Florida Senate - 2011 SENATOR AMENDMENT
Bill No. CS for SB 1736
Barcode 106136
LEGISLATIVE ACTION
Senate . House
.
.
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
Senator Latvala moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Subsection (1) of section 83.42, Florida
6 Statutes, is amended to read:
7 83.42 Exclusions from application of part.—This part does
8 not apply to:
9 (1) Residency or detention in a facility, whether public or
10 private, when residence or detention is incidental to the
11 provision of medical, geriatric, educational, counseling,
12 religious, or similar services. For residents of a facility
13 licensed under part II of chapter 400, the provisions of s.
14 400.0255 are the exclusive procedures for all transfers and
15 discharges.
16 Section 2. Paragraphs (f) through (k) of subsection (10) of
17 section 112.0455, Florida Statutes, are redesignated as
18 paragraphs (e) through (j), respectively, paragraph (e) of
19 subsection (12) is redesignated as paragraph (d), and present
20 paragraph (e) of subsection (10), present paragraph (d) of
21 subsection (12), and paragraph (e) of subsection (14) of that
22 section are amended to read:
23 112.0455 Drug-Free Workplace Act.—
24 (10) EMPLOYER PROTECTION.—
25 (e) Nothing in this section shall be construed to operate
26 retroactively, and nothing in this section shall abrogate the
27 right of an employer under state law to conduct drug tests prior
28 to January 1, 1990. A drug test conducted by an employer prior
29 to January 1, 1990, is not subject to this section.
30 (12) DRUG-TESTING STANDARDS; LABORATORIES.—
31 (d) The laboratory shall submit to the Agency for Health
32 Care Administration a monthly report with statistical
33 information regarding the testing of employees and job
34 applicants. The reports shall include information on the methods
35 of analyses conducted, the drugs tested for, the number of
36 positive and negative results for both initial and confirmation
37 tests, and any other information deemed appropriate by the
38 Agency for Health Care Administration. No monthly report shall
39 identify specific employees or job applicants.
40 (14) DISCIPLINE REMEDIES.—
41 (e) Upon resolving an appeal filed pursuant to paragraph
42 (c), and finding a violation of this section, the commission may
43 order the following relief:
44 1. Rescind the disciplinary action, expunge related records
45 from the personnel file of the employee or job applicant and
46 reinstate the employee.
47 2. Order compliance with paragraph (10)(f)(g).
48 3. Award back pay and benefits.
49 4. Award the prevailing employee or job applicant the
50 necessary costs of the appeal, reasonable attorney’s fees, and
51 expert witness fees.
52 Section 3. Paragraph (n) of subsection (1) of section
53 154.11, Florida Statutes, is amended to read:
54 154.11 Powers of board of trustees.—
55 (1) The board of trustees of each public health trust shall
56 be deemed to exercise a public and essential governmental
57 function of both the state and the county and in furtherance
58 thereof it shall, subject to limitation by the governing body of
59 the county in which such board is located, have all of the
60 powers necessary or convenient to carry out the operation and
61 governance of designated health care facilities, including, but
62 without limiting the generality of, the foregoing:
63 (n) To appoint originally the staff of physicians to
64 practice in any designated facility owned or operated by the
65 board and to approve the bylaws and rules to be adopted by the
66 medical staff of any designated facility owned and operated by
67 the board, such governing regulations to be in accordance with
68 the standards of the Joint Commission on the Accreditation of
69 Hospitals which provide, among other things, for the method of
70 appointing additional staff members and for the removal of staff
71 members.
72 Section 4. Subsection (15) of section 318.21, Florida
73 Statutes, is amended to read:
74 318.21 Disposition of civil penalties by county courts.—All
75 civil penalties received by a county court pursuant to the
76 provisions of this chapter shall be distributed and paid monthly
77 as follows:
78 (15) Of the additional fine assessed under s. 318.18(3)(e)
79 for a violation of s. 316.1893, 50 percent of the moneys
80 received from the fines shall be remitted to the Department of
81 Revenue and deposited into the Brain and Spinal Cord Injury
82 Trust Fund of Department of Health and shall be appropriated to
83 the Department of Health Agency for Health Care Administration
84 as general revenue to provide an enhanced Medicaid payment to
85 nursing homes that serve Medicaid recipients with brain and
86 spinal cord injuries that are medically complex and who are
87 technologically and respiratory dependent. The remaining 50
88 percent of the moneys received from the enhanced fine imposed
89 under s. 318.18(3)(e) shall be remitted to the Department of
90 Revenue and deposited into the Department of Health Emergency
91 Medical Services Trust Fund to provide financial support to
92 certified trauma centers in the counties where enhanced penalty
93 zones are established to ensure the availability and
94 accessibility of trauma services. Funds deposited into the
95 Emergency Medical Services Trust Fund under this subsection
96 shall be allocated as follows:
97 (a) Fifty percent shall be allocated equally among all
98 Level I, Level II, and pediatric trauma centers in recognition
99 of readiness costs for maintaining trauma services.
100 (b) Fifty percent shall be allocated among Level I, Level
101 II, and pediatric trauma centers based on each center’s relative
102 volume of trauma cases as reported in the Department of Health
103 Trauma Registry.
104 Section 5. Section 383.325, Florida Statutes, is repealed.
105 Section 6. Subsection (7) of section 394.4787, Florida
106 Statutes, is amended to read:
107 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
108 394.4789.—As used in this section and ss. 394.4786, 394.4788,
109 and 394.4789:
110 (7) “Specialty psychiatric hospital” means a hospital
111 licensed by the agency pursuant to s. 395.002(26)(28) and part
112 II of chapter 408 as a specialty psychiatric hospital.
113 Section 7. Subsection (2) of section 394.741, Florida
114 Statutes, is amended to read:
115 394.741 Accreditation requirements for providers of
116 behavioral health care services.—
117 (2) Notwithstanding any provision of law to the contrary,
118 accreditation shall be accepted by the agency and department in
119 lieu of the agency’s and department’s facility licensure onsite
120 review requirements and shall be accepted as a substitute for
121 the department’s administrative and program monitoring
122 requirements, except as required by subsections (3) and (4),
123 for:
124 (a) Any organization from which the department purchases
125 behavioral health care services that is accredited by the Joint
126 Commission on Accreditation of Healthcare Organizations or the
127 Council on Accreditation for Children and Family Services, or
128 has those services that are being purchased by the department
129 accredited by the Commission on Accreditation of Rehabilitation
130 Facilities CARF—the Rehabilitation Accreditation Commission.
131 (b) Any mental health facility licensed by the agency or
132 any substance abuse component licensed by the department that is
133 accredited by the Joint Commission on Accreditation of
134 Healthcare Organizations, the Commission on Accreditation of
135 Rehabilitation Facilities CARF—the Rehabilitation Accreditation
136 Commission, or the Council on Accreditation of Children and
137 Family Services.
138 (c) Any network of providers from which the department or
139 the agency purchases behavioral health care services accredited
140 by the Joint Commission on Accreditation of Healthcare
141 Organizations, the Commission on Accreditation of Rehabilitation
142 Facilities CARF—the Rehabilitation Accreditation Commission, the
143 Council on Accreditation of Children and Family Services, or the
144 National Committee for Quality Assurance. A provider
145 organization, which is part of an accredited network, is
146 afforded the same rights under this part.
147 Section 8. Present subsections (15) through (32) of section
148 395.002, Florida Statutes, are renumbered as subsections (14)
149 through (28), respectively, and present subsections (1), (14),
150 (24), (30), and (31) and paragraph (c) of present subsection
151 (28) of that section are amended to read:
152 395.002 Definitions.—As used in this chapter:
153 (1) “Accrediting organizations” means nationally recognized
154 or approved accrediting organizations whose standards
155 incorporate comparable licensure requirements as determined by
156 the agency the Joint Commission on Accreditation of Healthcare
157 Organizations, the American Osteopathic Association, the
158 Commission on Accreditation of Rehabilitation Facilities, and
159 the Accreditation Association for Ambulatory Health Care, Inc.
160 (14) “Initial denial determination” means a determination
161 by a private review agent that the health care services
162 furnished or proposed to be furnished to a patient are
163 inappropriate, not medically necessary, or not reasonable.
164 (24) “Private review agent” means any person or entity
165 which performs utilization review services for third-party
166 payors on a contractual basis for outpatient or inpatient
167 services. However, the term shall not include full-time
168 employees, personnel, or staff of health insurers, health
169 maintenance organizations, or hospitals, or wholly owned
170 subsidiaries thereof or affiliates under common ownership, when
171 performing utilization review for their respective hospitals,
172 health maintenance organizations, or insureds of the same
173 insurance group. For this purpose, health insurers, health
174 maintenance organizations, and hospitals, or wholly owned
175 subsidiaries thereof or affiliates under common ownership,
176 include such entities engaged as administrators of self
177 insurance as defined in s. 624.031.
178 (26)(28) “Specialty hospital” means any facility which
179 meets the provisions of subsection (12), and which regularly
180 makes available either:
181 (c) Intensive residential treatment programs for children
182 and adolescents as defined in subsection (14) (15).
183 (30) “Utilization review” means a system for reviewing the
184 medical necessity or appropriateness in the allocation of health
185 care resources of hospital services given or proposed to be
186 given to a patient or group of patients.
187 (31) “Utilization review plan” means a description of the
188 policies and procedures governing utilization review activities
189 performed by a private review agent.
190 Section 9. Paragraph (c) of subsection (1) and paragraph
191 (b) of subsection (2) of section 395.003, Florida Statutes, are
192 amended to read:
193 395.003 Licensure; denial, suspension, and revocation.—
194 (1)
195 (c) Until July 1, 2006, additional emergency departments
196 located off the premises of licensed hospitals may not be
197 authorized by the agency.
198 (2)
199 (b) The agency shall, at the request of a licensee that is
200 a teaching hospital as defined in s. 408.07(45), issue a single
201 license to a licensee for facilities that have been previously
202 licensed as separate premises, provided such separately licensed
203 facilities, taken together, constitute the same premises as
204 defined in s. 395.002(22)(23). Such license for the single
205 premises shall include all of the beds, services, and programs
206 that were previously included on the licenses for the separate
207 premises. The granting of a single license under this paragraph
208 shall not in any manner reduce the number of beds, services, or
209 programs operated by the licensee.
210 Section 10. Subsection (3) of section 395.0161, Florida
211 Statutes, is amended to read:
212 395.0161 Licensure inspection.—
213 (3) In accordance with s. 408.805, an applicant or licensee
214 shall pay a fee for each license application submitted under
215 this part, part II of chapter 408, and applicable rules. With
216 the exception of state-operated licensed facilities, each
217 facility licensed under this part shall pay to the agency, at
218 the time of inspection, the following fees:
219 (a) Inspection for licensure.—A fee shall be paid which is
220 not less than $8 per hospital bed, nor more than $12 per
221 hospital bed, except that the minimum fee shall be $400 per
222 facility.
223 (b) Inspection for lifesafety only.—A fee shall be paid
224 which is not less than 75 cents per hospital bed, nor more than
225 $1.50 per hospital bed, except that the minimum fee shall be $40
226 per facility.
227 Section 11. Paragraph (e) of subsection (2) and subsection
228 (4) of section 395.0193, Florida Statutes, are amended to read:
229 395.0193 Licensed facilities; peer review; disciplinary
230 powers; agency or partnership with physicians.—
231 (2) Each licensed facility, as a condition of licensure,
232 shall provide for peer review of physicians who deliver health
233 care services at the facility. Each licensed facility shall
234 develop written, binding procedures by which such peer review
235 shall be conducted. Such procedures shall include:
236 (e) Recording of agendas and minutes which do not contain
237 confidential material, for review by the Division of Medical
238 Quality Assurance of the department Health Quality Assurance of
239 the agency.
240 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
241 actions taken under subsection (3) shall be reported in writing
242 to the Division of Medical Quality Assurance of the department
243 Health Quality Assurance of the agency within 30 working days
244 after its initial occurrence, regardless of the pendency of
245 appeals to the governing board of the hospital. The notification
246 shall identify the disciplined practitioner, the action taken,
247 and the reason for such action. All final disciplinary actions
248 taken under subsection (3), if different from those which were
249 reported to the department agency within 30 days after the
250 initial occurrence, shall be reported within 10 working days to
251 the Division of Medical Quality Assurance of the department
252 Health Quality Assurance of the agency in writing and shall
253 specify the disciplinary action taken and the specific grounds
254 therefor. The division shall review each report and determine
255 whether it potentially involved conduct by the licensee that is
256 subject to disciplinary action, in which case s. 456.073 shall
257 apply. The reports are not subject to inspection under s.
258 119.07(1) even if the division’s investigation results in a
259 finding of probable cause.
260 Section 12. Section 395.1023, Florida Statutes, is amended
261 to read:
262 395.1023 Child abuse and neglect cases; duties.—Each
263 licensed facility shall adopt a protocol that, at a minimum,
264 requires the facility to:
265 (1) Incorporate a facility policy that every staff member
266 has an affirmative duty to report, pursuant to chapter 39, any
267 actual or suspected case of child abuse, abandonment, or
268 neglect; and
269 (2) In any case involving suspected child abuse,
270 abandonment, or neglect, designate, at the request of the
271 Department of Children and Family Services, a staff physician to
272 act as a liaison between the hospital and the Department of
273 Children and Family Services office which is investigating the
274 suspected abuse, abandonment, or neglect, and the child
275 protection team, as defined in s. 39.01, when the case is
276 referred to such a team.
277
278 Each general hospital and appropriate specialty hospital shall
279 comply with the provisions of this section and shall notify the
280 agency and the Department of Children and Family Services of its
281 compliance by sending a copy of its policy to the agency and the
282 Department of Children and Family Services as required by rule.
283 The failure by a general hospital or appropriate specialty
284 hospital to comply shall be punished by a fine not exceeding
285 $1,000, to be fixed, imposed, and collected by the agency. Each
286 day in violation is considered a separate offense.
287 Section 13. Subsection (2) and paragraph (d) of subsection
288 (3) of section 395.1041, Florida Statutes, are amended to read:
289 395.1041 Access to emergency services and care.—
290 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
291 shall establish and maintain an inventory of hospitals with
292 emergency services. The inventory shall list all services within
293 the service capability of the hospital, and such services shall
294 appear on the face of the hospital license. Each hospital having
295 emergency services shall notify the agency of its service
296 capability in the manner and form prescribed by the agency. The
297 agency shall use the inventory to assist emergency medical
298 services providers and others in locating appropriate emergency
299 medical care. The inventory shall also be made available to the
300 general public. On or before August 1, 1992, the agency shall
301 request that each hospital identify the services which are
302 within its service capability. On or before November 1, 1992,
303 the agency shall notify each hospital of the service capability
304 to be included in the inventory. The hospital has 15 days from
305 the date of receipt to respond to the notice. By December 1,
306 1992, the agency shall publish a final inventory. Each hospital
307 shall reaffirm its service capability when its license is
308 renewed and shall notify the agency of the addition of a new
309 service or the termination of a service prior to a change in its
310 service capability.
311 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
312 FACILITY OR HEALTH CARE PERSONNEL.—
313 (d)1. Every hospital shall ensure the provision of services
314 within the service capability of the hospital, at all times,
315 either directly or indirectly through an arrangement with
316 another hospital, through an arrangement with one or more
317 physicians, or as otherwise made through prior arrangements. A
318 hospital may enter into an agreement with another hospital for
319 purposes of meeting its service capability requirement, and
320 appropriate compensation or other reasonable conditions may be
321 negotiated for these backup services.
322 2. If any arrangement requires the provision of emergency
323 medical transportation, such arrangement must be made in
324 consultation with the applicable provider and may not require
325 the emergency medical service provider to provide transportation
326 that is outside the routine service area of that provider or in
327 a manner that impairs the ability of the emergency medical
328 service provider to timely respond to prehospital emergency
329 calls.
330 3. A hospital shall not be required to ensure service
331 capability at all times as required in subparagraph 1. if, prior
332 to the receiving of any patient needing such service capability,
333 such hospital has demonstrated to the agency that it lacks the
334 ability to ensure such capability and it has exhausted all
335 reasonable efforts to ensure such capability through backup
336 arrangements. In reviewing a hospital’s demonstration of lack of
337 ability to ensure service capability, the agency shall consider
338 factors relevant to the particular case, including the
339 following:
340 a. Number and proximity of hospitals with the same service
341 capability.
342 b. Number, type, credentials, and privileges of
343 specialists.
344 c. Frequency of procedures.
345 d. Size of hospital.
346 4. The agency shall publish proposed rules implementing a
347 reasonable exemption procedure by November 1, 1992. Subparagraph
348 1. shall become effective upon the effective date of said rules
349 or January 31, 1993, whichever is earlier. For a period not to
350 exceed 1 year from the effective date of subparagraph 1., a
351 hospital requesting an exemption shall be deemed to be exempt
352 from offering the service until the agency initially acts to
353 deny or grant the original request. The agency has 45 days after
354 from the date of receipt of the request to approve or deny the
355 request. After the first year from the effective date of
356 subparagraph 1., If the agency fails to initially act within
357 that the time period, the hospital is deemed to be exempt from
358 offering the service until the agency initially acts to deny the
359 request.
360 Section 14. Section 395.1046, Florida Statutes, is
361 repealed.
362 Section 15. Paragraphs (b) and (e) of subsection (1) of
363 section 395.1055, Florida Statutes, are amended to read:
364 395.1055 Rules and enforcement.—
365 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
366 and 120.54 to implement the provisions of this part, which shall
367 include reasonable and fair minimum standards for ensuring that:
368 (b) Infection control, housekeeping, sanitary conditions,
369 and medical record procedures that will adequately protect
370 patient care and safety are established and implemented. These
371 procedures shall require housekeeping and sanitation staff to
372 wear masks and gloves when cleaning patient rooms and
373 disinfecting environmental surfaces in patient rooms in
374 accordance with the time instructions on the label of the
375 disinfectant used by the hospital. The agency may impose an
376 administrative fine for each day that a violation of this
377 paragraph occurs.
378 (e) Licensed facility beds conform to minimum space,
379 equipment, and furnishings standards as specified by the agency,
380 the Florida Building Code, and the Florida Fire Prevention Code
381 department.
382 Section 16. Subsection (1) of section 395.10972, Florida
383 Statutes, is amended to read:
384 395.10972 Health Care Risk Manager Advisory Council.—The
385 Secretary of Health Care Administration may appoint a seven
386 member advisory council to advise the agency on matters
387 pertaining to health care risk managers. The members of the
388 council shall serve at the pleasure of the secretary. The
389 council shall designate a chair. The council shall meet at the
390 call of the secretary or at those times as may be required by
391 rule of the agency. The members of the advisory council shall
392 receive no compensation for their services, but shall be
393 reimbursed for travel expenses as provided in s. 112.061. The
394 council shall consist of individuals representing the following
395 areas:
396 (1) Two shall be active health care risk managers,
397 including one risk manager who is recommended by and a member of
398 the Florida Society for of Healthcare Risk Management and
399 Patient Safety.
400 Section 17. Subsection (3) of section 395.2050, Florida
401 Statutes, is amended to read:
402 395.2050 Routine inquiry for organ and tissue donation;
403 certification for procurement activities; death records review.—
404 (3) Each organ procurement organization designated by the
405 federal Centers for Medicare and Medicaid Services Health Care
406 Financing Administration and licensed by the state shall conduct
407 an annual death records review in the organ procurement
408 organization’s affiliated donor hospitals. The organ procurement
409 organization shall enlist the services of every Florida licensed
410 tissue bank and eye bank affiliated with or providing service to
411 the donor hospital and operating in the same service area to
412 participate in the death records review.
413 Section 18. Subsection (2) of section 395.3036, Florida
414 Statutes, is amended to read:
415 395.3036 Confidentiality of records and meetings of
416 corporations that lease public hospitals or other public health
417 care facilities.—The records of a private corporation that
418 leases a public hospital or other public health care facility
419 are confidential and exempt from the provisions of s. 119.07(1)
420 and s. 24(a), Art. I of the State Constitution, and the meetings
421 of the governing board of a private corporation are exempt from
422 s. 286.011 and s. 24(b), Art. I of the State Constitution when
423 the public lessor complies with the public finance
424 accountability provisions of s. 155.40(5) with respect to the
425 transfer of any public funds to the private lessee and when the
426 private lessee meets at least three of the five following
427 criteria:
428 (2) The public lessor and the private lessee do not
429 commingle any of their funds in any account maintained by either
430 of them, other than the payment of the rent and administrative
431 fees or the transfer of funds pursuant to s. 155.40 subsection
432 (2).
433 Section 19. Section 395.3037, Florida Statutes, is
434 repealed.
435 Section 20. Subsections (1), (4), and (5) of section
436 395.3038, Florida Statutes, are amended to read:
437 395.3038 State-listed primary stroke centers and
438 comprehensive stroke centers; notification of hospitals.—
439 (1) The agency shall make available on its website and to
440 the department a list of the name and address of each hospital
441 that meets the criteria for a primary stroke center and the name
442 and address of each hospital that meets the criteria for a
443 comprehensive stroke center. The list of primary and
444 comprehensive stroke centers shall include only those hospitals
445 that attest in an affidavit submitted to the agency that the
446 hospital meets the named criteria, or those hospitals that
447 attest in an affidavit submitted to the agency that the hospital
448 is certified as a primary or a comprehensive stroke center by
449 the Joint Commission on Accreditation of Healthcare
450 Organizations.
451 (4) The agency shall adopt by rule criteria for a primary
452 stroke center which are substantially similar to the
453 certification standards for primary stroke centers of the Joint
454 Commission on Accreditation of Healthcare Organizations.
455 (5) The agency shall adopt by rule criteria for a
456 comprehensive stroke center. However, if the Joint Commission on
457 Accreditation of Healthcare Organizations establishes criteria
458 for a comprehensive stroke center, the agency shall establish
459 criteria for a comprehensive stroke center which are
460 substantially similar to those criteria established by the Joint
461 Commission on Accreditation of Healthcare Organizations.
462 Section 21. Paragraph (d) of subsection (2) of section
463 395.4025, Florida Statutes, is amended to read:
464 395.4025 Trauma centers; selection; quality assurance;
465 records.—
466 (2)
467 (d)1. Notwithstanding other provisions in this section, the
468 department may grant up to an additional 18 months to a hospital
469 applicant that is unable to meet all requirements as provided in
470 paragraph (c) at the time of application if the number of
471 applicants in the service area in which the applicant is located
472 is equal to or less than the service area allocation, as
473 provided by rule of the department. An applicant that is granted
474 additional time pursuant to this paragraph shall submit a plan
475 for departmental approval which includes timelines and
476 activities that the applicant proposes to complete in order to
477 meet application requirements. Any applicant that demonstrates
478 an ongoing effort to complete the activities within the
479 timelines outlined in the plan shall be included in the number
480 of trauma centers at such time that the department has conducted
481 a provisional review of the application and has determined that
482 the application is complete and that the hospital has the
483 critical elements required for a trauma center. An applicant
484 that has received an additional 18 months pursuant to this
485 paragraph shall be granted up to two additional 6-month
486 extensions to meet all requirements as provided in paragraph
487 (c), if construction related to a critical element is delayed as
488 a result of governmental action or inaction with respect to
489 regulations or permitting, and the applicant has made a good
490 faith effort to comply with the applicable regulations or obtain
491 the required permits.
492 2. Timeframes provided in subsections (1)-(8) shall be
493 stayed until the department determines that the application is
494 complete and that the hospital has the critical elements
495 required for a trauma center.
496 Section 22. Paragraph (e) of subsection (2) of section
497 395.602, Florida Statutes, is amended to read:
498 395.602 Rural hospitals.—
499 (2) DEFINITIONS.—As used in this part:
500 (e) “Rural hospital” means an acute care hospital licensed
501 under this chapter, having 100 or fewer licensed beds and an
502 emergency room, which is:
503 1. The sole provider within a county with a population
504 density of no greater than 100 persons per square mile;
505 2. An acute care hospital, in a county with a population
506 density of no greater than 100 persons per square mile, which is
507 at least 30 minutes of travel time, on normally traveled roads
508 under normal traffic conditions, from any other acute care
509 hospital within the same county;
510 3. A hospital supported by a tax district or subdistrict
511 whose boundaries encompass a population of 100 persons or fewer
512 per square mile;
513 4. A hospital in a constitutional charter county with a
514 population of over 1 million persons that has imposed a local
515 option health service tax pursuant to law and in an area that
516 was directly impacted by a catastrophic event on August 24,
517 1992, for which the Governor of Florida declared a state of
518 emergency pursuant to chapter 125, and has 120 beds or less that
519 serves an agricultural community with an emergency room
520 utilization of no less than 20,000 visits and a Medicaid
521 inpatient utilization rate greater than 15 percent;
522 4.5. A hospital with a service area that has a population
523 of 100 persons or fewer per square mile. As used in this
524 subparagraph, the term “service area” means the fewest number of
525 zip codes that account for 75 percent of the hospital’s
526 discharges for the most recent 5-year period, based on
527 information available from the hospital inpatient discharge
528 database in the Florida Center for Health Information and Policy
529 Analysis at the Agency for Health Care Administration; or
530 5.6. A hospital designated as a critical access hospital,
531 as defined in s. 408.07(15).
532
533 Population densities used in this paragraph must be based upon
534 the most recently completed United States census. A hospital
535 that received funds under s. 409.9116 for a quarter beginning no
536 later than July 1, 2002, is deemed to have been and shall
537 continue to be a rural hospital from that date through June 30,
538 2015, if the hospital continues to have 100 or fewer licensed
539 beds and an emergency room, or meets the criteria of
540 subparagraph 4. An acute care hospital that has not previously
541 been designated as a rural hospital and that meets the criteria
542 of this paragraph shall be granted such designation upon
543 application, including supporting documentation to the Agency
544 for Health Care Administration.
545 Section 23. Subsections (8) and (16) of section 400.021,
546 Florida Statutes, are amended to read:
547 400.021 Definitions.—When used in this part, unless the
548 context otherwise requires, the term:
549 (8) “Geriatric outpatient clinic” means a site for
550 providing outpatient health care to persons 60 years of age or
551 older, which is staffed by a registered nurse or a physician
552 assistant, or a licensed practical nurse under the direct
553 supervision of a registered nurse, advanced registered nurse
554 practitioner, physician assistant, or physician.
555 (16) “Resident care plan” means a written plan developed,
556 maintained, and reviewed not less than quarterly by a registered
557 nurse, with participation from other facility staff and the
558 resident or his or her designee or legal representative, which
559 includes a comprehensive assessment of the needs of an
560 individual resident; the type and frequency of services required
561 to provide the necessary care for the resident to attain or
562 maintain the highest practicable physical, mental, and
563 psychosocial well-being; a listing of services provided within
564 or outside the facility to meet those needs; and an explanation
565 of service goals. The resident care plan must be signed by the
566 director of nursing or another registered nurse employed by the
567 facility to whom institutional responsibilities have been
568 delegated and by the resident, the resident’s designee, or the
569 resident’s legal representative. The facility may not use an
570 agency or temporary registered nurse to satisfy the foregoing
571 requirement and must document the institutional responsibilities
572 that have been delegated to the registered nurse.
573 Section 24. Paragraph (g) of subsection (2) of section
574 400.0239, Florida Statutes, is amended to read:
575 400.0239 Quality of Long-Term Care Facility Improvement
576 Trust Fund.—
577 (2) Expenditures from the trust fund shall be allowable for
578 direct support of the following:
579 (g) Other initiatives authorized by the Centers for
580 Medicare and Medicaid Services for the use of federal civil
581 monetary penalties, including projects recommended through the
582 Medicaid “Up-or-Out” Quality of Care Contract Management Program
583 pursuant to s. 400.148.
584 Section 25. Subsection (15) of section 400.0255, Florida
585 Statutes, is amended to read
586 400.0255 Resident transfer or discharge; requirements and
587 procedures; hearings.—
588 (15)(a) The department’s Office of Appeals Hearings shall
589 conduct hearings under this section. The office shall notify the
590 facility of a resident’s request for a hearing.
591 (b) The department shall, by rule, establish procedures to
592 be used for fair hearings requested by residents. These
593 procedures shall be equivalent to the procedures used for fair
594 hearings for other Medicaid cases appearing in s. 409.285 and
595 applicable rules, chapter 10-2, part VI, Florida Administrative
596 Code. The burden of proof must be clear and convincing evidence.
597 A hearing decision must be rendered within 90 days after receipt
598 of the request for hearing.
599 (c) If the hearing decision is favorable to the resident
600 who has been transferred or discharged, the resident must be
601 readmitted to the facility’s first available bed.
602 (d) The decision of the hearing officer shall be final. Any
603 aggrieved party may appeal the decision to the district court of
604 appeal in the appellate district where the facility is located.
605 Review procedures shall be conducted in accordance with the
606 Florida Rules of Appellate Procedure.
607 Section 26. Subsection (2) of section 400.063, Florida
608 Statutes, is amended to read:
609 400.063 Resident protection.—
610 (2) The agency is authorized to establish for each
611 facility, subject to intervention by the agency, a separate bank
612 account for the deposit to the credit of the agency of any
613 moneys received from the Health Care Trust Fund or any other
614 moneys received for the maintenance and care of residents in the
615 facility, and the agency is authorized to disburse moneys from
616 such account to pay obligations incurred for the purposes of
617 this section. The agency is authorized to requisition moneys
618 from the Health Care Trust Fund in advance of an actual need for
619 cash on the basis of an estimate by the agency of moneys to be
620 spent under the authority of this section. Any bank account
621 established under this section need not be approved in advance
622 of its creation as required by s. 17.58, but shall be secured by
623 depository insurance equal to or greater than the balance of
624 such account or by the pledge of collateral security in
625 conformance with criteria established in s. 18.11. The agency
626 shall notify the Chief Financial Officer of any such account so
627 established and shall make a quarterly accounting to the Chief
628 Financial Officer for all moneys deposited in such account.
629 Section 27. Subsections (1) and (5) of section 400.071,
630 Florida Statutes, are amended to read:
631 400.071 Application for license.—
632 (1) In addition to the requirements of part II of chapter
633 408, the application for a license shall be under oath and must
634 contain the following:
635 (a) The location of the facility for which a license is
636 sought and an indication, as in the original application, that
637 such location conforms to the local zoning ordinances.
638 (b) A signed affidavit disclosing any financial or
639 ownership interest that a controlling interest as defined in
640 part II of chapter 408 has held in the last 5 years in any
641 entity licensed by this state or any other state to provide
642 health or residential care which has closed voluntarily or
643 involuntarily; has filed for bankruptcy; has had a receiver
644 appointed; has had a license denied, suspended, or revoked; or
645 has had an injunction issued against it which was initiated by a
646 regulatory agency. The affidavit must disclose the reason any
647 such entity was closed, whether voluntarily or involuntarily.
648 (c) The total number of beds and the total number of
649 Medicare and Medicaid certified beds.
650 (b)(d) Information relating to the applicant and employees
651 which the agency requires by rule. The applicant must
652 demonstrate that sufficient numbers of qualified staff, by
653 training or experience, will be employed to properly care for
654 the type and number of residents who will reside in the
655 facility.
656 (e) Copies of any civil verdict or judgment involving the
657 applicant rendered within the 10 years preceding the
658 application, relating to medical negligence, violation of
659 residents’ rights, or wrongful death. As a condition of
660 licensure, the licensee agrees to provide to the agency copies
661 of any new verdict or judgment involving the applicant, relating
662 to such matters, within 30 days after filing with the clerk of
663 the court. The information required in this paragraph shall be
664 maintained in the facility’s licensure file and in an agency
665 database which is available as a public record.
666 (5) As a condition of licensure, each facility must
667 establish and submit with its application a plan for quality
668 assurance and for conducting risk management.
669 Section 28. Section 400.0712, Florida Statutes, is amended
670 to read:
671 400.0712 Application for inactive license.—
672 (1) As specified in this section, the agency may issue an
673 inactive license to a nursing home facility for all or a portion
674 of its beds. Any request by a licensee that a nursing home or
675 portion of a nursing home become inactive must be submitted to
676 the agency in the approved format. The facility may not initiate
677 any suspension of services, notify residents, or initiate
678 inactivity before receiving approval from the agency; and a
679 licensee that violates this provision may not be issued an
680 inactive license.
681 (1)(2) In addition to the powers granted under part II of
682 chapter 408, the agency may issue an inactive license for a
683 portion of the total beds to a nursing home that chooses to use
684 an unoccupied contiguous portion of the facility for an
685 alternative use to meet the needs of elderly persons through the
686 use of less restrictive, less institutional services.
687 (a) An inactive license issued under this subsection may be
688 granted for a period not to exceed the current licensure
689 expiration date but may be renewed by the agency at the time of
690 licensure renewal.
691 (b) A request to extend the inactive license must be
692 submitted to the agency in the approved format and approved by
693 the agency in writing.
694 (c) Nursing homes that receive an inactive license to
695 provide alternative services shall not receive preference for
696 participation in the Assisted Living for the Elderly Medicaid
697 waiver.
698 (2)(3) The agency shall adopt rules pursuant to ss.
699 120.536(1) and 120.54 necessary to implement this section.
700 Section 29. Section 400.111, Florida Statutes, is amended
701 to read:
702 400.111 Disclosure of controlling interest.—In addition to
703 the requirements of part II of chapter 408, when requested by
704 the agency, the licensee shall submit a signed affidavit
705 disclosing any financial or ownership interest that a
706 controlling interest has held within the last 5 years in any
707 entity licensed by the state or any other state to provide
708 health or residential care which entity has closed voluntarily
709 or involuntarily; has filed for bankruptcy; has had a receiver
710 appointed; has had a license denied, suspended, or revoked; or
711 has had an injunction issued against it which was initiated by a
712 regulatory agency. The affidavit must disclose the reason such
713 entity was closed, whether voluntarily or involuntarily.
714 Section 30. Subsection (2) of section 400.1183, Florida
715 Statutes, is amended to read:
716 400.1183 Resident grievance procedures.—
717 (2) Each facility shall maintain records of all grievances
718 and shall retain a log for agency inspection of report to the
719 agency at the time of relicensure the total number of grievances
720 handled during the prior licensure period, a categorization of
721 the cases underlying the grievances, and the final disposition
722 of the grievances.
723 Section 31. Section 400.141, Florida Statutes, is amended
724 to read:
725 400.141 Administration and management of nursing home
726 facilities.—
727 (1) Every licensed facility shall comply with all
728 applicable standards and rules of the agency and shall:
729 (a) Be under the administrative direction and charge of a
730 licensed administrator.
731 (b) Appoint a medical director licensed pursuant to chapter
732 458 or chapter 459. The agency may establish by rule more
733 specific criteria for the appointment of a medical director.
734 (c) Have available the regular, consultative, and emergency
735 services of physicians licensed by the state.
736 (d) Provide for resident use of a community pharmacy as
737 specified in s. 400.022(1)(q). Any other law to the contrary
738 notwithstanding, a registered pharmacist licensed in Florida,
739 that is under contract with a facility licensed under this
740 chapter or chapter 429, shall repackage a nursing facility
741 resident’s bulk prescription medication which has been packaged
742 by another pharmacist licensed in any state in the United States
743 into a unit dose system compatible with the system used by the
744 nursing facility, if the pharmacist is requested to offer such
745 service. In order to be eligible for the repackaging, a resident
746 or the resident’s spouse must receive prescription medication
747 benefits provided through a former employer as part of his or
748 her retirement benefits, a qualified pension plan as specified
749 in s. 4972 of the Internal Revenue Code, a federal retirement
750 program as specified under 5 C.F.R. s. 831, or a long-term care
751 policy as defined in s. 627.9404(1). A pharmacist who correctly
752 repackages and relabels the medication and the nursing facility
753 which correctly administers such repackaged medication under
754 this paragraph may not be held liable in any civil or
755 administrative action arising from the repackaging. In order to
756 be eligible for the repackaging, a nursing facility resident for
757 whom the medication is to be repackaged shall sign an informed
758 consent form provided by the facility which includes an
759 explanation of the repackaging process and which notifies the
760 resident of the immunities from liability provided in this
761 paragraph. A pharmacist who repackages and relabels prescription
762 medications, as authorized under this paragraph, may charge a
763 reasonable fee for costs resulting from the implementation of
764 this provision.
765 (e) Provide for the access of the facility residents to
766 dental and other health-related services, recreational services,
767 rehabilitative services, and social work services appropriate to
768 their needs and conditions and not directly furnished by the
769 licensee. When a geriatric outpatient nurse clinic is conducted
770 in accordance with rules adopted by the agency, outpatients
771 attending such clinic shall not be counted as part of the
772 general resident population of the nursing home facility, nor
773 shall the nursing staff of the geriatric outpatient clinic be
774 counted as part of the nursing staff of the facility, until the
775 outpatient clinic load exceeds 15 a day.
776 (f) Be allowed and encouraged by the agency to provide
777 other needed services under certain conditions. If the facility
778 has a standard licensure status, and has had no class I or class
779 II deficiencies during the past 2 years or has been awarded a
780 Gold Seal under the program established in s. 400.235, it may be
781 encouraged by the agency to provide services, including, but not
782 limited to, respite and adult day services, which enable
783 individuals to move in and out of the facility. A facility is
784 not subject to any additional licensure requirements for
785 providing these services, under the following conditions:.
786 1. Respite care may be offered to persons in need of short
787 term or temporary nursing home services. For each person
788 admitted under the respite care program, the facility licensee
789 must:
790 a. Have a written abbreviated plan of care that, at a
791 minimum, includes nutritional requirements, medication orders,
792 physician orders, nursing assessments, and dietary preferences.
793 The nursing or physician assessments may take the place of all
794 other assessments required for full-time residents.
795 b. Have a contract that, at a minimum, specifies the
796 services to be provided to the respite resident, including
797 charges for services, activities, equipment, emergency medical
798 services, and the administration of medications. If multiple
799 respite admissions for a single person are anticipated, the
800 original contract is valid for 1 year after the date of
801 execution.
802 c. Ensure that each resident is released to his or her
803 caregiver or an individual designated in writing by the
804 caregiver.
805 2. A person admitted under the respite care program is:
806 a. Exempt from requirements in rule related to discharge
807 planning.
808 b. Covered by the residents’ rights set forth in s.
809 400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
810 shall not be considered trust funds subject to the requirements
811 of s. 400.022(1)(h) until the resident has been in the facility
812 for more than 14 consecutive days.
813 c. Allowed to use his or her personal medications for the
814 respite stay if permitted by facility policy. The facility must
815 obtain a physician’s order for the medications. The caregiver
816 may provide information regarding the medications as part of the
817 nursing assessment and that information must agree with the
818 physician’s order. Medications shall be released with the
819 resident upon discharge in accordance with current physician’s
820 orders.
821 3. A person receiving respite care is entitled to reside in
822 the facility for a total of 60 days within a contract year or
823 within a calendar year if the contract is for less than 12
824 months. However, each single stay may not exceed 14 days. If a
825 stay exceeds 14 consecutive days, the facility must comply with
826 all assessment and care planning requirements applicable to
827 nursing home residents.
828 4. A person receiving respite care must reside in a
829 licensed nursing home bed.
830 5. A prospective respite resident must provide medical
831 information from a physician, physician assistant, or nurse
832 practitioner and other information from the primary caregiver as
833 may be required by the facility before or at the time of
834 admission to receive respite care. The medical information must
835 include a physician’s order for respite care and proof of a
836 physical examination by a licensed physician, physician
837 assistant, or nurse practitioner. The physician’s order and
838 physical examination may be used to provide intermittent respite
839 care for up to 12 months after the date the order is written.
840 6. The facility must assume the duties of the primary
841 caregiver. To ensure continuity of care and services, the
842 resident is entitled to retain his or her personal physician and
843 must have access to medically necessary services such as
844 physical therapy, occupational therapy, or speech therapy, as
845 needed. The facility must arrange for transportation to these
846 services if necessary. Respite care must be provided in
847 accordance with this part and rules adopted by the agency.
848 However, the agency shall, by rule, adopt modified requirements
849 for resident assessment, resident care plans, resident
850 contracts, physician orders, and other provisions, as
851 appropriate, for short-term or temporary nursing home services.
852 7. The agency shall allow for shared programming and staff
853 in a facility which meets minimum standards and offers services
854 pursuant to this paragraph, but, if the facility is cited for
855 deficiencies in patient care, may require additional staff and
856 programs appropriate to the needs of service recipients. A
857 person who receives respite care may not be counted as a
858 resident of the facility for purposes of the facility’s licensed
859 capacity unless that person receives 24-hour respite care. A
860 person receiving either respite care for 24 hours or longer or
861 adult day services must be included when calculating minimum
862 staffing for the facility. Any costs and revenues generated by a
863 nursing home facility from nonresidential programs or services
864 shall be excluded from the calculations of Medicaid per diems
865 for nursing home institutional care reimbursement.
866 (g) If the facility has a standard license or is a Gold
867 Seal facility, exceeds the minimum required hours of licensed
868 nursing and certified nursing assistant direct care per resident
869 per day, and is part of a continuing care facility licensed
870 under chapter 651 or a retirement community that offers other
871 services pursuant to part III of this chapter or part I or part
872 III of chapter 429 on a single campus, be allowed to share
873 programming and staff. At the time of inspection and in the
874 semiannual report required pursuant to paragraph (o), a
875 continuing care facility or retirement community that uses this
876 option must demonstrate through staffing records that minimum
877 staffing requirements for the facility were met. Licensed nurses
878 and certified nursing assistants who work in the nursing home
879 facility may be used to provide services elsewhere on campus if
880 the facility exceeds the minimum number of direct care hours
881 required per resident per day and the total number of residents
882 receiving direct care services from a licensed nurse or a
883 certified nursing assistant does not cause the facility to
884 violate the staffing ratios required under s. 400.23(3)(a).
885 Compliance with the minimum staffing ratios shall be based on
886 total number of residents receiving direct care services,
887 regardless of where they reside on campus. If the facility
888 receives a conditional license, it may not share staff until the
889 conditional license status ends. This paragraph does not
890 restrict the agency’s authority under federal or state law to
891 require additional staff if a facility is cited for deficiencies
892 in care which are caused by an insufficient number of certified
893 nursing assistants or licensed nurses. The agency may adopt
894 rules for the documentation necessary to determine compliance
895 with this provision.
896 (h) Maintain the facility premises and equipment and
897 conduct its operations in a safe and sanitary manner.
898 (i) If the licensee furnishes food service, provide a
899 wholesome and nourishing diet sufficient to meet generally
900 accepted standards of proper nutrition for its residents and
901 provide such therapeutic diets as may be prescribed by attending
902 physicians. In making rules to implement this paragraph, the
903 agency shall be guided by standards recommended by nationally
904 recognized professional groups and associations with knowledge
905 of dietetics.
906 (j) Keep full records of resident admissions and
907 discharges; medical and general health status, including medical
908 records, personal and social history, and identity and address
909 of next of kin or other persons who may have responsibility for
910 the affairs of the residents; and individual resident care plans
911 including, but not limited to, prescribed services, service
912 frequency and duration, and service goals. The records shall be
913 open to inspection by the agency. The facility must maintain
914 clinical records on each resident in accordance with accepted
915 professional standards and practices that are complete,
916 accurately documented, readily accessible, and systematically
917 organized.
918 (k) Keep such fiscal records of its operations and
919 conditions as may be necessary to provide information pursuant
920 to this part.
921 (l) Furnish copies of personnel records for employees
922 affiliated with such facility, to any other facility licensed by
923 this state requesting this information pursuant to this part.
924 Such information contained in the records may include, but is
925 not limited to, disciplinary matters and any reason for
926 termination. Any facility releasing such records pursuant to
927 this part shall be considered to be acting in good faith and may
928 not be held liable for information contained in such records,
929 absent a showing that the facility maliciously falsified such
930 records.
931 (m) Publicly display a poster provided by the agency
932 containing the names, addresses, and telephone numbers for the
933 state’s abuse hotline, the State Long-Term Care Ombudsman, the
934 Agency for Health Care Administration consumer hotline, the
935 Advocacy Center for Persons with Disabilities, the Florida
936 Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
937 with a clear description of the assistance to be expected from
938 each.
939 (n) Submit to the agency the information specified in s.
940 400.071(1)(b) for a management company within 30 days after the
941 effective date of the management agreement.
942 (n)(o)1. Submit semiannually to the agency, or more
943 frequently if requested by the agency, information regarding
944 facility staff-to-resident ratios, staff turnover, and staff
945 stability, including information regarding certified nursing
946 assistants, licensed nurses, the director of nursing, and the
947 facility administrator. For purposes of this reporting:
948 a. Staff-to-resident ratios must be reported in the
949 categories specified in s. 400.23(3)(a) and applicable rules.
950 The ratio must be reported as an average for the most recent
951 calendar quarter.
952 b. Staff turnover must be reported for the most recent 12
953 month period ending on the last workday of the most recent
954 calendar quarter prior to the date the information is submitted.
955 The turnover rate must be computed quarterly, with the annual
956 rate being the cumulative sum of the quarterly rates. The
957 turnover rate is the total number of terminations or separations
958 experienced during the quarter, excluding any employee
959 terminated during a probationary period of 3 months or less,
960 divided by the total number of staff employed at the end of the
961 period for which the rate is computed, and expressed as a
962 percentage.
963 c. The formula for determining staff stability is the total
964 number of employees that have been employed for more than 12
965 months, divided by the total number of employees employed at the
966 end of the most recent calendar quarter, and expressed as a
967 percentage.
968 d. A nursing facility that has failed to comply with state
969 minimum-staffing requirements for 2 consecutive days is
970 prohibited from accepting new admissions until the facility has
971 achieved the minimum-staffing requirements for a period of 6
972 consecutive days. For the purposes of this sub-subparagraph, any
973 person who was a resident of the facility and was absent from
974 the facility for the purpose of receiving medical care at a
975 separate location or was on a leave of absence is not considered
976 a new admission. Failure to impose such an admissions moratorium
977 is subject to a $1,000 fine constitutes a class II deficiency.
978 2.e. A nursing facility which does not have a conditional
979 license may be cited for failure to comply with the standards in
980 s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
981 standards on 2 consecutive days or if it has failed to meet at
982 least 97 percent of those standards on any one day.
983 3.f. A facility which has a conditional license must be in
984 compliance with the standards in s. 400.23(3)(a) at all times.
985 2. This paragraph does not limit the agency’s ability to
986 impose a deficiency or take other actions if a facility does not
987 have enough staff to meet the residents’ needs.
988 (o)(p) Notify a licensed physician when a resident exhibits
989 signs of dementia or cognitive impairment or has a change of
990 condition in order to rule out the presence of an underlying
991 physiological condition that may be contributing to such
992 dementia or impairment. The notification must occur within 30
993 days after the acknowledgment of such signs by facility staff.
994 If an underlying condition is determined to exist, the facility
995 shall arrange, with the appropriate health care provider, the
996 necessary care and services to treat the condition.
997 (p)(q) If the facility implements a dining and hospitality
998 attendant program, ensure that the program is developed and
999 implemented under the supervision of the facility director of
1000 nursing. A licensed nurse, licensed speech or occupational
1001 therapist, or a registered dietitian must conduct training of
1002 dining and hospitality attendants. A person employed by a
1003 facility as a dining and hospitality attendant must perform
1004 tasks under the direct supervision of a licensed nurse.
1005 (r) Report to the agency any filing for bankruptcy
1006 protection by the facility or its parent corporation,
1007 divestiture or spin-off of its assets, or corporate
1008 reorganization within 30 days after the completion of such
1009 activity.
1010 (q)(s) Maintain general and professional liability
1011 insurance coverage that is in force at all times. In lieu of
1012 general and professional liability insurance coverage, a state
1013 designated teaching nursing home and its affiliated assisted
1014 living facilities created under s. 430.80 may demonstrate proof
1015 of financial responsibility as provided in s. 430.80(3)(g).
1016 (r)(t) Maintain in the medical record for each resident a
1017 daily chart of certified nursing assistant services provided to
1018 the resident. The certified nursing assistant who is caring for
1019 the resident must complete this record by the end of his or her
1020 shift. This record must indicate assistance with activities of
1021 daily living, assistance with eating, and assistance with
1022 drinking, and must record each offering of nutrition and
1023 hydration for those residents whose plan of care or assessment
1024 indicates a risk for malnutrition or dehydration.
1025 (s)(u) Before November 30 of each year, subject to the
1026 availability of an adequate supply of the necessary vaccine,
1027 provide for immunizations against influenza viruses to all its
1028 consenting residents in accordance with the recommendations of
1029 the United States Centers for Disease Control and Prevention,
1030 subject to exemptions for medical contraindications and
1031 religious or personal beliefs. Subject to these exemptions, any
1032 consenting person who becomes a resident of the facility after
1033 November 30 but before March 31 of the following year must be
1034 immunized within 5 working days after becoming a resident.
1035 Immunization shall not be provided to any resident who provides
1036 documentation that he or she has been immunized as required by
1037 this paragraph. This paragraph does not prohibit a resident from
1038 receiving the immunization from his or her personal physician if
1039 he or she so chooses. A resident who chooses to receive the
1040 immunization from his or her personal physician shall provide
1041 proof of immunization to the facility. The agency may adopt and
1042 enforce any rules necessary to comply with or implement this
1043 paragraph.
1044 (t)(v) Assess all residents for eligibility for
1045 pneumococcal polysaccharide vaccination (PPV) and vaccinate
1046 residents when indicated within 60 days after the effective date
1047 of this act in accordance with the recommendations of the United
1048 States Centers for Disease Control and Prevention, subject to
1049 exemptions for medical contraindications and religious or
1050 personal beliefs. Residents admitted after the effective date of
1051 this act shall be assessed within 5 working days of admission
1052 and, when indicated, vaccinated within 60 days in accordance
1053 with the recommendations of the United States Centers for
1054 Disease Control and Prevention, subject to exemptions for
1055 medical contraindications and religious or personal beliefs.
1056 Immunization shall not be provided to any resident who provides
1057 documentation that he or she has been immunized as required by
1058 this paragraph. This paragraph does not prohibit a resident from
1059 receiving the immunization from his or her personal physician if
1060 he or she so chooses. A resident who chooses to receive the
1061 immunization from his or her personal physician shall provide
1062 proof of immunization to the facility. The agency may adopt and
1063 enforce any rules necessary to comply with or implement this
1064 paragraph.
1065 (u)(w) Annually encourage and promote to its employees the
1066 benefits associated with immunizations against influenza viruses
1067 in accordance with the recommendations of the United States
1068 Centers for Disease Control and Prevention. The agency may adopt
1069 and enforce any rules necessary to comply with or implement this
1070 paragraph.
1071
1072 This subsection does not limit the agency’s ability to impose a
1073 deficiency or take other actions if a facility does not have
1074 enough staff to meet the residents’ needs.
1075 (2) Facilities that have been awarded a Gold Seal under the
1076 program established in s. 400.235 may develop a plan to provide
1077 certified nursing assistant training as prescribed by federal
1078 regulations and state rules and may apply to the agency for
1079 approval of their program.
1080 (3) A facility may charge a reasonable fee for the copying
1081 of resident records. The fee may not exceed $1 per page for the
1082 first 25 pages and 25 cents per page for each page in excess of
1083 25 pages.
1084 Section 32. Subsection (3) of section 400.142, Florida
1085 Statutes, is amended to read:
1086 400.142 Emergency medication kits; orders not to
1087 resuscitate.—
1088 (3) Facility staff may withhold or withdraw cardiopulmonary
1089 resuscitation if presented with an order not to resuscitate
1090 executed pursuant to s. 401.45. The agency shall adopt rules
1091 providing for the implementation of such orders. Facility staff
1092 and facilities shall not be subject to criminal prosecution or
1093 civil liability, nor be considered to have engaged in negligent
1094 or unprofessional conduct, for withholding or withdrawing
1095 cardiopulmonary resuscitation pursuant to such an order and
1096 rules adopted by the agency. The absence of an order not to
1097 resuscitate executed pursuant to s. 401.45 does not preclude a
1098 physician from withholding or withdrawing cardiopulmonary
1099 resuscitation as otherwise permitted by law.
1100 Section 33. Sections 400.0234, 400.145, and 429.294,
1101 Florida Statutes, are repealed.
1102 Section 34. Subsection (9) and subsections (11) through
1103 (15) of section 400.147, Florida Statutes, are renumbered as
1104 subsections (8) through (13), respectively, and present
1105 subsections (7), (8), and (10) of that section are amended to
1106 read:
1107 400.147 Internal risk management and quality assurance
1108 program.—
1109 (7) The facility shall initiate an investigation and shall
1110 notify the agency within 1 business day after the risk manager
1111 or his or her designee has received a report pursuant to
1112 paragraph (1)(d). Each facility shall complete the investigation
1113 and submit a report to the agency within 15 calendar days after
1114 an incident is determined to be an adverse incident. The
1115 notification must be made in writing and be provided
1116 electronically, by facsimile device or overnight mail delivery.
1117 The agency shall develop a form for reporting this information
1118 and the notification must include the name of the risk manager
1119 of the facility, information regarding the identity of the
1120 affected resident, the type of adverse incident, the initiation
1121 of an investigation by the facility, and whether the events
1122 causing or resulting in the adverse incident represent a
1123 potential risk to any other resident. The notification is
1124 confidential as provided by law and is not discoverable or
1125 admissible in any civil or administrative action, except in
1126 disciplinary proceedings by the agency or the appropriate
1127 regulatory board. The agency may investigate, as it deems
1128 appropriate, any such incident and prescribe measures that must
1129 or may be taken in response to the incident. The agency shall
1130 review each report incident and determine whether it potentially
1131 involved conduct by the health care professional who is subject
1132 to disciplinary action, in which case the provisions of s.
1133 456.073 shall apply.
1134 (8)(a) Each facility shall complete the investigation and
1135 submit an adverse incident report to the agency for each adverse
1136 incident within 15 calendar days after its occurrence. If, after
1137 a complete investigation, the risk manager determines that the
1138 incident was not an adverse incident as defined in subsection
1139 (5), the facility shall include this information in the report.
1140 The agency shall develop a form for reporting this information.
1141 (b) The information reported to the agency pursuant to
1142 paragraph (a) which relates to persons licensed under chapter
1143 458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1144 by the agency. The agency shall determine whether any of the
1145 incidents potentially involved conduct by a health care
1146 professional who is subject to disciplinary action, in which
1147 case the provisions of s. 456.073 shall apply.
1148 (c) The report submitted to the agency must also contain
1149 the name of the risk manager of the facility.
1150 (d) The adverse incident report is confidential as provided
1151 by law and is not discoverable or admissible in any civil or
1152 administrative action, except in disciplinary proceedings by the
1153 agency or the appropriate regulatory board.
1154 (10) By the 10th of each month, each facility subject to
1155 this section shall report any notice received pursuant to s.
1156 400.0233(2) and each initial complaint that was filed with the
1157 clerk of the court and served on the facility during the
1158 previous month by a resident or a resident’s family member,
1159 guardian, conservator, or personal legal representative. The
1160 report must include the name of the resident, the resident’s
1161 date of birth and social security number, the Medicaid
1162 identification number for Medicaid-eligible persons, the date or
1163 dates of the incident leading to the claim or dates of
1164 residency, if applicable, and the type of injury or violation of
1165 rights alleged to have occurred. Each facility shall also submit
1166 a copy of the notices received pursuant to s. 400.0233(2) and
1167 complaints filed with the clerk of the court. This report is
1168 confidential as provided by law and is not discoverable or
1169 admissible in any civil or administrative action, except in such
1170 actions brought by the agency to enforce the provisions of this
1171 part.
1172 Section 35. Section 400.148, Florida Statutes, is repealed.
1173 Section 36. Paragraph (e) of subsection (2) of section
1174 400.179, Florida Statutes, is amended to read:
1175 400.179 Liability for Medicaid underpayments and
1176 overpayments.—
1177 (2) Because any transfer of a nursing facility may expose
1178 the fact that Medicaid may have underpaid or overpaid the
1179 transferor, and because in most instances, any such underpayment
1180 or overpayment can only be determined following a formal field
1181 audit, the liabilities for any such underpayments or
1182 overpayments shall be as follows:
1183 (e) For the 2009-2010 fiscal year only, the provisions of
1184 paragraph (d) shall not apply. This paragraph expires July 1,
1185 2010.
1186 Section 37. Subsection (3) of section 400.19, Florida
1187 Statutes, is amended to read:
1188 400.19 Right of entry and inspection.—
1189 (3) The agency shall every 15 months conduct at least one
1190 unannounced inspection to determine compliance by the licensee
1191 with statutes, and with rules promulgated under the provisions
1192 of those statutes, governing minimum standards of construction,
1193 quality and adequacy of care, and rights of residents. The
1194 survey shall be conducted every 6 months for the next 2-year
1195 period if the facility has been cited for a class I deficiency,
1196 has been cited for two or more class II deficiencies arising
1197 from separate surveys or investigations within a 60-day period,
1198 or has had three or more substantiated complaints within a 6
1199 month period, each resulting in at least one class I or class II
1200 deficiency. In addition to any other fees or fines in this part,
1201 the agency shall assess a fine for each facility that is subject
1202 to the 6-month survey cycle. The fine for the 2-year period
1203 shall be $6,000, one-half to be paid at the completion of each
1204 survey. The agency may adjust this fine by the change in the
1205 Consumer Price Index, based on the 12 months immediately
1206 preceding the increase, to cover the cost of the additional
1207 surveys. The agency shall verify through subsequent inspection
1208 that any deficiency identified during inspection is corrected.
1209 However, the agency may verify the correction of a class III or
1210 class IV deficiency unrelated to resident rights or resident
1211 care without reinspecting the facility if adequate written
1212 documentation has been received from the facility, which
1213 provides assurance that the deficiency has been corrected. The
1214 giving or causing to be given of advance notice of such
1215 unannounced inspections by an employee of the agency to any
1216 unauthorized person shall constitute cause for suspension of not
1217 fewer than 5 working days according to the provisions of chapter
1218 110.
1219 Section 38. Subsection (5) of section 400.23, Florida
1220 Statutes, is amended to read:
1221 400.23 Rules; evaluation and deficiencies; licensure
1222 status.—
1223 (5)(a) The agency, in collaboration with the Division of
1224 Children’s Medical Services Network of the Department of Health,
1225 must, no later than December 31, 1993, adopt rules for minimum
1226 standards of care for persons under 21 years of age who reside
1227 in nursing home facilities. The rules must include a methodology
1228 for reviewing a nursing home facility under ss. 408.031-408.045
1229 which serves only persons under 21 years of age. A facility may
1230 be exempt from these standards for specific persons between 18
1231 and 21 years of age, if the person’s physician agrees that
1232 minimum standards of care based on age are not necessary.
1233 (b) The agency, in collaboration with the Division of
1234 Children’s Medical Services Network, shall adopt rules for
1235 minimum staffing requirements for nursing home facilities that
1236 serve persons under 21 years of age, which shall apply in lieu
1237 of the standards contained in subsection (3).
1238 1. For persons under 21 years of age who require skilled
1239 care, the requirements shall include a minimum combined average
1240 of licensed nurses, respiratory therapists, respiratory care
1241 practitioners, and certified nursing assistants of 3.9 hours of
1242 direct care per resident per day for each nursing home facility.
1243 2. For persons under 21 years of age who are fragile, the
1244 requirements shall include a minimum combined average of
1245 licensed nurses, respiratory therapists, respiratory care
1246 practitioners, and certified nursing assistants of 5 hours of
1247 direct care per resident per day for each nursing home facility.
1248 Section 39. Subsection (1) of section 400.275, Florida
1249 Statutes, is amended to read:
1250 400.275 Agency duties.—
1251 (1) The agency shall ensure that each newly hired nursing
1252 home surveyor, as a part of basic training, is assigned full
1253 time to a licensed nursing home for at least 2 days within a 7
1254 day period to observe facility operations outside of the survey
1255 process before the surveyor begins survey responsibilities. Such
1256 observations may not be the sole basis of a deficiency citation
1257 against the facility. The agency may not assign an individual to
1258 be a member of a survey team for purposes of a survey,
1259 evaluation, or consultation visit at a nursing home facility in
1260 which the surveyor was an employee within the preceding 2 5
1261 years.
1262 Section 40. Subsection (27) of section 400.462, Florida
1263 Statutes, is amended to read:
1264 400.462 Definitions.—As used in this part, the term:
1265 (27) “Remuneration” means any payment or other benefit made
1266 directly or indirectly, overtly or covertly, in cash or in kind.
1267 However, when the term is used in any provision of law relating
1268 to a health care provider, such term does not mean an item with
1269 an individual value of up to $15, including, but not limited to,
1270 plaques, certificates, trophies, or novelties that are intended
1271 solely for presentation or are customarily given away solely for
1272 promotional, recognition, or advertising purposes.
1273 Section 41. Subsection (2) of section 400.484, Florida
1274 Statutes, is amended to read:
1275 400.484 Right of inspection; violations deficiencies;
1276 fines.—
1277 (2) The agency shall impose fines for various classes of
1278 violations deficiencies in accordance with the following
1279 schedule:
1280 (a) Class I violations are defined in s. 408.813. A class I
1281 deficiency is any act, omission, or practice that results in a
1282 patient’s death, disablement, or permanent injury, or places a
1283 patient at imminent risk of death, disablement, or permanent
1284 injury. Upon finding a class I violation deficiency, the agency
1285 shall impose an administrative fine in the amount of $15,000 for
1286 each occurrence and each day that the violation deficiency
1287 exists.
1288 (b) Class II violations are defined in s. 408.813. A class
1289 II deficiency is any act, omission, or practice that has a
1290 direct adverse effect on the health, safety, or security of a
1291 patient. Upon finding a class II violation deficiency, the
1292 agency shall impose an administrative fine in the amount of
1293 $5,000 for each occurrence and each day that the violation
1294 deficiency exists.
1295 (c) Class III violations are defined in s. 408.813. A class
1296 III deficiency is any act, omission, or practice that has an
1297 indirect, adverse effect on the health, safety, or security of a
1298 patient. Upon finding an uncorrected or repeated class III
1299 violation deficiency, the agency shall impose an administrative
1300 fine not to exceed $1,000 for each occurrence and each day that
1301 the uncorrected or repeated violation deficiency exists.
1302 (d) Class IV violations are defined in s. 408.813. A class
1303 IV deficiency is any act, omission, or practice related to
1304 required reports, forms, or documents which does not have the
1305 potential of negatively affecting patients. These violations are
1306 of a type that the agency determines do not threaten the health,
1307 safety, or security of patients. Upon finding an uncorrected or
1308 repeated class IV violation deficiency, the agency shall impose
1309 an administrative fine not to exceed $500 for each occurrence
1310 and each day that the uncorrected or repeated violation
1311 deficiency exists.
1312 Section 42. Subsections (16) and (17) of section 400.506,
1313 Florida Statutes, are renumbered as subsections (17) and (18),
1314 respectively, paragraph (a) of subsection (15) is amended, and a
1315 new subsection (16) is added to that section, to read:
1316 400.506 Licensure of nurse registries; requirements;
1317 penalties.—
1318 (15)(a) The agency may deny, suspend, or revoke the license
1319 of a nurse registry and shall impose a fine of $5,000 against a
1320 nurse registry that:
1321 1. Provides services to residents in an assisted living
1322 facility for which the nurse registry does not receive fair
1323 market value remuneration.
1324 2. Provides staffing to an assisted living facility for
1325 which the nurse registry does not receive fair market value
1326 remuneration.
1327 3. Fails to provide the agency, upon request, with copies
1328 of all contracts with assisted living facilities which were
1329 executed within the last 5 years.
1330 4. Gives remuneration to a case manager, discharge planner,
1331 facility-based staff member, or third-party vendor who is
1332 involved in the discharge planning process of a facility
1333 licensed under chapter 395 or this chapter and from whom the
1334 nurse registry receives referrals. A nurse registry is exempt
1335 from this subparagraph if it does not bill the Florida Medicaid
1336 program or the Medicare program or share a controlling interest
1337 with any entity licensed, registered, or certified under part II
1338 of chapter 408 that bills the Florida Medicaid program or the
1339 Medicare program.
1340 5. Gives remuneration to a physician, a member of the
1341 physician’s office staff, or an immediate family member of the
1342 physician, and the nurse registry received a patient referral in
1343 the last 12 months from that physician or the physician’s office
1344 staff. A nurse registry is exempt from this subparagraph if it
1345 does not bill the Florida Medicaid program or the Medicare
1346 program or share a controlling interest with any entity
1347 licensed, registered, or certified under part II of chapter 408
1348 that bills the Florida Medicaid program or the Medicare program.
1349 (16) An administrator may manage only one nurse registry,
1350 except that an administrator may manage up to five registries if
1351 all five registries have identical controlling interests as
1352 defined in s. 408.803 and are located within one agency
1353 geographic service area or within an immediately contiguous
1354 county. An administrator shall designate, in writing, for each
1355 licensed entity, a qualified alternate administrator to serve
1356 during the administrator’s absence.
1357 Section 43. Subsection (1) of section 400.509, Florida
1358 Statutes, is amended to read:
1359 400.509 Registration of particular service providers exempt
1360 from licensure; certificate of registration; regulation of
1361 registrants.—
1362 (1) Any organization that provides companion services or
1363 homemaker services and does not provide a home health service to
1364 a person is exempt from licensure under this part. However, any
1365 organization that provides companion services or homemaker
1366 services must register with the agency. An organization under
1367 contract with the Agency for Persons with Disabilities that
1368 provides companion services only for persons with a
1369 developmental disability, as defined in s. 393.063, are exempt
1370 from registration.
1371 Section 44. Paragraph (i) of subsection (1) and subsection
1372 (4) of section 400.606, Florida Statutes, are amended to read:
1373 400.606 License; application; renewal; conditional license
1374 or permit; certificate of need.—
1375 (1) In addition to the requirements of part II of chapter
1376 408, the initial application and change of ownership application
1377 must be accompanied by a plan for the delivery of home,
1378 residential, and homelike inpatient hospice services to
1379 terminally ill persons and their families. Such plan must
1380 contain, but need not be limited to:
1381 (i) The projected annual operating cost of the hospice.
1382 If the applicant is an existing licensed health care provider,
1383 the application must be accompanied by a copy of the most recent
1384 profit-loss statement and, if applicable, the most recent
1385 licensure inspection report.
1386 (4) A freestanding hospice facility that is primarily
1387 engaged in providing inpatient and related services and that is
1388 not otherwise licensed as a health care facility shall be
1389 required to obtain a certificate of need. However, a
1390 freestanding hospice facility with six or fewer beds shall not
1391 be required to comply with institutional standards such as, but
1392 not limited to, standards requiring sprinkler systems, emergency
1393 electrical systems, or special lavatory devices.
1394 Section 45. Subsection (2) of section 400.607, Florida
1395 Statutes, is amended to read:
1396 400.607 Denial, suspension, revocation of license;
1397 emergency actions; imposition of administrative fine; grounds.—
1398 (2) A violation of this part, part II of chapter 408, or
1399 applicable rules Any of the following actions by a licensed
1400 hospice or any of its employees shall be grounds for
1401 administrative action by the agency against a hospice.:
1402 (a) A violation of the provisions of this part, part II of
1403 chapter 408, or applicable rules.
1404 (b) An intentional or negligent act materially affecting
1405 the health or safety of a patient.
1406 Section 46. Section 400.915, Florida Statutes, is amended
1407 to read:
1408 400.915 Construction and renovation; requirements.—The
1409 requirements for the construction or renovation of a PPEC center
1410 shall comply with:
1411 (1) The provisions of chapter 553, which pertain to
1412 building construction standards, including plumbing, electrical
1413 code, glass, manufactured buildings, accessibility for the
1414 physically disabled;
1415 (2) The provisions of s. 633.022 and applicable rules
1416 pertaining to physical minimum standards for nonresidential
1417 child care physical facilities in rule 10M-12.003, Florida
1418 Administrative Code, Child Care Standards; and
1419 (3) The standards or rules adopted pursuant to this part
1420 and part II of chapter 408.
1421 Section 47. Subsection (1) of section 400.925, Florida
1422 Statutes, is amended to read:
1423 400.925 Definitions.—As used in this part, the term:
1424 (1) “Accrediting organizations” means the Joint Commission
1425 on Accreditation of Healthcare Organizations or other national
1426 accreditation agencies whose standards for accreditation are
1427 comparable to those required by this part for licensure.
1428 Section 48. Subsection (2) of section 400.931, Florida
1429 Statutes, is amended to read:
1430 400.931 Application for license; fee; provisional license;
1431 temporary permit.—
1432 (2) An applicant for initial licensure, change of
1433 ownership, or renewal to operate a licensed home medical
1434 equipment provider at a location outside the state must submit
1435 documentation of accreditation or an application for
1436 accreditation from an accrediting organization that is
1437 recognized by the agency. An applicant that has applied for
1438 accreditation must provide proof of accreditation that is not
1439 conditional or provisional within 120 days after the date the
1440 agency receives the application for licensure or the application
1441 shall be withdrawn from further consideration. Such
1442 accreditation must be maintained by the home medical equipment
1443 provider to maintain licensure. As an alternative to submitting
1444 proof of financial ability to operate as required in s.
1445 408.810(8), the applicant may submit a $50,000 surety bond to
1446 the agency.
1447 Section 49. Subsection (2) of section 400.932, Florida
1448 Statutes, is amended to read:
1449 400.932 Administrative penalties.—
1450 (2) A violation of this part, part II of chapter 408, or
1451 applicable rules Any of the following actions by an employee of
1452 a home medical equipment provider shall be are grounds for
1453 administrative action or penalties by the agency.:
1454 (a) Violation of this part, part II of chapter 408, or
1455 applicable rules.
1456 (b) An intentional, reckless, or negligent act that
1457 materially affects the health or safety of a patient.
1458 Section 50. Subsection (3) of section 400.967, Florida
1459 Statutes, is amended to read:
1460 400.967 Rules and classification of violations
1461 deficiencies.—
1462 (3) The agency shall adopt rules to provide that, when the
1463 criteria established under this part and part II of chapter 408
1464 are not met, such violations deficiencies shall be classified
1465 according to the nature of the violation deficiency. The agency
1466 shall indicate the classification on the face of the notice of
1467 deficiencies as follows:
1468 (a) Class I violations deficiencies are defined in s.
1469 408.813 those which the agency determines present an imminent
1470 danger to the residents or guests of the facility or a
1471 substantial probability that death or serious physical harm
1472 would result therefrom. The condition or practice constituting a
1473 class I violation must be abated or eliminated immediately,
1474 unless a fixed period of time, as determined by the agency, is
1475 required for correction. A class I violation deficiency is
1476 subject to a civil penalty in an amount not less than $5,000 and
1477 not exceeding $10,000 for each violation deficiency. A fine may
1478 be levied notwithstanding the correction of the violation
1479 deficiency.
1480 (b) Class II violations deficiencies are defined in s.
1481 408.813 those which the agency determines have a direct or
1482 immediate relationship to the health, safety, or security of the
1483 facility residents, other than class I deficiencies. A class II
1484 violation deficiency is subject to a civil penalty in an amount
1485 not less than $1,000 and not exceeding $5,000 for each violation
1486 deficiency. A citation for a class II violation deficiency shall
1487 specify the time within which the violation deficiency must be
1488 corrected. If a class II violation deficiency is corrected
1489 within the time specified, no civil penalty shall be imposed,
1490 unless it is a repeated offense.
1491 (c) Class III violations deficiencies are defined in s.
1492 408.813 those which the agency determines to have an indirect or
1493 potential relationship to the health, safety, or security of the
1494 facility residents, other than class I or class II deficiencies.
1495 A class III violation deficiency is subject to a civil penalty
1496 of not less than $500 and not exceeding $1,000 for each
1497 deficiency. A citation for a class III violation deficiency
1498 shall specify the time within which the violation deficiency
1499 must be corrected. If a class III violation deficiency is
1500 corrected within the time specified, no civil penalty shall be
1501 imposed, unless it is a repeated offense.
1502 (d) Class IV violations are defined in s. 408.813. Upon
1503 finding an uncorrected or repeated class IV violation, the
1504 agency shall impose an administrative fine not to exceed $500
1505 for each occurrence and each day that the uncorrected or
1506 repeated violation exists.
1507 Section 51. Subsections (4) and (7) of section 400.9905,
1508 Florida Statutes, are amended to read:
1509 400.9905 Definitions.—
1510 (4) “Clinic” means an entity at which health care services
1511 are provided to individuals and which tenders charges for
1512 reimbursement for such services, including a mobile clinic and a
1513 portable health service or equipment provider. For purposes of
1514 this part, the term does not include and the licensure
1515 requirements of this part do not apply to:
1516 (a) Entities licensed or registered by the state under
1517 chapter 395; or entities licensed or registered by the state and
1518 providing only health care services within the scope of services
1519 authorized under their respective licenses granted under ss.
1520 383.30-383.335, chapter 390, chapter 394, chapter 397, this
1521 chapter except part X, chapter 429, chapter 463, chapter 465,
1522 chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1523 chapter 651; end-stage renal disease providers authorized under
1524 42 C.F.R. part 405, subpart U; or providers certified under 42
1525 C.F.R. part 485, subpart B or subpart H; or any entity that
1526 provides neonatal or pediatric hospital-based health care
1527 services or other health care services by licensed practitioners
1528 solely within a hospital licensed under chapter 395.
1529 (b) Entities that own, directly or indirectly, entities
1530 licensed or registered by the state pursuant to chapter 395; or
1531 entities that own, directly or indirectly, entities licensed or
1532 registered by the state and providing only health care services
1533 within the scope of services authorized pursuant to their
1534 respective licenses granted under ss. 383.30-383.335, chapter
1535 390, chapter 394, chapter 397, this chapter except part X,
1536 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1537 part I of chapter 483, chapter 484, chapter 651; end-stage renal
1538 disease providers authorized under 42 C.F.R. part 405, subpart
1539 U; or providers certified under 42 C.F.R. part 485, subpart B or
1540 subpart H; or any entity that provides neonatal or pediatric
1541 hospital-based health care services by licensed practitioners
1542 solely within a hospital licensed under chapter 395.
1543 (c) Entities that are owned, directly or indirectly, by an
1544 entity licensed or registered by the state pursuant to chapter
1545 395; or entities that are owned, directly or indirectly, by an
1546 entity licensed or registered by the state and providing only
1547 health care services within the scope of services authorized
1548 pursuant to their respective licenses granted under ss. 383.30
1549 383.335, chapter 390, chapter 394, chapter 397, this chapter
1550 except part X, chapter 429, chapter 463, chapter 465, chapter
1551 466, chapter 478, part I of chapter 483, chapter 484, or chapter
1552 651; end-stage renal disease providers authorized under 42
1553 C.F.R. part 405, subpart U; or providers certified under 42
1554 C.F.R. part 485, subpart B or subpart H; or any entity that
1555 provides neonatal or pediatric hospital-based health care
1556 services by licensed practitioners solely within a hospital
1557 under chapter 395.
1558 (d) Entities that are under common ownership, directly or
1559 indirectly, with an entity licensed or registered by the state
1560 pursuant to chapter 395; or entities that are under common
1561 ownership, directly or indirectly, with an entity licensed or
1562 registered by the state and providing only health care services
1563 within the scope of services authorized pursuant to their
1564 respective licenses granted under ss. 383.30-383.335, chapter
1565 390, chapter 394, chapter 397, this chapter except part X,
1566 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1567 part I of chapter 483, chapter 484, or chapter 651; end-stage
1568 renal disease providers authorized under 42 C.F.R. part 405,
1569 subpart U; or providers certified under 42 C.F.R. part 485,
1570 subpart B or subpart H; or any entity that provides neonatal or
1571 pediatric hospital-based health care services by licensed
1572 practitioners solely within a hospital licensed under chapter
1573 395.
1574 (e) An entity that is exempt from federal taxation under 26
1575 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1576 under 26 U.S.C. s. 409 that has a board of trustees not less
1577 than two-thirds of which are Florida-licensed health care
1578 practitioners and provides only physical therapy services under
1579 physician orders, any community college or university clinic,
1580 and any entity owned or operated by the federal or state
1581 government, including agencies, subdivisions, or municipalities
1582 thereof.
1583 (f) A sole proprietorship, group practice, partnership, or
1584 corporation that provides health care services by physicians
1585 covered by s. 627.419, that is directly supervised by one or
1586 more of such physicians, and that is wholly owned by one or more
1587 of those physicians or by a physician and the spouse, parent,
1588 child, or sibling of that physician.
1589 (g) A sole proprietorship, group practice, partnership, or
1590 corporation that provides health care services by licensed
1591 health care practitioners under chapter 457, chapter 458,
1592 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1593 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1594 chapter 490, chapter 491, or part I, part III, part X, part
1595 XIII, or part XIV of chapter 468, or s. 464.012, which are
1596 wholly owned by one or more licensed health care practitioners,
1597 or the licensed health care practitioners set forth in this
1598 paragraph and the spouse, parent, child, or sibling of a
1599 licensed health care practitioner, so long as one of the owners
1600 who is a licensed health care practitioner is supervising the
1601 business activities and is legally responsible for the entity’s
1602 compliance with all federal and state laws. However, a health
1603 care practitioner may not supervise services beyond the scope of
1604 the practitioner’s license, except that, for the purposes of
1605 this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1606 provides only services authorized pursuant to s. 456.053(3)(b)
1607 may be supervised by a licensee specified in s. 456.053(3)(b).
1608 (h) Clinical facilities affiliated with an accredited
1609 medical school at which training is provided for medical
1610 students, residents, or fellows.
1611 (i) Entities that provide only oncology or radiation
1612 therapy services by physicians licensed under chapter 458 or
1613 chapter 459 or entities that provide oncology or radiation
1614 therapy services by physicians licensed under chapter 458 or
1615 chapter 459 which are owned by a corporation whose shares are
1616 publicly traded on a recognized stock exchange.
1617 (j) Clinical facilities affiliated with a college of
1618 chiropractic accredited by the Council on Chiropractic Education
1619 at which training is provided for chiropractic students.
1620 (k) Entities that provide licensed practitioners to staff
1621 emergency departments or to deliver anesthesia services in
1622 facilities licensed under chapter 395 and that derive at least
1623 90 percent of their gross annual revenues from the provision of
1624 such services. Entities claiming an exemption from licensure
1625 under this paragraph must provide documentation demonstrating
1626 compliance.
1627 (l) Orthotic, or prosthetic, pediatric cardiology, or
1628 perinatology clinical facilities that are a publicly traded
1629 corporation or that are wholly owned, directly or indirectly, by
1630 a publicly traded corporation. As used in this paragraph, a
1631 publicly traded corporation is a corporation that issues
1632 securities traded on an exchange registered with the United
1633 States Securities and Exchange Commission as a national
1634 securities exchange.
1635 (m) Entities that are owned by a corporation that has $250
1636 million or more in total annual sales of health care services
1637 provided by licensed health care practitioners if one or more of
1638 the owners of the entity is a health care practitioner who is
1639 licensed in this state, is responsible for supervising the
1640 business activities of the entity, and is legally responsible
1641 for the entity’s compliance with state law for purposes of this
1642 section.
1643 (n) Entities that are owned or controlled, directly or
1644 indirectly, by a publicly traded entity with $100 million or
1645 more, in the aggregate, in total annual revenues derived from
1646 providing health care services by licensed health care
1647 practitioners that are employed or contracted by an entity
1648 described in this paragraph.
1649 (o) Entities that employ 50 or more health care
1650 practitioners licensed under chapter 458 or chapter 459 when the
1651 billing for medical services is under a single tax
1652 identification number. The application for exemption under this
1653 paragraph shall contain information that includes the name,
1654 residence address, business address, and phone number of the
1655 entity that owns the practice; a complete list of the names and
1656 contact information of all the officers and directors of the
1657 entity; the name, residence address, business address, and
1658 medical license number of each licensed Florida health care
1659 practitioner employed by the entity; the corporate tax
1660 identification number of the entity seeking an exemption; a
1661 listing of health care services to be provided by the entity at
1662 the health care clinics owned or operated by the entity and a
1663 certified statement prepared by an independent certified public
1664 accountant which states that the entity and the health care
1665 clinics owned or operated by the entity have not received
1666 payment for health care services under personal injury
1667 protection insurance coverage for the previous year. If the
1668 agency determines that an entity that is exempt under this
1669 paragraph has received payments for medical services under
1670 personal injury protection insurance coverage the agency may
1671 deny or revoke the exemption from licensure under this
1672 paragraph.
1673 (7) “Portable health service or equipment provider” means
1674 an entity that contracts with or employs persons to provide
1675 portable health services or equipment to multiple locations
1676 performing treatment or diagnostic testing of individuals, that
1677 bills third-party payors for those services, and that otherwise
1678 meets the definition of a clinic in subsection (4).
1679 Section 52. Paragraph (b) of subsection (1) and paragraph
1680 (c) of subsection (4) of section 400.991, Florida Statutes, are
1681 amended to read:
1682 400.991 License requirements; background screenings;
1683 prohibitions.—
1684 (1)
1685 (b) Each mobile clinic must obtain a separate health care
1686 clinic license and must provide to the agency, at least
1687 quarterly, its projected street location to enable the agency to
1688 locate and inspect such clinic. A portable health service or
1689 equipment provider must obtain a health care clinic license for
1690 a single administrative office and is not required to submit
1691 quarterly projected street locations.
1692 (4) In addition to the requirements of part II of chapter
1693 408, the applicant must file with the application satisfactory
1694 proof that the clinic is in compliance with this part and
1695 applicable rules, including:
1696 (c) Proof of financial ability to operate as required under
1697 ss. s. 408.810(8) and 408.8065. As an alternative to submitting
1698 proof of financial ability to operate as required under s.
1699 408.810(8), the applicant may file a surety bond of at least
1700 $500,000 which guarantees that the clinic will act in full
1701 conformity with all legal requirements for operating a clinic,
1702 payable to the agency. The agency may adopt rules to specify
1703 related requirements for such surety bond.
1704 Section 53. Paragraph (g) of subsection (1) and paragraph
1705 (a) of subsection (7) of section 400.9935, Florida Statutes, are
1706 amended to read:
1707 400.9935 Clinic responsibilities.—
1708 (1) Each clinic shall appoint a medical director or clinic
1709 director who shall agree in writing to accept legal
1710 responsibility for the following activities on behalf of the
1711 clinic. The medical director or the clinic director shall:
1712 (g) Conduct systematic reviews of clinic billings to ensure
1713 that the billings are not fraudulent or unlawful. Upon discovery
1714 of an unlawful charge, the medical director or clinic director
1715 shall take immediate corrective action. If the clinic performs
1716 only the technical component of magnetic resonance imaging,
1717 static radiographs, computed tomography, or positron emission
1718 tomography, and provides the professional interpretation of such
1719 services, in a fixed facility that is accredited by the Joint
1720 Commission on Accreditation of Healthcare Organizations or the
1721 Accreditation Association for Ambulatory Health Care, and the
1722 American College of Radiology; and if, in the preceding quarter,
1723 the percentage of scans performed by that clinic which was
1724 billed to all personal injury protection insurance carriers was
1725 less than 15 percent, the chief financial officer of the clinic
1726 may, in a written acknowledgment provided to the agency, assume
1727 the responsibility for the conduct of the systematic reviews of
1728 clinic billings to ensure that the billings are not fraudulent
1729 or unlawful.
1730 (7)(a) Each clinic engaged in magnetic resonance imaging
1731 services must be accredited by the Joint Commission on
1732 Accreditation of Healthcare Organizations, the American College
1733 of Radiology, or the Accreditation Association for Ambulatory
1734 Health Care, within 1 year after licensure. A clinic that is
1735 accredited by the American College of Radiology or is within the
1736 original 1-year period after licensure and replaces its core
1737 magnetic resonance imaging equipment shall be given 1 year after
1738 the date on which the equipment is replaced to attain
1739 accreditation. However, a clinic may request a single, 6-month
1740 extension if it provides evidence to the agency establishing
1741 that, for good cause shown, such clinic cannot be accredited
1742 within 1 year after licensure, and that such accreditation will
1743 be completed within the 6-month extension. After obtaining
1744 accreditation as required by this subsection, each such clinic
1745 must maintain accreditation as a condition of renewal of its
1746 license. A clinic that files a change of ownership application
1747 must comply with the original accreditation timeframe
1748 requirements of the transferor. The agency shall deny a change
1749 of ownership application if the clinic is not in compliance with
1750 the accreditation requirements. When a clinic adds, replaces, or
1751 modifies magnetic resonance imaging equipment and the
1752 accreditation agency requires new accreditation, the clinic must
1753 be accredited within 1 year after the date of the addition,
1754 replacement, or modification but may request a single, 6-month
1755 extension if the clinic provides evidence of good cause to the
1756 agency.
1757 Section 54. Paragraph (a) of subsection (2) of section
1758 408.033, Florida Statutes, is amended to read:
1759 408.033 Local and state health planning.—
1760 (2) FUNDING.—
1761 (a) The Legislature intends that the cost of local health
1762 councils be borne by assessments on selected health care
1763 facilities subject to facility licensure by the Agency for
1764 Health Care Administration, including abortion clinics, assisted
1765 living facilities, ambulatory surgical centers, birthing
1766 centers, clinical laboratories except community nonprofit blood
1767 banks and clinical laboratories operated by practitioners for
1768 exclusive use regulated under s. 483.035, home health agencies,
1769 hospices, hospitals, intermediate care facilities for the
1770 developmentally disabled, nursing homes, health care clinics,
1771 and multiphasic testing centers and by assessments on
1772 organizations subject to certification by the agency pursuant to
1773 chapter 641, part III, including health maintenance
1774 organizations and prepaid health clinics. Fees assessed may be
1775 collected prospectively at the time of licensure renewal and
1776 prorated for the licensure period.
1777 Section 55. Subsection (2) of section 408.034, Florida
1778 Statutes, is amended to read:
1779 408.034 Duties and responsibilities of agency; rules.—
1780 (2) In the exercise of its authority to issue licenses to
1781 health care facilities and health service providers, as provided
1782 under chapters 393 and 395 and parts II, and IV, and VIII of
1783 chapter 400, the agency may not issue a license to any health
1784 care facility or health service provider that fails to receive a
1785 certificate of need or an exemption for the licensed facility or
1786 service.
1787 Section 56. Paragraph (d) of subsection (1) and paragraph
1788 (m) of subsection (3) of section 408.036, Florida Statutes, are
1789 amended to read:
1790 408.036 Projects subject to review; exemptions.—
1791 (1) APPLICABILITY.—Unless exempt under subsection (3), all
1792 health-care-related projects, as described in paragraphs (a)
1793 (g), are subject to review and must file an application for a
1794 certificate of need with the agency. The agency is exclusively
1795 responsible for determining whether a health-care-related
1796 project is subject to review under ss. 408.031-408.045.
1797 (d) The establishment of a hospice or hospice inpatient
1798 facility, except as provided in s. 408.043.
1799 (3) EXEMPTIONS.—Upon request, the following projects are
1800 subject to exemption from the provisions of subsection (1):
1801 (m)1. For the provision of adult open-heart services in a
1802 hospital located within the boundaries of a health service
1803 planning district, as defined in s. 408.032(5), which has
1804 experienced an annual net out-migration of at least 600 open
1805 heart-surgery cases for 3 consecutive years according to the
1806 most recent data reported to the agency, and the district’s
1807 population per licensed and operational open-heart programs
1808 exceeds the state average of population per licensed and
1809 operational open-heart programs by at least 25 percent. All
1810 hospitals within a health service planning district which meet
1811 the criteria reference in sub-subparagraphs 2.a.-h. shall be
1812 eligible for this exemption on July 1, 2004, and shall receive
1813 the exemption upon filing for it and subject to the following:
1814 a. A hospital that has received a notice of intent to grant
1815 a certificate of need or a final order of the agency granting a
1816 certificate of need for the establishment of an open-heart
1817 surgery program is entitled to receive a letter of exemption for
1818 the establishment of an adult open-heart-surgery program upon
1819 filing a request for exemption and complying with the criteria
1820 enumerated in sub-subparagraphs 2.a.-h., and is entitled to
1821 immediately commence operation of the program.
1822 b. An otherwise eligible hospital that has not received a
1823 notice of intent to grant a certificate of need or a final order
1824 of the agency granting a certificate of need for the
1825 establishment of an open-heart-surgery program is entitled to
1826 immediately receive a letter of exemption for the establishment
1827 of an adult open-heart-surgery program upon filing a request for
1828 exemption and complying with the criteria enumerated in sub
1829 subparagraphs 2.a.-h., but is not entitled to commence operation
1830 of its program until December 31, 2006.
1831 2. A hospital shall be exempt from the certificate-of-need
1832 review for the establishment of an open-heart-surgery program
1833 when the application for exemption submitted under this
1834 paragraph complies with the following criteria:
1835 a. The applicant must certify that it will meet and
1836 continuously maintain the minimum licensure requirements adopted
1837 by the agency governing adult open-heart programs, including the
1838 most current guidelines of the American College of Cardiology
1839 and American Heart Association Guidelines for Adult Open Heart
1840 Programs.
1841 b. The applicant must certify that it will maintain
1842 sufficient appropriate equipment and health personnel to ensure
1843 quality and safety.
1844 c. The applicant must certify that it will maintain
1845 appropriate times of operation and protocols to ensure
1846 availability and appropriate referrals in the event of
1847 emergencies.
1848 d. The applicant can demonstrate that it has discharged at
1849 least 300 inpatients with a principal diagnosis of ischemic
1850 heart disease for the most recent 12-month period as reported to
1851 the agency.
1852 e. The applicant is a general acute care hospital that is
1853 in operation for 3 years or more.
1854 f. The applicant is performing more than 300 diagnostic
1855 cardiac catheterization procedures per year, combined inpatient
1856 and outpatient.
1857 g. The applicant’s payor mix at a minimum reflects the
1858 community average for Medicaid, charity care, and self-pay
1859 patients or the applicant must certify that it will provide a
1860 minimum of 5 percent of Medicaid, charity care, and self-pay to
1861 open-heart-surgery patients.
1862 h. If the applicant fails to meet the established criteria
1863 for open-heart programs or fails to reach 300 surgeries per year
1864 by the end of its third year of operation, it must show cause
1865 why its exemption should not be revoked.
1866 3. By December 31, 2004, and annually thereafter, the
1867 agency shall submit a report to the Legislature providing
1868 information concerning the number of requests for exemption it
1869 has received under this paragraph during the calendar year and
1870 the number of exemptions it has granted or denied during the
1871 calendar year.
1872 Section 57. Paragraph (c) of subsection (1) of section
1873 408.037, Florida Statutes, is amended to read:
1874 408.037 Application content.—
1875 (1) Except as provided in subsection (2) for a general
1876 hospital, an application for a certificate of need must contain:
1877 (c) An audited financial statement of the applicant or the
1878 applicant’s parent corporation if audited financial statements
1879 of the applicant do not exist. In an application submitted by an
1880 existing health care facility, health maintenance organization,
1881 or hospice, financial condition documentation must include, but
1882 need not be limited to, a balance sheet and a profit-and-loss
1883 statement of the 2 previous fiscal years’ operation.
1884 Section 58. Subsection (2) of section 408.043, Florida
1885 Statutes, is amended to read:
1886 408.043 Special provisions.—
1887 (2) HOSPICES.—When an application is made for a certificate
1888 of need to establish or to expand a hospice, the need for such
1889 hospice shall be determined on the basis of the need for and
1890 availability of hospice services in the community. The formula
1891 on which the certificate of need is based shall discourage
1892 regional monopolies and promote competition. The inpatient
1893 hospice care component of a hospice which is a freestanding
1894 facility, or a part of a facility, which is primarily engaged in
1895 providing inpatient care and related services and is not
1896 licensed as a health care facility shall also be required to
1897 obtain a certificate of need. Provision of hospice care by any
1898 current provider of health care is a significant change in
1899 service and therefore requires a certificate of need for such
1900 services.
1901 Section 59. Paragraph (k) of subsection (3) of section
1902 408.05, Florida Statutes, is amended to read:
1903 408.05 Florida Center for Health Information and Policy
1904 Analysis.—
1905 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
1906 produce comparable and uniform health information and statistics
1907 for the development of policy recommendations, the agency shall
1908 perform the following functions:
1909 (k) Develop, in conjunction with the State Consumer Health
1910 Information and Policy Advisory Council, and implement a long
1911 range plan for making available health care quality measures and
1912 financial data that will allow consumers to compare health care
1913 services. The health care quality measures and financial data
1914 the agency must make available shall include, but is not limited
1915 to, pharmaceuticals, physicians, health care facilities, and
1916 health plans and managed care entities. The agency shall update
1917 the plan and report on the status of its implementation
1918 annually. The agency shall also make the plan and status report
1919 available to the public on its Internet website. As part of the
1920 plan, the agency shall identify the process and timeframes for
1921 implementation, any barriers to implementation, and
1922 recommendations of changes in the law that may be enacted by the
1923 Legislature to eliminate the barriers. As preliminary elements
1924 of the plan, the agency shall:
1925 1. Make available patient-safety indicators, inpatient
1926 quality indicators, and performance outcome and patient charge
1927 data collected from health care facilities pursuant to s.
1928 408.061(1)(a) and (2). The terms “patient-safety indicators” and
1929 “inpatient quality indicators” shall be as defined by the
1930 Centers for Medicare and Medicaid Services, the National Quality
1931 Forum, the Joint Commission on Accreditation of Healthcare
1932 Organizations, the Agency for Healthcare Research and Quality,
1933 the Centers for Disease Control and Prevention, or a similar
1934 national entity that establishes standards to measure the
1935 performance of health care providers, or by other states. The
1936 agency shall determine which conditions, procedures, health care
1937 quality measures, and patient charge data to disclose based upon
1938 input from the council. When determining which conditions and
1939 procedures are to be disclosed, the council and the agency shall
1940 consider variation in costs, variation in outcomes, and
1941 magnitude of variations and other relevant information. When
1942 determining which health care quality measures to disclose, the
1943 agency:
1944 a. Shall consider such factors as volume of cases; average
1945 patient charges; average length of stay; complication rates;
1946 mortality rates; and infection rates, among others, which shall
1947 be adjusted for case mix and severity, if applicable.
1948 b. May consider such additional measures that are adopted
1949 by the Centers for Medicare and Medicaid Studies, National
1950 Quality Forum, the Joint Commission on Accreditation of
1951 Healthcare Organizations, the Agency for Healthcare Research and
1952 Quality, Centers for Disease Control and Prevention, or a
1953 similar national entity that establishes standards to measure
1954 the performance of health care providers, or by other states.
1955
1956 When determining which patient charge data to disclose, the
1957 agency shall include such measures as the average of
1958 undiscounted charges on frequently performed procedures and
1959 preventive diagnostic procedures, the range of procedure charges
1960 from highest to lowest, average net revenue per adjusted patient
1961 day, average cost per adjusted patient day, and average cost per
1962 admission, among others.
1963 2. Make available performance measures, benefit design, and
1964 premium cost data from health plans licensed pursuant to chapter
1965 627 or chapter 641. The agency shall determine which health care
1966 quality measures and member and subscriber cost data to
1967 disclose, based upon input from the council. When determining
1968 which data to disclose, the agency shall consider information
1969 that may be required by either individual or group purchasers to
1970 assess the value of the product, which may include membership
1971 satisfaction, quality of care, current enrollment or membership,
1972 coverage areas, accreditation status, premium costs, plan costs,
1973 premium increases, range of benefits, copayments and
1974 deductibles, accuracy and speed of claims payment, credentials
1975 of physicians, number of providers, names of network providers,
1976 and hospitals in the network. Health plans shall make available
1977 to the agency any such data or information that is not currently
1978 reported to the agency or the office.
1979 3. Determine the method and format for public disclosure of
1980 data reported pursuant to this paragraph. The agency shall make
1981 its determination based upon input from the State Consumer
1982 Health Information and Policy Advisory Council. At a minimum,
1983 the data shall be made available on the agency’s Internet
1984 website in a manner that allows consumers to conduct an
1985 interactive search that allows them to view and compare the
1986 information for specific providers. The website must include
1987 such additional information as is determined necessary to ensure
1988 that the website enhances informed decisionmaking among
1989 consumers and health care purchasers, which shall include, at a
1990 minimum, appropriate guidance on how to use the data and an
1991 explanation of why the data may vary from provider to provider.
1992 4. Publish on its website undiscounted charges for no fewer
1993 than 150 of the most commonly performed adult and pediatric
1994 procedures, including outpatient, inpatient, diagnostic, and
1995 preventative procedures.
1996 Section 60. Paragraph (a) of subsection (1) of section
1997 408.061, Florida Statutes, is amended to read:
1998 408.061 Data collection; uniform systems of financial
1999 reporting; information relating to physician charges;
2000 confidential information; immunity.—
2001 (1) The agency shall require the submission by health care
2002 facilities, health care providers, and health insurers of data
2003 necessary to carry out the agency’s duties. Specifications for
2004 data to be collected under this section shall be developed by
2005 the agency with the assistance of technical advisory panels
2006 including representatives of affected entities, consumers,
2007 purchasers, and such other interested parties as may be
2008 determined by the agency.
2009 (a) Data submitted by health care facilities, including the
2010 facilities as defined in chapter 395, shall include, but are not
2011 limited to: case-mix data, patient admission and discharge data,
2012 hospital emergency department data which shall include the
2013 number of patients treated in the emergency department of a
2014 licensed hospital reported by patient acuity level, data on
2015 hospital-acquired infections as specified by rule, data on
2016 complications as specified by rule, data on readmissions as
2017 specified by rule, with patient and provider-specific
2018 identifiers included, actual charge data by diagnostic groups,
2019 financial data, accounting data, operating expenses, expenses
2020 incurred for rendering services to patients who cannot or do not
2021 pay, interest charges, depreciation expenses based on the
2022 expected useful life of the property and equipment involved, and
2023 demographic data. The agency shall adopt nationally recognized
2024 risk adjustment methodologies or software consistent with the
2025 standards of the Agency for Healthcare Research and Quality and
2026 as selected by the agency for all data submitted as required by
2027 this section. Data may be obtained from documents such as, but
2028 not limited to: leases, contracts, debt instruments, itemized
2029 patient bills, medical record abstracts, and related diagnostic
2030 information. Reported data elements shall be reported
2031 electronically and in accordance with rule 59E-7.012, Florida
2032 Administrative Code. Data submitted shall be certified by the
2033 chief executive officer or an appropriate and duly authorized
2034 representative or employee of the licensed facility that the
2035 information submitted is true and accurate.
2036 Section 61. Subsection (43) of section 408.07, Florida
2037 Statutes, is amended to read:
2038 408.07 Definitions.—As used in this chapter, with the
2039 exception of ss. 408.031-408.045, the term:
2040 (43) “Rural hospital” means an acute care hospital licensed
2041 under chapter 395, having 100 or fewer licensed beds and an
2042 emergency room, and which is:
2043 (a) The sole provider within a county with a population
2044 density of no greater than 100 persons per square mile;
2045 (b) An acute care hospital, in a county with a population
2046 density of no greater than 100 persons per square mile, which is
2047 at least 30 minutes of travel time, on normally traveled roads
2048 under normal traffic conditions, from another acute care
2049 hospital within the same county;
2050 (c) A hospital supported by a tax district or subdistrict
2051 whose boundaries encompass a population of 100 persons or fewer
2052 per square mile;
2053 (d) A hospital with a service area that has a population of
2054 100 persons or fewer per square mile. As used in this paragraph,
2055 the term “service area” means the fewest number of zip codes
2056 that account for 75 percent of the hospital’s discharges for the
2057 most recent 5-year period, based on information available from
2058 the hospital inpatient discharge database in the Florida Center
2059 for Health Information and Policy Analysis at the Agency for
2060 Health Care Administration; or
2061 (e) A critical access hospital.
2062
2063 Population densities used in this subsection must be based upon
2064 the most recently completed United States census. A hospital
2065 that received funds under s. 409.9116 for a quarter beginning no
2066 later than July 1, 2002, is deemed to have been and shall
2067 continue to be a rural hospital from that date through June 30,
2068 2015, if the hospital continues to have 100 or fewer licensed
2069 beds and an emergency room, or meets the criteria of s.
2070 395.602(2)(e)4. An acute care hospital that has not previously
2071 been designated as a rural hospital and that meets the criteria
2072 of this subsection shall be granted such designation upon
2073 application, including supporting documentation, to the Agency
2074 for Health Care Administration.
2075 Section 62. Section 408.10, Florida Statutes, is amended to
2076 read:
2077 408.10 Consumer complaints.—The agency shall:
2078 (1) publish and make available to the public a toll-free
2079 telephone number for the purpose of handling consumer complaints
2080 and shall serve as a liaison between consumer entities and other
2081 private entities and governmental entities for the disposition
2082 of problems identified by consumers of health care.
2083 (2) Be empowered to investigate consumer complaints
2084 relating to problems with health care facilities’ billing
2085 practices and issue reports to be made public in any cases where
2086 the agency determines the health care facility has engaged in
2087 billing practices which are unreasonable and unfair to the
2088 consumer.
2089 Section 63. Subsections (12) through (30) of section
2090 408.802, Florida Statutes, are renumbered as subsections (11)
2091 through (29), respectively, and present subsection (11) of that
2092 section is amended to read:
2093 408.802 Applicability.—The provisions of this part apply to
2094 the provision of services that require licensure as defined in
2095 this part and to the following entities licensed, registered, or
2096 certified by the agency, as described in chapters 112, 383, 390,
2097 394, 395, 400, 429, 440, 483, and 765:
2098 (11) Private review agents, as provided under part I of
2099 chapter 395.
2100 Section 64. Subsection (3) is added to section 408.804,
2101 Florida Statutes, to read:
2102 408.804 License required; display.—
2103 (3) Any person who knowingly alters, defaces, or falsifies
2104 a license certificate issued by the agency, or causes or
2105 procures any person to commit such an offense, commits a
2106 misdemeanor of the second degree, punishable as provided in s.
2107 775.082 or s 775.083. Any licensee or provider who displays an
2108 altered, defaced, or falsified license certificate is subject to
2109 the penalties set forth in s. 408.815 and an administrative fine
2110 of $1,000 for each day of illegal display.
2111 Section 65. Paragraph (d) of subsection (2) of section
2112 408.806, Florida Statutes, is amended, and paragraph (e) is
2113 added to that subsection, to read:
2114 408.806 License application process.—
2115 (2)
2116 (d) The agency shall notify the licensee by mail or
2117 electronically at least 90 days before the expiration of a
2118 license that a renewal license is necessary to continue
2119 operation. The licensee’s failure to timely file submit a
2120 renewal application and license application fee with the agency
2121 shall result in a $50 per day late fee charged to the licensee
2122 by the agency; however, the aggregate amount of the late fee may
2123 not exceed 50 percent of the licensure fee or $500, whichever is
2124 less. The agency shall provide a courtesy notice to the licensee
2125 by United States mail, electronically, or by any other manner at
2126 its address of record or mailing address, if provided, at least
2127 90 days prior to the expiration of a license informing the
2128 licensee of the expiration of the license. If the licensee does
2129 not receive the courtesy notice, the licensee continues to be
2130 legally obligated to timely file the renewal application and
2131 license application fee with the agency and is not excused from
2132 the payment of a late fee. If an application is received after
2133 the required filing date and exhibits a hand-canceled postmark
2134 obtained from a United States post office dated on or before the
2135 required filing date, no fine will be levied.
2136 (e) The applicant must pay the late fee before a late
2137 application is considered complete and failure to pay the late
2138 fee is considered an omission from the application for licensure
2139 pursuant to paragraph (3)(b).
2140 Section 66. Paragraph (b) of subsection (1) of section
2141 408.8065, Florida Statutes, is amended to read:
2142 408.8065 Additional licensure requirements for home health
2143 agencies, home medical equipment providers, and health care
2144 clinics.—
2145 (1) An applicant for initial licensure, or initial
2146 licensure due to a change of ownership, as a home health agency,
2147 home medical equipment provider, or health care clinic shall:
2148 (b) Submit projected pro forma financial statements,
2149 including a balance sheet, income and expense statement, and a
2150 statement of cash flows for the first 2 years of operation which
2151 provide evidence that the applicant has sufficient assets,
2152 credit, and projected revenues to cover liabilities and
2153 expenses.
2154
2155 All documents required under this subsection must be prepared in
2156 accordance with generally accepted accounting principles and may
2157 be in a compilation form. The financial statements must be
2158 signed by a certified public accountant.
2159 Section 67. Subsections (5) through (8) of section 408.809,
2160 Florida Statutes are renumbered as subsections (6) through (9),
2161 respectively, and subsection (4) of that section is amended to
2162 read:
2163 408.809 Background screening; prohibited offenses.—
2164 (4) In addition to the offenses listed in s. 435.04, all
2165 persons required to undergo background screening pursuant to
2166 this part or authorizing statutes must not have an arrest
2167 awaiting final disposition for, must not have been found guilty
2168 of, regardless of adjudication, or entered a plea of nolo
2169 contendere or guilty to, and must not have been adjudicated
2170 delinquent and the record not have been sealed or expunged for
2171 any of the following offenses or any similar offense of another
2172 jurisdiction:
2173 (a) Any authorizing statutes, if the offense was a felony.
2174 (b) This chapter, if the offense was a felony.
2175 (c) Section 409.920, relating to Medicaid provider fraud.
2176 (d) Section 409.9201, relating to Medicaid fraud.
2177 (e) Section 741.28, relating to domestic violence.
2178 (f) Section 817.034, relating to fraudulent acts through
2179 mail, wire, radio, electromagnetic, photoelectronic, or
2180 photooptical systems.
2181 (g) Section 817.234, relating to false and fraudulent
2182 insurance claims.
2183 (h) Section 817.505, relating to patient brokering.
2184 (i) Section 817.568, relating to criminal use of personal
2185 identification information.
2186 (j) Section 817.60, relating to obtaining a credit card
2187 through fraudulent means.
2188 (k) Section 817.61, relating to fraudulent use of credit
2189 cards, if the offense was a felony.
2190 (l) Section 831.01, relating to forgery.
2191 (m) Section 831.02, relating to uttering forged
2192 instruments.
2193 (n) Section 831.07, relating to forging bank bills, checks,
2194 drafts, or promissory notes.
2195 (o) Section 831.09, relating to uttering forged bank bills,
2196 checks, drafts, or promissory notes.
2197 (p) Section 831.30, relating to fraud in obtaining
2198 medicinal drugs.
2199 (q) Section 831.31, relating to the sale, manufacture,
2200 delivery, or possession with the intent to sell, manufacture, or
2201 deliver any counterfeit controlled substance, if the offense was
2202 a felony.
2203 (5) A person who serves as a controlling interest of, is
2204 employed by, or contracts with a licensee on July 31, 2010, who
2205 has been screened and qualified according to standards specified
2206 in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
2207 in accordance with the schedule provided in paragraphs (a)-(c).
2208 The agency may adopt rules to establish a schedule to stagger
2209 the implementation of the required rescreening over the 5-year
2210 period, beginning July 31, 2010, through July 31, 2015. If, upon
2211 rescreening, such person has a disqualifying offense that was
2212 not a disqualifying offense at the time of the last screening,
2213 but is a current disqualifying offense and was committed before
2214 the last screening, he or she may apply for an exemption from
2215 the appropriate licensing agency and, if agreed to by the
2216 employer, may continue to perform his or her duties until the
2217 licensing agency renders a decision on the application for
2218 exemption if the person is eligible to apply for an exemption
2219 and the exemption request is received by the agency within 30
2220 days after receipt of the rescreening results by the person. The
2221 rescreening schedule shall be:
2222 (a) Individuals whose last screening was conducted before
2223 December 31, 2003, must be rescreened by July 31, 2013.
2224 (b) Individuals whose last screening was conducted between
2225 January 1, 2004, through December 31, 2007, must be rescreened
2226 by July 31, 2014.
2227 (c) Individuals whose last screening was conducted between
2228 January 1, 2008, through July 31, 2010, must be rescreened by
2229 July 31, 2015.
2230 Section 68. Subsection (9) of section 408.810, Florida
2231 Statutes, is amended to read:
2232 408.810 Minimum licensure requirements.—In addition to the
2233 licensure requirements specified in this part, authorizing
2234 statutes, and applicable rules, each applicant and licensee must
2235 comply with the requirements of this section in order to obtain
2236 and maintain a license.
2237 (9) A controlling interest may not withhold from the agency
2238 any evidence of financial instability, including, but not
2239 limited to, checks returned due to insufficient funds,
2240 delinquent accounts, nonpayment of withholding taxes, unpaid
2241 utility expenses, nonpayment for essential services, or adverse
2242 court action concerning the financial viability of the provider
2243 or any other provider licensed under this part that is under the
2244 control of the controlling interest. A controlling interest
2245 shall notify the agency within 10 days after a court action to
2246 initiate bankruptcy, foreclosure, or eviction proceedings
2247 concerning the provider in which the controlling interest is a
2248 petitioner or defendant. Any person who violates this subsection
2249 commits a misdemeanor of the second degree, punishable as
2250 provided in s. 775.082 or s. 775.083. Each day of continuing
2251 violation is a separate offense.
2252 Section 69. Subsection (3) is added to section 408.813,
2253 Florida Statutes, to read:
2254 408.813 Administrative fines; violations.—As a penalty for
2255 any violation of this part, authorizing statutes, or applicable
2256 rules, the agency may impose an administrative fine.
2257 (3) The agency may impose an administrative fine for a
2258 violation that is not designated as a class I, class II, class
2259 III, or class IV violation. Unless otherwise specified by law,
2260 the amount of the fine shall not exceed $500 for each violation.
2261 Unclassified violations may include:
2262 (a) Violating any term or condition of a license.
2263 (b) Violating any provision of this part, authorizing
2264 statutes, or applicable rules.
2265 (c) Exceeding licensed capacity.
2266 (d) Providing services beyond the scope of the license.
2267 (e) Violating a moratorium imposed pursuant to s. 408.814.
2268 Section 70. Subsection (4) of section 408.815, Florida
2269 Statutes, is amended, and subsections (5) and (6) are added to
2270 that section, to read:
2271 408.815 License or application denial; revocation.—
2272 (4) Unless an applicant is determined by the agency to
2273 satisfy the provisions of subsection (5) for the action in
2274 question, the agency shall deny an application for a license or
2275 license renewal based upon any of the following actions of an
2276 applicant, a controlling interest of the applicant, or any
2277 entity in which a controlling interest of the applicant was an
2278 owner or officer when the following actions occurred In addition
2279 to the grounds provided in authorizing statutes, the agency
2280 shall deny an application for a license or license renewal if
2281 the applicant or a person having a controlling interest in an
2282 applicant has been:
2283 (a) Conviction Convicted of, or enters a plea of guilty or
2284 nolo contendere to, regardless of adjudication, a felony under
2285 chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
2286 42 U.S.C. ss. 1395-1396, Medicare fraud, Medicaid fraud, or
2287 insurance fraud, unless the sentence and any subsequent period
2288 of probation for such convictions or plea ended more than 15
2289 years prior to the date of the application;
2290 (b) Termination Terminated for cause from the Medicare
2291 program or a state Florida Medicaid program pursuant to s.
2292 409.913, unless the applicant has been in good standing with the
2293 Medicare program or a state Florida Medicaid program for the
2294 most recent 5 years and the termination occurred at least 20
2295 years before the date of the application.; or
2296 (c) Terminated for cause, pursuant to the appeals
2297 procedures established by the state or Federal Government, from
2298 the federal Medicare program or from any other state Medicaid
2299 program, unless the applicant has been in good standing with a
2300 state Medicaid program or the federal Medicare program for the
2301 most recent 5 years and the termination occurred at least 20
2302 years prior to the date of the application.
2303 (5) For any application subject to denial under subsection
2304 (4), the agency may consider mitigating circumstances, as
2305 applicable, including, but not limited to:
2306 (a) Completion or lawful release from confinement,
2307 supervision, or sanction, including any terms of probation, and
2308 full restitution;
2309 (b) Execution of a compliance plan with the agency;
2310 (c) Compliance with any integrity agreement or compliance
2311 plan with any other government agency;
2312 (d) Determination by the Medicare program or a state
2313 Medicaid program that the controlling interest or entity in
2314 which the controlling interest was an owner or officer is
2315 currently allowed to participate in the Medicare program or a
2316 state Medicaid program, either directly as a provider or
2317 indirectly as an owner or officer of a provider entity;
2318 (e) Continuation of licensure by the controlling interest
2319 or entity in which the controlling interest was an owner or
2320 officer, either directly as a licensee or indirectly as an owner
2321 or officer of a licensed entity in the state where the action
2322 occurred;
2323 (f) Overall impact upon the public health, safety, or
2324 welfare; or
2325 (g) Determination that license denial is not commensurate
2326 with the prior action taken by the Medicare program or a state
2327 Medicaid program.
2328
2329 After considering the circumstances set forth in this
2330 subsection, the agency shall grant the license, with or without
2331 conditions, grant a provisional license for a period of no more
2332 than the licensure cycle, with or without conditions, or deny
2333 the license.
2334 (6) In order to ensure the health, safety, and welfare of
2335 clients when a license has been denied, revoked, or is set to
2336 terminate, the agency may extend the license expiration date for
2337 a period of up to 30 days for the sole purpose of allowing the
2338 safe and orderly discharge of clients. The agency may impose
2339 conditions on the extension, including, but not limited to,
2340 prohibiting or limiting admissions, expedited discharge
2341 planning, required status reports, and mandatory monitoring by
2342 the agency or third parties. When imposing these conditions, the
2343 agency shall take into consideration the nature and number of
2344 clients, the availability and location of acceptable alternative
2345 placements, and the ability of the licensee to continue
2346 providing care to the clients. The agency may terminate the
2347 extension or modify the conditions at any time. This authority
2348 is in addition to any other authority granted to the agency
2349 under chapter 120, this part, and authorizing statutes but
2350 creates no right or entitlement to an extension of a license
2351 expiration date.
2352 Section 71. Paragraph (c) of subsection (4) of section
2353 409.212, Florida Statutes, is amended to read:
2354 409.212 Optional supplementation.—
2355 (4) In addition to the amount of optional supplementation
2356 provided by the state, a person may receive additional
2357 supplementation from third parties to contribute to his or her
2358 cost of care. Additional supplementation may be provided under
2359 the following conditions:
2360 (c) The additional supplementation shall not exceed three
2361 two times the provider rate recognized under the optional state
2362 supplementation program.
2363 Section 72. Subsection (1) of section 409.91196, Florida
2364 Statutes, is amended to read:
2365 409.91196 Supplemental rebate agreements; public records
2366 and public meetings exemption.—
2367 (1) The rebate amount, percent of rebate, manufacturer’s
2368 pricing, and supplemental rebate, and other trade secrets as
2369 defined in s. 688.002 that the agency has identified for use in
2370 negotiations, held by the Agency for Health Care Administration
2371 under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2372 119.07(1) and s. 24(a), Art. I of the State Constitution.
2373 Section 73. Paragraph (a) of subsection (39) of section
2374 409.912, Florida Statutes, is amended to read:
2375 409.912 Cost-effective purchasing of health care.—The
2376 agency shall purchase goods and services for Medicaid recipients
2377 in the most cost-effective manner consistent with the delivery
2378 of quality medical care. To ensure that medical services are
2379 effectively utilized, the agency may, in any case, require a
2380 confirmation or second physician’s opinion of the correct
2381 diagnosis for purposes of authorizing future services under the
2382 Medicaid program. This section does not restrict access to
2383 emergency services or poststabilization care services as defined
2384 in 42 C.F.R. part 438.114. Such confirmation or second opinion
2385 shall be rendered in a manner approved by the agency. The agency
2386 shall maximize the use of prepaid per capita and prepaid
2387 aggregate fixed-sum basis services when appropriate and other
2388 alternative service delivery and reimbursement methodologies,
2389 including competitive bidding pursuant to s. 287.057, designed
2390 to facilitate the cost-effective purchase of a case-managed
2391 continuum of care. The agency shall also require providers to
2392 minimize the exposure of recipients to the need for acute
2393 inpatient, custodial, and other institutional care and the
2394 inappropriate or unnecessary use of high-cost services. The
2395 agency shall contract with a vendor to monitor and evaluate the
2396 clinical practice patterns of providers in order to identify
2397 trends that are outside the normal practice patterns of a
2398 provider’s professional peers or the national guidelines of a
2399 provider’s professional association. The vendor must be able to
2400 provide information and counseling to a provider whose practice
2401 patterns are outside the norms, in consultation with the agency,
2402 to improve patient care and reduce inappropriate utilization.
2403 The agency may mandate prior authorization, drug therapy
2404 management, or disease management participation for certain
2405 populations of Medicaid beneficiaries, certain drug classes, or
2406 particular drugs to prevent fraud, abuse, overuse, and possible
2407 dangerous drug interactions. The Pharmaceutical and Therapeutics
2408 Committee shall make recommendations to the agency on drugs for
2409 which prior authorization is required. The agency shall inform
2410 the Pharmaceutical and Therapeutics Committee of its decisions
2411 regarding drugs subject to prior authorization. The agency is
2412 authorized to limit the entities it contracts with or enrolls as
2413 Medicaid providers by developing a provider network through
2414 provider credentialing. The agency may competitively bid single
2415 source-provider contracts if procurement of goods or services
2416 results in demonstrated cost savings to the state without
2417 limiting access to care. The agency may limit its network based
2418 on the assessment of beneficiary access to care, provider
2419 availability, provider quality standards, time and distance
2420 standards for access to care, the cultural competence of the
2421 provider network, demographic characteristics of Medicaid
2422 beneficiaries, practice and provider-to-beneficiary standards,
2423 appointment wait times, beneficiary use of services, provider
2424 turnover, provider profiling, provider licensure history,
2425 previous program integrity investigations and findings, peer
2426 review, provider Medicaid policy and billing compliance records,
2427 clinical and medical record audits, and other factors. Providers
2428 shall not be entitled to enrollment in the Medicaid provider
2429 network. The agency shall determine instances in which allowing
2430 Medicaid beneficiaries to purchase durable medical equipment and
2431 other goods is less expensive to the Medicaid program than long
2432 term rental of the equipment or goods. The agency may establish
2433 rules to facilitate purchases in lieu of long-term rentals in
2434 order to protect against fraud and abuse in the Medicaid program
2435 as defined in s. 409.913. The agency may seek federal waivers
2436 necessary to administer these policies.
2437 (39)(a) The agency shall implement a Medicaid prescribed
2438 drug spending-control program that includes the following
2439 components:
2440 1. A Medicaid preferred drug list, which shall be a listing
2441 of cost-effective therapeutic options recommended by the
2442 Medicaid Pharmacy and Therapeutics Committee established
2443 pursuant to s. 409.91195 and adopted by the agency for each
2444 therapeutic class on the preferred drug list. At the discretion
2445 of the committee, and when feasible, the preferred drug list
2446 should include at least two products in a therapeutic class. The
2447 agency may post the preferred drug list and updates to the
2448 preferred drug list on an Internet website without following the
2449 rulemaking procedures of chapter 120. Antiretroviral agents are
2450 excluded from the preferred drug list. The agency shall also
2451 limit the amount of a prescribed drug dispensed to no more than
2452 a 34-day supply unless the drug products’ smallest marketed
2453 package is greater than a 34-day supply, or the drug is
2454 determined by the agency to be a maintenance drug in which case
2455 a 100-day maximum supply may be authorized. The agency is
2456 authorized to seek any federal waivers necessary to implement
2457 these cost-control programs and to continue participation in the
2458 federal Medicaid rebate program, or alternatively to negotiate
2459 state-only manufacturer rebates. The agency may adopt rules to
2460 implement this subparagraph. The agency shall continue to
2461 provide unlimited contraceptive drugs and items. The agency must
2462 establish procedures to ensure that:
2463 a. There is a response to a request for prior consultation
2464 by telephone or other telecommunication device within 24 hours
2465 after receipt of a request for prior consultation; and
2466 b. A 72-hour supply of the drug prescribed is provided in
2467 an emergency or when the agency does not provide a response
2468 within 24 hours as required by sub-subparagraph a.
2469 2. Reimbursement to pharmacies for Medicaid prescribed
2470 drugs shall be set at the lesser of: the average wholesale price
2471 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2472 plus 4.75 percent, the federal upper limit (FUL), the state
2473 maximum allowable cost (SMAC), or the usual and customary (UAC)
2474 charge billed by the provider.
2475 3. For a prescribed drug billed as a 340B prescribed
2476 medication rendered to all Medicaid-eligible individuals,
2477 including claims for cost sharing for which the agency is
2478 responsible, the claim must meet the requirements of the Deficit
2479 Reduction Act of 2005 and the federal 340B program and contain a
2480 national drug code.
2481 4.3. The agency shall develop and implement a process for
2482 managing the drug therapies of Medicaid recipients who are using
2483 significant numbers of prescribed drugs each month. The
2484 management process may include, but is not limited to,
2485 comprehensive, physician-directed medical-record reviews, claims
2486 analyses, and case evaluations to determine the medical
2487 necessity and appropriateness of a patient’s treatment plan and
2488 drug therapies. The agency may contract with a private
2489 organization to provide drug-program-management services. The
2490 Medicaid drug benefit management program shall include
2491 initiatives to manage drug therapies for HIV/AIDS patients,
2492 patients using 20 or more unique prescriptions in a 180-day
2493 period, and the top 1,000 patients in annual spending. The
2494 agency shall enroll any Medicaid recipient in the drug benefit
2495 management program if he or she meets the specifications of this
2496 provision and is not enrolled in a Medicaid health maintenance
2497 organization.
2498 5.4. The agency may limit the size of its pharmacy network
2499 based on need, competitive bidding, price negotiations,
2500 credentialing, or similar criteria. The agency shall give
2501 special consideration to rural areas in determining the size and
2502 location of pharmacies included in the Medicaid pharmacy
2503 network. A pharmacy credentialing process may include criteria
2504 such as a pharmacy’s full-service status, location, size,
2505 patient educational programs, patient consultation, disease
2506 management services, and other characteristics. The agency may
2507 impose a moratorium on Medicaid pharmacy enrollment when it is
2508 determined that it has a sufficient number of Medicaid
2509 participating providers. The agency must allow dispensing
2510 practitioners to participate as a part of the Medicaid pharmacy
2511 network regardless of the practitioner’s proximity to any other
2512 entity that is dispensing prescription drugs under the Medicaid
2513 program. A dispensing practitioner must meet all credentialing
2514 requirements applicable to his or her practice, as determined by
2515 the agency.
2516 6.5. The agency shall develop and implement a program that
2517 requires Medicaid practitioners who prescribe drugs to use a
2518 counterfeit-proof prescription pad for Medicaid prescriptions.
2519 The agency shall require the use of standardized counterfeit
2520 proof prescription pads by Medicaid-participating prescribers or
2521 prescribers who write prescriptions for Medicaid recipients. The
2522 agency may implement the program in targeted geographic areas or
2523 statewide.
2524 7.6. The agency may enter into arrangements that require
2525 manufacturers of generic drugs prescribed to Medicaid recipients
2526 to provide rebates of at least 15.1 percent of the average
2527 manufacturer price for the manufacturer’s generic products.
2528 These arrangements shall require that if a generic-drug
2529 manufacturer pays federal rebates for Medicaid-reimbursed drugs
2530 at a level below 15.1 percent, the manufacturer must provide a
2531 supplemental rebate to the state in an amount necessary to
2532 achieve a 15.1-percent rebate level.
2533 8.7. The agency may establish a preferred drug list as
2534 described in this subsection, and, pursuant to the establishment
2535 of such preferred drug list, it is authorized to negotiate
2536 supplemental rebates from manufacturers that are in addition to
2537 those required by Title XIX of the Social Security Act and at no
2538 less than 14 percent of the average manufacturer price as
2539 defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2540 the federal or supplemental rebate, or both, equals or exceeds
2541 29 percent. There is no upper limit on the supplemental rebates
2542 the agency may negotiate. The agency may determine that specific
2543 products, brand-name or generic, are competitive at lower rebate
2544 percentages. Agreement to pay the minimum supplemental rebate
2545 percentage will guarantee a manufacturer that the Medicaid
2546 Pharmaceutical and Therapeutics Committee will consider a
2547 product for inclusion on the preferred drug list. However, a
2548 pharmaceutical manufacturer is not guaranteed placement on the
2549 preferred drug list by simply paying the minimum supplemental
2550 rebate. Agency decisions will be made on the clinical efficacy
2551 of a drug and recommendations of the Medicaid Pharmaceutical and
2552 Therapeutics Committee, as well as the price of competing
2553 products minus federal and state rebates. The agency is
2554 authorized to contract with an outside agency or contractor to
2555 conduct negotiations for supplemental rebates. For the purposes
2556 of this section, the term “supplemental rebates” means cash
2557 rebates. Effective July 1, 2004, value-added programs as a
2558 substitution for supplemental rebates are prohibited. The agency
2559 is authorized to seek any federal waivers to implement this
2560 initiative.
2561 9.8. The Agency for Health Care Administration shall expand
2562 home delivery of pharmacy products. To assist Medicaid patients
2563 in securing their prescriptions and reduce program costs, the
2564 agency shall expand its current mail-order-pharmacy diabetes
2565 supply program to include all generic and brand-name drugs used
2566 by Medicaid patients with diabetes. Medicaid recipients in the
2567 current program may obtain nondiabetes drugs on a voluntary
2568 basis. This initiative is limited to the geographic area covered
2569 by the current contract. The agency may seek and implement any
2570 federal waivers necessary to implement this subparagraph.
2571 10.9. The agency shall limit to one dose per month any drug
2572 prescribed to treat erectile dysfunction.
2573 11.10.a. The agency may implement a Medicaid behavioral
2574 drug management system. The agency may contract with a vendor
2575 that has experience in operating behavioral drug management
2576 systems to implement this program. The agency is authorized to
2577 seek federal waivers to implement this program.
2578 b. The agency, in conjunction with the Department of
2579 Children and Family Services, may implement the Medicaid
2580 behavioral drug management system that is designed to improve
2581 the quality of care and behavioral health prescribing practices
2582 based on best practice guidelines, improve patient adherence to
2583 medication plans, reduce clinical risk, and lower prescribed
2584 drug costs and the rate of inappropriate spending on Medicaid
2585 behavioral drugs. The program may include the following
2586 elements:
2587 (I) Provide for the development and adoption of best
2588 practice guidelines for behavioral health-related drugs such as
2589 antipsychotics, antidepressants, and medications for treating
2590 bipolar disorders and other behavioral conditions; translate
2591 them into practice; review behavioral health prescribers and
2592 compare their prescribing patterns to a number of indicators
2593 that are based on national standards; and determine deviations
2594 from best practice guidelines.
2595 (II) Implement processes for providing feedback to and
2596 educating prescribers using best practice educational materials
2597 and peer-to-peer consultation.
2598 (III) Assess Medicaid beneficiaries who are outliers in
2599 their use of behavioral health drugs with regard to the numbers
2600 and types of drugs taken, drug dosages, combination drug
2601 therapies, and other indicators of improper use of behavioral
2602 health drugs.
2603 (IV) Alert prescribers to patients who fail to refill
2604 prescriptions in a timely fashion, are prescribed multiple same
2605 class behavioral health drugs, and may have other potential
2606 medication problems.
2607 (V) Track spending trends for behavioral health drugs and
2608 deviation from best practice guidelines.
2609 (VI) Use educational and technological approaches to
2610 promote best practices, educate consumers, and train prescribers
2611 in the use of practice guidelines.
2612 (VII) Disseminate electronic and published materials.
2613 (VIII) Hold statewide and regional conferences.
2614 (IX) Implement a disease management program with a model
2615 quality-based medication component for severely mentally ill
2616 individuals and emotionally disturbed children who are high
2617 users of care.
2618 12.11.a. The agency shall implement a Medicaid prescription
2619 drug management system. The agency may contract with a vendor
2620 that has experience in operating prescription drug management
2621 systems in order to implement this system. Any management system
2622 that is implemented in accordance with this subparagraph must
2623 rely on cooperation between physicians and pharmacists to
2624 determine appropriate practice patterns and clinical guidelines
2625 to improve the prescribing, dispensing, and use of drugs in the
2626 Medicaid program. The agency may seek federal waivers to
2627 implement this program.
2628 b. The drug management system must be designed to improve
2629 the quality of care and prescribing practices based on best
2630 practice guidelines, improve patient adherence to medication
2631 plans, reduce clinical risk, and lower prescribed drug costs and
2632 the rate of inappropriate spending on Medicaid prescription
2633 drugs. The program must:
2634 (I) Provide for the development and adoption of best
2635 practice guidelines for the prescribing and use of drugs in the
2636 Medicaid program, including translating best practice guidelines
2637 into practice; reviewing prescriber patterns and comparing them
2638 to indicators that are based on national standards and practice
2639 patterns of clinical peers in their community, statewide, and
2640 nationally; and determine deviations from best practice
2641 guidelines.
2642 (II) Implement processes for providing feedback to and
2643 educating prescribers using best practice educational materials
2644 and peer-to-peer consultation.
2645 (III) Assess Medicaid recipients who are outliers in their
2646 use of a single or multiple prescription drugs with regard to
2647 the numbers and types of drugs taken, drug dosages, combination
2648 drug therapies, and other indicators of improper use of
2649 prescription drugs.
2650 (IV) Alert prescribers to patients who fail to refill
2651 prescriptions in a timely fashion, are prescribed multiple drugs
2652 that may be redundant or contraindicated, or may have other
2653 potential medication problems.
2654 (V) Track spending trends for prescription drugs and
2655 deviation from best practice guidelines.
2656 (VI) Use educational and technological approaches to
2657 promote best practices, educate consumers, and train prescribers
2658 in the use of practice guidelines.
2659 (VII) Disseminate electronic and published materials.
2660 (VIII) Hold statewide and regional conferences.
2661 (IX) Implement disease management programs in cooperation
2662 with physicians and pharmacists, along with a model quality
2663 based medication component for individuals having chronic
2664 medical conditions.
2665 13.12. The agency is authorized to contract for drug rebate
2666 administration, including, but not limited to, calculating
2667 rebate amounts, invoicing manufacturers, negotiating disputes
2668 with manufacturers, and maintaining a database of rebate
2669 collections.
2670 14.13. The agency may specify the preferred daily dosing
2671 form or strength for the purpose of promoting best practices
2672 with regard to the prescribing of certain drugs as specified in
2673 the General Appropriations Act and ensuring cost-effective
2674 prescribing practices.
2675 15.14. The agency may require prior authorization for
2676 Medicaid-covered prescribed drugs. The agency may, but is not
2677 required to, prior-authorize the use of a product:
2678 a. For an indication not approved in labeling;
2679 b. To comply with certain clinical guidelines; or
2680 c. If the product has the potential for overuse, misuse, or
2681 abuse.
2682
2683 The agency may require the prescribing professional to provide
2684 information about the rationale and supporting medical evidence
2685 for the use of a drug. The agency shall accept electronic prior
2686 authorization requests from prescribers or pharmacists for any
2687 drug requiring prior authorization and may post prior
2688 authorization criteria and protocol and updates to the list of
2689 drugs that are subject to prior authorization on an Internet
2690 website without amending its rule or engaging in additional
2691 rulemaking.
2692 16.15. The agency, in conjunction with the Pharmaceutical
2693 and Therapeutics Committee, may require age-related prior
2694 authorizations for certain prescribed drugs. The agency may
2695 preauthorize the use of a drug for a recipient who may not meet
2696 the age requirement or may exceed the length of therapy for use
2697 of this product as recommended by the manufacturer and approved
2698 by the Food and Drug Administration. Prior authorization may
2699 require the prescribing professional to provide information
2700 about the rationale and supporting medical evidence for the use
2701 of a drug.
2702 17.16. The agency shall implement a step-therapy prior
2703 authorization approval process for medications excluded from the
2704 preferred drug list. Medications listed on the preferred drug
2705 list must be used within the previous 12 months prior to the
2706 alternative medications that are not listed. The step-therapy
2707 prior authorization may require the prescriber to use the
2708 medications of a similar drug class or for a similar medical
2709 indication unless contraindicated in the Food and Drug
2710 Administration labeling. The trial period between the specified
2711 steps may vary according to the medical indication. The step
2712 therapy approval process shall be developed in accordance with
2713 the committee as stated in s. 409.91195(7) and (8). A drug
2714 product may be approved without meeting the step-therapy prior
2715 authorization criteria if the prescribing physician provides the
2716 agency with additional written medical or clinical documentation
2717 that the product is medically necessary because:
2718 a. There is not a drug on the preferred drug list to treat
2719 the disease or medical condition which is an acceptable clinical
2720 alternative;
2721 b. The alternatives have been ineffective in the treatment
2722 of the beneficiary’s disease; or
2723 c. Based on historic evidence and known characteristics of
2724 the patient and the drug, the drug is likely to be ineffective,
2725 or the number of doses have been ineffective.
2726
2727 The agency shall work with the physician to determine the best
2728 alternative for the patient. The agency may adopt rules waiving
2729 the requirements for written clinical documentation for specific
2730 drugs in limited clinical situations.
2731 18.17. The agency shall implement a return and reuse
2732 program for drugs dispensed by pharmacies to institutional
2733 recipients, which includes payment of a $5 restocking fee for
2734 the implementation and operation of the program. The return and
2735 reuse program shall be implemented electronically and in a
2736 manner that promotes efficiency. The program must permit a
2737 pharmacy to exclude drugs from the program if it is not
2738 practical or cost-effective for the drug to be included and must
2739 provide for the return to inventory of drugs that cannot be
2740 credited or returned in a cost-effective manner. The agency
2741 shall determine if the program has reduced the amount of
2742 Medicaid prescription drugs which are destroyed on an annual
2743 basis and if there are additional ways to ensure more
2744 prescription drugs are not destroyed which could safely be
2745 reused. The agency’s conclusion and recommendations shall be
2746 reported to the Legislature by December 1, 2005.
2747 Section 74. Subsection (3) and paragraph (c) of subsection
2748 (4) of section 429.07, Florida Statutes, are amended, and
2749 subsections (6) and (7) are added to that section, to read:
2750 429.07 License required; fee; inspections.—
2751 (3) In addition to the requirements of s. 408.806, each
2752 license granted by the agency must state the type of care for
2753 which the license is granted. Licenses shall be issued for one
2754 or more of the following categories of care: standard, extended
2755 congregate care, limited nursing services, or limited mental
2756 health.
2757 (a) A standard license shall be issued to a facility
2758 facilities providing one or more of the personal services
2759 identified in s. 429.02. Such licensee facilities may also
2760 employ or contract with a person licensed under part I of
2761 chapter 464 to administer medications and perform other tasks as
2762 specified in s. 429.255.
2763 (b) An extended congregate care license shall be issued to
2764 a licensee facilities providing, directly or through contract,
2765 services beyond those authorized in paragraph (a), including
2766 services performed by persons licensed under part I of chapter
2767 464 and supportive services, as defined by rule, to persons who
2768 would otherwise be disqualified from continued residence in a
2769 facility licensed under this part.
2770 1. In order for extended congregate care services to be
2771 provided, the agency must first determine that all requirements
2772 established in law and rule are met and must specifically
2773 designate, on the facility’s license, that such services may be
2774 provided and whether the designation applies to all or part of
2775 the facility. Such designation may be made at the time of
2776 initial licensure or relicensure, or upon request in writing by
2777 a licensee under this part and part II of chapter 408. The
2778 notification of approval or the denial of the request shall be
2779 made in accordance with part II of chapter 408. An existing
2780 licensee facilities qualifying to provide extended congregate
2781 care services must have maintained a standard license and may
2782 not have been subject to administrative sanctions during the
2783 previous 2 years, or since initial licensure if the facility has
2784 been licensed for less than 2 years, for any of the following
2785 reasons:
2786 a. A class I or class II violation;
2787 b. Three or more repeat or recurring class III violations
2788 of identical or similar resident care standards from which a
2789 pattern of noncompliance is found by the agency;
2790 c. Three or more class III violations that were not
2791 corrected in accordance with the corrective action plan approved
2792 by the agency;
2793 d. Violation of resident care standards which results in
2794 requiring the facility to employ the services of a consultant
2795 pharmacist or consultant dietitian;
2796 e. Denial, suspension, or revocation of a license for
2797 another facility licensed under this part in which the applicant
2798 for an extended congregate care license has at least 25 percent
2799 ownership interest; or
2800 f. Imposition of a moratorium pursuant to this part or part
2801 II of chapter 408 or initiation of injunctive proceedings.
2802 2. A facility that is licensed to provide extended
2803 congregate care services shall maintain a written progress
2804 report for on each person who receives services which describes
2805 the type, amount, duration, scope, and outcome of services that
2806 are rendered and the general status of the resident’s health. A
2807 registered nurse, or appropriate designee, representing the
2808 agency shall visit the facility at least quarterly to monitor
2809 residents who are receiving extended congregate care services
2810 and to determine if the facility is in compliance with this
2811 part, part II of chapter 408, and relevant rules. One of the
2812 visits may be in conjunction with the regular survey. The
2813 monitoring visits may be provided through contractual
2814 arrangements with appropriate community agencies. A registered
2815 nurse shall serve as part of the team that inspects the
2816 facility. The agency may waive one of the required yearly
2817 monitoring visits for a facility that has been licensed for at
2818 least 24 months to provide extended congregate care services,
2819 if, during the inspection, the registered nurse determines that
2820 extended congregate care services are being provided
2821 appropriately, and if the facility has no class I or class II
2822 violations and no uncorrected class III violations. The agency
2823 must first consult with the long-term care ombudsman council for
2824 the area in which the facility is located to determine if any
2825 complaints have been made and substantiated about the quality of
2826 services or care. The agency may not waive one of the required
2827 yearly monitoring visits if complaints have been made and
2828 substantiated.
2829 3. A facility that is licensed to provide extended
2830 congregate care services must:
2831 a. Demonstrate the capability to meet unanticipated
2832 resident service needs.
2833 b. Offer a physical environment that promotes a homelike
2834 setting, provides for resident privacy, promotes resident
2835 independence, and allows sufficient congregate space as defined
2836 by rule.
2837 c. Have sufficient staff available, taking into account the
2838 physical plant and firesafety features of the building, to
2839 assist with the evacuation of residents in an emergency.
2840 d. Adopt and follow policies and procedures that maximize
2841 resident independence, dignity, choice, and decisionmaking to
2842 permit residents to age in place, so that moves due to changes
2843 in functional status are minimized or avoided.
2844 e. Allow residents or, if applicable, a resident’s
2845 representative, designee, surrogate, guardian, or attorney in
2846 fact to make a variety of personal choices, participate in
2847 developing service plans, and share responsibility in
2848 decisionmaking.
2849 f. Implement the concept of managed risk.
2850 g. Provide, directly or through contract, the services of a
2851 person licensed under part I of chapter 464.
2852 h. In addition to the training mandated in s. 429.52,
2853 provide specialized training as defined by rule for facility
2854 staff.
2855 4. A facility that is licensed to provide extended
2856 congregate care services is exempt from the criteria for
2857 continued residency set forth in rules adopted under s. 429.41.
2858 A licensed facility must adopt its own requirements within
2859 guidelines for continued residency set forth by rule. However,
2860 the facility may not serve residents who require 24-hour nursing
2861 supervision. A licensed facility that provides extended
2862 congregate care services must also provide each resident with a
2863 written copy of facility policies governing admission and
2864 retention.
2865 5. The primary purpose of extended congregate care services
2866 is to allow residents, as they become more impaired, the option
2867 of remaining in a familiar setting from which they would
2868 otherwise be disqualified for continued residency. A facility
2869 licensed to provide extended congregate care services may also
2870 admit an individual who exceeds the admission criteria for a
2871 facility with a standard license, if the individual is
2872 determined appropriate for admission to the extended congregate
2873 care facility.
2874 6. Before the admission of an individual to a facility
2875 licensed to provide extended congregate care services, the
2876 individual must undergo a medical examination as provided in s.
2877 429.26(4) and the facility must develop a preliminary service
2878 plan for the individual.
2879 7. When a licensee facility can no longer provide or
2880 arrange for services in accordance with the resident’s service
2881 plan and needs and the licensee’s facility’s policy, the
2882 licensee facility shall make arrangements for relocating the
2883 person in accordance with s. 429.28(1)(k).
2884 8. Failure to provide extended congregate care services may
2885 result in denial of extended congregate care license renewal.
2886 (c) A limited nursing services license shall be issued to a
2887 facility that provides services beyond those authorized in
2888 paragraph (a) and as specified in this paragraph.
2889 1. In order for limited nursing services to be provided in
2890 a facility licensed under this part, the agency must first
2891 determine that all requirements established in law and rule are
2892 met and must specifically designate, on the facility’s license,
2893 that such services may be provided. Such designation may be made
2894 at the time of initial licensure or relicensure, or upon request
2895 in writing by a licensee under this part and part II of chapter
2896 408. Notification of approval or denial of such request shall be
2897 made in accordance with part II of chapter 408. Existing
2898 facilities qualifying to provide limited nursing services shall
2899 have maintained a standard license and may not have been subject
2900 to administrative sanctions that affect the health, safety, and
2901 welfare of residents for the previous 2 years or since initial
2902 licensure if the facility has been licensed for less than 2
2903 years.
2904 2. Facilities that are licensed to provide limited nursing
2905 services shall maintain a written progress report on each person
2906 who receives such nursing services, which report describes the
2907 type, amount, duration, scope, and outcome of services that are
2908 rendered and the general status of the resident’s health. A
2909 registered nurse representing the agency shall visit such
2910 facilities at least twice a year to monitor residents who are
2911 receiving limited nursing services and to determine if the
2912 facility is in compliance with applicable provisions of this
2913 part, part II of chapter 408, and related rules. The monitoring
2914 visits may be provided through contractual arrangements with
2915 appropriate community agencies. A registered nurse shall also
2916 serve as part of the team that inspects such facility.
2917 3. A person who receives limited nursing services under
2918 this part must meet the admission criteria established by the
2919 agency for assisted living facilities. When a resident no longer
2920 meets the admission criteria for a facility licensed under this
2921 part, arrangements for relocating the person shall be made in
2922 accordance with s. 429.28(1)(k), unless the facility is licensed
2923 to provide extended congregate care services.
2924 (4) In accordance with s. 408.805, an applicant or licensee
2925 shall pay a fee for each license application submitted under
2926 this part, part II of chapter 408, and applicable rules. The
2927 amount of the fee shall be established by rule.
2928 (c) In addition to the total fee assessed under paragraph
2929 (a), the agency shall require facilities that are licensed to
2930 provide limited nursing services under this part to pay an
2931 additional fee per licensed facility. The amount of the biennial
2932 fee shall be $250 per license, with an additional fee of $10 per
2933 resident based on the total licensed resident capacity of the
2934 facility.
2935 (6) In order to determine whether the facility is
2936 adequately protecting residents’ rights as provided in s.
2937 429.28, the agency’s standard licensure survey shall include
2938 private informal conversations with a sample of residents and
2939 consultation with the ombudsman council in the planning and
2940 service area in which the facility is located to discuss
2941 residents’ experiences within the facility.
2942 (7) An assisted living facility that has been cited within
2943 the previous 24-month period for a class I or class II
2944 violation, regardless of the status of any enforcement or
2945 disciplinary action, is subject to periodic unannounced
2946 monitoring to determine if the facility is in compliance with
2947 this part, part II of chapter 408, and applicable rules.
2948 Monitoring may occur through a desk review or an onsite
2949 assessment. If the class I or class II violation relates to
2950 providing or failing to provide nursing care, a registered nurse
2951 must participate in monitoring activities during the 12-month
2952 period following the violation.
2953 Section 75. Subsection (7) of section 429.11, Florida
2954 Statutes, is renumbered as subsection (6), and present
2955 subsection (6) of that section is amended to read:
2956 429.11 Initial application for license; provisional
2957 license.—
2958 (6) In addition to the license categories available in s.
2959 408.808, a provisional license may be issued to an applicant
2960 making initial application for licensure or making application
2961 for a change of ownership. A provisional license shall be
2962 limited in duration to a specific period of time not to exceed 6
2963 months, as determined by the agency.
2964 Section 76. Section 429.12, Florida Statutes, is amended to
2965 read:
2966 429.12 Sale or transfer of ownership of a facility.—It is
2967 the intent of the Legislature to protect the rights of the
2968 residents of an assisted living facility when the facility is
2969 sold or the ownership thereof is transferred. Therefore, in
2970 addition to the requirements of part II of chapter 408, whenever
2971 a facility is sold or the ownership thereof is transferred,
2972 including leasing,:
2973 (1) the transferee shall notify the residents, in writing,
2974 of the change of ownership within 7 days after receipt of the
2975 new license.
2976 (2) The transferor of a facility the license of which is
2977 denied pending an administrative hearing shall, as a part of the
2978 written change-of-ownership contract, advise the transferee that
2979 a plan of correction must be submitted by the transferee and
2980 approved by the agency at least 7 days before the change of
2981 ownership and that failure to correct the condition which
2982 resulted in the moratorium pursuant to part II of chapter 408 or
2983 denial of licensure is grounds for denial of the transferee’s
2984 license.
2985 Section 77. Subsection (5) of section 429.14, Florida
2986 Statutes, is amended to read:
2987 429.14 Administrative penalties.—
2988 (5) An action taken by the agency to suspend, deny, or
2989 revoke a facility’s license under this part or part II of
2990 chapter 408, in which the agency claims that the facility owner
2991 or an employee of the facility has threatened the health,
2992 safety, or welfare of a resident of the facility, shall be heard
2993 by the Division of Administrative Hearings of the Department of
2994 Management Services within 120 days after receipt of the
2995 facility’s request for a hearing, unless that time limitation is
2996 waived by both parties. The administrative law judge must render
2997 a decision within 30 days after receipt of a proposed
2998 recommended order.
2999 Section 78. Subsections (1), (4), and (5) of section
3000 429.17, Florida Statutes, are amended to read:
3001 429.17 Expiration of license; renewal; conditional
3002 license.—
3003 (1) Limited nursing, Extended congregate care, and limited
3004 mental health licenses shall expire at the same time as the
3005 facility’s standard license, regardless of when issued.
3006 (4) In addition to the license categories available in s.
3007 408.808, a conditional license may be issued to an applicant for
3008 license renewal if the applicant fails to meet all standards and
3009 requirements for licensure. A conditional license issued under
3010 this subsection shall be limited in duration to a specific
3011 period of time not to exceed 6 months, as determined by the
3012 agency, and shall be accompanied by an agency-approved plan of
3013 correction.
3014 (5) When an extended congregate care or limited nursing
3015 license is requested during a facility’s biennial license
3016 period, the fee shall be prorated in order to permit the
3017 additional license to expire at the end of the biennial license
3018 period. The fee shall be calculated as of the date the
3019 additional license application is received by the agency.
3020 Section 79. Section 429.195, Florida Statutes, is amended
3021 to read:
3022 429.195 Rebates prohibited; penalties.—
3023 (1) It is unlawful for any assisted living facility
3024 licensed under this part to contract or promise to pay or
3025 receive any commission, bonus, kickback, or rebate or engage in
3026 any split-fee arrangement in any form whatsoever with any health
3027 care provider or health care facility pursuant to s. 817.505
3028 physician, surgeon, organization, agency, or person, either
3029 directly or indirectly, for residents referred to an assisted
3030 living facility licensed under this part. A facility may employ
3031 or contract with persons to market the facility, provided the
3032 employee or contract provider clearly indicates that he or she
3033 represents the facility. A person or agency independent of the
3034 facility may provide placement or referral services for a fee to
3035 individuals seeking assistance in finding a suitable facility;
3036 however, any fee paid for placement or referral services must be
3037 paid by the individual looking for a facility, not by the
3038 facility.
3039 (2) A violation of this section shall be considered patient
3040 brokering and is punishable as provided in s. 817.505.
3041 (3) This section does not apply to:
3042 (a) An individual employed by the facility, or with whom
3043 the facility contracts to market the facility, if the employee
3044 or contract provider clearly indicates that he or she works with
3045 or for the facility.
3046 (b) A referral service that provides information,
3047 consultation, or referrals to consumers to assist them in
3048 finding appropriate care or housing options for seniors or
3049 disabled adults, provided that such referred consumers are not
3050 Medicaid recipients.
3051 (c) Residents of an assisted living facility who refer
3052 friends, family members, or other individuals with whom they
3053 have a personal relationship to the assisted living facility,
3054 and does not prohibit the assisted living facility from
3055 providing a monetary reward to the resident for making such a
3056 referral.
3057 Section 80. Subsections (6) through (10) of section 429.23,
3058 Florida Statutes, are renumbered as subsections (5) through (9),
3059 respectively, and present subsection (5) of that section is
3060 amended to read:
3061 429.23 Internal risk management and quality assurance
3062 program; adverse incidents and reporting requirements.—
3063 (5) Each facility shall report monthly to the agency any
3064 liability claim filed against it. The report must include the
3065 name of the resident, the dates of the incident leading to the
3066 claim, if applicable, and the type of injury or violation of
3067 rights alleged to have occurred. This report is not discoverable
3068 in any civil or administrative action, except in such actions
3069 brought by the agency to enforce the provisions of this part.
3070 Section 81. Paragraph (a) of subsection (1) and subsection
3071 (2) of section 429.255, Florida Statutes, are amended to read:
3072 429.255 Use of personnel; emergency care.—
3073 (1)(a) Persons under contract to the facility or, facility
3074 staff, or volunteers, who are licensed according to part I of
3075 chapter 464, or those persons exempt under s. 464.022(1), and
3076 others as defined by rule, may administer medications to
3077 residents, take residents’ vital signs, manage individual weekly
3078 pill organizers for residents who self-administer medication,
3079 give prepackaged enemas ordered by a physician, observe
3080 residents, document observations on the appropriate resident’s
3081 record, report observations to the resident’s physician, and
3082 contract or allow residents or a resident’s representative,
3083 designee, surrogate, guardian, or attorney in fact to contract
3084 with a third party, provided residents meet the criteria for
3085 appropriate placement as defined in s. 429.26. Persons under
3086 contract to the facility or facility staff who are licensed
3087 according to part I of chapter 464 may provide limited nursing
3088 services. Nursing assistants certified pursuant to part II of
3089 chapter 464 may take residents’ vital signs as directed by a
3090 licensed nurse or physician. The facility is responsible for
3091 maintaining documentation of services provided under this
3092 paragraph and as required by rule and for ensuring that staff
3093 are adequately trained to monitor residents receiving these
3094 services.
3095 (2) In facilities licensed to provide extended congregate
3096 care, persons under contract to the facility or, facility staff,
3097 or volunteers, who are licensed according to part I of chapter
3098 464, or those persons exempt under s. 464.022(1), or those
3099 persons certified as nursing assistants pursuant to part II of
3100 chapter 464, may also perform all duties within the scope of
3101 their license or certification, as approved by the facility
3102 administrator and pursuant to this part.
3103 Section 82. Subsections (4), (5), (6), and (7) of section
3104 429.28, Florida Statutes, are renumbered as subsections (3),
3105 (4), (5), and (6), respectively, and present subsections (3) and
3106 (6) of that section are amended to read:
3107 429.28 Resident bill of rights.—
3108 (3)(a) The agency shall conduct a survey to determine
3109 general compliance with facility standards and compliance with
3110 residents’ rights as a prerequisite to initial licensure or
3111 licensure renewal.
3112 (b) In order to determine whether the facility is
3113 adequately protecting residents’ rights, the biennial survey
3114 shall include private informal conversations with a sample of
3115 residents and consultation with the ombudsman council in the
3116 planning and service area in which the facility is located to
3117 discuss residents’ experiences within the facility.
3118 (c) During any calendar year in which no survey is
3119 conducted, the agency shall conduct at least one monitoring
3120 visit of each facility cited in the previous year for a class I
3121 or class II violation, or more than three uncorrected class III
3122 violations.
3123 (d) The agency may conduct periodic followup inspections as
3124 necessary to monitor the compliance of facilities with a history
3125 of any class I, class II, or class III violations that threaten
3126 the health, safety, or security of residents.
3127 (e) The agency may conduct complaint investigations as
3128 warranted to investigate any allegations of noncompliance with
3129 requirements required under this part or rules adopted under
3130 this part.
3131 (5)(6) Any facility which terminates the residency of an
3132 individual who participated in activities specified in
3133 subsection (4) (5) shall show good cause in a court of competent
3134 jurisdiction.
3135 Section 83. Subsections (4) and (5) of section 429.41,
3136 Florida Statutes, are renumbered as subsections (3) and (4),
3137 respectively, and paragraphs (i) and (j) of subsection (1) and
3138 present subsection (3) of that section are amended to read:
3139 429.41 Rules establishing standards.—
3140 (1) It is the intent of the Legislature that rules
3141 published and enforced pursuant to this section shall include
3142 criteria by which a reasonable and consistent quality of
3143 resident care and quality of life may be ensured and the results
3144 of such resident care may be demonstrated. Such rules shall also
3145 ensure a safe and sanitary environment that is residential and
3146 noninstitutional in design or nature. It is further intended
3147 that reasonable efforts be made to accommodate the needs and
3148 preferences of residents to enhance the quality of life in a
3149 facility. The agency, in consultation with the department, may
3150 adopt rules to administer the requirements of part II of chapter
3151 408. In order to provide safe and sanitary facilities and the
3152 highest quality of resident care accommodating the needs and
3153 preferences of residents, the department, in consultation with
3154 the agency, the Department of Children and Family Services, and
3155 the Department of Health, shall adopt rules, policies, and
3156 procedures to administer this part, which must include
3157 reasonable and fair minimum standards in relation to:
3158 (i) Facilities holding an a limited nursing, extended
3159 congregate care, or limited mental health license.
3160 (j) The establishment of specific criteria to define
3161 appropriateness of resident admission and continued residency in
3162 a facility holding a standard, limited nursing, extended
3163 congregate care, and limited mental health license.
3164 (3) The department shall submit a copy of proposed rules to
3165 the Speaker of the House of Representatives, the President of
3166 the Senate, and appropriate committees of substance for review
3167 and comment prior to the promulgation thereof. Rules promulgated
3168 by the department shall encourage the development of homelike
3169 facilities which promote the dignity, individuality, personal
3170 strengths, and decisionmaking ability of residents.
3171 Section 84. Subsections (1) and (2) of section 429.53,
3172 Florida Statutes, are amended to read:
3173 429.53 Consultation by the agency.—
3174 (1) The area offices of licensure and certification of the
3175 agency shall provide consultation to the following upon request:
3176 (a) A licensee of a facility.
3177 (b) A person interested in obtaining a license to operate a
3178 facility under this part.
3179 (2) As used in this section, “consultation” includes:
3180 (a) An explanation of the requirements of this part and
3181 rules adopted pursuant thereto;
3182 (b) An explanation of the license application and renewal
3183 procedures; and
3184 (c) The provision of a checklist of general local and state
3185 approvals required prior to constructing or developing a
3186 facility and a listing of the types of agencies responsible for
3187 such approvals;
3188 (d) An explanation of benefits and financial assistance
3189 available to a recipient of supplemental security income
3190 residing in a facility;
3191 (c)(e) Any other information which the agency deems
3192 necessary to promote compliance with the requirements of this
3193 part; and
3194 (f) A preconstruction review of a facility to ensure
3195 compliance with agency rules and this part.
3196 Section 85. Subsection (6) of section 429.71, Florida
3197 Statutes, is renumbered as subsection (5), and subsection (1)
3198 and present subsection (5) of that section are amended to read:
3199 429.71 Classification of violations deficiencies;
3200 administrative fines.—
3201 (1) In addition to the requirements of part II of chapter
3202 408 and in addition to any other liability or penalty provided
3203 by law, the agency may impose an administrative fine on a
3204 provider according to the following classification:
3205 (a) Class I violations are defined in s. 408.813 those
3206 conditions or practices related to the operation and maintenance
3207 of an adult family-care home or to the care of residents which
3208 the agency determines present an imminent danger to the
3209 residents or guests of the facility or a substantial probability
3210 that death or serious physical or emotional harm would result
3211 therefrom. The condition or practice that constitutes a class I
3212 violation must be abated or eliminated within 24 hours, unless a
3213 fixed period, as determined by the agency, is required for
3214 correction. A class I violation deficiency is subject to an
3215 administrative fine in an amount not less than $500 and not
3216 exceeding $1,000 for each violation. A fine may be levied
3217 notwithstanding the correction of the deficiency.
3218 (b) Class II violations are defined in s. 408.813 those
3219 conditions or practices related to the operation and maintenance
3220 of an adult family-care home or to the care of residents which
3221 the agency determines directly threaten the physical or
3222 emotional health, safety, or security of the residents, other
3223 than class I violations. A class II violation is subject to an
3224 administrative fine in an amount not less than $250 and not
3225 exceeding $500 for each violation. A citation for a class II
3226 violation must specify the time within which the violation is
3227 required to be corrected. If a class II violation is corrected
3228 within the time specified, no civil penalty shall be imposed,
3229 unless it is a repeated offense.
3230 (c) Class III violations are defined in s. 408.813 those
3231 conditions or practices related to the operation and maintenance
3232 of an adult family-care home or to the care of residents which
3233 the agency determines indirectly or potentially threaten the
3234 physical or emotional health, safety, or security of residents,
3235 other than class I or class II violations. A class III violation
3236 is subject to an administrative fine in an amount not less than
3237 $100 and not exceeding $250 for each violation. A citation for a
3238 class III violation shall specify the time within which the
3239 violation is required to be corrected. If a class III violation
3240 is corrected within the time specified, no civil penalty shall
3241 be imposed, unless it is a repeated violation offense.
3242 (d) Class IV violations are defined in s. 408.813 those
3243 conditions or occurrences related to the operation and
3244 maintenance of an adult family-care home, or related to the
3245 required reports, forms, or documents, which do not have the
3246 potential of negatively affecting the residents. A provider that
3247 does not correct A class IV violation within the time limit
3248 specified by the agency is subject to an administrative fine in
3249 an amount not less than $50 and not exceeding $100 for each
3250 violation. Any class IV violation that is corrected during the
3251 time the agency survey is conducted will be identified as an
3252 agency finding and not as a violation, unless it is a repeat
3253 violation.
3254 (5) As an alternative to or in conjunction with an
3255 administrative action against a provider, the agency may request
3256 a plan of corrective action that demonstrates a good faith
3257 effort to remedy each violation by a specific date, subject to
3258 the approval of the agency.
3259 Section 86. Section 429.915, Florida Statutes, is amended
3260 to read:
3261 429.915 Conditional license.—In addition to the license
3262 categories available in part II of chapter 408, the agency may
3263 issue a conditional license to an applicant for license renewal
3264 or change of ownership if the applicant fails to meet all
3265 standards and requirements for licensure. A conditional license
3266 issued under this subsection must be limited to a specific
3267 period not exceeding 6 months, as determined by the agency, and
3268 must be accompanied by an approved plan of correction.
3269 Section 87. Paragraphs (b) and (g) of subsection (3) of
3270 section 430.80, Florida Statutes, are amended to read:
3271 430.80 Implementation of a teaching nursing home pilot
3272 project.—
3273 (3) To be designated as a teaching nursing home, a nursing
3274 home licensee must, at a minimum:
3275 (b) Participate in a nationally recognized accreditation
3276 program and hold a valid accreditation, such as the
3277 accreditation awarded by the Joint Commission on Accreditation
3278 of Healthcare Organizations, or, at the time of initial
3279 designation, possess a Gold Seal Award as conferred by the state
3280 on its licensed nursing home;
3281 (g) Maintain insurance coverage pursuant to s.
3282 400.141(1)(q)(s) or proof of financial responsibility in a
3283 minimum amount of $750,000. Such proof of financial
3284 responsibility may include:
3285 1. Maintaining an escrow account consisting of cash or
3286 assets eligible for deposit in accordance with s. 625.52; or
3287 2. Obtaining and maintaining pursuant to chapter 675 an
3288 unexpired, irrevocable, nontransferable and nonassignable letter
3289 of credit issued by any bank or savings association organized
3290 and existing under the laws of this state or any bank or savings
3291 association organized under the laws of the United States that
3292 has its principal place of business in this state or has a
3293 branch office which is authorized to receive deposits in this
3294 state. The letter of credit shall be used to satisfy the
3295 obligation of the facility to the claimant upon presentment of a
3296 final judgment indicating liability and awarding damages to be
3297 paid by the facility or upon presentment of a settlement
3298 agreement signed by all parties to the agreement when such final
3299 judgment or settlement is a result of a liability claim against
3300 the facility.
3301 Section 88. Paragraph (d) of subsection (9) of section
3302 440.102, Florida Statutes, is amended to read:
3303 440.102 Drug-free workplace program requirements.—The
3304 following provisions apply to a drug-free workplace program
3305 implemented pursuant to law or to rules adopted by the Agency
3306 for Health Care Administration:
3307 (9) DRUG-TESTING STANDARDS FOR LABORATORIES.—
3308 (d) The laboratory shall submit to the Agency for Health
3309 Care Administration a monthly report with statistical
3310 information regarding the testing of employees and job
3311 applicants. The report must include information on the methods
3312 of analysis conducted, the drugs tested for, the number of
3313 positive and negative results for both initial tests and
3314 confirmation tests, and any other information deemed appropriate
3315 by the Agency for Health Care Administration. A monthly report
3316 must not identify specific employees or job applicants.
3317 Section 89. Paragraph (a) of subsection (2) of section
3318 440.13, Florida Statutes, is amended to read:
3319 440.13 Medical services and supplies; penalty for
3320 violations; limitations.—
3321 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3322 (a) Subject to the limitations specified elsewhere in this
3323 chapter, the employer shall furnish to the employee such
3324 medically necessary remedial treatment, care, and attendance for
3325 such period as the nature of the injury or the process of
3326 recovery may require, which is in accordance with established
3327 practice parameters and protocols of treatment as provided for
3328 in this chapter, including medicines, medical supplies, durable
3329 medical equipment, orthoses, prostheses, and other medically
3330 necessary apparatus. Remedial treatment, care, and attendance,
3331 including work-hardening programs or pain-management programs
3332 accredited by the Commission on Accreditation of Rehabilitation
3333 Facilities or the Joint Commission on the Accreditation of
3334 Health Organizations or pain-management programs affiliated with
3335 medical schools, shall be considered as covered treatment only
3336 when such care is given based on a referral by a physician as
3337 defined in this chapter. Medically necessary treatment, care,
3338 and attendance does not include chiropractic services in excess
3339 of 24 treatments or rendered 12 weeks beyond the date of the
3340 initial chiropractic treatment, whichever comes first, unless
3341 the carrier authorizes additional treatment or the employee is
3342 catastrophically injured.
3343
3344 Failure of the carrier to timely comply with this subsection
3345 shall be a violation of this chapter and the carrier shall be
3346 subject to penalties as provided for in s. 440.525.
3347 Section 90. Paragraph (h) of subsection (3) of section
3348 456.053, Florida Statutes, is amended to read:
3349 456.053 Financial arrangements between referring health
3350 care providers and providers of health care services.—
3351 (3) DEFINITIONS.—For the purpose of this section, the word,
3352 phrase, or term:
3353 (h) “Group practice” means a group of two or more health
3354 care providers legally organized as a partnership, professional
3355 corporation, or similar association:
3356 1. In which each health care provider who is a member of
3357 the group provides substantially the full range of services
3358 which the health care provider routinely provides, including
3359 medical care, consultation, diagnosis, or treatment, through the
3360 joint use of shared office space, facilities, equipment, and
3361 personnel;
3362 2. For which substantially all of the services of the
3363 health care providers who are members of the group are provided
3364 through the group and are billed in the name of the group and
3365 amounts so received are treated as receipts of the group; and
3366 3. In which the overhead expenses of and the income from
3367 the practice are distributed in accordance with methods
3368 previously determined by members of the group; and
3369 4. In which a group practice that provides radiation
3370 therapy services provides the full range of radiation therapy
3371 services such that no single type of cancer, either as a primary
3372 or secondary diagnosis as described by the International
3373 Statistical Classification of Diseases, constitutes 40 percent
3374 or more of the group’s cases that require professional and
3375 technical services for radiation therapy, and in which the
3376 health care providers within the group who are referring
3377 patients for radiation therapy services do not own 50 percent or
3378 more of the group practice. For purposes of this subparagraph,
3379 the term “cases” means a patient’s radiation treatment course.
3380 Section 91. Subsection (1) of section 483.035, Florida
3381 Statutes, is amended to read:
3382 483.035 Clinical laboratories operated by practitioners for
3383 exclusive use; licensure and regulation.—
3384 (1) A clinical laboratory operated by one or more
3385 practitioners licensed under chapter 458, chapter 459, chapter
3386 460, chapter 461, chapter 462, part I of chapter 464, or chapter
3387 466, exclusively in connection with the diagnosis and treatment
3388 of their own patients, must be licensed under this part and must
3389 comply with the provisions of this part, except that the agency
3390 shall adopt rules for staffing, for personnel, including
3391 education and training of personnel, for proficiency testing,
3392 and for construction standards relating to the licensure and
3393 operation of the laboratory based upon and not exceeding the
3394 same standards contained in the federal Clinical Laboratory
3395 Improvement Amendments of 1988 and the federal regulations
3396 adopted thereunder.
3397 Section 92. Subsections (1) and (9) of section 483.051,
3398 Florida Statutes, are amended to read:
3399 483.051 Powers and duties of the agency.—The agency shall
3400 adopt rules to implement this part, which rules must include,
3401 but are not limited to, the following:
3402 (1) LICENSING; QUALIFICATIONS.—The agency shall provide for
3403 biennial licensure of all nonwaived clinical laboratories
3404 meeting the requirements of this part and shall prescribe the
3405 qualifications necessary for such licensure, including, but not
3406 limited to, application for or proof of a federal Clinical
3407 Laboratory Improvement Amendment (CLIA) certificate. For
3408 purposes of this section, the term “nonwaived clinical
3409 laboratories” means laboratories that perform any test that the
3410 Centers for Medicare and Medicaid Services has determined does
3411 not qualify for a certificate of waiver under the Clinical
3412 Laboratory Improvement Amendments of 1988 and the federal rules
3413 adopted thereunder.
3414 (9) ALTERNATE-SITE TESTING.—The agency, in consultation
3415 with the Board of Clinical Laboratory Personnel, shall adopt, by
3416 rule, the criteria for alternate-site testing to be performed
3417 under the supervision of a clinical laboratory director. The
3418 elements to be addressed in the rule include, but are not
3419 limited to: a hospital internal needs assessment; a protocol of
3420 implementation including tests to be performed and who will
3421 perform the tests; criteria to be used in selecting the method
3422 of testing to be used for alternate-site testing; minimum
3423 training and education requirements for those who will perform
3424 alternate-site testing, such as documented training, licensure,
3425 certification, or other medical professional background not
3426 limited to laboratory professionals; documented inservice
3427 training as well as initial and ongoing competency validation;
3428 an appropriate internal and external quality control protocol;
3429 an internal mechanism for identifying and tracking alternate
3430 site testing by the central laboratory; and recordkeeping
3431 requirements. Alternate-site testing locations must register
3432 when the clinical laboratory applies to renew its license. For
3433 purposes of this subsection, the term “alternate-site testing”
3434 means any laboratory testing done under the administrative
3435 control of a hospital, but performed out of the physical or
3436 administrative confines of the central laboratory.
3437 Section 93. Section 483.294, Florida Statutes, is amended
3438 to read:
3439 483.294 Inspection of centers.—In accordance with s.
3440 408.811, the agency shall biennially, at least once annually,
3441 inspect the premises and operations of all centers subject to
3442 licensure under this part.
3443 Section 94. Paragraph (a) of subsection (54) of section
3444 499.003, Florida Statutes, is amended to read:
3445 499.003 Definitions of terms used in this part.—As used in
3446 this part, the term:
3447 (54) “Wholesale distribution” means distribution of
3448 prescription drugs to persons other than a consumer or patient,
3449 but does not include:
3450 (a) Any of the following activities, which is not a
3451 violation of s. 499.005(21) if such activity is conducted in
3452 accordance with s. 499.01(2)(g):
3453 1. The purchase or other acquisition by a hospital or other
3454 health care entity that is a member of a group purchasing
3455 organization of a prescription drug for its own use from the
3456 group purchasing organization or from other hospitals or health
3457 care entities that are members of that organization.
3458 2. The sale, purchase, or trade of a prescription drug or
3459 an offer to sell, purchase, or trade a prescription drug by a
3460 charitable organization described in s. 501(c)(3) of the
3461 Internal Revenue Code of 1986, as amended and revised, to a
3462 nonprofit affiliate of the organization to the extent otherwise
3463 permitted by law.
3464 3. The sale, purchase, or trade of a prescription drug or
3465 an offer to sell, purchase, or trade a prescription drug among
3466 hospitals or other health care entities that are under common
3467 control. For purposes of this subparagraph, “common control”
3468 means the power to direct or cause the direction of the
3469 management and policies of a person or an organization, whether
3470 by ownership of stock, by voting rights, by contract, or
3471 otherwise.
3472 4. The sale, purchase, trade, or other transfer of a
3473 prescription drug from or for any federal, state, or local
3474 government agency or any entity eligible to purchase
3475 prescription drugs at public health services prices pursuant to
3476 Pub. L. No. 102-585, s. 602 to a contract provider or its
3477 subcontractor for eligible patients of the agency or entity
3478 under the following conditions:
3479 a. The agency or entity must obtain written authorization
3480 for the sale, purchase, trade, or other transfer of a
3481 prescription drug under this subparagraph from the State Surgeon
3482 General or his or her designee.
3483 b. The contract provider or subcontractor must be
3484 authorized by law to administer or dispense prescription drugs.
3485 c. In the case of a subcontractor, the agency or entity
3486 must be a party to and execute the subcontract.
3487 d. A contract provider or subcontractor must maintain
3488 separate and apart from other prescription drug inventory any
3489 prescription drugs of the agency or entity in its possession.
3490 d.e. The contract provider and subcontractor must maintain
3491 and produce immediately for inspection all records of movement
3492 or transfer of all the prescription drugs belonging to the
3493 agency or entity, including, but not limited to, the records of
3494 receipt and disposition of prescription drugs. Each contractor
3495 and subcontractor dispensing or administering these drugs must
3496 maintain and produce records documenting the dispensing or
3497 administration. Records that are required to be maintained
3498 include, but are not limited to, a perpetual inventory itemizing
3499 drugs received and drugs dispensed by prescription number or
3500 administered by patient identifier, which must be submitted to
3501 the agency or entity quarterly.
3502 e.f. The contract provider or subcontractor may administer
3503 or dispense the prescription drugs only to the eligible patients
3504 of the agency or entity or must return the prescription drugs
3505 for or to the agency or entity. The contract provider or
3506 subcontractor must require proof from each person seeking to
3507 fill a prescription or obtain treatment that the person is an
3508 eligible patient of the agency or entity and must, at a minimum,
3509 maintain a copy of this proof as part of the records of the
3510 contractor or subcontractor required under sub-subparagraph e.
3511 f.g. In addition to the departmental inspection authority
3512 set forth in s. 499.051, the establishment of the contract
3513 provider and subcontractor and all records pertaining to
3514 prescription drugs subject to this subparagraph shall be subject
3515 to inspection by the agency or entity. All records relating to
3516 prescription drugs of a manufacturer under this subparagraph
3517 shall be subject to audit by the manufacturer of those drugs,
3518 without identifying individual patient information.
3519 Section 95. Subsection (1) of section 627.645, Florida
3520 Statutes, is amended to read:
3521 627.645 Denial of health insurance claims restricted.—
3522 (1) No claim for payment under a health insurance policy or
3523 self-insured program of health benefits for treatment, care, or
3524 services in a licensed hospital which is accredited by the Joint
3525 Commission on the Accreditation of Hospitals, the American
3526 Osteopathic Association, or the Commission on the Accreditation
3527 of Rehabilitative Facilities shall be denied because such
3528 hospital lacks major surgical facilities and is primarily of a
3529 rehabilitative nature, if such rehabilitation is specifically
3530 for treatment of physical disability.
3531 Section 96. Paragraph (c) of subsection (2) of section
3532 627.668, Florida Statutes, is amended to read:
3533 627.668 Optional coverage for mental and nervous disorders
3534 required; exception.—
3535 (2) Under group policies or contracts, inpatient hospital
3536 benefits, partial hospitalization benefits, and outpatient
3537 benefits consisting of durational limits, dollar amounts,
3538 deductibles, and coinsurance factors shall not be less favorable
3539 than for physical illness generally, except that:
3540 (c) Partial hospitalization benefits shall be provided
3541 under the direction of a licensed physician. For purposes of
3542 this part, the term “partial hospitalization services” is
3543 defined as those services offered by a program accredited by the
3544 Joint Commission on Accreditation of Hospitals (JCAH) or in
3545 compliance with equivalent standards. Alcohol rehabilitation
3546 programs accredited by the Joint Commission on Accreditation of
3547 Hospitals or approved by the state and licensed drug abuse
3548 rehabilitation programs shall also be qualified providers under
3549 this section. In any benefit year, if partial hospitalization
3550 services or a combination of inpatient and partial
3551 hospitalization are utilized, the total benefits paid for all
3552 such services shall not exceed the cost of 30 days of inpatient
3553 hospitalization for psychiatric services, including physician
3554 fees, which prevail in the community in which the partial
3555 hospitalization services are rendered. If partial
3556 hospitalization services benefits are provided beyond the limits
3557 set forth in this paragraph, the durational limits, dollar
3558 amounts, and coinsurance factors thereof need not be the same as
3559 those applicable to physical illness generally.
3560 Section 97. Subsection (3) of section 627.669, Florida
3561 Statutes, is amended to read:
3562 627.669 Optional coverage required for substance abuse
3563 impaired persons; exception.—
3564 (3) The benefits provided under this section shall be
3565 applicable only if treatment is provided by, or under the
3566 supervision of, or is prescribed by, a licensed physician or
3567 licensed psychologist and if services are provided in a program
3568 accredited by the Joint Commission on Accreditation of Hospitals
3569 or approved by the state.
3570 Section 98. Paragraph (a) of subsection (1) of section
3571 627.736, Florida Statutes, is amended to read:
3572 627.736 Required personal injury protection benefits;
3573 exclusions; priority; claims.—
3574 (1) REQUIRED BENEFITS.—Every insurance policy complying
3575 with the security requirements of s. 627.733 shall provide
3576 personal injury protection to the named insured, relatives
3577 residing in the same household, persons operating the insured
3578 motor vehicle, passengers in such motor vehicle, and other
3579 persons struck by such motor vehicle and suffering bodily injury
3580 while not an occupant of a self-propelled vehicle, subject to
3581 the provisions of subsection (2) and paragraph (4)(e), to a
3582 limit of $10,000 for loss sustained by any such person as a
3583 result of bodily injury, sickness, disease, or death arising out
3584 of the ownership, maintenance, or use of a motor vehicle as
3585 follows:
3586 (a) Medical benefits.—Eighty percent of all reasonable
3587 expenses for medically necessary medical, surgical, X-ray,
3588 dental, and rehabilitative services, including prosthetic
3589 devices, and medically necessary ambulance, hospital, and
3590 nursing services. However, the medical benefits shall provide
3591 reimbursement only for such services and care that are lawfully
3592 provided, supervised, ordered, or prescribed by a physician
3593 licensed under chapter 458 or chapter 459, a dentist licensed
3594 under chapter 466, or a chiropractic physician licensed under
3595 chapter 460 or that are provided by any of the following persons
3596 or entities:
3597 1. A hospital or ambulatory surgical center licensed under
3598 chapter 395.
3599 2. A person or entity licensed under ss. 401.2101-401.45
3600 that provides emergency transportation and treatment.
3601 3. An entity wholly owned by one or more physicians
3602 licensed under chapter 458 or chapter 459, chiropractic
3603 physicians licensed under chapter 460, or dentists licensed
3604 under chapter 466 or by such practitioner or practitioners and
3605 the spouse, parent, child, or sibling of that practitioner or
3606 those practitioners.
3607 4. An entity wholly owned, directly or indirectly, by a
3608 hospital or hospitals.
3609 5. A health care clinic licensed under ss. 400.990-400.995
3610 that is:
3611 a. Accredited by the Joint Commission on Accreditation of
3612 Healthcare Organizations, the American Osteopathic Association,
3613 the Commission on Accreditation of Rehabilitation Facilities, or
3614 the Accreditation Association for Ambulatory Health Care, Inc.;
3615 or
3616 b. A health care clinic that:
3617 (I) Has a medical director licensed under chapter 458,
3618 chapter 459, or chapter 460;
3619 (II) Has been continuously licensed for more than 3 years
3620 or is a publicly traded corporation that issues securities
3621 traded on an exchange registered with the United States
3622 Securities and Exchange Commission as a national securities
3623 exchange; and
3624 (III) Provides at least four of the following medical
3625 specialties:
3626 (A) General medicine.
3627 (B) Radiography.
3628 (C) Orthopedic medicine.
3629 (D) Physical medicine.
3630 (E) Physical therapy.
3631 (F) Physical rehabilitation.
3632 (G) Prescribing or dispensing outpatient prescription
3633 medication.
3634 (H) Laboratory services.
3635
3636 The Financial Services Commission shall adopt by rule the form
3637 that must be used by an insurer and a health care provider
3638 specified in subparagraph 3., subparagraph 4., or subparagraph
3639 5. to document that the health care provider meets the criteria
3640 of this paragraph, which rule must include a requirement for a
3641 sworn statement or affidavit.
3642
3643 Only insurers writing motor vehicle liability insurance in this
3644 state may provide the required benefits of this section, and no
3645 such insurer shall require the purchase of any other motor
3646 vehicle coverage other than the purchase of property damage
3647 liability coverage as required by s. 627.7275 as a condition for
3648 providing such required benefits. Insurers may not require that
3649 property damage liability insurance in an amount greater than
3650 $10,000 be purchased in conjunction with personal injury
3651 protection. Such insurers shall make benefits and required
3652 property damage liability insurance coverage available through
3653 normal marketing channels. Any insurer writing motor vehicle
3654 liability insurance in this state who fails to comply with such
3655 availability requirement as a general business practice shall be
3656 deemed to have violated part IX of chapter 626, and such
3657 violation shall constitute an unfair method of competition or an
3658 unfair or deceptive act or practice involving the business of
3659 insurance; and any such insurer committing such violation shall
3660 be subject to the penalties afforded in such part, as well as
3661 those which may be afforded elsewhere in the insurance code.
3662 Section 99. Section 633.081, Florida Statutes, is amended
3663 to read:
3664 633.081 Inspection of buildings and equipment; orders;
3665 firesafety inspection training requirements; certification;
3666 disciplinary action.—The State Fire Marshal and her or his
3667 agents shall, at any reasonable hour, when the State Fire
3668 Marshal has reasonable cause to believe that a violation of this
3669 chapter or s. 509.215, or a rule promulgated thereunder, or a
3670 minimum firesafety code adopted by a local authority, may exist,
3671 inspect any and all buildings and structures which are subject
3672 to the requirements of this chapter or s. 509.215 and rules
3673 promulgated thereunder. The authority to inspect shall extend to
3674 all equipment, vehicles, and chemicals which are located within
3675 the premises of any such building or structure. The State Fire
3676 Marshal and her or his agents shall inspect nursing homes
3677 licensed under part II of chapter 400 only once every calendar
3678 year and upon receiving a complaint forming the basis of a
3679 reasonable cause to believe that a violation of this chapter or
3680 s. 509.215, or a rule promulgated thereunder, or a minimum
3681 firesafety code adopted by a local authority may exist and upon
3682 identifying such a violation in the course of conducting
3683 orientation or training activities within a nursing home.
3684 (1) Each county, municipality, and special district that
3685 has firesafety enforcement responsibilities shall employ or
3686 contract with a firesafety inspector. Except as provided in s.
3687 633.082(2), the firesafety inspector must conduct all firesafety
3688 inspections that are required by law. The governing body of a
3689 county, municipality, or special district that has firesafety
3690 enforcement responsibilities may provide a schedule of fees to
3691 pay only the costs of inspections conducted pursuant to this
3692 subsection and related administrative expenses. Two or more
3693 counties, municipalities, or special districts that have
3694 firesafety enforcement responsibilities may jointly employ or
3695 contract with a firesafety inspector.
3696 (2) Except as provided in s. 633.082(2), every firesafety
3697 inspection conducted pursuant to state or local firesafety
3698 requirements shall be by a person certified as having met the
3699 inspection training requirements set by the State Fire Marshal.
3700 Such person shall:
3701 (a) Be a high school graduate or the equivalent as
3702 determined by the department;
3703 (b) Not have been found guilty of, or having pleaded guilty
3704 or nolo contendere to, a felony or a crime punishable by
3705 imprisonment of 1 year or more under the law of the United
3706 States, or of any state thereof, which involves moral turpitude,
3707 without regard to whether a judgment of conviction has been
3708 entered by the court having jurisdiction of such cases;
3709 (c) Have her or his fingerprints on file with the
3710 department or with an agency designated by the department;
3711 (d) Have good moral character as determined by the
3712 department;
3713 (e) Be at least 18 years of age;
3714 (f) Have satisfactorily completed the firesafety inspector
3715 certification examination as prescribed by the department; and
3716 (g)1. Have satisfactorily completed, as determined by the
3717 department, a firesafety inspector training program of not less
3718 than 200 hours established by the department and administered by
3719 agencies and institutions approved by the department for the
3720 purpose of providing basic certification training for firesafety
3721 inspectors; or
3722 2. Have received in another state training which is
3723 determined by the department to be at least equivalent to that
3724 required by the department for approved firesafety inspector
3725 education and training programs in this state.
3726 (3) Each special state firesafety inspection which is
3727 required by law and is conducted by or on behalf of an agency of
3728 the state must be performed by an individual who has met the
3729 provision of subsection (2), except that the duration of the
3730 training program shall not exceed 120 hours of specific training
3731 for the type of property that such special state firesafety
3732 inspectors are assigned to inspect.
3733 (4) A firefighter certified pursuant to s. 633.35 may
3734 conduct firesafety inspections, under the supervision of a
3735 certified firesafety inspector, while on duty as a member of a
3736 fire department company conducting inservice firesafety
3737 inspections without being certified as a firesafety inspector,
3738 if such firefighter has satisfactorily completed an inservice
3739 fire department company inspector training program of at least
3740 24 hours’ duration as provided by rule of the department.
3741 (5) Every firesafety inspector or special state firesafety
3742 inspector certificate is valid for a period of 3 years from the
3743 date of issuance. Renewal of certification shall be subject to
3744 the affected person’s completing proper application for renewal
3745 and meeting all of the requirements for renewal as established
3746 under this chapter or by rule promulgated thereunder, which
3747 shall include completion of at least 40 hours during the
3748 preceding 3-year period of continuing education as required by
3749 the rule of the department or, in lieu thereof, successful
3750 passage of an examination as established by the department.
3751 (6) The State Fire Marshal may deny, refuse to renew,
3752 suspend, or revoke the certificate of a firesafety inspector or
3753 special state firesafety inspector if it finds that any of the
3754 following grounds exist:
3755 (a) Any cause for which issuance of a certificate could
3756 have been refused had it then existed and been known to the
3757 State Fire Marshal.
3758 (b) Violation of this chapter or any rule or order of the
3759 State Fire Marshal.
3760 (c) Falsification of records relating to the certificate.
3761 (d) Having been found guilty of or having pleaded guilty or
3762 nolo contendere to a felony, whether or not a judgment of
3763 conviction has been entered.
3764 (e) Failure to meet any of the renewal requirements.
3765 (f) Having been convicted of a crime in any jurisdiction
3766 which directly relates to the practice of fire code inspection,
3767 plan review, or administration.
3768 (g) Making or filing a report or record that the
3769 certificateholder knows to be false, or knowingly inducing
3770 another to file a false report or record, or knowingly failing
3771 to file a report or record required by state or local law, or
3772 knowingly impeding or obstructing such filing, or knowingly
3773 inducing another person to impede or obstruct such filing.
3774 (h) Failing to properly enforce applicable fire codes or
3775 permit requirements within this state which the
3776 certificateholder knows are applicable by committing willful
3777 misconduct, gross negligence, gross misconduct, repeated
3778 negligence, or negligence resulting in a significant danger to
3779 life or property.
3780 (i) Accepting labor, services, or materials at no charge or
3781 at a noncompetitive rate from any person who performs work that
3782 is under the enforcement authority of the certificateholder and
3783 who is not an immediate family member of the certificateholder.
3784 For the purpose of this paragraph, the term “immediate family
3785 member” means a spouse, child, parent, sibling, grandparent,
3786 aunt, uncle, or first cousin of the person or the person’s
3787 spouse or any person who resides in the primary residence of the
3788 certificateholder.
3789 (7) The Division of State Fire Marshal and the Florida
3790 Building Code Administrators and Inspectors Board, established
3791 pursuant to s. 468.605, shall enter into a reciprocity agreement
3792 to facilitate joint recognition of continuing education
3793 recertification hours for certificateholders licensed under s.
3794 468.609 and firesafety inspectors certified under subsection
3795 (2).
3796 (8) The State Fire Marshal shall develop by rule an
3797 advanced training and certification program for firesafety
3798 inspectors having fire code management responsibilities. The
3799 program must be consistent with the appropriate provisions of
3800 NFPA 1037, or similar standards adopted by the division, and
3801 establish minimum training, education, and experience levels for
3802 firesafety inspectors having fire code management
3803 responsibilities.
3804 (9) The department shall provide by rule for the
3805 certification of firesafety inspectors.
3806 Section 100. Subsection (12) of section 641.495, Florida
3807 Statutes, is amended to read:
3808 641.495 Requirements for issuance and maintenance of
3809 certificate.—
3810 (12) The provisions of part I of chapter 395 do not apply
3811 to a health maintenance organization that, on or before January
3812 1, 1991, provides not more than 10 outpatient holding beds for
3813 short-term and hospice-type patients in an ambulatory care
3814 facility for its members, provided that such health maintenance
3815 organization maintains current accreditation by the Joint
3816 Commission on Accreditation of Health Care Organizations, the
3817 Accreditation Association for Ambulatory Health Care, or the
3818 National Committee for Quality Assurance.
3819 Section 101. Subsection (13) of section 651.118, Florida
3820 Statutes, is amended to read:
3821 651.118 Agency for Health Care Administration; certificates
3822 of need; sheltered beds; community beds.—
3823 (13) Residents, as defined in this chapter, are not
3824 considered new admissions for the purpose of s.
3825 400.141(1)(n)(o)1.d.
3826 Section 102. Subsection (2) of section 766.1015, Florida
3827 Statutes, is amended to read:
3828 766.1015 Civil immunity for members of or consultants to
3829 certain boards, committees, or other entities.—
3830 (2) Such committee, board, group, commission, or other
3831 entity must be established in accordance with state law or in
3832 accordance with requirements of the Joint Commission on
3833 Accreditation of Healthcare Organizations, established and duly
3834 constituted by one or more public or licensed private hospitals
3835 or behavioral health agencies, or established by a governmental
3836 agency. To be protected by this section, the act, decision,
3837 omission, or utterance may not be made or done in bad faith or
3838 with malicious intent.
3839 Section 103. Subsection (4) of section 766.202, Florida
3840 Statutes, is amended to read:
3841 766.202 Definitions; ss. 766.201-766.212.—As used in ss.
3842 766.201-766.212, the term:
3843 (4) “Health care provider” means any hospital, ambulatory
3844 surgical center, or mobile surgical facility as defined and
3845 licensed under chapter 395; a birth center licensed under
3846 chapter 383; any person licensed under chapter 458, chapter 459,
3847 chapter 460, chapter 461, chapter 462, chapter 463, part I of
3848 chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3849 or chapter 486; a clinical lab licensed under chapter 483; a
3850 health maintenance organization certificated under part I of
3851 chapter 641; a blood bank; a plasma center; an industrial
3852 clinic; a renal dialysis facility; or a professional association
3853 partnership, corporation, joint venture, or other association
3854 for professional activity by health care providers.
3855 Section 104. Paragraph (j) is added to subsection (3) of
3856 section 817.505, Florida Statutes, to read:
3857 817.505 Patient brokering prohibited; exceptions;
3858 penalties.—
3859 (3) This section shall not apply to:
3860 (j) Any payments by an assisted living facility, as defined
3861 in s. 429.02, or any agreement for or solicitation, offer, or
3862 receipt of such payment by a referral service, which is
3863 permitted under s. 429.195(3).
3864 Section 105. The per-bed standard assisted living facility
3865 licensure fees, including the total fee, have been adjusted by
3866 the Consumer Price Index annually since 1998 and are not
3867 intended to be reset by this act. In addition to the Consumer
3868 Price Index adjustment, the per-bed fee is increased by $9 to
3869 neutralize the elimination of the limited nursing services
3870 specialty license fee.
3871 Section 106. This act shall take effect July 1, 2011.
3872
3873 ================= T I T L E A M E N D M E N T ================
3874 And the title is amended as follows:
3875 Delete everything before the enacting clause
3876 and insert:
3877 A bill to be entitled
3878 An act relating to health care; amending s. 83.42,
3879 F.S., establishing that s. 400.0255, F.S., provides
3880 exclusive procedures for resident transfer and
3881 discharge; amending s. 112.0455, F.S., relating to the
3882 Drug-Free Workplace Act; deleting an obsolete
3883 provision; deleting a requirement that a laboratory
3884 that conducts drug tests submit certain reports to the
3885 Agency for Health Care Administration; amending s.
3886 318.21, F.S.; revising distribution of funds from
3887 civil penalties imposed for traffic infractions by
3888 county courts; repealing s. 383.325, F.S., relating to
3889 confidentiality of inspection reports of licensed
3890 birth center facilities; amending s. 395.002, F.S.;
3891 revising and deleting definitions applicable to
3892 regulation of hospitals and other licensed facilities;
3893 conforming a cross-reference; amending s. 395.003,
3894 F.S.; deleting an obsolete provision; conforming a
3895 cross-reference; amending s. 395.0161, F.S.; deleting
3896 a provision requiring licensure inspection fees for
3897 hospitals, ambulatory surgical centers, and mobile
3898 surgical facilities to be paid at the time of the
3899 inspection; amending s. 395.0193, F.S.; requiring a
3900 licensed facility to report certain peer review
3901 information and final disciplinary actions to the
3902 Division of Medical Quality Assurance of the
3903 Department of Health rather than the Division of
3904 Health Quality Assurance of the Agency for Health Care
3905 Administration; amending s. 395.1023, F.S.; providing
3906 for the Department of Children and Family Services
3907 rather than the Department of Health to perform
3908 certain functions with respect to child protection
3909 cases; requiring certain hospitals to notify the
3910 Department of Children and Family Services of
3911 compliance; amending s. 395.1041, F.S., relating to
3912 hospital emergency services and care; deleting
3913 obsolete provisions; repealing s. 395.1046, F.S.,
3914 relating to complaint investigation procedures;
3915 amending s. 395.1055, F.S.; requiring additional
3916 housekeeping and sanitation procedures in licensed
3917 facilities for infection control purposes; requiring
3918 licensed facility beds to conform to standards
3919 specified by the Agency for Health Care
3920 Administration, the Florida Building Code, and the
3921 Florida Fire Prevention Code; amending s. 395.10972,
3922 F.S.; revising a reference to the Florida Society of
3923 Healthcare Risk Management to conform to the current
3924 designation; amending s. 395.2050, F.S.; revising a
3925 reference to the federal Health Care Financing
3926 Administration to conform to the current designation;
3927 amending s. 395.3036, F.S.; correcting a reference;
3928 repealing s. 395.3037, F.S., relating to redundant
3929 definitions; amending ss. 154.11, 394.741, 395.3038,
3930 400.925, 400.9935, 408.05, 440.13, 627.645, 627.668,
3931 627.669, 627.736, 641.495, and 766.1015, F.S.;
3932 revising references to the Joint Commission on
3933 Accreditation of Healthcare Organizations, the
3934 Commission on Accreditation of Rehabilitation
3935 Facilities, and the Council on Accreditation to
3936 conform to their current designations; amending s.
3937 395.4025, F.S.; authorizing the Department of Health
3938 to grant additional extensions for trauma center
3939 applicants under certain circumstances; amending s.
3940 395.602, F.S.; revising the definition of the term
3941 “rural hospital” to delete an obsolete provision;
3942 amending s. 400.021, F.S.; revising the definition of
3943 the term “geriatric outpatient clinic” to include
3944 additional staff; revising the term “resident care
3945 plan”; removing a provision that requires certain
3946 signatures on the plan; amending s. 400.0255, F.S.;
3947 correcting an obsolete cross-reference to
3948 administrative rules; amending s. 400.063, F.S.;
3949 deleting an obsolete provision; amending ss. 400.071
3950 and 400.0712, F.S.; revising applicability of general
3951 licensure requirements under part II of ch. 408, F.S.,
3952 the Health Care Licensing Procedures Act, to
3953 applications for nursing home licensure; revising
3954 provisions governing inactive licenses; amending s.
3955 400.111, F.S.; providing for disclosure of controlling
3956 interest of a nursing home facility upon request by
3957 the Agency for Health Care Administration; amending s.
3958 400.1183, F.S.; revising grievance record maintenance
3959 and reporting requirements for nursing homes; amending
3960 s. 400.141, F.S.; providing criteria for the provision
3961 of respite services by nursing homes; requiring a
3962 written plan of care; requiring a contract for
3963 services; requiring resident release to caregivers to
3964 be designated in writing; providing an exemption to
3965 the application of discharge planning rules; providing
3966 for residents’ rights; providing for use of personal
3967 medications; providing terms of respite stay;
3968 providing for communication of patient information;
3969 requiring a physician’s order for care and proof of a
3970 physical examination; providing for services for
3971 respite patients and duties of facilities with respect
3972 to such patients; conforming a cross-reference;
3973 requiring facilities to maintain clinical records that
3974 meet specified standards; providing a fine relating to
3975 an admissions moratorium; deleting requirement for
3976 facilities to submit certain information related to
3977 management companies to the agency; deleting a
3978 requirement for facilities to notify the agency of
3979 certain bankruptcy filings to conform to changes made
3980 by the act; providing a limit on fees charged by a
3981 facility for copies of patient records; amending s.
3982 400.142, F.S.; deleting language relating to agency
3983 adoption of rules; repealing s. 400.145, F.S.,
3984 relating to records of care and treatment of
3985 residents; repealing ss. 400.0234 and 429.294, F.S.,
3986 relating to availability of facility records for
3987 investigation of resident’s rights violations and
3988 defenses; amending 400.147, F.S.; removing a
3989 requirement for nursing homes and related health care
3990 facilities to notify the agency within a specified
3991 period of time after receipt of an adverse incident
3992 report; revising reporting requirements for licensed
3993 nursing home facilities relating to adverse incidents;
3994 repealing s. 400.148, F.S., relating to the Medicaid
3995 “Up-or-Out” Quality of Care Contract Management
3996 Program; amending s. 400.179, F.S.; deleting an
3997 obsolete provision; amending s. 400.19, F.S.; revising
3998 inspection requirements; amending s. 400.23, F.S.;
3999 deleting an obsolete provision; correcting a
4000 reference; directing the agency to adopt rules for
4001 minimum staffing standards in nursing homes that serve
4002 persons under 21 years of age; providing minimum
4003 staffing standards; amending s. 400.275, F.S.;
4004 revising agency duties with regard to training nursing
4005 home surveyor teams; revising requirements for team
4006 members; amending s. 400.462, F.S.; revising the
4007 definition of the term “remuneration” as it applies to
4008 home health agencies; amending s. 400.484, F.S.;
4009 revising the schedule of home health agency inspection
4010 violations; amending s. 400.506, F.S.; deleting
4011 language relating to exemptions from penalties imposed
4012 on nurse registries if a nurse registry does not bill
4013 the Florida Medicaid Program; providing criteria for
4014 an administrator to manage a nurse registry; amending
4015 s. 400.509, F.S.; revising the service providers
4016 exempt from licensure registration to include
4017 organizations that provide companion services only for
4018 persons with developmental disabilities; amending s.
4019 400.606, F.S.; revising the content requirements of
4020 the plan accompanying an initial or change-of
4021 ownership application for licensure of a hospice;
4022 revising requirements relating to certificates of need
4023 for certain hospice facilities; amending s. 400.607,
4024 F.S.; revising grounds for agency action against a
4025 hospice; amending s. 400.915, F.S.; correcting an
4026 obsolete cross-reference to administrative rules;
4027 amending s. 400.931, F.S.; deleting a requirement that
4028 an applicant for a home medical equipment provider
4029 license submit a surety bond to the agency; requiring
4030 applicants to submit documentation of accreditation
4031 within a specified period of time; amending s.
4032 400.932, F.S.; revising grounds for the imposition of
4033 administrative penalties for certain violations by an
4034 employee of a home medical equipment provider;
4035 amending s. 400.967, F.S.; revising the schedule of
4036 inspection violations for intermediate care facilities
4037 for the developmentally disabled; providing a penalty
4038 for certain violations; amending s. 400.9905, F.S.;
4039 revising the definitions of the terms “clinic” and
4040 “portable equipment provider”; providing that part X
4041 of ch. 400, F.S., the Health Care Clinic Act, does not
4042 apply to certain clinical facilities, an entity owned
4043 by a corporation with a specified amount of annual
4044 sales of health care services under certain
4045 circumstances, an entity owned or controlled by a
4046 publicly traded entity with a specified amount of
4047 annual revenues, or an entity that employs a specified
4048 number of licensed health care practitioners under
4049 certain conditions; amending s. 400.991, F.S.;
4050 conforming terminology; revising application
4051 requirements relating to documentation of financial
4052 ability to operate a mobile clinic; amending s.
4053 408.033, F.S.; permitting fees assessed on certain
4054 health care facilities to be collected prospectively
4055 at the time of licensure renewal and prorated for the
4056 licensure period; amending s. 408.034, F.S.; revising
4057 agency authority relating to licensing of intermediate
4058 care facilities for the developmentally disabled;
4059 amending s. 408.036, F.S.; deleting an exemption from
4060 certain certificate-of-need review requirements for a
4061 hospice or a hospice inpatient facility; deleting a
4062 requirement that the agency submit a report regarding
4063 requests for exemption; amending s. 408.037, F.S.;
4064 revising certificate-of-need requirements for general
4065 hospital applicants to evaluate the applicant’s parent
4066 corporation if audited financial statements of the
4067 applicant do not exist; amending s. 408.043, F.S.;
4068 revising requirements for certain freestanding
4069 inpatient hospice care facilities to obtain a
4070 certificate of need; amending s. 408.061, F.S.;
4071 revising health care facility data reporting
4072 requirements; amending s. 408.10, F.S.; removing
4073 agency authority to investigate certain consumer
4074 complaints; amending s. 408.802, F.S.; removing
4075 applicability of part II of ch. 408, F.S., relating to
4076 general licensure requirements, to private review
4077 agents; amending s. 408.804, F.S.; providing penalties
4078 for altering, defacing, or falsifying a license
4079 certificate issued by the agency or displaying such an
4080 altered, defaced, or falsified certificate; amending
4081 s. 408.806, F.S.; revising agency responsibilities for
4082 notification of licensees of impending expiration of a
4083 license; requiring payment of a late fee for a license
4084 application to be considered complete under certain
4085 circumstances; amending s. 408.8065, F.S.; requiring
4086 home health agencies, home medical equipment
4087 providers, and health care clinics to submit projected
4088 financial statements; amending s. 408.809, F.S.,
4089 relating to background screening of specified
4090 employees of health care providers; revising
4091 provisions for required rescreening; removing
4092 provisions authorizing the agency to adopt rules
4093 establishing a rescreening schedule; establishing a
4094 rescreening schedule; amending s. 408.810, F.S.;
4095 requiring disclosure of information by a controlling
4096 interest of certain court actions relating to
4097 financial instability within a specified time period;
4098 amending s. 408.813, F.S.; authorizing the agency to
4099 impose fines for unclassified violations of part II of
4100 ch. 408, F.S.; amending s. 408.815, F.S.; providing
4101 for certain mitigating circumstances to be considered
4102 for any application subject to denial; authorizing the
4103 agency to extend a license expiration date under
4104 certain circumstances; amending s. s. 409.212, F.S.;
4105 increasing the limit on the amount of additional
4106 supplementation provided by a third party under the
4107 optional state supplementation program; amending s.
4108 409.91196, F.S.; revising components of a Medicaid
4109 prescribed-drug spending-control program; conforming a
4110 cross-reference; amending s. 409.912, F.S.; revising
4111 procedures for implementation of a Medicaid
4112 prescribed-drug spending-control program; amending s.
4113 429.07, F.S.; deleting the requirement for an assisted
4114 living facility to obtain an additional license in
4115 order to provide limited nursing services; deleting
4116 the requirement for the agency to conduct quarterly
4117 monitoring visits of facilities that hold a license to
4118 provide extended congregate care services; deleting
4119 the requirement for the department to report annually
4120 on the status of and recommendations related to
4121 extended congregate care; deleting the requirement for
4122 the agency to conduct monitoring visits at least twice
4123 a year to facilities providing limited nursing
4124 services; eliminating the license fee for the limited
4125 nursing services license; transferring from another
4126 provision of law the requirement that the standard
4127 survey of an assisted living facility include specific
4128 actions to determine whether the facility is
4129 adequately protecting residents’ rights; providing
4130 that under specified conditions an assisted living
4131 facility that has a class I or class II violation is
4132 subject to periodic unannounced monitoring; requiring
4133 a registered nurse to participate in certain
4134 monitoring visits; amending s. 429.11, F.S.; revising
4135 licensure application requirements for assisted living
4136 facilities to eliminate provisional licenses; amending
4137 s. 429.12, F.S.; deleting a requirement that a
4138 transferor of an assisted living facility advise the
4139 transferee to submit a plan for correction of certain
4140 deficiencies to the Agency for Health Care
4141 Administration before ownership of the facility is
4142 transferred; amending s. 429.14, F.S.; clarifying
4143 provisions relating to a facility’s request for a
4144 hearing under certain circumstances; amending s.
4145 429.17, F.S.; deleting provisions relating to the
4146 limited nursing services license; revising agency
4147 responsibilities regarding the issuance of conditional
4148 licenses; amending s. 429.195, F.S.; revising the list
4149 of entities prohibited from providing rebates;
4150 providing exceptions to prohibited patient brokering
4151 for assisted living facilities; amending s. 429.23,
4152 F.S.; deleting reporting requirements for assisted
4153 living facilities relating to liability claims;
4154 amending s. 429.255, F.S.; eliminating provisions
4155 authorizing the use of volunteers to provide certain
4156 health-care-related services in assisted living
4157 facilities; authorizing assisted living facilities to
4158 provide limited nursing services; requiring an
4159 assisted living facility to be responsible for certain
4160 recordkeeping and staff to be trained to monitor
4161 residents receiving certain health-care-related
4162 services; amending s. 429.28, F.S.; deleting a
4163 requirement for a biennial survey of an assisted
4164 living facility, to conform to changes made by the
4165 act; conforming a cross-reference; amending s. 429.41,
4166 F.S., relating to rulemaking; conforming provisions to
4167 changes made by the act; deleting the requirement for
4168 the Department of Elderly Affairs to submit a copy of
4169 proposed rules to the Legislature; amending s. 429.53,
4170 F.S.; revising provisions relating to consultation by
4171 the agency; revising a definition; amending s. 429.71,
4172 F.S.; revising schedule of inspection violations for
4173 adult family-care homes; amending s. 429.915, F.S.;
4174 revising agency responsibilities regarding the
4175 issuance of conditional licenses; amending s. 440.102,
4176 F.S.; deleting the requirement for laboratories to
4177 submit a monthly report to the agency with statistical
4178 information regarding the testing of employees and job
4179 applicants; amending s. 456.053, F.S.; revising the
4180 definition of the term “group practice” as it relates
4181 to financial arrangements of referring health care
4182 providers and providers of health care services to
4183 include group practices that provide radiation therapy
4184 services under certain circumstances; amending s.
4185 483.035, F.S.; requiring certain clinical laboratories
4186 operated by one or more practitioners licensed under
4187 part I of ch. 464, F.S., the Nurse Practice Act, to be
4188 licensed under part I of ch. 483, F.S., the Florida
4189 Clinical Laboratory Law; amending s. 483.051, F.S.;
4190 establishing qualifications necessary for clinical
4191 laboratory licensure; amending s. 483.294, F.S.;
4192 revising frequency of agency inspections of
4193 multiphasic health testing centers; amending s.
4194 499.003, F.S.; removing the requirement for certain
4195 prescription drug purchasers to maintain a separate
4196 inventory of certain prescription drugs; amending s.
4197 633.081, F.S.; limiting State Fire Marshal inspections
4198 of nursing homes to once a year; providing for
4199 additional inspections based on complaints and
4200 violations identified in the course of orientation or
4201 training activities; amending s. 766.202, F.S.; adding
4202 persons licensed under part XIV of ch. 468, F.S.,
4203 relating to orthotics, prosthetics, and pedorthics, to
4204 the definition of “health care provider”; amending s.
4205 817.505, F.S.; creating an exception to the patient
4206 brokering prohibition for assisted living facilities;
4207 amending ss. 394.4787, 400.0239, 408.07, 430.80, and
4208 651.118, F.S.; conforming terminology and references
4209 to changes made by the act; revising a reference;
4210 establishing that assisted living facility licensure
4211 fees have been adjusted by Consumer Price Index since
4212 1998 and are not intended to be reset by the act;
4213 providing an effective date.