocation
  167  to a nursing home, hospital, or specialized health care
  168  facility. Such records shall be maintained in the facility for
  169  inspection by the agency and shall be forwarded to the
  170  resident’s case manager, if applicable.
  171         (5)(4)If possible, Each resident must shall have been
  172  examined by a licensed physician, a licensed physician
  173  assistant, or a licensed advanced practice registered nurse
  174  practitioner within 60 days before admission to the facility or
  175  within 30 days after admission to the facility, except as
  176  provided in s. 429.07. The information from the medical
  177  examination must be recorded on the practitioner’s form or on a
  178  form adopted by agency rule. The signed and completed medical
  179  examination form, signed by the practitioner, must report shall
  180  be submitted to the owner or administrator of the facility, who
  181  shall use the information contained therein to assist in the
  182  determination of the appropriateness of the resident’s admission
  183  to or and continued residency stay in the facility. The medical
  184  examination form will only be used to record the health care
  185  provider’s direct observation of the patient at the time of
  186  examination and shall include any known medical history. The
  187  medical examination form is not a guarantee of admission,
  188  continued residency, or services to be delivered and must only
  189  be used as an informative tool to assist in the determination of
  190  the appropriateness of the resident’s admission to or continued
  191  residency in the facility. The medical
  193  ====== D I R E C T O R Y  C L A U S E  A M E N D M E N T ======
  194  And the directory clause is amended as follows:
  195         Delete lines 352 - 356
  196  and insert:
  197         Section 5. Subsections (2) through (5) and (9) of section
  198  429.23, Florida Statutes, are amended to read:
  200  ================= T I T L E  A M E N D M E N T ================
  201  And the title is amended as follows:
  202         Delete lines 16 - 39
  203  and insert:
  204         F.S.; removing restrictions on the method by which a
  205         facility may send a report to the Agency for Health
  206         Care Administration; requiring the agency to send a
  207         reminder to the facility 3 business days prior to the
  208         deadline for submission of the full report; removing a
  209         requirement that each facility file reports of
  210         liability claims; amending s. 429.255, F.S.;
  211         clarifying that the absence of an order not to
  212         resuscitate does not preclude a physician from
  213         withholding or withdrawing cardiopulmonary
  214         resuscitation or use of an automated external
  215         defibrillator; amending s. 429.256, F.S.; requiring a
  216         person assisting with a resident’s self-administration
  217         of medication to confirm that the medication is
  218         intended for that resident and to orally advise the
  219         resident of the medication name and purpose; amending
  220         s. 429.26, F.S.; including medical examinations within
  221         criteria used for admission to an assisted living
  222         facility; providing specified criteria for
  223         determination of appropriateness for admission and
  224         continued residency at an assisted living facility;
  225         defining the term “bedridden”; requiring that a
  226         resident receive a medical examination within a
  227         specified timeframe after admission to a facility;
  228         requiring that such examination be recorded on a
  229         specified form; providing minimum requirements for
  230         such form; providing limitations on the use of such
  231         form; revising provisions relating to the