Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. CS for SB 2074
       
       
       
       
       
       
                                Barcode 243514                          
       
                              LEGISLATIVE ACTION                        
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       The Committee on Budget Subcommittee on Health and Human
       Services Appropriations (Garcia) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 394.4574, Florida Statutes, is amended
    6  to read:
    7         394.4574 Department responsibilities for a mental health
    8  resident who resides in an assisted living facility that holds a
    9  limited mental health license.—
   10         (1) The term “mental health resident,” for purposes of this
   11  section, means an individual who receives social security
   12  disability income due to a mental disorder as determined by the
   13  Social Security Administration or receives supplemental security
   14  income due to a mental disorder as determined by the Social
   15  Security Administration and receives optional state
   16  supplementation.
   17         (2) The department must ensure that:
   18         (a) A mental health resident has been assessed by a
   19  psychiatrist, clinical psychologist, clinical social worker, or
   20  psychiatric nurse, or an individual who is supervised by one of
   21  these professionals, and determined to be appropriate to reside
   22  in an assisted living facility. The documentation must be
   23  provided to the administrator of the facility within 30 days
   24  after the mental health resident has been admitted to the
   25  facility. An evaluation completed upon discharge from a state
   26  mental hospital meets the requirements of this subsection
   27  related to appropriateness for placement as a mental health
   28  resident if it was completed within 90 days prior to admission
   29  to the facility.
   30         (b) A cooperative agreement, as required in s. 429.075, is
   31  developed between the mental health care services provider that
   32  serves a mental health resident and the administrator of the
   33  assisted living facility with a limited mental health license in
   34  which the mental health resident is living. The cooperative
   35  agreement must provide detailed information concerning case
   36  management services; access to consumer-operated drop-in
   37  centers; reliable access to services during evenings, weekends,
   38  and holidays which avoids the use of hospital emergency
   39  departments except in emergencies; supervision of clinical needs
   40  of the residents; and access to emergency psychiatric care. Any
   41  entity that provides Medicaid prepaid health plan services shall
   42  ensure the appropriate coordination of health care services with
   43  an assisted living facility in cases where a Medicaid recipient
   44  is both a member of the entity’s prepaid health plan and a
   45  resident of the assisted living facility. If the entity is at
   46  risk for Medicaid targeted case management and behavioral health
   47  services, the entity shall inform the assisted living facility
   48  of the procedures to follow should an emergent condition arise.
   49         (c) The community living support plan, as defined in s.
   50  429.02, has been prepared by a mental health resident and a
   51  mental health case manager of that resident in consultation with
   52  the administrator of the facility or the administrator’s
   53  designee. The plan must be provided to the administrator of the
   54  assisted living facility with a limited mental health license in
   55  which the mental health resident lives. The support plan and the
   56  agreement may be in one document.
   57         (d) The assisted living facility with a limited mental
   58  health license is provided with documentation that the
   59  individual meets the definition of a mental health resident.
   60         (e) The mental health services provider assigns a case
   61  manager to each mental health resident who lives in an assisted
   62  living facility with a limited mental health license. The case
   63  manager is responsible for coordinating the development of and
   64  implementation of the community living support plan defined in
   65  s. 429.02. The plan must be updated as needed, but at least
   66  annually to ensure that the ongoing needs of the resident are
   67  addressed. The community living support plan must include a
   68  detailed description of how the clinical needs of the resident
   69  will be supervised, how often the case manager will see the
   70  resident, and how the resident may access the case manager, and
   71  must identify conditions indicative of a change in the condition
   72  of the resident which might warrant changes in clinical
   73  supervision or which might prompt the assisted living facility
   74  to contact the case manager on behalf of the resident and the
   75  steps that will be taken to ensure that the resident receives
   76  appropriate emergency psychiatric care through the mental health
   77  provider. Each case manager shall keep a record of the date and
   78  time of any face-to-face interaction with the mental health
   79  resident and make the record available to the department for
   80  inspection. The record must be retained for 2 years after the
   81  date of the most recent interaction.
   82         (f) There is adequate and consistent monitoring and
   83  enforcement of community living support plans and cooperative
   84  agreements by the department.
   85         (3) Medicaid prepaid health plans shall ensure the
   86  appropriate coordination of health care services with an
   87  assisted living facility when a Medicaid recipient is both a
   88  member of the entity’s prepaid health plan and a resident of the
   89  assisted living facility. If the Medicaid prepaid plan is
   90  responsible for Medicaid targeted case management and behavioral
   91  health services, the plan shall inform the assisted living
   92  facility of the procedures to follow should an emergency
   93  condition arise.
   94         (4) The department shall include in contracts with service
   95  providers provisions that require the service provider to assign
   96  a case manager for a mental health resident, prepare a community
   97  living support plan, enter into a cooperative agreement with the
   98  assisted living facility, and otherwise comply with this
   99  section. The department shall establish and impose penalties for
  100  mental health service providers under contract with the
  101  department which fail to comply with the provisions of this
  102  section.
  103         (5) The Agency for Health Care Administration shall
  104  establish and impose contract penalties for Medicaid prepaid
  105  plans that fail to comply with the provisions of this section.
  106         (6) The department shall enter into an interagency
  107  agreement with the Agency for Health Care Administration which
  108  delineates responsibilities and procedures for enforcing the
  109  provisions of this section related to the requirements of
  110  facilities and mental health providers.
  111         (7)(3) The Secretary of Children and Family Services, in
  112  consultation with the Agency for Health Care Administration,
  113  shall annually require each district administrator to develop,
  114  with community input, detailed plans that demonstrate how the
  115  district will ensure the provision of state-funded mental health
  116  and substance abuse treatment services to residents of assisted
  117  living facilities that hold a limited mental health license.
  118  These plans must be consistent with the substance abuse and
  119  mental health district plan developed pursuant to s. 394.75 and
  120  must address case management services; access to consumer
  121  operated drop-in centers; access to services during evenings,
  122  weekends, and holidays; supervision of the clinical needs of the
  123  residents; and access to emergency psychiatric care.
  124         Section 2. Subsection (2) of section 400.0078, Florida
  125  Statutes, is amended to read:
  126         400.0078 Citizen access to State Long-Term Care Ombudsman
  127  Program services.—
  128         (2) Every resident or representative of a resident shall
  129  receive, Upon admission to a long-term care facility, each
  130  resident or representative of a resident must receive
  131  information regarding the purpose of the State Long-Term Care
  132  Ombudsman Program, the statewide toll-free telephone number for
  133  receiving complaints, the confidentiality of a complaint if the
  134  complaint will result in the identification of the resident
  135  about whom the complaint is made and the confidentiality of the
  136  complainant’s name and identity, and other relevant information
  137  regarding how to contact the program. Residents or their
  138  representatives must be furnished additional copies of this
  139  information upon request.
  140         Section 3. Paragraph (a) of subsection (1) of section
  141  415.1034, Florida Statutes, is amended to read:
  142         415.1034 Mandatory reporting of abuse, neglect, or
  143  exploitation of vulnerable adults; mandatory reports of death.—
  144         (1) MANDATORY REPORTING.—
  145         (a) Any person, including, but not limited to, any:
  146         1. A physician, osteopathic physician, medical examiner,
  147  chiropractic physician, nurse, paramedic, emergency medical
  148  technician, or hospital personnel engaged in the admission,
  149  examination, care, or treatment of vulnerable adults;
  150         2. A health professional or mental health professional
  151  other than one listed in subparagraph 1.;
  152         3. A practitioner who relies solely on spiritual means for
  153  healing;
  154         4. Nursing home staff; assisted living facility staff;
  155  adult day care center staff; adult family-care home staff;
  156  social worker; or other professional adult care, residential, or
  157  institutional staff;
  158         5. A state, county, or municipal criminal justice employee
  159  or law enforcement officer;
  160         6. An employee of the Department of Business and
  161  Professional Regulation conducting inspections of public lodging
  162  establishments under s. 509.032;
  163         7. A Florida advocacy council member or long-term care
  164  ombudsman council member; or
  165         8. A bank, savings and loan, or credit union officer,
  166  trustee, or employee; or,
  167         9. An employee or agent of a state or local agency who has
  168  regulatory responsibilities over state-licensed facilities, or
  169  who provides services to persons residing in a state-licensed
  170  facility,
  171  
  172  who knows, or has reasonable cause to suspect, that a vulnerable
  173  adult has been or is being abused, neglected, or exploited must
  174  shall immediately report such knowledge or suspicion to the
  175  central abuse hotline.
  176         Section 4. Subsections (5) and (11) of section 429.02,
  177  Florida Statutes, are amended, present subsections (6) through
  178  (14) of that section are redesignated as subsections (7) through
  179  (15), respectively, present subsections (15) through (26) of
  180  that section are redesignated as subsections (17) through (28),
  181  respectively, and new subsections (6) and (16) are added to that
  182  section, to read:
  183         429.02 Definitions.—When used in this part, the term:
  184         (5) “Assisted living facility” or “facility” means any
  185  building or buildings, section or distinct part of a building,
  186  private home, boarding home, home for the aged, or other
  187  residential facility, whether operated for profit or not, which
  188  undertakes through its ownership or management to provide
  189  housing, meals, and one or more personal services for a period
  190  exceeding 24 hours to one or more adults who are not relatives
  191  of the owner or administrator.
  192         (6) “Board” means the Board of Long Term Care
  193  Administrators established under s. 468.1665.
  194         (12)(11) “Extended congregate care” means acts beyond those
  195  authorized in subsection (18) which subsection (16) that may be
  196  performed pursuant to part I of chapter 464 by persons licensed
  197  thereunder while carrying out their professional duties, and
  198  other supportive services which may be specified by rule. The
  199  purpose of such services is to enable residents to age in place
  200  in a residential environment despite mental or physical
  201  limitations that might otherwise disqualify them from residency
  202  in a facility licensed under this part.
  203         (16) “Mental health surveyor” means a person:
  204         (a) Licensed under chapter 458, chapter 459, chapter 464,
  205  chapter 490, or chapter 491 who provides mental health services
  206  as defined under s. 394.67 or has received training approved by
  207  the agency;
  208         (b) Who has a baccalaureate degree with a concentration in
  209  mental health from an accredited college or university and at
  210  least 5 years of experience providing services that improve an
  211  individual’s mental health or that treat mental illness; or
  212         (c) Who has a baccalaureate degree and who has received
  213  training approved by the agency that enables the individual to
  214  effectively perform surveys of facilities with a limited mental
  215  health license to ensure the mental health residents are
  216  receiving services consistent with the community living support
  217  plan.
  218         Section 5. Paragraphs (b) and (c) of subsection (3) of
  219  section 429.07, Florida Statutes, are amended, and paragraph (d)
  220  is added to subsection (4) of that section, to read:
  221         429.07 License required; fee.—
  222         (3) In addition to the requirements of s. 408.806, each
  223  license granted by the agency must state the type of care for
  224  which the license is granted. Licenses shall be issued for one
  225  or more of the following categories of care: standard, extended
  226  congregate care, limited nursing services, or limited mental
  227  health.
  228         (b) An extended congregate care license shall be issued to
  229  facilities providing, directly or through contract, services
  230  beyond those authorized in paragraph (a), including services
  231  performed by persons licensed under part I of chapter 464 and
  232  supportive services, as defined by rule, to persons who would
  233  otherwise be disqualified from continued residence in a facility
  234  licensed under this part.
  235         1. In order for extended congregate care services to be
  236  provided, the agency must first determine that all requirements
  237  established in law and rule are met and must specifically
  238  designate, on the facility’s license, that such services may be
  239  provided and whether the designation applies to all or part of
  240  the facility. Such designation may be made at the time of
  241  initial licensure or relicensure, or upon request in writing by
  242  a licensee under this part and part II of chapter 408. The
  243  notification of approval or the denial of the request shall be
  244  made in accordance with part II of chapter 408. Existing
  245  facilities qualifying to provide extended congregate care
  246  services must have maintained a standard license and may not
  247  have been subject to administrative sanctions during the
  248  previous 2 years, or since initial licensure if the facility has
  249  been licensed for less than 2 years, for any of the following
  250  reasons:
  251         a. A class I or class II violation;
  252         b. Three or more repeat or recurring class III violations
  253  of identical or similar resident care standards from which a
  254  pattern of noncompliance is found by the agency;
  255         c. Three or more class III violations that were not
  256  corrected in accordance with the corrective action plan approved
  257  by the agency;
  258         d. Violation of resident care standards which results in
  259  requiring the facility to employ the services of a consultant
  260  pharmacist or consultant dietitian;
  261         e. Denial, suspension, or revocation of a license for
  262  another facility licensed under this part in which the applicant
  263  for an extended congregate care license has at least 25 percent
  264  ownership interest; or
  265         f. Imposition of a moratorium pursuant to this part or part
  266  II of chapter 408 or initiation of injunctive proceedings.
  267         2. A facility that is licensed to provide extended
  268  congregate care services must shall maintain a written progress
  269  report on each person who receives services which describes the
  270  type, amount, duration, scope, and outcome of services that are
  271  rendered and the general status of the resident’s health. A
  272  registered nurse, or appropriate designee, representing the
  273  agency shall visit the facility at least quarterly to monitor
  274  residents who are receiving extended congregate care services
  275  and to determine if the facility is in compliance with this
  276  part, part II of chapter 408, and relevant rules. One of the
  277  visits may be in conjunction with the regular survey. The
  278  monitoring visits may be provided through contractual
  279  arrangements with appropriate community agencies. A registered
  280  nurse shall serve as part of the team that inspects the
  281  facility. The agency may waive a monitoring visit during the
  282  licensure cycle one of the required yearly monitoring visits for
  283  a facility that has been licensed for at least 24 months to
  284  provide extended congregate care services, if, during the
  285  inspection, the registered nurse determines that extended
  286  congregate care services are being provided appropriately, and
  287  if the facility:
  288         a. Has no class I or class II violations and no uncorrected
  289  class III violations;.
  290         b. Has no ombudsman referrals that were made to the agency
  291  which resulted in a citation for a licensure violation; and
  292         c. Has no complaints that resulted in citation for a
  293  licensure violation. The agency must first consult with the
  294  long-term care ombudsman council for the area in which the
  295  facility is located to determine if any complaints have been
  296  made and substantiated about the quality of services or care.
  297  The agency may not waive one of the required yearly monitoring
  298  visits if complaints have been made and substantiated.
  299         3. A facility that is licensed to provide extended
  300  congregate care services must:
  301         a. Demonstrate the capability to meet unanticipated
  302  resident service needs.
  303         b. Offer a physical environment that promotes a homelike
  304  setting, provides for resident privacy, promotes resident
  305  independence, and allows sufficient congregate space as defined
  306  by rule.
  307         c. Have sufficient staff available, taking into account the
  308  physical plant and firesafety features of the building, to
  309  assist with the evacuation of residents in an emergency.
  310         d. Adopt and follow policies and procedures that maximize
  311  resident independence, dignity, choice, and decisionmaking to
  312  permit residents to age in place, so that moves due to changes
  313  in functional status are minimized or avoided.
  314         e. Allow residents or, if applicable, a resident’s
  315  representative, designee, surrogate, guardian, or attorney in
  316  fact to make a variety of personal choices, participate in
  317  developing service plans, and share responsibility in
  318  decisionmaking.
  319         f. Implement the concept of managed risk.
  320         g. Provide, directly or through contract, the services of a
  321  person licensed under part I of chapter 464.
  322         h. In addition to the training mandated in s. 429.52,
  323  provide specialized training as defined by rule for facility
  324  staff.
  325         4. A facility that is licensed to provide extended
  326  congregate care services is exempt from the criteria for
  327  continued residency set forth in rules adopted under s. 429.41.
  328  A licensed facility must adopt its own requirements within
  329  guidelines for continued residency set forth by rule. However,
  330  the facility may not serve residents who require 24-hour nursing
  331  supervision. A licensed facility that provides extended
  332  congregate care services must also provide each resident with a
  333  written copy of facility policies governing admission and
  334  retention.
  335         5. The primary purpose of extended congregate care services
  336  is to allow residents, as they become more impaired, the option
  337  of remaining in a familiar setting from which they would
  338  otherwise be disqualified for continued residency. A facility
  339  licensed to provide extended congregate care services may also
  340  admit an individual who exceeds the admission criteria for a
  341  facility with a standard license, if the individual is
  342  determined appropriate for admission to the extended congregate
  343  care facility.
  344         6. Before the admission of an individual to a facility
  345  licensed to provide extended congregate care services, the
  346  individual must undergo a medical examination as provided in s.
  347  429.26(4) and the facility must develop a preliminary service
  348  plan for the individual.
  349         7. If When a facility can no longer provide or arrange for
  350  services in accordance with the resident’s service plan and
  351  needs and the facility’s policy, the facility must shall make
  352  arrangements for relocating the person in accordance with s.
  353  429.28(1)(k).
  354         8. Failure to provide extended congregate care services may
  355  result in denial of extended congregate care license renewal.
  356         (c) A limited nursing services license shall be issued to a
  357  facility that provides services beyond those authorized in
  358  paragraph (a) and as specified in this paragraph.
  359         1. In order for limited nursing services to be provided in
  360  a facility licensed under this part, the agency must first
  361  determine that all requirements established in law and rule are
  362  met and must specifically designate, on the facility’s license,
  363  that such services may be provided. Such designation may be made
  364  at the time of initial licensure or relicensure, or upon request
  365  in writing by a licensee under this part and part II of chapter
  366  408. Notification of approval or denial of such request shall be
  367  made in accordance with part II of chapter 408. Existing
  368  facilities qualifying to provide limited nursing services shall
  369  have maintained a standard license and may not have been subject
  370  to administrative sanctions that affect the health, safety, and
  371  welfare of residents for the previous 2 years or since initial
  372  licensure if the facility has been licensed for less than 2
  373  years.
  374         2. Facilities that are licensed to provide limited nursing
  375  services shall maintain a written progress report on each person
  376  who receives such nursing services, which report describes the
  377  type, amount, duration, scope, and outcome of services that are
  378  rendered and the general status of the resident’s health. A
  379  registered nurse representing the agency shall visit such
  380  facilities at least twice a year to monitor residents who are
  381  receiving limited nursing services and to determine if the
  382  facility is in compliance with applicable provisions of this
  383  part, part II of chapter 408, and related rules. The monitoring
  384  visits may be provided through contractual arrangements with
  385  appropriate community agencies. A registered nurse shall also
  386  serve as part of the team that inspects such facility. The
  387  agency may waive a monitoring visit during the licensure cycle
  388  for a facility that has been licensed for at least 24 months to
  389  provide limited nursing services if the facility:
  390         a. Has no class I or class II violations and no uncorrected
  391  class III violations;
  392         b. Has no ombudsman referrals that were made to the agency
  393  which resulted in a citation for a licensure violation; and
  394         c. Has no complaints which resulted in citation for a
  395  licensure violation.
  396         3. A person who receives limited nursing services under
  397  this part must meet the admission criteria established by the
  398  agency for assisted living facilities. When a resident no longer
  399  meets the admission criteria for a facility licensed under this
  400  part, arrangements for relocating the person shall be made in
  401  accordance with s. 429.28(1)(k), unless the facility is licensed
  402  to provide extended congregate care services.
  403         (4) In accordance with s. 408.805, an applicant or licensee
  404  shall pay a fee for each license application submitted under
  405  this part, part II of chapter 408, and applicable rules. The
  406  amount of the fee shall be established by rule.
  407         (d) A licensed facility that has one or more class I or
  408  class II violations imposed by final order within the 2 years
  409  before licensure renewal is required to pay an additional $500
  410  license fee plus an additional fee of $55 for each licensed bed,
  411  without exception. The increased fee amounts are subject to
  412  annual adjustment pursuant to s. 408.805.
  413         Section 6. Section 429.075, Florida Statutes, is amended to
  414  read:
  415         429.075 Limited mental health license.—An assisted living
  416  facility that serves three or more mental health residents must
  417  obtain a limited mental health license.
  418         (1) To obtain a limited mental health license, a facility
  419  must hold and maintain a standard license as an assisted living
  420  facility and, must not have been subject to administrative
  421  sanctions during the previous 2 years, or since initial
  422  licensure if the facility has been licensed for less than 2
  423  years, for any of the following reasons:
  424         (a) Two or more class I or class II violations;
  425         (b) Three or more repeat or recurring class III violations
  426  of resident care standards from which a pattern of noncompliance
  427  is found by the agency;
  428         (c) Three or more class III violations that were not
  429  corrected in accordance within the time specified by the agency
  430  for correction;
  431         (d) Denial, suspension, or revocation of a license for
  432  another facility licensed under this part in which the applicant
  433  had at least a 25 percent ownership interest; or
  434         (f) Imposition of a moratorium pursuant to this part or
  435  part II of chapter 408 or initiation of injunctive proceedings.
  436  any current uncorrected deficiencies or violations, and must
  437  ensure that, within 6 months after receiving a limited mental
  438  health license, the facility administrator and the staff of the
  439  facility who are in direct contact with mental health residents
  440  must complete training of no less than 6 hours related to their
  441  duties. Such designation
  442         (2) Licensure to provide services to mental health
  443  residents may be made at the time of initial licensure or
  444  relicensure or upon request in writing by a licensee under this
  445  part and part II of chapter 408. Notification of agency approval
  446  or denial of such request must shall be made in accordance with
  447  this part, part II of chapter 408, and applicable rules. This
  448  training will be provided by or approved by the Department of
  449  Children and Family Services.
  450         (3)(2) Facilities licensed to provide services to mental
  451  health residents shall provide appropriate supervision and
  452  staffing to provide for the health, safety, and welfare of such
  453  residents. In addition to the general training or educational
  454  requirements under this part or part II of chapter 468, as
  455  applicable, each administrator and staff member who provides
  456  regular or direct care to the residents of a facility licensed
  457  to provide services to mental health residents must meet the
  458  specialized limited mental health training requirements set
  459  forth in s. 429.52.
  460         (4)(3) A facility that holds has a limited mental health
  461  license must:
  462         (a) Have a copy of each mental health resident’s community
  463  living support plan and the cooperative agreement with the
  464  mental health care services provider. The support plan and the
  465  agreement may be combined.
  466         (b) Have documentation that is provided by the Department
  467  of Children and Family Services that each mental health resident
  468  has been assessed and determined to be able to live in the
  469  community in an assisted living facility with a limited mental
  470  health license.
  471         (c) Make the community living support plan available for
  472  inspection by the resident, the resident’s legal guardian, the
  473  resident’s health care surrogate, and other individuals who have
  474  a lawful basis for reviewing this document.
  475         (d) Assist the mental health resident in carrying out the
  476  activities identified in the individual’s community living
  477  support plan.
  478         (5)(4) A facility that holds with a limited mental health
  479  license may enter into a cooperative agreement with a private
  480  mental health provider. For purposes of the limited mental
  481  health license, the private mental health provider may act as
  482  the case manager.
  483         (6)Effective January 1, 2013, a mental health surveyor
  484  shall serve as part of the team that inspects a facility that
  485  holds a limited mental health license, and may conduct the
  486  inspection without other agency representatives. The role of the
  487  mental health surveyor is to determine the facility’s compliance
  488  in meeting obligations specified in the cooperative agreement
  489  pursuant to s. 394.4574. The agency shall enter into an
  490  interagency agreement with the Department of Children and Family
  491  Services to receive from the contracted community agencies
  492  reports concerning compliance with the requirements of
  493  cooperative agreements and community support plans under s.
  494  394.4574 applicable to a licensed facility, and whether the
  495  mental health residents are receiving the services required
  496  under those documents while residing in the licensed facility.
  497  Monitoring visits shall occur at least twice a year. The agency
  498  may waive a monitoring visit for a facility that has been
  499  licensed for at least 24 months to provide limited mental health
  500  services if the mental health surveyor determines the
  501  cooperative agreements and community support plans are in
  502  compliance with applicable requirements and the mental health
  503  residents are receiving the appropriate services under those
  504  documents while residing in the licensed facility and the
  505  facility:
  506         (a) Has had no class I or class II violations and no
  507  uncorrected class III violations;
  508         (b) Has no ombudsman referrals that were made to the agency
  509  which resulted in a citation for a licensure violation; and
  510         (c) Has no complaints that resulted in a citation for a
  511  licensure violation.
  512         Section 7. Subsection (4) of section 429.14, Florida
  513  Statutes, is amended to read:
  514         429.14 Administrative penalties.—
  515         (4) The agency shall deny or revoke the license of an
  516  assisted living facility that:
  517         (a) Has two or more class I violations and had a class I or
  518  class II violation from separate monitoring visits, surveys, or
  519  investigations that are similar or identical to violations
  520  identified by the agency during a survey, inspection, monitoring
  521  visit, or complaint investigation occurring within the previous
  522  2 years; or.
  523         (b) Commits a class I violation that causes the death of a
  524  resident or an intentional or negligent act that, based on a
  525  court’s findings, caused the death of a resident.
  526         Section 8. Section 429.176, Florida Statutes, is amended to
  527  read:
  528         429.176 Notice of change of Administrator; managers.—
  529         (1) Effective July 1, 2013, an assisted living facility
  530  must have an assisted living facility administrator who is
  531  licensed under part II of chapter 468. An administrator may be
  532  responsible for up to three assisted living facilities if all
  533  three assisted living facilities have identical controlling
  534  interests as defined in s. 408.803 and are located within 50
  535  miles of each other. If an administrator is responsible for more
  536  than one assisted living facility, a manager must be appointed
  537  for each facility to assume responsibility for the facility
  538  during the administrator’s absence. The manager must be reported
  539  to the agency within 10 days after appointment.
  540         (2) If, during the period for which a license is issued,
  541  the owner changes administrators, the administrator changes, the
  542  licensee owner must notify the agency of the change and the name
  543  and license number of the new administrator within 10 days after
  544  the change and provide documentation within 90 days that the new
  545  administrator has completed the applicable core educational
  546  requirements under s. 429.52.
  547         (3) If an administrator leaves the employment of an
  548  assisted living facility, and a licensed administrator is not
  549  named as required in subsection (2), the assisted living
  550  facility must notify the agency within 2 days after the
  551  administrator’s departure and may operate for up to 3 months
  552  with a manager who will assume responsibility for the operation
  553  of the facility during that period. The manager must have
  554  completed the 40-hour core training and successfully passed the
  555  examination described in s. 429.52(5).
  556         (4) A manager of a facility who assumes responsibility for
  557  the operation of the facility during the absence of an
  558  administrator in accordance with subsection (1) must have
  559  completed the 40-hour core training and successfully passed the
  560  examination described in s. 429.52(5) within 30 days after being
  561  employed as, or becoming, a facility manager.
  562         Section 9. Paragraphs (a) and (b) of subsection (2) of
  563  section 429.178, Florida Statutes, are amended to read:
  564         429.178 Special care for persons with Alzheimer’s disease
  565  or other related disorders.—
  566         (2)(a) Staff, including administrators, An individual who
  567  are is employed by a facility that provides special care for
  568  residents who have with Alzheimer’s disease or other related
  569  disorders, and who provide has regular or direct care to contact
  570  with such residents, must complete up to 4 hours of initial
  571  dementia-specific training developed or approved by the
  572  department. The training must shall be completed within 3 months
  573  after beginning employment and shall satisfy the core training
  574  requirements of s. 429.52(2)(g).
  575         (b) A direct caregiver who is employed by a facility that
  576  provides special care for residents with Alzheimer’s disease or
  577  other related disorders, and who provides direct care to such
  578  residents, must complete the required initial training required
  579  in paragraph (a) and 4 additional hours of training developed or
  580  approved by the department. The training must shall be completed
  581  within 6 9 months after beginning employment and shall satisfy
  582  the core training requirements of s. 429.52(2)(g).
  583         Section 10. Subsection (2) of section 429.19, Florida
  584  Statutes, is amended to read:
  585         429.19 Violations; imposition of administrative fines;
  586  grounds.—
  587         (2) Each violation of this part and adopted rules shall be
  588  classified according to the nature of the violation and the
  589  gravity of its probable effect on facility residents as provided
  590  in s. 408.813.
  591         (a) The agency shall indicate the classification on the
  592  written notice of the violation as follows:
  593         1.(a)For class “I” violations, are defined in s. 408.813.
  594  the agency shall issue a citation regardless of correction and
  595  impose an administrative fine for a cited class I violation in
  596  an amount not less than $5,000 and not exceeding $10,000 for
  597  each violation.
  598         2.(b)For class “II” violations, are defined in s. 408.813.
  599  the agency shall issue a citation regardless of correction and
  600  impose an administrative fine for a cited class II violation in
  601  an amount not less than $1,000 and not exceeding $5,000 for each
  602  violation.
  603         3.(c)For class “III” violations, are defined in s.
  604  408.813. the agency shall impose an administrative fine for a
  605  cited class III violation in an amount not less than $500 and
  606  not exceeding $1,000 for each violation.
  607         4.(d)For class “IV” violations, are defined in s. 408.813.
  608  the agency shall impose an administrative fine for a cited class
  609  IV violation in an amount not less than $100 and not exceeding
  610  $200 for each violation.
  611         (b) The agency shall impose the maximum penalty within the
  612  class if the violation findings involve the death of a resident.
  613  If the facility is cited for a repeat violation within a 2-year
  614  period, the agency shall double the fine for the second and
  615  subsequent violation even if the fine exceeds the maximum amount
  616  authorized. Notwithstanding s. 408.813, if a facility is cited
  617  for 15 or more class III violations during an inspection or
  618  survey, the agency shall impose a fine for each violation.
  619         Section 11. Section 429.231, Florida Statutes, is created
  620  to read:
  621         429.231Advisory council, membership, duties.—
  622         (1) The department shall establish an advisory council to
  623  review the facts and circumstances of unexpected deaths in
  624  assisted living facilities and of elopements that result in harm
  625  to a resident. The purpose of this review is to:
  626         (a) Achieve a greater understanding of the causes and
  627  contributing factors of the unexpected deaths and elopements.
  628         (b) Identify any gaps, deficiencies, or problems in the
  629  delivery of services to the residents.
  630         (2) Based on the review, the advisory council shall make
  631  recommendations for:
  632         (a) Industry best practices that could be used to prevent
  633  unexpected deaths and elopements.
  634         (b) Training and educational requirements for employees and
  635  administrators of assisted living facilities.
  636         (c) Changes in the law, rules, or other policies to prevent
  637  unexpected deaths and elopements.
  638         (3) The advisory council shall prepare an annual
  639  statistical report on the incidence and causes of unexpected
  640  deaths in assisted living facilities and of elopements that
  641  result in harm to residents during the prior calendar year. The
  642  advisory council shall submit a copy of the report by December
  643  31 of each year to the Governor, the President of the Senate,
  644  and the Speaker of the House of Representatives. The report may
  645  make recommendations for state action, including specific
  646  policy, procedural, regulatory, or statutory changes, and any
  647  other recommended preventive action.
  648         (4) The advisory council shall consist of the following
  649  members:
  650         (a) The Secretary of Elderly Affairs, or a designee, who
  651  shall be the chair.
  652         (b) The Secretary of Health Care Administration, or a
  653  designee.
  654         (c) The Secretary of Children and Family Services, or a
  655  designee.
  656         (d) The State Long-Term Care Ombudsman, or a designee.
  657         (e) The following persons who are selected by the Governor:
  658         1. An owner or administrator of an assisted living facility
  659  with fewer than 17 beds.
  660         2. An owner or administrator of an assisted living facility
  661  with 17 or more beds.
  662         3. An owner or administrator or an assisted living facility
  663  with a limited mental health license.
  664         4. A representative from each of three statewide
  665  associations that represent assisted living facilities.
  666         5. A resident of an assisted living facility.
  667         (5) The advisory council shall meet at least twice each
  668  calendar year or at the call of the chair. The chair may appoint
  669  ad hoc committees as necessary to carry out the duties of the
  670  council.
  671         (6) The members of the advisory council selected by the
  672  Governor shall be appointed to staggered terms of office which
  673  may not exceed 2 years. Members are eligible for reappointment.
  674         (7) Members of the advisory council shall serve without
  675  compensation but are entitled to reimbursement for per diem and
  676  travel expenses incurred in the performance of their duties as
  677  provided in s. 112.061 and to the extent that funds are
  678  available.
  679         Section 12. Effective October 1, 2012, subsections (1) and
  680  (2), paragraph (d) of subsection (3), and subsection (6) of
  681  section 429.28, Florida Statutes, are amended to read:
  682         429.28 Resident bill of rights.—
  683         (1) A No resident of a facility may not shall be deprived
  684  of any civil or legal rights, benefits, or privileges guaranteed
  685  by law, the Constitution of the State of Florida, or the
  686  Constitution of the United States as a resident of a facility.
  687  Every resident of a facility shall have the right to:
  688         (a) Live in a safe and decent living environment, free from
  689  abuse and neglect.
  690         (b) Be treated with consideration and respect and with due
  691  recognition of personal dignity, individuality, and the need for
  692  privacy.
  693         (c) Retain and use his or her own clothes and other
  694  personal property in his or her immediate living quarters, so as
  695  to maintain individuality and personal dignity, except when the
  696  facility can demonstrate that such would be unsafe, impractical,
  697  or an infringement upon the rights of other residents.
  698         (d) Unrestricted private communication, including receiving
  699  and sending unopened correspondence, access to a telephone, and
  700  visiting with any person of his or her choice, at any time
  701  between the hours of 9 a.m. and 9 p.m. at a minimum. Upon
  702  request, the facility shall make provisions to extend visiting
  703  hours for caregivers and out-of-town guests, and in other
  704  similar situations.
  705         (e) Freedom to participate in and benefit from community
  706  services and activities and to achieve the highest possible
  707  level of independence, autonomy, and interaction within the
  708  community.
  709         (f) Manage his or her financial affairs unless the resident
  710  or, if applicable, the resident’s representative, designee,
  711  surrogate, guardian, or attorney in fact authorizes the
  712  administrator of the facility to provide safekeeping for funds
  713  as provided in s. 429.27.
  714         (g) Share a room with his or her spouse if both are
  715  residents of the facility.
  716         (h) Reasonable opportunity for regular exercise several
  717  times a week and to be outdoors at regular and frequent
  718  intervals except when prevented by inclement weather.
  719         (i) Exercise civil and religious liberties, including the
  720  right to independent personal decisions. No religious beliefs or
  721  practices, nor any attendance at religious services, shall be
  722  imposed upon any resident.
  723         (j) Access to adequate and appropriate health care
  724  consistent with established and recognized standards within the
  725  community.
  726         (k) At least 30 45 days’ notice of relocation or
  727  termination of residency from the facility unless, for medical
  728  reasons, the resident is certified by a physician to require an
  729  emergency relocation to a facility providing a more skilled
  730  level of care or the resident engages in a pattern of conduct
  731  that is harmful or offensive to other residents. In the case of
  732  a resident who has been adjudicated mentally incapacitated, the
  733  guardian shall be given at least 30 45 days’ notice of a
  734  nonemergency relocation or residency termination. Reasons for
  735  relocation shall be set forth in writing. A resident or the
  736  resident’s legal guardian or representative may file a grievance
  737  with the facility pursuant to s. 429.281 in response to
  738  receiving a notice of relocation or termination of residency
  739  from the facility. If a grievance is filed, the effective date
  740  of the relocation or termination or residency is extended at
  741  least 15 days. In order for a facility to terminate the
  742  residency of an individual without notice as provided herein,
  743  the facility shall show good cause in a court of competent
  744  jurisdiction.
  745         (l) Present grievances and recommend changes in policies,
  746  procedures, and services to the staff of the facility, governing
  747  officials, or any other person without restraint, interference,
  748  coercion, discrimination, or reprisal. Each facility shall
  749  establish a grievance procedure to facilitate the residents’
  750  exercise of this right. This right includes access to ombudsman
  751  volunteers and advocates and the right to be a member of, to be
  752  active in, and to associate with advocacy or special interest
  753  groups.
  754         (2) The administrator of a facility shall ensure that a
  755  written notice of the rights, obligations, and prohibitions set
  756  forth in this part is posted in a prominent place in each
  757  facility and read or explained to residents who cannot read. The
  758  This notice must shall include the name, address, and telephone
  759  numbers of the local ombudsman council and central abuse hotline
  760  and, if when applicable, Disability Rights Florida the Advocacy
  761  Center for Persons with Disabilities, Inc., and the Florida
  762  local advocacy council, where complaints may be lodged. The
  763  notice must state that the names or identities of the
  764  complainants or residents involved in a complaint made to the
  765  Office of State Long-Term Care Ombudsman or a local long-term
  766  care ombudsman council are confidential pursuant to s. 400.0077.
  767  The facility must ensure a resident’s access to a telephone to
  768  call the local ombudsman council, central abuse hotline,
  769  Advocacy Center for Persons with Disabilities, Inc., and the
  770  Florida local advocacy council.
  771         (3)
  772         (d) The agency shall conduct periodic followup inspections
  773  to monitor the compliance of facilities having a history of
  774  class I violations that threaten the health, safety, or security
  775  of residents, and may conduct periodic followup inspections as
  776  necessary to monitor the compliance of facilities having with a
  777  history of any class I, class II, or class III violations that
  778  threaten the health, safety, or security of residents.
  779         (6) A Any facility that which terminates the residency of
  780  an individual who participated in activities specified in
  781  subsection (5) must shall show good cause in a court of
  782  competent jurisdiction. If good cause is not shown, the agency
  783  shall impose a fine of $2,500 in addition to any other penalty
  784  assessed against the facility.
  785         Section 13. Effective October 1, 2012, section 429.281,
  786  Florida Statutes, is created to read:
  787         429.281Grievances for resident relocation or termination
  788  of residency.—
  789         (1) As used in this section, the term:
  790         (a) “Relocation” means to move a resident from one facility
  791  to another facility that is responsible for the resident’s care.
  792         (b) “Termination of residency” means the release of a
  793  resident from a facility that ceases to be responsible for the
  794  resident’s care.
  795         (2) Each facility licensed under this part must comply with
  796  s. 429.28(1)(k) when a decision is made to relocate or terminate
  797  the residency of a resident.
  798         (3) Except as provided in s. 429.28(1)(k), at least 30 days
  799  before a proposed relocation or termination of residency, the
  800  facility must provide advance notice of the proposed relocation
  801  or termination of residency to the resident and to a family
  802  member, if known, or the resident’s legal guardian or
  803  representative.
  804         (4) The notice must be in writing and contain at a minimum,
  805  the following:
  806         (a) The date on which the notice is provided to the
  807  resident or resident’s legal guardian or representative;
  808         (b) The effective date of the relocation or termination of
  809  residency if the resident:
  810         1. Does not file a grievance; and
  811         2. Files a grievance, which may not be less than 15 days
  812  after the effective date if a grievance is not filed;
  813         (c) Information about the facility’s procedures for filing
  814  a grievance which is presented in a concise, straightforward
  815  manner and is written at an eighth-grade reading level;
  816         (d) Information about how to seek assistance from the local
  817  long-term care ombudsman council for a grievance;
  818         (e) The location to which the resident is being relocated,
  819  if known; and
  820         (f) The reason that the resident is being relocated or the
  821  residency is being terminated, along with a supporting
  822  explanation.
  823         (5) A resident may be relocated or have his or her
  824  residency terminated by the facility only if:
  825         (a) The resident’s needs cannot be met in the facility;
  826         (b) The resident no longer needs the services provided by
  827  the facility;
  828         (c) The health or safety of individuals in the facility is
  829  endangered by the resident;
  830         (d) The resident, resident’s family, or resident’s visitors
  831  cause disruption in the facility’s normal environment; or
  832         (e) The resident has failed, after reasonable and
  833  appropriate notice, to pay.
  834         (6) A resident is entitled to challenge a facility’s
  835  proposed relocation or termination of residency through the
  836  facility’s grievance procedure. The grievance must be filed
  837  within 15 days after receipt of the notice of relocation or
  838  termination of residency. If the resident files a grievance, the
  839  resident may not be required to leave the facility until at
  840  least 45 days after the notice of proposed relocation or
  841  termination of residency is received by the resident or the
  842  resident’s legal guardian or representative.
  843         (7) A resident may request that the local long-term care
  844  ombudsman council review any notice of relocation or termination
  845  of residency given to the resident. If requested, the local
  846  long-term care ombudsman council shall assist the resident, or
  847  the resident’s legal guardian or representative, with filing a
  848  grievance and completing the grievance process.
  849         (8) Unless an emergency relocation is necessary as provided
  850  in this section, the facility may not impede the resident’s
  851  right to remain in the facility, and the resident may remain in
  852  the facility until the outcome of the grievance, which must be
  853  completed within 45 days after receipt of the notice of
  854  relocation or termination of residency, unless both the facility
  855  and the resident, or the resident’s legal guardian or
  856  representative, agree to extend the deadline for the conclusion
  857  of the grievance process. The facility must ensure that
  858  responsible representatives of the facility are reasonably
  859  available to participate in the grievance process.
  860         (9) This section applies to relocations or terminations of
  861  residency which are initiated by the assisted living facility,
  862  and does not apply to those initiated by the resident or by the
  863  resident’s physician, legal guardian, or representative.
  864         (10) This section does not affect the rights the resident
  865  has to seek civil remedies.
  866         Section 14. Section 429.34, Florida Statutes, is amended to
  867  read:
  868         429.34 Right of entry and inspection.—
  869         (1) In addition to the requirements of s. 408.811, a any
  870  duly designated officer or employee of the department, the
  871  Department of Children and Family Services, the Medicaid Fraud
  872  Control Unit of the Office of the Attorney General, the state or
  873  local fire marshal, or a member of the state or local long-term
  874  care ombudsman council shall have the right to enter unannounced
  875  upon and into the premises of any facility licensed pursuant to
  876  this part in order to determine the state of compliance with the
  877  provisions of this part, part II of chapter 408, and applicable
  878  rules. Data collected by the state or local long-term care
  879  ombudsman councils or the state or local advocacy councils may
  880  be used by the agency in investigations involving violations of
  881  regulatory standards.
  882         (2) The agency is designated the central agency for
  883  tracking complaints that involve potential licensure violations
  884  to ensure a timely response to allegations regarding facilities
  885  and the initiation of licensure enforcement action, if
  886  warranted. Any other state agency regulating, or providing
  887  services to residents of, assisted living facilities, including
  888  the department, the Long-Term Care Ombudsman Council, and the
  889  Department of Children and Family Services, must report any
  890  allegations or complaints that have been substantiated or are
  891  likely to have occurred to the agency within 2 business days if
  892  the report reflects serious and immediate risk to residents. All
  893  other referrals must be made within 10 business days.
  894         (3) The agency shall have lead surveyors in each field
  895  office who specialize in assessing assisted living facilities.
  896  The lead surveyors shall provide initial and ongoing training to
  897  surveyors who will be inspecting and monitoring facilities. The
  898  lead surveyors shall ensure that consistent inspection and
  899  monitoring assessments are conducted.
  900         (4) The agency shall have one statewide lead surveyor who
  901  specializes in assisted living facility inspections. The lead
  902  surveyor shall coordinate communication between lead surveyors
  903  of assisted living facilities throughout the state and ensure
  904  statewide consistency in applying facility inspection laws and
  905  rules.
  906         Section 15. Paragraph (l) of subsection (1) and subsections
  907  (2) and (5) of section 429.41, Florida Statutes, are amended to
  908  read:
  909         429.41 Rules establishing standards.—
  910         (1) It is the intent of the Legislature that rules
  911  published and enforced pursuant to this section shall include
  912  criteria by which a reasonable and consistent quality of
  913  resident care and quality of life may be ensured and the results
  914  of such resident care may be demonstrated. Such rules shall also
  915  ensure a safe and sanitary environment that is residential and
  916  noninstitutional in design or nature. It is further intended
  917  that reasonable efforts be made to accommodate the needs and
  918  preferences of residents to enhance the quality of life in a
  919  facility. The agency, in consultation with the department, may
  920  adopt rules to administer the requirements of part II of chapter
  921  408. In order to provide safe and sanitary facilities and the
  922  highest quality of resident care accommodating the needs and
  923  preferences of residents, the department, in consultation with
  924  the agency, the Department of Children and Family Services, and
  925  the Department of Health, shall adopt rules, policies, and
  926  procedures to administer this part, which must include
  927  reasonable and fair minimum standards in relation to:
  928         (l) The establishment of specific policies and procedures
  929  on resident elopement. Facilities shall conduct a minimum of two
  930  resident elopement drills each year. All administrators and
  931  direct care staff shall participate in the drills. Facilities
  932  shall document the drills. Each calendar year, the agency shall
  933  observe the elopement drills of 10 percent of the licensed
  934  facilities in the state. The facilities must be randomly
  935  selected by the agency and the elopement drills must coincide
  936  with an inspection or survey conducted by the agency. If an
  937  agency employee observes an elopement drill that does not meet
  938  licensure standards, the agency shall cite violations in
  939  accordance with s. 429.19(2).
  940         (2) In adopting any rules pursuant to this part, the
  941  department, in conjunction with the agency, shall make distinct
  942  standards for facilities based upon facility size; the types of
  943  care provided; the physical and mental capabilities and needs of
  944  residents; the type, frequency, and amount of services and care
  945  offered; and the staffing characteristics of the facility. Rules
  946  developed pursuant to this section may shall not restrict the
  947  use of shared staffing and shared programming in facilities that
  948  are part of retirement communities that provide multiple levels
  949  of care and otherwise meet the requirements of law and rule.
  950  Except for uniform firesafety standards, the department shall
  951  adopt by rule separate and distinct standards for facilities
  952  with 16 or fewer beds and for facilities with 17 or more beds.
  953  The standards for facilities with 16 or fewer beds must shall be
  954  appropriate for a noninstitutional residential environment if,
  955  provided that the structure is no more than two stories in
  956  height and all persons who cannot exit the facility unassisted
  957  in an emergency reside on the first floor. The department, in
  958  conjunction with the agency, may make other distinctions among
  959  types of facilities as necessary to enforce the provisions of
  960  this part. If Where appropriate, the agency shall offer
  961  alternate solutions for complying with established standards,
  962  based on distinctions made by the department and the agency
  963  relative to the physical characteristics of facilities and the
  964  types of care offered therein.
  965         (5) In order to allocate resources efficiently, the agency
  966  shall conduct may use an abbreviated biennial standard licensure
  967  inspection that consists of a review of key quality-of-care
  968  standards in lieu of a full inspection in a facility that has a
  969  good record of past performance. However, a full inspection must
  970  be conducted in a facility that has a history of class I or
  971  class II violations, uncorrected class III violations, confirmed
  972  ombudsman council complaints that resulted in a citation for
  973  licensure, or confirmed licensure complaints which resulted in a
  974  citation for a licensure violation, within the previous
  975  licensure period immediately preceding the inspection or if a
  976  potentially serious problem is identified during the abbreviated
  977  inspection. The agency, in consultation with the department,
  978  shall develop the key quality-of-care standards with input from
  979  the State Long-Term Care Ombudsman Council and representatives
  980  of provider groups for incorporation into its rules.
  981         Section 16. Subsection (1) of section 429.49, Florida
  982  Statutes, is amended to read:
  983         429.49 Resident records; penalties for alteration.—
  984         (1) Any person who fraudulently alters, defaces, or
  985  falsifies any medical or other record of an assisted living
  986  facility, or causes or procures any such offense to be
  987  committed, commits a misdemeanor of the first second degree,
  988  punishable as provided in s. 775.082 or s. 775.083.
  989         Section 17. Section 429.515, Florida Statutes, is created
  990  to read:
  991         429.515Preservice orientation.—
  992         (1) Each employee, including an administrator, of an
  993  assisted living facility who is newly hired on or after July 1,
  994  2012, must attend a preservice orientation provided by the
  995  facility which covers topics that will enable the employee to
  996  relate and respond to the residents of the facility. The
  997  orientation must be at least 2 hours in duration, be available
  998  in English and, if the employee is not fluent in English but is
  999  fluent in Spanish, Spanish, and, at a minimum, cover the
 1000  following topics:
 1001         (a) Care of persons who have Alzheimer’s disease or other
 1002  related disorders.
 1003         (b) Deescalation techniques.
 1004         (c) Aggression control.
 1005         (d) Elopement prevention.
 1006         (e) Behavior management.
 1007         (2)Upon completion of the preservice orientation, the
 1008  administrator or owner of the facility must sign an affidavit,
 1009  under penalty of perjury, stating that the employee completed
 1010  the preservice orientation. The administrator of the facility
 1011  must maintain the signed affidavit in the employee’s work file.
 1012         Section 18. Section 429.52, Florida Statutes, is amended to
 1013  read:
 1014         (Substantial rewording of section. See
 1015         s. 429.52, F.S., for present text.)
 1016         429.52Training; examination; tutorial; continuing
 1017  education.—
 1018         (1) Staff, other than administrators, hired on or after
 1019  January 1, 2013, who provide regular or direct care to residents
 1020  must complete a 20-hour staff training curriculum, and
 1021  interactive online tutorial that demonstrates an understanding
 1022  of the training. The training and tutorial must be completed
 1023  within 90 days after employment and is in addition to the
 1024  preservice orientation required under s. 429.515. Any cost or
 1025  fee associated with the training and tutorial shall be borne by
 1026  the participant or the participant’s employer. The department
 1027  may grant an exemption from the applicable hours to nurses,
 1028  certified nursing assistants, or home health aides who can
 1029  demonstrate completion of training that is substantially similar
 1030  to all or portions of the staff training curriculum.
 1031         (2) Staff, other than administrators, providing regular or
 1032  direct care to residents must participate in a minimum of 4
 1033  hours of continuing education every 2 years. The continuing
 1034  education may be offered through online courses and any fee
 1035  associated with the online service shall be borne by the
 1036  participant or the participant’s employer.
 1037         (3) A certificate must be provided to each person upon
 1038  completion of the training required in this section. A copy of
 1039  the certificate must be maintained in the employee’s work file.
 1040         (4) A person who can document that he or she has completed
 1041  the training and continuing education required by this section
 1042  is not required to retake the training or continuing education
 1043  for the applicable 2-year cycle upon employment with a different
 1044  facility if the break in employment does not exceed 6 months.
 1045         (5) The department, in consultation with the agency, the
 1046  Department of Children and Family Services, and their agents,
 1047  shall develop the following:
 1048         (a) Assisted living facility administrator core training
 1049  that includes at least 40 hours of training. The curriculum, at
 1050  a minimum, must cover the following topics:
 1051         1. State law and rules relating to assisted living
 1052  facilities.
 1053         2. Resident rights and the identification and reporting of
 1054  abuse, neglect, and exploitation.
 1055         3. The special needs of elderly persons, persons who have
 1056  mental illness, and persons who have developmental disabilities
 1057  and how to meet those needs.
 1058         4. Nutrition and food service, including acceptable
 1059  sanitation practices for preparing, storing, and serving food.
 1060         5. Medication management, recordkeeping, and proper
 1061  techniques for assisting residents who self-administer
 1062  medication.
 1063         6. Firesafety requirements, including procedures for fire
 1064  evacuation drills and other emergency procedures.
 1065         7. The care of persons who have Alzheimer’s disease and
 1066  related disorders.
 1067         8. Elopement prevention.
 1068         9. Aggression and behavior management, deescalation
 1069  techniques, and proper protocols and procedures relating to the
 1070  Baker Act as provided in part I of chapter 394.
 1071         10. Do-not-resuscitate orders.
 1072         11. Infection control.
 1073         12. Admission and continued residency.
 1074         13. Phases of care and interacting with residents.
 1075         14. Best practices in the industry.
 1076         15. Business operations, including, but not limited to,
 1077  human resources, financial management, and supervision of staff.
 1078         (b) An assisted living facility administrator examination
 1079  that tests the applicant’s knowledge and training of the core
 1080  training topics listed in paragraph (a).
 1081         (c) A continuing education curriculum of 16 hours for
 1082  licensed assisted living facility administrators. The department
 1083  or its agent shall also develop an examination that corresponds
 1084  with each continuing education course. Continuing education must
 1085  include topics similar to those of the core training in
 1086  paragraph (a), and may include additional subject matter that
 1087  enhances the knowledge, skills, and abilities of assisted living
 1088  facility administrators, as adopted by rule.
 1089         (d) Specialty training, continuing education, examinations,
 1090  and tutorials for the requirements in paragraph (7).
 1091         (6) The department, in consultation with stakeholders, the
 1092  agency, and the Department of Children and Family Services shall
 1093  develop the standardized staff training curriculum and
 1094  continuing education required under subsections (1) and (2). The
 1095  curriculum must include at least 20 hours of inservice training,
 1096  with at least 1 hour of training per topic, covering at least
 1097  the following topics:
 1098         (a) Reporting major incidents.
 1099         (b) Reporting adverse incidents.
 1100         (c) Facility emergency procedures, including chain-of
 1101  command and staff member roles relating to emergency evacuation.
 1102         (d)Resident rights in an assisted living facility.
 1103         (e) Recognizing and reporting resident abuse, neglect, and
 1104  exploitation.
 1105         (f) Resident behavior and needs.
 1106         (g) Providing assistance with the activities of daily
 1107  living.
 1108         (h) Infection control.
 1109         (i) Aggression and behavior management and deescalation
 1110  techniques.
 1111         (7) Additional specialty training and continuing education
 1112  for assisted living facility staff and administrators is
 1113  required as follows:
 1114         (a) Administrators and staff who provide regular or direct
 1115  care to residents of a facility that holds an extended
 1116  congregate care license must complete a minimum of 4 hours of
 1117  extended congregate care training within 90 days after beginning
 1118  employment or after the facility receives an extended congregate
 1119  care license and 2 hours of continuing education every 2 years.
 1120         (b) If a facility holds a limited nursing services license:
 1121         1. The administrator must complete a minimum of 4 hours of
 1122  courses that train and educate administrators on the special
 1123  needs and care of those residents requiring limited nursing
 1124  services within 90 days after employment or after the facility
 1125  receives a limited nursing services license.
 1126         2. Staff providing regular and direct care to residents
 1127  receiving limited nursing services must complete a minimum of 2
 1128  hours of courses that train and educate staff on the special
 1129  needs and care of those requiring limited nursing services. The
 1130  training must be completed within 90 days after employment or
 1131  after the facility receives a limited nursing services license.
 1132         (c) Staff who provide regular or direct care to mental
 1133  health residents and administrators who are employed by a
 1134  facility that holds a limited mental health license must
 1135  complete a minimum of 8 hours of department-approved mental
 1136  health training within 90 days after beginning employment or
 1137  after the facility receives a limited mental health license.
 1138  Staff and administrators must also complete 2 hours of
 1139  continuing education that enhances the ability to care for
 1140  mental health residents. A staff member must complete an online
 1141  interactive tutorial related to the training and continuing
 1142  education in order to demonstrate an understanding of the
 1143  material and receive a certificate of completion. An
 1144  administrator must pass an examination related to the
 1145  administrator’s training with a minimum score of 80 percent. An
 1146  administrator must complete an online interactive tutorial
 1147  related to the continuing education in order to demonstrate an
 1148  understanding of the material and receive a certificate of
 1149  completion. The participant or the participant’s employer shall
 1150  pay any fee associated with the training, tutorial, or
 1151  examination.
 1152         1. A staff member who does not complete the initial
 1153  training tutorial within the 90 days may not provide regular or
 1154  direct care to mental health residents until he or she
 1155  successfully completes the tutorial.
 1156         2. An administrator who does not pass the examination
 1157  within 6 months after completing the mental health training may
 1158  not be an administrator of a facility that holds a limited
 1159  mental health license until the administrator achieves a passing
 1160  score.
 1161         (d) Staff, including administrators, who prepare or serve
 1162  food must receive a minimum of 1 hour of inservice training in
 1163  safe food handling practices within 30 days after beginning
 1164  employment.
 1165         (e) Staff, including administrators, must receive at least
 1166  1 hour of inservice training on the facility’s resident
 1167  elopement response policies and procedures within 30 days after
 1168  beginning employment.
 1169         1. A copy of the facility’s resident elopement response
 1170  policies and procedures must be provided to staff and the
 1171  administrator.
 1172         2. Staff members and the administrator must demonstrate
 1173  understanding and competency in the implementation of the
 1174  elopement response policies and procedures.
 1175         (f) Staff, including the administrator, involved with the
 1176  management of medications and the assistance with self
 1177  administration of medications under s. 429.256 must complete a
 1178  minimum of 4 additional hours of training provided by a
 1179  registered nurse, licensed pharmacist, or department staff
 1180  member. The department shall establish by rule the minimum
 1181  requirements of this training, including continuing education
 1182  requirements.
 1183         (8)Other facility staff members shall participate in
 1184  training relevant to their job duties and as specified by rule.
 1185         (9) The department, in consultation with a panel of at
 1186  least three mental health professionals, the agency, and the
 1187  Department of Children and Family Services, and their agents
 1188  shall develop a limited mental health curriculum, examination,
 1189  and on-line interactive tutorial.
 1190         (10) The agency or department may require or cause to be
 1191  provided the training or education of staff of an assisted
 1192  living facility beyond that which is required under this part if
 1193  the agency or department determines that there are problems in a
 1194  facility which could be reduced through specific staff training
 1195  or education.
 1196         (11) Existing curricula, examinations, and tutorials may be
 1197  used, modified, or enhanced as appropriate. To the extent
 1198  funding is available, the department may contract for assistance
 1199  with the development, review, updating of the training,
 1200  examinations, and on-line tutorials required under this section.
 1201  
 1202  All training, examinations, and tutorials must be developed and
 1203  offered in English and Spanish, and must be reviewed at least
 1204  annually and updated as needed to reflect changes in the law,
 1205  rules, and best practices.
 1206         Section 19. Section 429.522, Florida Statutes, is created
 1207  to read:
 1208         429.522Assisted living training providers; certification.—
 1209         (1) Effective January 1, 2013, an individual seeking to
 1210  provide assisted living training in this state must be certified
 1211  by the department. The applicant must provide the department
 1212  with proof of completion of the minimum core training
 1213  requirements, successful passage of the assisted living facility
 1214  administrator licensure examination, and proof of compliance
 1215  with continuing education requirements for assisted living
 1216  facility administrators since completion of training.
 1217         (2) A person seeking to be certified as a trainer must
 1218  also:
 1219         (a) Provide proof of completion of a 4-year baccalaureate
 1220  degree from an accredited college or university and must have
 1221  worked in a management position in an assisted living facility
 1222  for 3 years after obtaining certification in core training
 1223  courses;
 1224         (b) Have worked in a management position in an assisted
 1225  living facility for 5 years;
 1226         (c) Have been previously employed as a trainer of core
 1227  training courses for the department;
 1228         (d) Have at least 5 years of employment with the agency as
 1229  a surveyor of assisted living facilities;
 1230         (e) Have at least 5 years of employment as an educator or
 1231  staff trainer for persons working in an assisted living facility
 1232  or another long-term care setting;
 1233         (f) Have a 4-year baccalaureate degree from an accredited
 1234  college or university in the areas of health care, gerontology,
 1235  social work, education, or human services and at least 4 years
 1236  of experience as an educator or staff trainer for persons
 1237  working in an assisted living facility or another long-term care
 1238  setting after receiving certification in core courses; or
 1239         (g) Meet other qualification criteria as defined by rule of
 1240  the department.
 1241         (3)Training may also be provided by faculty in a Florida
 1242  College System institution.
 1243         (4) The department shall provide oversight of the assisted
 1244  living training providers. The department shall adopt rules to
 1245  establish requirements for trainer certification and
 1246  recertification requirements, including continuing education
 1247  requirments, disciplinary action that may be taken against a
 1248  trainer, a trainer decertification process, and required
 1249  electronic reporting of persons who have successfully completing
 1250  training courses.
 1251         (5) If funding is available, by January 1, 2013, the
 1252  department shall develop and maintain an electronic database,
 1253  accessible to the public, which lists all persons holding
 1254  certification as an assisted living trainer, including any
 1255  history of violations. Assisted living trainers shall keep a
 1256  record of individuals who complete training and shall submit the
 1257  record to the department electronically within 24 hours after
 1258  the completion of a course in order for the department to
 1259  include the information in the database.
 1260         Section 20. Section 429.54, Florida Statutes, is amended to
 1261  read:
 1262         429.54 Collection of information; local subsidy;
 1263  interagency communication; facility reporting.—
 1264         (1) To enable the department to collect the information
 1265  requested by the Legislature regarding the actual cost of
 1266  providing room, board, and personal care in assisted living
 1267  facilities, the department may is authorized to conduct field
 1268  visits and audits of facilities as may be necessary. The owners
 1269  of randomly sampled facilities shall submit such reports,
 1270  audits, and accountings of cost as the department may require by
 1271  rule; however, provided that such reports, audits, and
 1272  accountings may not be more than shall be the minimum necessary
 1273  to implement the provisions of this subsection section. Any
 1274  facility selected to participate in the study shall cooperate
 1275  with the department by providing cost of operation information
 1276  to interviewers.
 1277         (2) Local governments or organizations may contribute to
 1278  the cost of care of local facility residents by further
 1279  subsidizing the rate of state-authorized payment to such
 1280  facilities. Implementation of local subsidy shall require
 1281  departmental approval and may shall not result in reductions in
 1282  the state supplement.
 1283         (3) Subject to the availability of funds, the agency, the
 1284  department, the Department of Children and Family Services, and
 1285  the Agency for Persons with Disabilities shall develop or modify
 1286  electronic systems of communication among state-supported
 1287  automated systems to ensure that relevant information pertaining
 1288  to the regulation of assisted living facilities and facility
 1289  staff is timely and effectively communicated among agencies in
 1290  order to facilitate the protection of residents.
 1291         (4) All assisted living facilities shall submit electronic
 1292  reports to the agency twice a year.
 1293         (a) The reports must represent facility data on March 30
 1294  and September 30 of each year and be submitted within 15
 1295  calendar days. The following information and must be submitted:
 1296         1. The number of beds in the facility;
 1297         2. The number of occupied beds;
 1298         3. The number of residents, by age group, younger than 65
 1299  years of age, from 65 to 74 years of age, from 75 to 84 years of
 1300  age, and 85 years of age or older;
 1301         4. The number of residents who are mental health residents,
 1302  who are receiving extended congregate care, who are receiving
 1303  limited nursing services, and who are receiving hospice care;
 1304         5. If there is a facility waiting list, the number of
 1305  individuals on the waiting list and the type of services or care
 1306  they require, if known;
 1307         6. The number of residents receiving optional state
 1308  supplementation; and
 1309         7. The number of residents who are Medicaid recipients and
 1310  the type of waiver used to fund their assisted living facility
 1311  certification care.
 1312         (b) The agency must maintain electronically the electronic
 1313  information submitted and, at a minimum, use the information to
 1314  track trends in resident populations and needs.
 1315         (c) Reporting under this subsection begins March 1, 2013,
 1316  and expires July 1, 2017.
 1317         Section 21. Section 429.55, Florida Statutes, is created to
 1318  read:
 1319         429.55Assisted living facility rating system.—
 1320         (1) The agency, in consultation with the department, the
 1321  Department of Children and Family Services, and the Office of
 1322  State Long-Term Care Ombudsman, shall develop and adopt by rule
 1323  a user-friendly assisted living facility rating system.
 1324         (2) The rating system must be publicly available on the
 1325  Internet in order to assist consumers in evaluating assisted
 1326  living facilities and the services provided by such facilities.
 1327         (3) The rating system must be based on resident
 1328  satisfaction, the number and class of deficiencies for which the
 1329  facility has been cited, agency inspection reports, the
 1330  inspection reports of any other regulatory agency, assessments
 1331  conducted by the ombudsman program pursuant to part I of chapter
 1332  400, and other criteria as determined by the agency.
 1333         (4) The Internet home page for the rating system must
 1334  include a link that allows consumers to complete a voluntary
 1335  survey that provides feedback on whether the rating system is
 1336  helpful and suggestions for improvement.
 1337         (5) The agency may adopt rules as necessary to administer
 1338  this section.
 1339         Section 22. The Division of Statutory Revision is requested
 1340  to rename part II of chapter 468, Florida Statutes, consisting
 1341  of ss. 468.1635-468.1756, Florida Statutes, as “Nursing Home and
 1342  Assisted Living Facility Administration.”
 1343         Section 23. Section 468.1635, Florida Statutes, is amended
 1344  to read:
 1345         468.1635 Purpose.—The sole legislative purpose for enacting
 1346  this part chapter is to ensure that every nursing home
 1347  administrator and assisted living facility administrator
 1348  practicing in this state meets minimum requirements for safe
 1349  practice. It is the legislative intent that nursing home
 1350  administrators and assisted living facility administrators who
 1351  fall below minimum competency or who otherwise present a danger
 1352  to the public shall be prohibited from practicing in this state.
 1353         Section 24. Section 468.1645, Florida Statutes, is amended
 1354  to read:
 1355         468.1645 Administrator license required.—
 1356         (1) A No nursing home in the state may not operate in this
 1357  state unless it is under the management of a nursing home
 1358  administrator, and effective July 1, 2013, an assisted living
 1359  facility may not operate in this state unless it is under the
 1360  management of an assisted living facility administrator who
 1361  holds a currently valid license, provisional license, or
 1362  temporary license.
 1363         (2) Nothing in This part, and or in the rules adopted
 1364  pursuant to this part, do not hereunder shall require an
 1365  administrator of a any facility or institution operated by and
 1366  for persons who rely exclusively upon treatment by spiritual
 1367  means through prayer, in accordance with the creed or tenets of
 1368  any organized church or religious denomination, to be licensed
 1369  as a nursing home administrator or assisted living facility
 1370  administrator if the administrator is employed only to
 1371  administer in such facilities or institutions for the care and
 1372  treatment of the sick.
 1373         Section 25. Section 468.1655, Florida Statutes, is amended
 1374  to read:
 1375         468.1655 Definitions.—As used in this part:
 1376         (1)“Assisted living facility” means a facility licensed
 1377  under part I of chapter 429.
 1378         (2) “Assisted living facility administrator” means a person
 1379  who is licensed to engage in the practice of assisted living
 1380  facility administration in this state under the authority of
 1381  this part.
 1382         (3) “Assisted living facility administrator certification”
 1383  means a professional credential awarded by a board-approved
 1384  third-party credentialing entity to individuals who demonstrate
 1385  core competency in the practice of assisted living facility
 1386  administration and who meet the education, background screening,
 1387  and other criteria specified by the board for licensure as an
 1388  assisted living facility administrator.
 1389         (4)(1) “Board” means the Board of Long-Term Care Nursing
 1390  Home Administrators.
 1391         (5)(2) “Department” means the Department of Health.
 1392         (6)“Long-term care” means any service provided in
 1393  facilities licensed under part II of chapter 400 or part I of
 1394  chapter 429.
 1395         (7)(3) “Nursing home administrator” means a person who is
 1396  licensed to engage in the practice of nursing home
 1397  administration in this state under the authority of this part.
 1398         (8)“Practice of assisted living facility administration”
 1399  means any service requiring education, training, or experience
 1400  in assisted living facility administration and its application
 1401  to the planning, organizing, staffing, directing, and
 1402  controlling of the total management of an assisted living
 1403  facility. A person is practicing or offering to practice
 1404  assisted living facility administration if such person:
 1405         (a) Practices any of the above services.
 1406         (b) Holds himself or herself out as able to perform, or
 1407  does perform, any form of assisted living facility
 1408  administration by written or verbal claim, sign, advertisement,
 1409  letterhead, or card; or in any other way represents himself or
 1410  herself to be, or implies that he or she is, an assisted living
 1411  facility administrator.
 1412         (9)(4) “Practice of nursing home administration” means any
 1413  service requiring education, training, or experience in nursing
 1414  home administration education, training, or experience and the
 1415  application of such to the planning, organizing, staffing,
 1416  directing, and controlling of the total management of a nursing
 1417  home. A person is practicing or offering shall be construed to
 1418  practice or to offer to practice nursing home administration if
 1419  the person who:
 1420         (a) Practices any of the above services.
 1421         (b) Holds himself or herself out as able to perform, or
 1422  does perform, any form of nursing home administration by written
 1423  or verbal claim, sign, advertisement, letterhead, or card; or in
 1424  any other way represents himself or herself to be, or implies
 1425  that he or she is, a nursing home administrator.
 1426         (10)(5) “Nursing home” means an institution or facility
 1427  licensed as such under part II of chapter 400.
 1428         Section 26. Section 468.1665, Florida Statutes, is amended
 1429  to read:
 1430         468.1665 Board of Long-Term Care Nursing Home
 1431  Administrators; membership; appointment; terms.—
 1432         (1) The Board of Long-Term Care Nursing Home Administrators
 1433  is created within the department and shall consist of eleven
 1434  seven members, to be appointed by the Governor and confirmed by
 1435  the Senate to a term of 4 years or for a term to complete an
 1436  unexpired vacancy.
 1437         (2) Three members of the board must be licensed nursing
 1438  home administrators. Three members of the board must be licensed
 1439  assisted living facility administrators. Two members of the
 1440  board must be health care practitioners. Three The remaining two
 1441  members of the board must be laypersons who are not, and have
 1442  never been, nursing home or assisted living facility
 1443  administrators or members of any health care profession or
 1444  occupation, and at least one of these laypersons must be a
 1445  resident of an assisted living facility. At least one member of
 1446  the board must be 60 years of age or older.
 1447         (3) Only board members who are nursing home administrators
 1448  may have a direct financial interest in any nursing home. Only
 1449  board members who are assisted living facility administrators
 1450  may have a direct financial interest in any assisted living
 1451  facility.
 1452         (4) All provisions of chapter 456 relating to activities of
 1453  regulatory boards shall apply.
 1454         Section 27. Section 468.1685, Florida Statutes, is amended
 1455  to read:
 1456         468.1685 Powers and duties of board and department.—It is
 1457  the function and duty of the board, together with the
 1458  department, to:
 1459         (1) Adopt rules pursuant to ss. 120.536(1) and 120.54 to
 1460  implement the provisions of this part conferring duties upon the
 1461  board.
 1462         (2) Develop, impose, and enforce specific standards within
 1463  the scope of the general qualifications established by this part
 1464  which must be met by individuals in order to receive licenses as
 1465  nursing home or assisted living facility administrators. These
 1466  standards shall be designed to ensure that nursing home and
 1467  assisted living facility administrators are individuals of good
 1468  character and otherwise suitable and, by training or experience
 1469  in the field of health care facility institutional
 1470  administration, qualified to serve as nursing home or assisted
 1471  living facility administrators.
 1472         (3) Develop by appropriate techniques, including
 1473  examinations and investigations, a method for determining
 1474  whether an individual meets such standards.
 1475         (a) The board shall approve one or more third-party
 1476  credentialing entities for the purpose of developing and
 1477  administering certification programs for assisted living
 1478  facility administrators. A third-party credentialing entity must
 1479  be a nonprofit organization that has met nationally recognized
 1480  standards for developing and administering professional
 1481  certification programs.
 1482         (b) In order to obtain approval, a third-party
 1483  credentialing entity must also:
 1484         1. Establish professional requirements and standards that
 1485  applicants must achieve in order to obtain an assisted living
 1486  facility administrator certification and to maintain such
 1487  certification. At a minimum, these requirements and standards
 1488  must include completion of the requirements for assisted living
 1489  facility administrators required in this part and in rules
 1490  adopted by the board, including all education, experience, and
 1491  continuing education requirements;
 1492         2. Agree to assist the Department of Elderly Affairs with
 1493  developing the training and testing materials under section
 1494  429.52 using nationally recognized certification and
 1495  psychometric standards;
 1496         3. Maintain an Internet-based database, accessible to the
 1497  public, of all persons holding an assisted living facility
 1498  administrator certification; and
 1499         4. Require continuing education and, at least, biennial
 1500  certification renewal for persons holding an assisted living
 1501  facility administrator certification.
 1502         (4) Issue licenses to qualified individuals meeting the
 1503  standards of the board and revoke or suspend licenses previously
 1504  issued by the board if when the individual holding such license
 1505  is determined to have failed to conform substantially conform to
 1506  the requirements of such standards.
 1507         (5) Establish by rule and carry out procedures, by rule,
 1508  designed to ensure that licensed nursing home or assisted living
 1509  facility administrators will comply with the standards adopted
 1510  by the board.
 1511         (6) Receive, investigate, and take appropriate action with
 1512  respect to any charge or complaint filed with the department to
 1513  the effect that a licensed nursing home or assisted living
 1514  facility administrator has failed to comply with the
 1515  requirements or standards adopted by the board.
 1516         (7) Conduct a continuing study and investigation of nursing
 1517  homes and assisted living facilities and the administrators of
 1518  nursing homes and assisted living facilities in order to improve
 1519  the standards imposed for the licensing of such administrators
 1520  and the procedures and methods for enforcing such standards with
 1521  respect to licensed administrators of nursing homes who have
 1522  been licensed as such.
 1523         (8) Set up procedures by rule for advising and acting
 1524  together with the department of Health and other boards of other
 1525  health professions in matters affecting procedures and methods
 1526  for effectively enforcing the purpose of this part and the
 1527  administration of chapters 400 and 429.
 1528         Section 28. Section 468.1695, Florida Statutes, is amended
 1529  to read:
 1530         468.1695 Licensure by examination; licensure by
 1531  certification.—
 1532         (1) Any person desiring to be licensed as a nursing home
 1533  administrator shall apply to the department to take the
 1534  licensure examination. The examination shall be given at least
 1535  two times a year and shall include, but not be limited to,
 1536  questions on the subjects of nursing home administration such
 1537  as:
 1538         (a) Applicable standards of nursing home health and safety;
 1539         (b) Federal, state, and local health and safety laws and
 1540  rules;
 1541         (c) General administration;
 1542         (d) Psychology of patient care;
 1543         (e) Principles of medical care;
 1544         (f) Personal and social care;
 1545         (g) Therapeutic and supportive care and services in long
 1546  term care;
 1547         (h) Departmental organization and management;
 1548         (i) Community interrelationships; and
 1549         (j) Terminology.
 1550  
 1551  The board may, by rule, adopt use of a national examination in
 1552  lieu of part or all of the examination required by this part.
 1553         (2) The department shall examine each applicant for a
 1554  nursing home administrator license who the board certifies has
 1555  completed the application form and remitted an examination fee
 1556  set by the board not to exceed $250 and who:
 1557         (a)1. Holds a baccalaureate degree from an accredited
 1558  college or university and majored in health care administration
 1559  or has credit for at least 60 semester hours in subjects, as
 1560  prescribed by rule of the board, which prepare the applicant for
 1561  total management of a nursing home; and
 1562         2. Has fulfilled the requirements of a college-affiliated
 1563  or university-affiliated internship in nursing home
 1564  administration or of a 1,000-hour nursing home administrator-in
 1565  training program prescribed by the board; or
 1566         (b)1. Holds a baccalaureate degree from an accredited
 1567  college or university; and
 1568         2.a. Has fulfilled the requirements of a 2,000-hour nursing
 1569  home administrator-in-training program prescribed by the board;
 1570  or
 1571         b. Has 1 year of management experience allowing for the
 1572  application of executive duties and skills, including the
 1573  staffing, budgeting, and directing of resident care, dietary,
 1574  and bookkeeping departments within a skilled nursing facility,
 1575  hospital, hospice, assisted living facility with a minimum of 60
 1576  licensed beds, or geriatric residential treatment program and,
 1577  if such experience is not in a skilled nursing facility, has
 1578  fulfilled the requirements of a 1,000-hour nursing home
 1579  administrator-in-training program prescribed by the board.
 1580         (3) The department shall issue a license to practice
 1581  nursing home administration to any applicant who successfully
 1582  completes the examination in accordance with this section and
 1583  otherwise meets the requirements of this part. The department
 1584  shall not issue a license to any applicant who is under
 1585  investigation in this state or another jurisdiction for an
 1586  offense which would constitute a violation of s. 468.1745 or s.
 1587  468.1755. Upon completion of the investigation, the provisions
 1588  of s. 468.1755 shall apply.
 1589         (4) The board may by rule establish a preceptor
 1590  certification and recertification fee not to exceed $100 which
 1591  shall be remitted by those individuals seeking board approval to
 1592  act as preceptors in administrator-in-training programs as
 1593  prescribed by the board. This Said fee may be charged at the
 1594  time of application for initial certification and at the time of
 1595  application for recertification. The board may by rule establish
 1596  a trainee application fee not to exceed $500 to defray the costs
 1597  of the board’s supervision of the administrator-in-training
 1598  program, to be remitted by those individuals seeking to undergo
 1599  a board prescribed administrator-in-training program.
 1600         (5) Any person desiring to be licensed as an assisted
 1601  living facility administrator must apply to the department,
 1602  remit a nonrefundable fee set by the board not to exceed $150,
 1603  and provide proof of a current and valid assisted living
 1604  facility administrator certification.
 1605         (6) An assisted living facility administrator certification
 1606  must be issued by a board-approved third-party credentialing
 1607  entity that certifies that the individual:
 1608         (a) Is at least 21 years old;
 1609         (b) Holds a 4-year baccalaureate degree from an accredited
 1610  college or university, including completion of coursework in
 1611  health care, gerontology, or geriatrics; holds a 4-year
 1612  baccalaureate degree from an accredited college or university
 1613  and has at least 2 years of experience in direct care in or
 1614  management of an assisted living facility or nursing home; or
 1615  holds a 2-year associate degree and has at least 4 years of
 1616  experience in direct care in an assisted living facility or
 1617  nursing home;
 1618         (c) Has completed a least 40 hours of core training;
 1619         (d) Has passed an examination that documents core
 1620  competencies in the training required for assisted living
 1621  facility administrators prior to licensure with a minimum score
 1622  of 80 percent;
 1623         (e) Has completed background screening pursuant to ss.
 1624  429.174 and 456.0365; and
 1625         (f) Otherwise meets the requirements of this part and part
 1626  I of chapter 429.
 1627         (7) An assisted living facility administrator who is
 1628  continuously employed as a facility administrator, or a nursing
 1629  home administrator who is continuously employed as a nursing
 1630  home administrator, for at least the 2 years before January 1,
 1631  2013, is eligible for certification as an assisted living
 1632  facility administrator without meeting the requirements in
 1633  subsection (6) if:
 1634         (a) The applicant completed the core training, examination,
 1635  and continuing education requirements under chapter 429 which
 1636  were in effect on June 30, 2012; and
 1637         (b) The applicant was not the administrator of a facility
 1638  or nursing home that was cited for a class I or class II
 1639  violation within the 2 years before January 1, 2013.
 1640         (8) Other licensed professionals may be exempted from some
 1641  or all of the training requirements of this section for assisted
 1642  living facility administrator certification, as determined by
 1643  the board, in consultation with the Department of Elderly
 1644  Affairs and the Agency for Health Care Administration, by rule.
 1645         (9) A licensed assisted living facility administrator
 1646  applying for relicensure must submit an application, remit a
 1647  renewal fee of $150, and demonstrate that he or she has obtained
 1648  and maintained his or her assisted living facility administrator
 1649  certification that substantiates that he or she has completed at
 1650  least 16 hours of general continuing education, any specialty
 1651  training and continuing education required based on licensure of
 1652  the facility for which the applicant is an administrator, has
 1653  successfully passed all required examinations, and satisfies all
 1654  other requirements for licensure renewal under this part and
 1655  part I of chapter 429.
 1656         (10) The board may adopt rules for licensure forms,
 1657  staggered license expirations dates, prorated licensure fees,
 1658  and certification to implement the licensure and relicensure of
 1659  assisted living facility administrators.
 1660         Section 29. Subsection (1) of section 468.1705, Florida
 1661  Statutes, is amended to read:
 1662         468.1705 Licensure by endorsement; temporary license.—
 1663         (1) The department shall issue a nursing home administrator
 1664  license by endorsement to an any applicant who, upon applying to
 1665  the department and remitting a fee set by the board not to
 1666  exceed $500, demonstrates to the board that he or she:
 1667         (a) Meets one of the following requirements:
 1668         1. Holds a valid active license to practice nursing home
 1669  administration in another state of the United States if,
 1670  provided that the current requirements for licensure in that
 1671  state are substantially equivalent to, or more stringent than,
 1672  current requirements in this state; or
 1673         2. Meets the qualifications for licensure in s. 468.1695;
 1674  and
 1675         (b)1. Has successfully completed a national examination
 1676  which is substantially equivalent to, or more stringent than,
 1677  the examination given by the department;
 1678         2. Has passed an examination on the laws and rules of this
 1679  state governing the administration of nursing homes; and
 1680         3. Has worked as a fully licensed nursing home
 1681  administrator for 2 years within the 5-year period immediately
 1682  preceding the application by endorsement.
 1683         Section 30. Section 468.1745, Florida Statutes, is amended
 1684  to read:
 1685         468.1745 Prohibitions; penalties.—
 1686         (1) A No person may not shall:
 1687         (a) Practice nursing home administration unless the person
 1688  holds an active license to practice nursing home administration.
 1689         (b) Use the name or title “nursing home administrator” if
 1690  when the person has not been licensed pursuant to this part act.
 1691         (c) Present as his or her own the license of another.
 1692         (d) Give false or forged evidence to the board or a member
 1693  thereof for the purpose of obtaining a license.
 1694         (e) Use or attempt to use a nursing home administrator’s
 1695  license or an assisted living facility administrator’s license
 1696  that which has been suspended or revoked.
 1697         (f) Knowingly employ unlicensed persons in the practice of
 1698  nursing home administration or assisted living facility
 1699  administration.
 1700         (g) Knowingly conceal information relative to violations of
 1701  this part.
 1702         (h) Practice assisted living facility administration unless
 1703  the person holds an active license to practice assisted living
 1704  facility administration.
 1705         (i) Use the name or title “assisted living facility
 1706  administrator” if the person has not been licensed pursuant to
 1707  this part.
 1708         (2) Any person who violates the provisions of this section
 1709  is guilty of a misdemeanor of the second degree, punishable as
 1710  provided in s. 775.082 or s. 775.083.
 1711         Section 31. Section 468.1755, Florida Statutes, is amended
 1712  to read:
 1713         468.1755 Disciplinary proceedings.—
 1714         (1) The following acts constitute grounds for denial of a
 1715  nursing home administrator license, assisted living facility
 1716  administrator license, or disciplinary action, as specified in
 1717  s. 456.072(2):
 1718         (a) Violation of any provision of s. 456.072(1) or s.
 1719  468.1745(1).
 1720         (b) Attempting to procure a license to practice nursing
 1721  home administration or assisted living facility administration
 1722  by bribery, by fraudulent misrepresentation, or through an error
 1723  of the department or the board.
 1724         (c) Having a license to practice nursing home
 1725  administration or assisted living facility administration
 1726  revoked, suspended, or otherwise acted against, including the
 1727  denial of licensure, by the licensing authority of another
 1728  state, territory, or country.
 1729         (d) Being convicted or found guilty, regardless of
 1730  adjudication, of a crime in any jurisdiction which relates to
 1731  the practice of nursing home administration, assisted living
 1732  facility administration, or the ability to practice nursing home
 1733  administration or assisted living facility administration. Any
 1734  plea of nolo contendere shall be considered a conviction for
 1735  purposes of this part.
 1736         (e) Making or filing a report or record which the licensee
 1737  knows to be false, intentionally failing to file a report or
 1738  record required by state or federal law, willfully impeding or
 1739  obstructing such filing, or inducing another person to impede or
 1740  obstruct such filing. Such reports or records shall include only
 1741  those which are signed in the capacity of a licensed nursing
 1742  home administrator or licensed assisted living facility
 1743  administrator.
 1744         (f) Authorizing the discharge or transfer of a resident by
 1745  a nursing home administrator for a reason other than those
 1746  provided in ss. 400.022 and 400.0255.
 1747         (g) Advertising goods or services in a manner which is
 1748  fraudulent, false, deceptive, or misleading in form or content.
 1749         (h) Fraud or deceit, negligence, incompetence, or
 1750  misconduct in the practice of nursing home administration or
 1751  assisted living facility administration.
 1752         (i) Violation of a lawful order of the board or department
 1753  previously entered in a disciplinary hearing or failing to
 1754  comply with a lawfully issued subpoena of the board or
 1755  department.
 1756         (j) Practicing with a revoked, suspended, inactive, or
 1757  delinquent license.
 1758         (k) Repeatedly acting in a manner inconsistent with the
 1759  health, safety, or welfare of the patients of the facility in
 1760  which he or she is the administrator.
 1761         (l) Being unable to practice nursing home administration or
 1762  assisted living facility administration with reasonable skill
 1763  and safety to patients by reason of illness, drunkenness, use of
 1764  drugs, narcotics, chemicals, or any other material or substance
 1765  or as a result of any mental or physical condition. In enforcing
 1766  this paragraph, upon a finding of the State Surgeon General or
 1767  his or her designee that probable cause exists to believe that
 1768  the licensee is unable to serve as a nursing home administrator
 1769  or assisted living facility administrator due to the reasons
 1770  stated in this paragraph, the department shall have the
 1771  authority to issue an order to compel the licensee to submit to
 1772  a mental or physical examination by a physician designated by
 1773  the department. If the licensee refuses to comply with such
 1774  order, the department’s order directing such examination may be
 1775  enforced by filing a petition for enforcement in the circuit
 1776  court where the licensee resides or serves as a nursing home
 1777  administrator or assisted living facility administrator. The
 1778  licensee against whom the petition is filed shall not be named
 1779  or identified by initials in any public court records or
 1780  documents, and the proceedings shall be closed to the public.
 1781  The department shall be entitled to the summary procedure
 1782  provided in s. 51.011. A licensee affected under this paragraph
 1783  shall have the opportunity, at reasonable intervals, to
 1784  demonstrate that he or she can resume the competent practice of
 1785  nursing home administration or assisted living facility
 1786  administration with reasonable skill and safety to patients.
 1787         (m) Willfully or repeatedly violating any of the provisions
 1788  of the law, code, or rules of the licensing or supervising
 1789  authority or agency of the state or political subdivision
 1790  thereof having jurisdiction of the operation and licensing of
 1791  nursing homes or assisted living facilities.
 1792         (n) Paying, giving, causing to be paid or given, or
 1793  offering to pay or to give to any person a commission or other
 1794  valuable consideration for the solicitation or procurement,
 1795  either directly or indirectly, of nursing home usage or assisted
 1796  living facility usage, except as specifically authorized by law.
 1797         (o) Willfully permitting unauthorized disclosure of
 1798  information relating to a patient or his or her records.
 1799         (p) Discriminating with respect to patients, residents,
 1800  employees, or staff on account of race, religion, color, sex, or
 1801  national origin.
 1802         (q) Failing to implement an ongoing quality assurance
 1803  program by a nursing home administrator which is directed by an
 1804  interdisciplinary team that meets at least every other month.
 1805         (r) Violating any provision of this chapter or chapter 456,
 1806  or any rules adopted pursuant thereto.
 1807         (2) The board may enter an order denying nursing home
 1808  administrator licensure, assisted living facility administrator
 1809  licensure, or imposing any of the penalties in s. 456.072(2)
 1810  against any applicant for licensure or licensee who:
 1811         (a) Is found guilty of violating any provision of
 1812  subsection (1) of this section or who is found guilty of
 1813  violating any provision of s. 456.072(1).
 1814         (b) Has a controlling interest in or knowingly participates
 1815  in one or more violations at an assisted living facility or
 1816  nursing home which results in denial or revocation of an
 1817  assisted living facility license or nursing home license.
 1818         (c) Has a controlling interest in or knowingly operates an
 1819  unlicensed assisted living facility.
 1820         (3) The board shall revoke the license of an assisted
 1821  living facility administrator who knowingly participates in
 1822  intentional misconduct or engages in conduct that constitutes
 1823  gross negligence which contributes to the death of a resident.
 1824         (4)(3) The department shall reissue the license of a
 1825  disciplined licensee upon certification by the board that the
 1826  disciplined licensee has complied with all of the terms and
 1827  conditions set forth in the final order.
 1828         Section 32. Section 468.1756, Florida Statutes, is amended
 1829  to read:
 1830         468.1756 Statute of limitations.—An administrative
 1831  complaint may only be filed pursuant to s. 456.073 for an act
 1832  listed in s. 468.1755 s. 468.1755(1)(c)-(q) within 4 years after
 1833  from the time of the incident giving rise to the complaint, or
 1834  within 4 years after from the time the incident is discovered or
 1835  should have been discovered.
 1836         Section 33. Assisted living facility streamlining task
 1837  force.—
 1838         (1) The Agency for Health Care Administration shall create
 1839  a task force consisting of at least one representative of the
 1840  agency, the Department of Elderly Affairs, the Department of
 1841  Children and Family Services, the Department of Health, and the
 1842  Office of State Long-Term Care Ombudsman.
 1843         (2) The purpose of the task force is to determine whether
 1844  agencies currently have overlapping regulatory responsibilities
 1845  over assisted living facilities and whether increased efficiency
 1846  and effectiveness may be realized by transferring,
 1847  consolidating, eliminating, or modifying such oversight between
 1848  agencies.
 1849         (3) The task force shall meet at least three times and
 1850  submit a report to the Governor, the President of the Senate,
 1851  and the Speaker of the House of Representatives by January 1,
 1852  2013, which includes the task force’s findings and
 1853  recommendations pertaining to streamlining agency oversight and
 1854  improving the effectiveness of regulatory functions.
 1855         (4) The task force is terminated effective March 1, 2013.
 1856         Section 34. By January 1, 2013, the Agency for Health Care
 1857  Administration shall submit copies of all of its inspection
 1858  forms used to inspect assisted living facilities to the Office
 1859  of State Long-Term Care Ombudsman. The office shall create and
 1860  act as the chair of a task force of up to 11 members, consisting
 1861  of an ombudsman, one representative of a nonprofit assisted
 1862  living facility, one representative of a for-profit assisted
 1863  living facility, at least one resident or family member of a
 1864  resident, other stakeholders, and one representative of the
 1865  agency, the Department of Elderly Affairs, the Department of
 1866  Children and Family Services, and the Department of Health, to
 1867  review the inspection forms. The task force shall provide
 1868  recommendations, if any, to modify the forms in order to ensure
 1869  that inspections adequately assess whether the assisted living
 1870  facilities are in compliance with the law, meet the needs of
 1871  residents, and ensure resident safety. The task force must
 1872  provide its recommendations, including explanations of its
 1873  recommendations, to the agency within 90 days after receiving
 1874  the inspection forms. The task force is terminated July 1, 2013.
 1875         Section 35. Except as otherwise expressly provided in this
 1876  act, this act shall take effect July 1, 2012.
 1877  
 1878  ================= T I T L E  A M E N D M E N T ================
 1879         And the title is amended as follows:
 1880         Delete everything before the enacting clause
 1881  and insert:
 1882                        A bill to be entitled                      
 1883         An act relating to assisted living facilities;
 1884         amending s. 394.4574, F.S.; revising the duties of the
 1885         case manager for, and requirements relating to the
 1886         cooperative agreement and the community living support
 1887         plan of, a mental health resident of an assisted
 1888         living facility; amending s. 400.0078, F.S.; requiring
 1889         that residents of long-term care facilities be
 1890         informed about the confidentiality of the identity of
 1891         the complainant of a complaint received by the State
 1892         Long-Term Care Ombudsman Program; amending s.
 1893         415.1034, F.S.; adding certain employees or agents of
 1894         a state or local agency to the list of persons who
 1895         must report the known or suspected abuse of a
 1896         vulnerable adult to the abuse hotline; amending s.
 1897         429.02, F.S.; providing definitions for “board” and
 1898         “mental health surveyor”; amending s. 429.07, F.S.;
 1899         authorizing the waiver of certain monitoring
 1900         requirements under certain conditions; increasing the
 1901         biennial license fee required for a facility that has
 1902         certain violations within the 2 years preceding
 1903         license renewal; amending s. 429.075, F.S.; revising
 1904         the criteria preventing a licensed facility from
 1905         receiving a limited mental health license; providing
 1906         training requirements for administrators and staff
 1907         members of facilities that hold a limited mental
 1908         health license; requiring that a mental health
 1909         surveyor be part of the team inspecting a facility
 1910         that holds a limited mental health license; requiring
 1911         semiannual monitoring of the facility; providing for
 1912         an exception from semiannual monitoring; amending s.
 1913         429.14, F.S.; revising the conditions for mandatory
 1914         license denial or revocation; requiring the revocation
 1915         of a facility license for certain violations that
 1916         result in the death of a resident; amending s.
 1917         429.176, F.S.; requiring the licensure of facility
 1918         administrators; authorizing one administrator for
 1919         multiple facilities under certain conditions;
 1920         authorizing qualified facility managers during the
 1921         temporary absence of an administrator; amending s.
 1922         429.178, F.S.; revising training requirements for
 1923         staff who provide care for persons who have
 1924         Alzheimer’s disease and related disorders; amending s.
 1925         429.19, F.S.; conforming provisions to changes made by
 1926         the act; authorizing the Agency for Health Care
 1927         Administration to impose certain citations and fines
 1928         regardless of correction of a violation, an increased
 1929         fine for certain violations that result in the death
 1930         of a resident, and enhanced fines; creating s.
 1931         429.231, F.S.; creating an advisory council to review
 1932         unexpected deaths and elopements; providing for
 1933         membership and duties; amending s. 429.28, F.S.;
 1934         authorizing a resident to file a grievance with a
 1935         facility when a notice of relocation or termination of
 1936         residency has been received; requiring residents of
 1937         facilities to be informed about the confidentiality of
 1938         the identity of the resident and complainant of a
 1939         complaint made to the State Long-Term Care Ombudsman
 1940         Program; requiring the agency to conduct followup
 1941         inspections of facilities that have a history of
 1942         certain violations; providing that a facility that
 1943         terminates an individual’s residency will be fined if
 1944         good cause is not shown in court; creating s. 429.281,
 1945         F.S.; establishing procedures for a resident grievance
 1946         process upon notification of resident relocation or
 1947         termination of residency; amending s. 429.34, F.S.;
 1948         providing that the agency is designated as the central
 1949         agency for tracking facility complaints; specifying
 1950         timeframes for other state agencies to submit reports
 1951         to the agency; requiring the agency to have lead
 1952         surveyors who specialize in assessing facilities;
 1953         amending s. 429.41, F.S.; requiring the agency to
 1954         observe the elopement drills of a randomly selected
 1955         group of facilities; requiring the agency to conduct
 1956         an abbreviated biennial licensure inspection; amending
 1957         s. 429.49, F.S.; increasing the criminal penalty for
 1958         altering facility records; creating s. 429.515, F.S.;
 1959         requiring new facility employees to attend a
 1960         preservice orientation; providing requirements for
 1961         such orientation; amending s. 429.52, F.S.; revising
 1962         training, examination, and continuing education
 1963         requirements for facility staff, including
 1964         administrators; providing for the use of interactive
 1965         online tutorials; requiring the Department of Elderly
 1966         Affairs to develop training, examinations, and
 1967         tutorials; creating s. 429.522, F.S.; requiring
 1968         training providers to be certified by the Department
 1969         of Elderly Affairs and provide trainer oversight;
 1970         providing trainer requirements; requiring the
 1971         department to maintain an electronic database of
 1972         certified providers and persons who complete training
 1973         if funding is available; amending s. 429.54, F.S.;
 1974         requiring specified state agencies to have an
 1975         electronic system of communication pertaining to the
 1976         regulation of facilities; requiring facilities to
 1977         submit certain facility and resident information
 1978         electronically to the agency twice yearly; providing
 1979         for the maintenance and use of such information;
 1980         providing for expiration of this requirement; creating
 1981         s. 429.55, F.S.; directing the agency to establish an
 1982         online, user-friendly facility rating system that may
 1983         be accessed by the public; providing a directive to
 1984         the Division of Statutory Revision; amending s.
 1985         468.1635, F.S.; revising the purpose of part II of ch.
 1986         468, F.S., to include assisted living administrators;
 1987         amending s. 468.1645, F.S.; requiring assisted living
 1988         facilities to be operated under the management of a
 1989         licensed administrator; amending s. 468.1655, F.S.;
 1990         revising and providing definitions; amending s.
 1991         468.1665, F.S.; renaming the Board of Nursing Home
 1992         Administrators as the “Board of Long-Term Care
 1993         Administrators”; providing for membership; prohibiting
 1994         certain conflicts of interest with respect to board
 1995         members; amending s. 468.1685, F.S.; revising duties
 1996         of the board to include approving third-party
 1997         credentialing entities for the purpose of an assisted
 1998         living facility administrator certification program;
 1999         amending s. 468.1695, F.S.; providing for licensure of
 2000         assisted living facility administrators through
 2001         certification; providing licensure requirements;
 2002         establishing a maximum fee; amending s. 468.1705,
 2003         F.S., relating to licensure by endorsement; conforming
 2004         provisions to changes made by the act; amending s.
 2005         468.1745, F.S.; providing requirements for who must be
 2006         licensed as an assisted living facility administrator;
 2007         amending s. 468.1755, F.S.; conforming provisions to
 2008         changes made by the act; providing grounds for
 2009         disciplinary action for assisted living facility
 2010         administrators; amending s. 468.1756, F.S.; conforming
 2011         provisions to changes made by the act; requiring the
 2012         agency to create a task force to determine whether
 2013         state agencies have overlapping regulatory
 2014         jurisdiction over facilities and to submit findings
 2015         and recommendations to the Governor and Legislature by
 2016         a certain date; providing for termination; requiring
 2017         the Office of the State Long-Term Care Ombudsman to
 2018         create a task force to review the agency’s facility
 2019         inspection forms and to submit its recommendations to
 2020         the agency by a certain date; providing for
 2021         termination; providing effective dates.