Florida Senate - 2019 SB 184
By Senator Book
32-00734B-19 2019184__
1 A bill to be entitled
2 An act relating to aging programs; transferring the
3 powers, duties, and functions of the Department of
4 Elderly Affairs relating to hospices, assisted living
5 facilities, adult family-care homes, and adult day
6 care centers to the Agency for Health Care
7 Administration; amending s. 20.41, F.S.; requiring the
8 department to provide certain documents and
9 information to the agency upon request; amending s.
10 20.42, F.S.; establishing that the agency is the lead
11 agency responsible for the regulation of hospices,
12 assisted living facilities, adult day care centers,
13 and adult family-care homes; amending ss. 400.605,
14 400.60501, 400.6095, 400.610, 429.02, 429.17, 429.23,
15 429.24, 429.255, 429.256, 429.27, 429.275, 429.31,
16 429.34, 429.41, 429.42, 429.52, 429.54, 429.63,
17 429.67, 429.71, 429.73, 429.75, 429.81, 429.929, and
18 765.110, F.S.; conforming provisions to changes made
19 by the act; providing an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. All powers, duties, functions, records,
24 personnel, property, salary rate, budget authority, and
25 administrative authority of the Department of Elderly Affairs
26 relating to hospices, assisted living facilities, adult family
27 care homes, and adult day care centers, and the administrative
28 rules in chapters 58A-2, 58A-5, 58A-6, and 58A-14, Florida
29 Administrative Code, are transferred by a type two transfer, as
30 defined in s. 20.06(2), Florida Statutes, to the Agency for
31 Health Care Administration.
32 Section 2. Subsection (9) is added to section 20.41,
33 Florida Statutes, to read:
34 20.41 Department of Elderly Affairs.—There is created a
35 Department of Elderly Affairs.
36 (9) Upon request, the department shall provide the Agency
37 for Health Care Administration with any documents and
38 information needed for the agency’s regulation of hospices,
39 assisted living facilities, adult family-care homes, and adult
40 day care centers.
41 Section 3. Subsection (3) of section 20.42, Florida
42 Statutes, is amended to read:
43 20.42 Agency for Health Care Administration.—
44 (3) The department shall be the chief health policy and
45 planning entity for the state. The department is responsible for
46 health facility licensure, inspection, and regulatory
47 enforcement; investigation of consumer complaints related to
48 health care facilities and managed care plans; the
49 implementation of the certificate of need program; the operation
50 of the Florida Center for Health Information and Transparency;
51 the administration of the Medicaid program; the administration
52 of the contracts with the Florida Healthy Kids Corporation; the
53 certification of health maintenance organizations and prepaid
54 health clinics as set forth in part III of chapter 641; and any
55 other duties prescribed by statute or agreement. The department
56 is the lead agency responsible for the regulation of hospices,
57 assisted living facilities, adult day care centers, and adult
58 family-care homes.
59 Section 4. Subsection (1) of section 400.605, Florida
60 Statutes, is amended to read:
61 400.605 Administration; forms; fees; rules; inspections;
62 fines.—
63 (1) The agency, in consultation with the department, may
64 adopt rules to administer the requirements of part II of chapter
65 408. The department, in consultation with the agency, shall by
66 rule establish minimum standards and procedures for a hospice
67 pursuant to this part. The rules must include:
68 (a) The qualifications of professional and ancillary
69 personnel to ensure the provision of appropriate and adequate
70 hospice care.
71 (b) Standards and procedures for the administrative
72 management of a hospice.
73 (c) Standards for hospice services that ensure the
74 provision of quality patient care.
75 (d) Components of a patient plan of care.
76 (e) Procedures relating to the implementation of advanced
77 directives and do-not-resuscitate orders.
78 (f) Procedures for maintaining and ensuring confidentiality
79 of patient records.
80 (g) Standards for hospice care provided in freestanding
81 inpatient facilities that are not otherwise licensed medical
82 facilities and in residential care facilities such as nursing
83 homes, assisted living facilities, adult family-care homes, and
84 hospice residential units and facilities.
85 (h) Components of a comprehensive emergency management
86 plan, developed in consultation with the Department of Health,
87 the Department of Elderly Affairs, and the Division of Emergency
88 Management.
89 (i) Standards and procedures relating to the establishment
90 and activities of a quality assurance and utilization review
91 committee.
92 (j) Components and procedures relating to the collection of
93 patient demographic data and other information on the provision
94 of hospice care in this state.
95 Section 5. Section 400.60501, Florida Statutes, is amended
96 to read:
97 400.60501 Outcome measures; adoption of federal quality
98 measures; public reporting; annual report.—
99 (1) No later than December 31, 2019, the department, in
100 conjunction with the agency, shall adopt the national hospice
101 outcome measures and survey data in 42 C.F.R. part 418 to
102 determine the quality and effectiveness of hospice care for
103 hospices licensed in the state.
104 (2) The department, in conjunction with The agency, shall:
105 (a) Make available to the public the national hospice
106 outcome measures and survey data in a format that is
107 comprehensible by a layperson and that allows a consumer to
108 compare such measures of one or more hospices.
109 (b) Develop an annual report that analyzes and evaluates
110 the information collected under this act and any other data
111 collection or reporting provisions of law.
112 Section 6. Subsection (8) of section 400.6095, Florida
113 Statutes, is amended to read:
114 400.6095 Patient admission; assessment; plan of care;
115 discharge; death.—
116 (8) The hospice care team may withhold or withdraw
117 cardiopulmonary resuscitation if presented with an order not to
118 resuscitate executed pursuant to s. 401.45. The agency
119 department shall adopt rules providing for the implementation of
120 such orders. Hospice staff shall not be subject to criminal
121 prosecution or civil liability, nor be considered to have
122 engaged in negligent or unprofessional conduct, for withholding
123 or withdrawing cardiopulmonary resuscitation pursuant to such an
124 order and applicable rules. The absence of an order to
125 resuscitate executed pursuant to s. 401.45 does not preclude a
126 physician from withholding or withdrawing cardiopulmonary
127 resuscitation as otherwise permitted by law.
128 Section 7. Paragraph (b) of subsection (1) of section
129 400.610, Florida Statutes, is amended to read:
130 400.610 Administration and management of a hospice.—
131 (1) A hospice shall have a clearly defined organized
132 governing body, consisting of a minimum of seven persons who are
133 representative of the general population of the community
134 served. The governing body shall have autonomous authority and
135 responsibility for the operation of the hospice and shall meet
136 at least quarterly. The governing body shall:
137 (b)1. Prepare and maintain a comprehensive emergency
138 management plan that provides for continuing hospice services in
139 the event of an emergency that is consistent with local special
140 needs plans. The plan shall include provisions for ensuring
141 continuing care to hospice patients who go to special needs
142 shelters. The plan shall include the means by which the hospice
143 provider will continue to provide staff to provide the same type
144 and quantity of services to their patients who evacuate to
145 special needs shelters which were being provided to those
146 patients prior to evacuation. The plan is subject to review and
147 approval by the county health department, except as provided in
148 subparagraph 2. During its review, the county health department
149 shall contact state and local health and medical stakeholders
150 when necessary. The county health department shall complete its
151 review to ensure that the plan complies with criteria in rules
152 of the agency Department of Elderly Affairs within 90 days after
153 receipt of the plan and shall either approve the plan or advise
154 the hospice of necessary revisions. Hospice providers may
155 establish links to local emergency operations centers to
156 determine a mechanism by which to approach specific areas within
157 a disaster area in order for the provider to reach its clients.
158 A hospice shall demonstrate a good faith effort to comply with
159 the requirements of this paragraph by documenting attempts of
160 staff to follow procedures as outlined in the hospice’s
161 comprehensive emergency management plan and to provide
162 continuing care for those hospice clients who have been
163 identified as needing alternative caregiver services in the
164 event of an emergency.
165 2. For any hospice that operates in more than one county,
166 the Department of Health during its review shall contact state
167 and local health and medical stakeholders when necessary. The
168 Department of Health shall complete its review to ensure that
169 the plan complies with criteria in rules of the agency
170 Department of Elderly Affairs within 90 days after receipt of
171 the plan and shall approve the plan or advise the hospice of
172 necessary revisions. The Department of Health shall make every
173 effort to avoid imposing differing requirements on a hospice
174 that operates in more than one county as a result of differing
175 or conflicting comprehensive plan requirements of the counties
176 in which the hospice operates.
177 Section 8. Subsections (13) and (17) of section 429.02,
178 Florida Statutes, are amended to read:
179 429.02 Definitions.—When used in this part, the term:
180 (13) “Limited nursing services” means acts that may be
181 performed by a person licensed under part I of chapter 464.
182 Limited nursing services shall be for persons who meet the
183 admission criteria established by the agency department for
184 assisted living facilities but are and shall not be complex
185 enough to require 24-hour nursing supervision and may include
186 such services as the application and care of routine dressings,
187 and care of casts, braces, and splints.
188 (17) “Personal services” means direct physical assistance
189 with or supervision of the activities of daily living, the self
190 administration of medication, or other similar services that
191 which the agency department may define by rule. The term may not
192 be construed to mean the provision of medical, nursing, dental,
193 or mental health services.
194 Section 9. Subsection (6) of section 429.17, Florida
195 Statutes, is amended to read:
196 429.17 Expiration of license; renewal; conditional
197 license.—
198 (6) The agency department may by rule establish renewal
199 procedures, identify forms, and specify documentation necessary
200 to administer this section and. The agency, in consultation with
201 the department, may adopt rules to administer the requirements
202 of part II of chapter 408.
203 Section 10. Subsection (10) of section 429.23, Florida
204 Statutes, is amended to read:
205 429.23 Internal risk management and quality assurance
206 program; adverse incidents and reporting requirements.—
207 (10) The agency Department of Elderly Affairs may adopt
208 rules necessary to administer this section.
209 Section 11. Subsection (8) of section 429.24, Florida
210 Statutes, is amended to read:
211 429.24 Contracts.—
212 (8) The agency department may by rule clarify terms,
213 establish procedures, clarify refund policies and contract
214 provisions, and specify documentation as necessary to administer
215 this section.
216 Section 12. Subsections (4) and (5) of section 429.255,
217 Florida Statutes, are amended to read:
218 429.255 Use of personnel; emergency care.—
219 (4) Facility staff may withhold or withdraw cardiopulmonary
220 resuscitation or the use of an automated external defibrillator
221 if presented with an order not to resuscitate executed pursuant
222 to s. 401.45. The agency department shall adopt rules providing
223 for the implementation of such orders. Facility staff and
224 facilities may shall not be subject to criminal prosecution or
225 civil liability, nor be considered to have engaged in negligent
226 or unprofessional conduct, for withholding or withdrawing
227 cardiopulmonary resuscitation or use of an automated external
228 defibrillator pursuant to such an order and rules adopted by the
229 agency department. The absence of an order to resuscitate
230 executed pursuant to s. 401.45 does not preclude a physician
231 from withholding or withdrawing cardiopulmonary resuscitation or
232 use of an automated external defibrillator as otherwise
233 permitted by law.
234 (5) The agency Department of Elderly Affairs may adopt
235 rules to implement the provisions of this section relating to
236 use of an automated external defibrillator.
237 Section 13. Subsection (6) of section 429.256, Florida
238 Statutes, is amended to read:
239 429.256 Assistance with self-administration of medication.—
240 (6) The agency department may by rule establish facility
241 procedures and interpret terms as necessary to implement this
242 section.
243 Section 14. Subsection (8) of section 429.27, Florida
244 Statutes, is amended to read:
245 429.27 Property and personal affairs of residents.—
246 (8) The agency department may by rule clarify terms and
247 specify procedures and documentation necessary to administer the
248 provisions of this section relating to the proper management of
249 residents’ funds and personal property and the execution of
250 surety bonds.
251 Section 15. Subsection (4) of section 429.275, Florida
252 Statutes, is amended to read:
253 429.275 Business practice; personnel records; liability
254 insurance.—The assisted living facility shall be administered on
255 a sound financial basis that is consistent with good business
256 practices.
257 (4) The agency department may by rule clarify terms,
258 establish requirements for financial records, accounting
259 procedures, personnel procedures, insurance coverage, and
260 reporting procedures, and specify documentation as necessary to
261 implement the requirements of this section.
262 Section 16. Subsection (2) of section 429.31, Florida
263 Statutes, is amended to read:
264 429.31 Closing of facility; notice; penalty.—
265 (2) Immediately upon the notice by the agency of the
266 voluntary or involuntary termination of such operation, the
267 agency shall monitor the transfer of residents to other
268 facilities and ensure that residents’ rights are being
269 protected. The agency department, in consultation with the
270 Department of Children and Families, shall specify procedures
271 for ensuring that all residents who receive services are
272 appropriately relocated.
273 Section 17. Subsection (1) of section 429.34, Florida
274 Statutes, is amended to read:
275 429.34 Right of entry and inspection.—
276 (1) In addition to the requirements of s. 408.811, a duly
277 designated officer or employee of the agency department, of the
278 Department of Children and Families, of the Medicaid Fraud
279 Control Unit of the Office of the Attorney General, or of the
280 state or local fire marshal, or a representative of the State
281 Long-Term Care Ombudsman Program or a member of the state or
282 local long-term care ombudsman council has the right to enter
283 unannounced upon and into the premises of any facility licensed
284 under this part in order to determine the state of compliance
285 with this part, part II of chapter 408, and applicable rules.
286 Data collected by the State Long-Term Care Ombudsman Program,
287 local long-term care ombudsman councils, or the state or local
288 advocacy councils may be used by the agency in investigations
289 involving violations of regulatory standards. A person specified
290 in this section who knows or has reasonable cause to suspect
291 that a vulnerable adult has been or is being abused, neglected,
292 or exploited shall immediately report such knowledge or
293 suspicion to the central abuse hotline pursuant to chapter 415.
294 Section 18. Section 429.41, Florida Statutes, is amended to
295 read:
296 429.41 Rules establishing standards.—
297 (1) It is the intent of the Legislature that rules
298 published and enforced pursuant to this section shall include
299 criteria by which a reasonable and consistent quality of
300 resident care and quality of life may be ensured and the results
301 of such resident care may be demonstrated. Such rules shall also
302 ensure a safe and sanitary environment that is residential and
303 noninstitutional in design or nature. It is further intended
304 that reasonable efforts be made to accommodate the needs and
305 preferences of residents to enhance the quality of life in a
306 facility. Uniform firesafety standards for assisted living
307 facilities shall be established by the State Fire Marshal
308 pursuant to s. 633.206. The agency, in consultation with the
309 department, may adopt rules to administer the requirements of
310 part II of chapter 408. In order to provide safe and sanitary
311 facilities and the highest quality of resident care
312 accommodating the needs and preferences of residents, the agency
313 department, in consultation with the agency, the Department of
314 Children and Families, and the Department of Health, shall adopt
315 rules, policies, and procedures to administer this part, which
316 must include reasonable and fair minimum standards in relation
317 to:
318 (a) The requirements for and maintenance of facilities, not
319 in conflict with chapter 553, relating to plumbing, heating,
320 cooling, lighting, ventilation, living space, and other housing
321 conditions, which will ensure the health, safety, and comfort of
322 residents suitable to the size of the structure.
323 1. Firesafety evacuation capability determination.—An
324 evacuation capability evaluation for initial licensure shall be
325 conducted within 6 months after the date of licensure.
326 2. Firesafety requirements.—
327 a. The National Fire Protection Association, Life Safety
328 Code, NFPA 101 and 101A, current editions, shall be used in
329 determining the uniform firesafety code adopted by the State
330 Fire Marshal for assisted living facilities, pursuant to s.
331 633.206.
332 b. A local government or a utility may charge fees only in
333 an amount not to exceed the actual expenses incurred by the
334 local government or the utility relating to the installation and
335 maintenance of an automatic fire sprinkler system in a licensed
336 assisted living facility structure.
337 c. All licensed facilities must have an annual fire
338 inspection conducted by the local fire marshal or authority
339 having jurisdiction.
340 d. An assisted living facility that is issued a building
341 permit or certificate of occupancy before July 1, 2016, may at
342 its option and after notifying the authority having
343 jurisdiction, remain under the provisions of the 1994 and 1995
344 editions of the National Fire Protection Association, Life
345 Safety Code, NFPA 101, and NFPA 101A. The facility opting to
346 remain under such provisions may make repairs, modernizations,
347 renovations, or additions to, or rehabilitate, the facility in
348 compliance with NFPA 101, 1994 edition, and may utilize the
349 alternative approaches to life safety in compliance with NFPA
350 101A, 1995 edition. However, a facility for which a building
351 permit or certificate of occupancy is issued before July 1,
352 2016, that undergoes Level III building alteration or
353 rehabilitation, as defined in the Florida Building Code, or
354 seeks to utilize features not authorized under the 1994 or 1995
355 editions of the Life Safety Code must thereafter comply with all
356 aspects of the uniform firesafety standards established under s.
357 633.206, and the Florida Fire Prevention Code, in effect for
358 assisted living facilities as adopted by the State Fire Marshal.
359 3. Resident elopement requirements.—Facilities are required
360 to conduct a minimum of two resident elopement prevention and
361 response drills per year. All administrators and direct care
362 staff must participate in the drills, which shall include a
363 review of procedures to address resident elopement. Facilities
364 must document the implementation of the drills and ensure that
365 the drills are conducted in a manner consistent with the
366 facility’s resident elopement policies and procedures.
367 (b) The preparation and annual update of a comprehensive
368 emergency management plan. Such standards must be included in
369 the rules adopted by the agency department after consultation
370 with the Division of Emergency Management. At a minimum, the
371 rules must provide for plan components that address emergency
372 evacuation transportation; adequate sheltering arrangements;
373 postdisaster activities, including provision of emergency power,
374 food, and water; postdisaster transportation; supplies;
375 staffing; emergency equipment; individual identification of
376 residents and transfer of records; communication with families;
377 and responses to family inquiries. The comprehensive emergency
378 management plan is subject to review and approval by the local
379 emergency management agency. During its review, the local
380 emergency management agency shall ensure that the following
381 agencies, at a minimum, are given the opportunity to review the
382 plan: the Department of Elderly Affairs, the Department of
383 Health, the Agency for Health Care Administration, and the
384 Division of Emergency Management. Also, appropriate volunteer
385 organizations must be given the opportunity to review the plan.
386 The local emergency management agency shall complete its review
387 within 60 days and either approve the plan or advise the
388 facility of necessary revisions.
389 (c) The number, training, and qualifications of all
390 personnel having responsibility for the care of residents. The
391 rules must require adequate staff to provide for the safety of
392 all residents. Facilities licensed for 17 or more residents are
393 required to maintain an alert staff for 24 hours per day.
394 (d) All sanitary conditions within the facility and its
395 surroundings which will ensure the health and comfort of
396 residents. The rules must clearly delineate the responsibilities
397 of the agency’s licensure and survey staff, the county health
398 departments, and the local authority having jurisdiction over
399 firesafety and ensure that inspections are not duplicative. The
400 agency may collect fees for food service inspections conducted
401 by the county health departments and transfer such fees to the
402 Department of Health.
403 (e) License application and license renewal, transfer of
404 ownership, proper management of resident funds and personal
405 property, surety bonds, resident contracts, refund policies,
406 financial ability to operate, and facility and staff records.
407 (f) Inspections, complaint investigations, moratoriums,
408 classification of deficiencies, levying and enforcement of
409 penalties, and use of income from fees and fines.
410 (g) The enforcement of the resident bill of rights
411 specified in s. 429.28.
412 (h) The care and maintenance of residents, which must
413 include, but is not limited to:
414 1. The supervision of residents;
415 2. The provision of personal services;
416 3. The provision of, or arrangement for, social and leisure
417 activities;
418 4. The arrangement for appointments and transportation to
419 appropriate medical, dental, nursing, or mental health services,
420 as needed by residents;
421 5. The management of medication;
422 6. The nutritional needs of residents;
423 7. Resident records; and
424 8. Internal risk management and quality assurance.
425 (i) Facilities holding a limited nursing, extended
426 congregate care, or limited mental health license.
427 (j) The establishment of specific criteria to define
428 appropriateness of resident admission and continued residency in
429 a facility holding a standard, limited nursing, extended
430 congregate care, and limited mental health license.
431 (k) The use of physical or chemical restraints. The use of
432 physical restraints is limited to half-bed rails as prescribed
433 and documented by the resident’s physician with the consent of
434 the resident or, if applicable, the resident’s representative or
435 designee or the resident’s surrogate, guardian, or attorney in
436 fact. The use of chemical restraints is limited to prescribed
437 dosages of medications authorized by the resident’s physician
438 and must be consistent with the resident’s diagnosis. Residents
439 who are receiving medications that can serve as chemical
440 restraints must be evaluated by their physician at least
441 annually to assess:
442 1. The continued need for the medication.
443 2. The level of the medication in the resident’s blood.
444 3. The need for adjustments in the prescription.
445 (l) The establishment of specific policies and procedures
446 on resident elopement. Facilities shall conduct a minimum of two
447 resident elopement drills each year. All administrators and
448 direct care staff shall participate in the drills. Facilities
449 shall document the drills.
450 (2) In adopting any rules pursuant to this part, the
451 department, in conjunction with the agency, shall make distinct
452 standards for facilities based upon facility size; the types of
453 care provided; the physical and mental capabilities and needs of
454 residents; the type, frequency, and amount of services and care
455 offered; and the staffing characteristics of the facility. Rules
456 developed pursuant to this section may not restrict the use of
457 shared staffing and shared programming in facilities that are
458 part of retirement communities that provide multiple levels of
459 care and otherwise meet the requirements of law and rule. If a
460 continuing care facility licensed under chapter 651 or a
461 retirement community offering multiple levels of care licenses a
462 building or part of a building designated for independent living
463 for assisted living, staffing requirements established in rule
464 apply only to residents who receive personal, limited nursing,
465 or extended congregate care services under this part. Such
466 facilities shall retain a log listing the names and unit number
467 for residents receiving these services. The log must be
468 available to surveyors upon request. Except for uniform
469 firesafety standards, the agency department shall adopt by rule
470 separate and distinct standards for facilities with 16 or fewer
471 beds and for facilities with 17 or more beds. The standards for
472 facilities with 16 or fewer beds must be appropriate for a
473 noninstitutional residential environment; however, the structure
474 may not be more than two stories in height and all persons who
475 cannot exit the facility unassisted in an emergency must reside
476 on the first floor. The department, in conjunction with the
477 agency, may make other distinctions among types of facilities as
478 necessary to enforce this part. Where appropriate, the agency
479 shall offer alternate solutions for complying with established
480 standards, based on distinctions made by the department and the
481 agency relative to the physical characteristics of facilities
482 and the types of care offered.
483 (3) The department shall submit a copy of proposed rules to
484 the Speaker of the House of Representatives, the President of
485 the Senate, and appropriate committees of substance for review
486 and comment prior to the promulgation thereof. Rules adopted
487 promulgated by the agency department shall encourage the
488 development of homelike facilities that which promote the
489 dignity, individuality, personal strengths, and decisionmaking
490 ability of residents.
491 (4) The agency, in consultation with the department, may
492 waive rules adopted under promulgated pursuant to this part in
493 order to demonstrate and evaluate innovative or cost-effective
494 congregate care alternatives that which enable individuals to
495 age in place. Such waivers may be granted only in instances
496 where there is reasonable assurance that the health, safety, or
497 welfare of residents will not be endangered. To apply for a
498 waiver, the licensee shall submit to the agency a written
499 description of the concept to be demonstrated, including goals,
500 objectives, and anticipated benefits; the number and types of
501 residents who will be affected, if applicable; a brief
502 description of how the demonstration will be evaluated; and any
503 other information deemed appropriate by the agency. Any facility
504 granted a waiver shall submit a report of findings to the agency
505 and the department within 12 months. At such time, the agency
506 may renew or revoke the waiver or pursue any regulatory or
507 statutory changes necessary to allow other facilities to adopt
508 the same practices. The agency department may by rule clarify
509 terms and establish waiver application procedures, criteria for
510 reviewing waiver proposals, and procedures for reporting
511 findings, as necessary to implement this subsection.
512 (5) The agency may use an abbreviated biennial standard
513 licensure inspection that consists of a review of key quality
514 of-care standards in lieu of a full inspection in a facility
515 that has a good record of past performance. However, a full
516 inspection must be conducted in a facility that has a history of
517 class I or class II violations, uncorrected class III
518 violations, confirmed ombudsman council complaints, or confirmed
519 licensure complaints, within the previous licensure period
520 immediately preceding the inspection or if a potentially serious
521 problem is identified during the abbreviated inspection. The
522 agency, in consultation with the department, shall develop the
523 key quality-of-care standards with input from the State Long
524 Term Care Ombudsman Council and representatives of provider
525 groups for incorporation into its rules.
526 Section 19. Subsection (4) of section 429.42, Florida
527 Statutes, is amended to read:
528 429.42 Pharmacy and dietary services.—
529 (4) The agency department may by rule establish procedures
530 and specify documentation as necessary to implement this
531 section.
532 Section 20. Subsections (2), (3), (4), and (6) through (12)
533 of section 429.52, Florida Statutes, are amended to read:
534 429.52 Staff training and educational programs; core
535 educational requirement.—
536 (2) Administrators and other assisted living facility staff
537 must meet minimum training and education requirements
538 established by the agency Department of Elderly Affairs by rule.
539 This training and education is intended to assist facilities to
540 appropriately respond to the needs of residents, to maintain
541 resident care and facility standards, and to meet licensure
542 requirements.
543 (3) The agency, in conjunction with providers, department
544 shall develop establish a competency test and a minimum required
545 score to indicate successful completion of the training and
546 educational requirements. The competency test must be developed
547 by the department in conjunction with the agency and providers.
548 The required training and education must cover at least the
549 following topics:
550 (a) State law and rules relating to assisted living
551 facilities.
552 (b) Resident rights and identifying and reporting abuse,
553 neglect, and exploitation.
554 (c) Special needs of elderly persons, persons with mental
555 illness, and persons with developmental disabilities and how to
556 meet those needs.
557 (d) Nutrition and food service, including acceptable
558 sanitation practices for preparing, storing, and serving food.
559 (e) Medication management, recordkeeping, and proper
560 techniques for assisting residents with self-administered
561 medication.
562 (f) Firesafety requirements, including fire evacuation
563 drill procedures and other emergency procedures.
564 (g) Care of persons with Alzheimer’s disease and related
565 disorders.
566 (4) A new facility administrator must complete the required
567 training and education, including the competency test, within 90
568 days after date of employment as an administrator. Failure to do
569 so is a violation of this part and subjects the violator to an
570 administrative fine as prescribed in s. 429.19. Administrators
571 licensed in accordance with part II of chapter 468 are exempt
572 from this requirement. Other licensed professionals may be
573 exempted, as determined by the agency department by rule.
574 (6) Staff involved with the management of medications and
575 assisting with the self-administration of medications under s.
576 429.256 must complete a minimum of 6 additional hours of
577 training provided by a registered nurse, a licensed pharmacist,
578 or agency department staff. The agency department shall
579 establish by rule the minimum requirements of this additional
580 training.
581 (7) Other facility staff shall participate in training
582 relevant to their job duties as specified by rule of the agency
583 department.
584 (8) If the department or the agency determines that there
585 are problems in a facility which that could be reduced through
586 specific staff training or education beyond that already
587 required under this section, the department or the agency may
588 require, and provide, or cause to be provided, the training or
589 education of any personal care staff in the facility.
590 (9) The agency department shall adopt rules related to
591 these training requirements, the competency test, necessary
592 procedures, and competency test fees and shall adopt or contract
593 with another entity to develop a curriculum, which shall be used
594 as the minimum core training requirements. The agency department
595 shall consult with representatives of stakeholder associations
596 and agencies in the development of the curriculum.
597 (10) The training required by this section other than the
598 preservice orientation must be conducted by persons registered
599 with the agency department as having the requisite experience
600 and credentials to conduct the training. A person seeking to
601 register as a trainer must provide the agency department with
602 proof of completion of the minimum core training education
603 requirements, successful passage of the competency test
604 established under this section, and proof of compliance with the
605 continuing education requirement in subsection (5).
606 (11) A person seeking to register as a trainer must also:
607 (a) Provide proof of completion of a 4-year degree from an
608 accredited college or university and must have worked in a
609 management position in an assisted living facility for 3 years
610 after being core certified;
611 (b) Have worked in a management position in an assisted
612 living facility for 5 years after being core certified and have
613 1 year of teaching experience as an educator or staff trainer
614 for persons who work in assisted living facilities or other
615 long-term care settings;
616 (c) Have been previously employed as a core trainer for the
617 agency or department; or
618 (d) Meet other qualification criteria as defined in rule,
619 which the agency department is authorized to adopt.
620 (12) The agency department shall adopt rules to establish
621 trainer registration requirements.
622 Section 21. Section 429.54, Florida Statutes, is amended to
623 read:
624 429.54 Collection of information; local subsidy.—
625 (1) To enable the agency department to collect the
626 information requested by the Legislature regarding the actual
627 cost of providing room, board, and personal care in facilities,
628 the agency department is authorized to conduct field visits and
629 audits of facilities as may be necessary. The owners of randomly
630 sampled facilities shall submit such reports, audits, and
631 accountings of cost as the agency department may require by
632 rule; provided that such reports, audits, and accountings shall
633 be the minimum necessary to implement the provisions of this
634 section. Any facility selected to participate in the study shall
635 cooperate with the agency department by providing cost of
636 operation information to interviewers.
637 (2) Local governments or organizations may contribute to
638 the cost of care of local facility residents by further
639 subsidizing the rate of state-authorized payment to such
640 facilities. Implementation of local subsidy requires agency
641 shall require departmental approval and may shall not result in
642 reductions in the state supplement.
643 Section 22. Subsections (4) and (5) of section 429.63,
644 Florida Statutes, are amended to read:
645 429.63 Legislative intent; purpose.—
646 (4) The Legislature further finds and declares that
647 licensure under this part is a public trust and a privilege, and
648 not an entitlement. This principle must guide the finder of fact
649 or trier of law at any administrative proceeding or circuit
650 court action initiated by the agency department to enforce this
651 part.
652 (5) Rules of the agency department relating to adult
653 family-care homes shall be as minimal and flexible as possible
654 to ensure the protection of residents while minimizing the
655 obstacles that could inhibit the establishment of adult family
656 care homes.
657 Section 23. Subsections (9), (10), and (11) of section
658 429.67, Florida Statutes, are amended to read:
659 429.67 Licensure.—
660 (9) In addition to the license categories available in s.
661 408.808, the agency may issue a conditional license to a
662 provider for the purpose of bringing the adult family-care home
663 into compliance with licensure requirements. A conditional
664 license must be limited to a specific period, not exceeding 6
665 months. The agency department shall, by rule, establish criteria
666 for issuing conditional licenses.
667 (10) The agency department may adopt rules to establish
668 procedures, identify forms, specify documentation, and clarify
669 terms, as necessary, to administer this section.
670 (11) The agency may adopt rules to administer the
671 requirements of part II of chapter 408.
672 Section 24. Subsection (6) of section 429.71, Florida
673 Statutes, is amended to read:
674 429.71 Classification of deficiencies; administrative
675 fines.—
676 (6) The agency shall establish department shall set forth,
677 by rule, notice requirements and procedures for correction of
678 deficiencies.
679 Section 25. Section 429.73, Florida Statutes, is amended to
680 read:
681 429.73 Rules and standards relating to adult family-care
682 homes.—
683 (1) The agency, in consultation with the department, may
684 adopt rules to administer the requirements of part II of chapter
685 408. The department, in consultation with the Department of
686 Health and, the Department of Children and Families, and the
687 agency shall, by rule, establish by rule minimum standards to
688 ensure the health, safety, and well-being of each resident in
689 the adult family-care home pursuant to this part. The rules must
690 address:
691 (a) Requirements for the physical site of the facility and
692 facility maintenance.
693 (b) Services that must be provided to all residents of an
694 adult family-care home and standards for such services, which
695 must include, but need not be limited to:
696 1. Room and board.
697 2. Assistance necessary to perform the activities of daily
698 living.
699 3. Assistance necessary to administer medication.
700 4. Supervision of residents.
701 5. Health monitoring.
702 6. Social and leisure activities.
703 (c) Standards and procedures for license application and
704 annual license renewal, advertising, proper management of each
705 resident’s funds and personal property and personal affairs,
706 financial ability to operate, medication management,
707 inspections, complaint investigations, and facility, staff, and
708 resident records.
709 (d) Qualifications, training, standards, and
710 responsibilities for providers and staff.
711 (e) Compliance with chapter 419, relating to community
712 residential homes.
713 (f) Criteria and procedures for determining the
714 appropriateness of a resident’s placement and continued
715 residency in an adult family-care home. A resident who requires
716 24-hour nursing supervision may not be retained in an adult
717 family-care home unless such resident is an enrolled hospice
718 patient and the resident’s continued residency is mutually
719 agreeable to the resident and the provider.
720 (g) Procedures for providing notice and assuring the least
721 possible disruption of residents’ lives when residents are
722 relocated, an adult family-care home is closed, or the ownership
723 of an adult family-care home is transferred.
724 (h) Procedures to protect the residents’ rights as provided
725 in s. 429.85.
726 (i) Procedures to promote the growth of adult family-care
727 homes as a component of a long-term care system.
728 (j) Procedures to promote the goal of aging in place for
729 residents of adult family-care homes.
730 (2) The agency department shall by rule provide by rule
731 minimum standards and procedures for emergencies. Pursuant to s.
732 633.206, the State Fire Marshal, in consultation with the
733 department and the agency, shall adopt uniform firesafety
734 standards for adult family-care homes.
735 (3) The agency department shall adopt rules providing for
736 the implementation of orders not to resuscitate. The provider
737 may withhold or withdraw cardiopulmonary resuscitation if
738 presented with an order not to resuscitate executed pursuant to
739 s. 401.45. The provider shall not be subject to criminal
740 prosecution or civil liability, nor be considered to have
741 engaged in negligent or unprofessional conduct, for withholding
742 or withdrawing cardiopulmonary resuscitation pursuant to such an
743 order and applicable rules.
744 Section 26. Subsections (3), (4), and (5) of section
745 429.75, Florida Statutes, are amended to read:
746 429.75 Training and education programs.—
747 (3) Providers must complete the training and education
748 program within a reasonable time determined by the agency
749 department. Failure to complete the training and education
750 program within the time set by the agency department is a
751 violation of this part and subjects the provider to revocation
752 of the license.
753 (4) If the Department of Children and Families or, the
754 agency, or the department determines that there are problems in
755 an adult family-care home which could be reduced through
756 specific training or education beyond that required under this
757 section, the agency may require the provider or staff to
758 complete such training or education.
759 (5) The agency department may adopt rules as necessary to
760 administer this section.
761 Section 27. Subsection (2) of section 429.81, Florida
762 Statutes, is amended to read:
763 429.81 Residency agreements.—
764 (2) Each residency agreement must specify the personal care
765 and accommodations to be provided by the adult family-care home,
766 the rates or charges, a requirement of at least 30 days’ notice
767 before a rate increase, and any other provisions required by
768 rule of the agency department.
769 Section 28. Section 429.929, Florida Statutes, is amended
770 to read:
771 429.929 Rules establishing standards.—
772 (1) The agency, in consultation with the department, may
773 adopt rules to administer the requirements of part II of chapter
774 408. The Department of Elderly Affairs, in conjunction with the
775 agency, shall adopt rules to implement the provisions of this
776 part. The rules must include reasonable and fair standards. Any
777 conflict between these standards and those that may be set forth
778 in local, county, or municipal ordinances shall be resolved in
779 favor of those having statewide effect. Such standards must
780 relate to:
781 (a) The maintenance of adult day care centers with respect
782 to plumbing, heating, lighting, ventilation, and other building
783 conditions, including adequate meeting space, to ensure the
784 health, safety, and comfort of participants and protection from
785 fire hazard. Such standards may not conflict with chapter 553
786 and must be based upon the size of the structure and the number
787 of participants.
788 (b) The number and qualifications of all personnel employed
789 by adult day care centers who have responsibilities for the care
790 of participants.
791 (c) All sanitary conditions within adult day care centers
792 and their surroundings, including water supply, sewage disposal,
793 food handling, and general hygiene, and maintenance of sanitary
794 conditions, to ensure the health and comfort of participants.
795 (d) Basic services provided by adult day care centers.
796 (e) Supportive and optional services provided by adult day
797 care centers.
798 (f) Data and information relative to participants and
799 programs of adult day care centers, including, but not limited
800 to, the physical and mental capabilities and needs of the
801 participants, the availability, frequency, and intensity of
802 basic services and of supportive and optional services provided,
803 the frequency of participation, the distances traveled by
804 participants, the hours of operation, the number of referrals to
805 other centers or elsewhere, and the incidence of illness.
806 (g) Components of a comprehensive emergency management
807 plan, developed in consultation with the Department of Health,
808 the Agency for Health Care Administration, and the Division of
809 Emergency Management.
810 (2) Pursuant to this part, s. 408.811, and applicable
811 rules, the agency may conduct an abbreviated biennial inspection
812 of key quality-of-care standards, in lieu of a full inspection,
813 of a center that has a record of good performance. However, the
814 agency must conduct a full inspection of a center that has had
815 one or more confirmed complaints within the licensure period
816 immediately preceding the inspection or which has a serious
817 problem identified during the abbreviated inspection. The agency
818 shall develop the key quality-of-care standards, taking into
819 consideration the comments and recommendations of the Department
820 of Elderly Affairs and of provider groups. These standards shall
821 be included in rules adopted by the agency Department of Elderly
822 Affairs.
823 Section 29. Subsection (4) of section 765.110, Florida
824 Statutes, is amended to read:
825 765.110 Health care facilities and providers; discipline.—
826 (4) The Department of Elderly Affairs for hospices and, in
827 consultation with the Department of Elderly Affairs, the
828 Department of Health, in consultation with the Department of
829 Elderly Affairs, for health care providers; the Agency for
830 Health Care Administration for hospitals, hospices, nursing
831 homes, home health agencies, and health maintenance
832 organizations; and the Department of Children and Families for
833 facilities subject to part I of chapter 394 shall adopt rules to
834 implement this the provisions of the section.
835 Section 30. This act shall take effect July 1, 2019.