HB 397

1
A bill to be entitled
2An act relating to assisted living facilities;
3creating the Florida Assisted Living Quality
4Improvement Initiative Pilot Project; providing
5purpose; providing definitions; limiting the pilot
6project to specified area offices of the Agency for
7Health Care Administration; providing for statewide
8expansion of the pilot program on December 31, 2017,
9unless repealed by the Legislature; providing criteria
10for participation in the pilot project; providing
11duties of the agency for implementation of the pilot
12project; requiring the agency to use an electronic
13data collection system for quality assurance;
14providing for establishment of a data collection
15workgroup and providing its duties; authorizing the
16agency to establish a fee for facilities that use the
17data collection system; providing system requirements;
18providing for establishment of a monitoring workgroup
19and providing its duties, including a report to the
20Governor and Legislature; providing for development,
21in collaboration with the Medicaid Fraud Unit, of an
22interagency task force to conduct investigations of
23certain facilities and revoke licenses, suspend
24payments, and relocate residents for substantial
25noncompliance or failure to provide adequate care;
26authorizing the agency to impose a fine for transfers
27or discharges from a hospital to an assisted living
28facility that do not meet certain standards; providing
29for development and implementation of a statewide
30administrator certification program; requiring an
31assisted living facility to employ a certified
32administrator as a condition for continued licensure;
33providing requirements for and limitations on
34certified administrators; requiring the administrator
35of a licensed facility that is eligible to participate
36in the pilot project to notify the agency when the
37facility enrolls in the pilot project; requiring each
38facility, before enrollment, to execute a memorandum
39of agreement that includes a provision authorizing the
40agency to terminate the facility's participation in
41the pilot project; prohibiting a facility from
42challenging or appealing the agency's decision under
43ch. 120, F.S.; providing for annual open enrollment;
44providing that a facility's enrollment in the pilot
45project does not prohibit the facility from seeking
46alternative accreditation; requiring the agency to
47establish quality improvement teams; providing for the
48composition and duties of a quality improvement team;
49providing conditions for a quality improvement team to
50terminate the operation of an assisted living
51facility; providing for the resumption of inspections
52by the agency if a facility's participation in the
53pilot project is terminated; requiring compliance with
54agency rules before an assisted living facility may be
55reenrolled in the pilot project; requiring the agency
56to approve or reject a facility's request for
57termination of participation in the pilot project;
58requiring that the facility be subject to survey,
59inspection, and monitoring visits by the agency;
60providing that reports and documents generated by a
61quality improvement team may not be used in certain
62tort actions; authorizing the Department of Elderly
63Affairs to adopt rules and impose fees and
64requirements for providers of core training; providing
65educational requirements for assisted living facility
66administrators; providing an effective date.
67
68Be It Enacted by the Legislature of the State of Florida:
69
70     Section 1.  Florida Assisted Living Quality Improvement
71Initiative Pilot Project.-
72     (1)  The Florida Assisted Living Quality Improvement
73Initiative Pilot Project is created to identify best practices
74for providing care to residents of licensed assisted living
75facilities, improve regulatory oversight and protection of
76residents, promote increased information sharing, collaboration,
77and implementation of best practices by frontline caregivers,
78and develop, in collaboration with the facility, a quality
79improvement plan to reduce the need for institutional care.
80     (2)  As used in this section, the term:
81     (a)  "Agency" means the Agency for Health Care
82Administration.
83     (b)  "Department" means the Department of Elderly Affairs.
84     (3)  The pilot project shall be limited to 150 facilities
85in each of agency areas 4, 5, 6, 8, and 11. The pilot project
86shall expand statewide on December 31, 2017, unless repealed by
87the Legislature. A facility is eligible to participate in the
88pilot project if the facility has not been cited for a class I
89or class II violation and has no more than five uncorrected
90class III violations on the prior two annual surveys and on any
91survey that resulted from a complaint.
92     (4)  To implement the pilot project, the agency shall,
93within funds appropriated:
94     (a)  Establish an enrollment process and a timeline for
95implementation of the pilot project.
96     (b)  Establish a method to measure facility improvement and
97collect data with respect to critical factors that affect
98quality of care and occupancy rates.
99     (c)  Use electronic means to collect data on facility
100quality assurance.
101     (d)  Establish a data collection workgroup to develop
102criteria for a request for proposal to implement a statewide
103data collection system. The request for proposal must specify
104the data elements that the data collection system must capture
105and how the data will be used to track quality of care and
106occupancy rates. The agency may reallocate funding within its
107budget to implement the system in the pilot project areas. An
108assisted living facility that receives Medicaid funding must use
109the data collection system. The agency may establish a fee for
110users of the data collection system. The agency shall require
111that the data collection system:
112     1.  Be compatible with changes in long-term care resulting
113from Medicaid reform enacted by the Federal Government.
114     2.  Permit user access from all parts of the system of care
115associated with licensed assisted living facilities that receive
116Medicaid funding.
117     3.  Permit frontline caregivers to collect defined data
118elements that indicate a change in a resident's condition and
119employ intuitive technology to forecast patient care needs and
120trends in facility quality improvement.
121     4.  Provide online training videos to improve the skills of
122frontline caregivers. A training provider may make online
123training material available via the statewide data collection
124system. Training shall be provided on a subscription basis and
125shall include online competency examinations for caregivers. The
126system shall verify the identity of the subscriber and the
127amount of time the subscriber participates in online training.
128This information shall be made available to the agency through
129electronic means.
130     5.  Include specialized training for staff who care for
131adults with mental illness, which shall include aggression
132control training, information regarding involuntary commitment
133procedures under the Baker Act, how to recognize a change in
134mental condition, use of psychiatric medications, how to manage
135difficult behaviors of adults with mental illness, and other
136training in services provided by the state mental health
137services delivery system.
138     6.  Include a technical interface between a mental health
139provider and an assisted living facility if the provider and the
140facility have established a cooperative agreement, as defined in
141s. 429.02(8), Florida Statutes. The interface shall permit a
142mental health case manager to review client information and care
143trends associated with residents of an assisted living facility.
144A case manager shall record any face-to-face contact with a
145resident and update the community living support plan in real
146time when changes are needed. The agency survey staff and the
147department shall have access to this information for agency
148monitoring purposes.
149     (e)  Establish a monitoring workgroup, to be comprised of
150representatives of state agencies that regulate assisted living
151facilities, owners of assisted living facilities, and other
152interested parties, to:
153     1.  Develop a request for information, establish
154requirements for certification, and approve proposed fees by
155July 1, 2013.
156     2.  Review survey forms, the inspection process, and how
157compliance is determined to ensure the safety and protection of
158residents who reside in a licensed assisted living facility.
159     3.  Develop a streamlined regulatory oversight system.
160     4.  Monitor the implementation of the pilot project.
161     5.  Propose specific changes to implement a cost-effective
162oversight system for assisted living facilities.
163     6.  Establish a plan that uses an abbreviated survey
164process to enable agency surveyors to concentrate on facilities
165that require greater oversight and that includes appropriately
166trained lead assisted living facility surveyors.
167     7.  Submit a report of its findings to the Governor, the
168President of the Senate, and the Speaker of the House of
169Representatives by January 1, 2013.
170     (f)  In collaboration with the Medicaid Fraud Control Unit,
171develop an interagency task force to investigate facilities that
172have failed to improve care for residents, are suspected of
173operating without a license, or have been subject to fines or
174other sanctions. The agency shall be the lead agency and shall
175schedule random onsite inspections of such facilities to
176evaluate compliance with assisted living facility standards and
177Medicaid rules. The task force may revoke a facility's license
178if substantial noncompliance is found. The task force may
179suspend payments to the facility and relocate residents who are
180not receiving appropriate care.
181     (g)  Review discharge plans for a patient who is being
182transferred from a hospital to an assisted living facility,
183require the hospital to complete a health assessment of the
184patient signed by a licensed health care professional prior to
185discharge, and provide a copy of the assessment to the
186administrator of the assisted living facility before the patient
187is discharged. The agency shall levy a $500 fine for each
188transfer or discharge from a hospital that fails to meet the
189requirements of this paragraph.
190     (h)  Work with private-sector providers of certification to
191develop and implement a statewide administrator certification
192program. Each certified assisted living facility administrator
193must pass a competency examination every 4 years and is
194responsible for renewing the certification. An assisted living
195facility must employ a certified administrator as a condition
196for continued licensure. A certified assisted living facility
197administrator may not supervise more than three facilities. The
198certification must be posted in a visible place in the facility.
199Each facility must have a certified administrator on call at all
200times.
201     (5)  The administrator of a licensed facility that is
202eligible to participate in the pilot project shall notify the
203agency when the facility agrees to enroll in the pilot project.
204Enrollment in the pilot project is voluntary but may be required
205if the agency determines that enrollment in the pilot project is
206necessary to improve the quality of care offered by the
207facility. The agency shall enroll the first 150 eligible
208facilities in each authorized agency area that seek enrollment.
209Before enrollment, each facility must execute a memorandum of
210agreement with the agency that includes a provision authorizing
211the agency to terminate the facility's participation in the
212pilot project at will. The agency's decision to terminate a
213facility's participation in the pilot project may not be
214challenged or appealed under chapter 120, Florida Statutes.
215     (6)  The open enrollment period to participate in the pilot
216project begins January 1 and ends March 1 each year. A
217facility's enrollment in the pilot project does not prohibit the
218facility from seeking alternative accreditation from a
219recognized health care accreditation organization, such as the
220Commission on Accreditation of Rehabilitative Facilities or the
221Joint Commission.
222     (7)  The agency, within funds appropriated by the
223Legislature, shall establish an assisted living facility quality
224improvement team in each pilot project area for the purpose of
225evaluating and improving the quality of facilities participating
226in the pilot project.
227     (a)  A quality improvement team shall include:
228     1.  An agency lead surveyor who has received training
229relating to the requirements for providing care to residents of
230an assisted living facility, who shall head the team.
231     2.  A quality improvement specialist who has professional
232expertise or a background in working with behavioral health
233needs or elder and aging needs.
234     3.  A registered nurse.
235     4.  A licensed dietician.
236     5.  If the facility being evaluated is an assisted living
237facility with a limited mental health license is being
238evaluated, a mental health professional.
239     (b)  A quality improvement team shall:
240     1.  Establish criteria for quality improvement plans, which
241shall include an evaluation of the plan based upon client access
242to adequate care, provision of personal services and support,
243adequate documentation and reporting of client information,
244supervision and training of the staff and residents, and
245compliance with physical plant and safety standards that promote
246independence and dignity for facility residents.
247     2.  Evaluate the progress of the facility in meeting the
248goals of the quality improvement plan.
249     3.  Conduct an annual assessment and followup visits as
250needed to monitor the progress of the facility in meeting the
251goals of the quality improvement plan.
252     4.  Consult with the owner and administrator of the
253facility in meeting plan requirements, create electronic systems
254to monitor compliance with agency rules, ensure that training
255standards established under s. 429.52, Florida Statutes, are
256met, and work to help ensure an adequate system of care that
257provides access to community-based services that would improve
258the care of the residents and the conditions in the facility.
259     5.  Maintain records of the assessments and ongoing efforts
260to assist the facility in meeting quality improvement goals.
261     6.  Use electronic means to capture data and generate
262reports relating to compliance with the quality improvement
263plan.
264     (8)  A quality improvement team may terminate a facility
265that has failed to meet the goals of the plan from the pilot
266project after reasonable efforts are made to seek cooperation
267and assistance from the owner and the administrator of the
268facility. If a facility is terminated under these conditions,
269the facility's participation in the pilot project is
270automatically terminated.
271     (9)  If a facility's participation in the pilot project is
272terminated, the quality improvement team shall notify the
273Division of Health Quality Assurance of the agency, and that
274facility shall be subject to the survey, inspection, and
275monitoring visits conducted under s. 408.811, Florida Statutes.
276The facility is not eligible to reenroll in the pilot project
277until the agency has certified that the facility is in
278substantial compliance with agency rules.
279     (10)  A facility may terminate its participation in the
280pilot project, and the agency shall require the facility to be
281subject to the survey, inspection, and monitoring visits
282conducted pursuant to s. 408.811, Florida Statutes. If such
283termination is sought, the facility administrator shall notify
284the agency area office in writing and specify the reasons the
285facility seeks to terminate its participation in the pilot
286project. The agency shall approve or reject the request under
287the terms and conditions of the memorandum of agreement
288completed by the facility before enrolling in the pilot project.
289     (11)  Reports and documents generated by a quality
290improvement team may not be used in any tort action sought
291against the licenseholder of an enrolled facility.
292     (12)  The Department of Elderly Affairs may adopt rules,
293impose fees, and provide requirements necessary to certify
294providers that seek to offer the assisted living facility staff
295core training. The department shall review the total number of
296hours required for completion of core training, which shall be
297at least 40 hours. The department may charge a fee for core
298training and revoke certification for core trainers that fail to
299meet requirements as established under department rule. Fees
300imposed under this subsection may not, in the aggregate, exceed
301the costs necessary to adequately administer the certification
302process for providers of core training.
303     (13)  An assisted living facility administrator must
304complete a minimum of 40 hours in the core training program,
305have a minimum of 5 years' administrative experience at a
306licensed assisted living facility, or have a 4-year
307baccalaureate degree from an accredited college or university.
308An administrator must obtain 8 hours of continuing education in
309areas that relate to the number and type of residents served at
310the assisted living facility. The administrator may enroll in
311online education courses or other accredited programs that offer
312continuing education units, class credits, or a department-
313approved curriculum by an assisted living core training
314provider.
315     Section 2.  This act shall take effect July 1, 2012.


CODING: Words stricken are deletions; words underlined are additions.