Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. CS for SB 402
       
       
       
       
       
       
                                Ì884902)Î884902                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/18/2020           .                                
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       Appropriations Subcommittee on Health and Human Services
       (Harrell) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present subsections (7) through (27) of section
    6  429.02, Florida Statutes, are redesignated as subsections (8)
    7  through (28), respectively, a new subsection (7) is added to
    8  that section, and present subsections (11) and (18) are amended,
    9  to read:
   10         429.02 Definitions.—When used in this part, the term:
   11         (7)“Assistive device” means any device designed or adapted
   12  to help a resident perform an action, a task, an activity of
   13  daily living, or a transfer; prevent a fall; or recover from a
   14  fall. The term does not include a total body lift or a motorized
   15  sit-to-stand lift, with the exception of a chair lift or
   16  recliner lift that a resident is able to operate independently.
   17         (12)(11) “Extended congregate care” means acts beyond those
   18  authorized in subsection (18) which (17) that may be performed
   19  pursuant to part I of chapter 464 by persons licensed thereunder
   20  while carrying out their professional duties, and other
   21  supportive services that which may be specified by rule. The
   22  purpose of such services is to enable residents to age in place
   23  in a residential environment despite mental or physical
   24  limitations that might otherwise disqualify them from residency
   25  in a facility licensed under this part.
   26         (19)(18) “Physical restraint” means a device that which
   27  physically limits, restricts, or deprives an individual of
   28  movement or mobility, including, but not limited to, a half-bed
   29  rail, a full-bed rail, a geriatric chair, and a posey restraint.
   30  The term “physical restraint” shall also include any device that
   31  is which was not specifically manufactured as a restraint but is
   32  which has been altered, arranged, or otherwise used for that
   33  this purpose. The term does shall not include any device that
   34  the resident chooses to use and is able to remove or avoid
   35  independently, or any bandage material used for the purpose of
   36  binding a wound or injury.
   37         Section 2. Paragraphs (b) and (c) of subsection (3) of
   38  section 429.07, Florida Statutes, are amended to read:
   39         429.07 License required; fee.—
   40         (3) In addition to the requirements of s. 408.806, each
   41  license granted by the agency must state the type of care for
   42  which the license is granted. Licenses shall be issued for one
   43  or more of the following categories of care: standard, extended
   44  congregate care, limited nursing services, or limited mental
   45  health.
   46         (b) An extended congregate care license shall be issued to
   47  each facility that has been licensed as an assisted living
   48  facility for 2 or more years and that provides services,
   49  directly or through contract, beyond those authorized in
   50  paragraph (a), including services performed by persons licensed
   51  under part I of chapter 464 and supportive services, as defined
   52  by rule, to persons who would otherwise be disqualified from
   53  continued residence in a facility licensed under this part. An
   54  extended congregate care license may be issued to a facility
   55  that has a provisional extended congregate care license and
   56  meets the requirements for licensure under subparagraph 2. The
   57  primary purpose of extended congregate care services is to allow
   58  residents the option of remaining in a familiar setting from
   59  which they would otherwise be disqualified for continued
   60  residency as they become more impaired. A facility licensed to
   61  provide extended congregate care services may also admit an
   62  individual who exceeds the admission criteria for a facility
   63  with a standard license, if he or she is determined appropriate
   64  for admission to the extended congregate care facility.
   65         1. In order for extended congregate care services to be
   66  provided, the agency must first determine that all requirements
   67  established in law and rule are met and must specifically
   68  designate, on the facility’s license, that such services may be
   69  provided and whether the designation applies to all or part of
   70  the facility. This designation may be made at the time of
   71  initial licensure or relicensure, or upon request in writing by
   72  a licensee under this part and part II of chapter 408. The
   73  notification of approval or the denial of the request shall be
   74  made in accordance with part II of chapter 408. Each existing
   75  facility that qualifies to provide extended congregate care
   76  services must have maintained a standard license and may not
   77  have been subject to administrative sanctions during the
   78  previous 2 years, or since initial licensure if the facility has
   79  been licensed for less than 2 years, for any of the following
   80  reasons:
   81         a. A class I or class II violation;
   82         b. Three or more repeat or recurring class III violations
   83  of identical or similar resident care standards from which a
   84  pattern of noncompliance is found by the agency;
   85         c. Three or more class III violations that were not
   86  corrected in accordance with the corrective action plan approved
   87  by the agency;
   88         d. Violation of resident care standards which results in
   89  requiring the facility to employ the services of a consultant
   90  pharmacist or consultant dietitian;
   91         e. Denial, suspension, or revocation of a license for
   92  another facility licensed under this part in which the applicant
   93  for an extended congregate care license has at least 25 percent
   94  ownership interest; or
   95         f. Imposition of a moratorium pursuant to this part or part
   96  II of chapter 408 or initiation of injunctive proceedings.
   97  
   98  The agency may deny or revoke a facility’s extended congregate
   99  care license for not meeting the criteria for an extended
  100  congregate care license as provided in this subparagraph.
  101         2. If an assisted living facility has been licensed for
  102  less than 2 years, the initial extended congregate care license
  103  must be provisional and may not exceed 6 months. The licensee
  104  shall notify the agency, in writing, when it has admitted at
  105  least one extended congregate care resident, after which an
  106  unannounced inspection shall be made to determine compliance
  107  with the requirements of an extended congregate care license. A
  108  licensee with a provisional extended congregate care license
  109  which that demonstrates compliance with all the requirements of
  110  an extended congregate care license during the inspection shall
  111  be issued an extended congregate care license. In addition to
  112  sanctions authorized under this part, if violations are found
  113  during the inspection and the licensee fails to demonstrate
  114  compliance with all assisted living facility requirements during
  115  a followup inspection, the licensee shall immediately suspend
  116  extended congregate care services, and the provisional extended
  117  congregate care license expires. The agency may extend the
  118  provisional license for not more than 1 month in order to
  119  complete a followup visit.
  120         3. A facility that is licensed to provide extended
  121  congregate care services shall maintain a written progress
  122  report on each person who receives nursing services from the
  123  facility’s staff which describes the type, amount, duration,
  124  scope, and outcome of services that are rendered and the general
  125  status of the resident’s health. A registered nurse, or
  126  appropriate designee, representing the agency shall visit the
  127  facility at least twice a year to monitor residents who are
  128  receiving extended congregate care services and to determine if
  129  the facility is in compliance with this part, part II of chapter
  130  408, and relevant rules. One of the visits may be in conjunction
  131  with the regular survey. The monitoring visits may be provided
  132  through contractual arrangements with appropriate community
  133  agencies. A registered nurse shall serve as part of the team
  134  that inspects the facility. The agency may waive one of the
  135  required yearly monitoring visits for a facility that has:
  136         a. Held an extended congregate care license for at least 24
  137  months;
  138         b. No class I or class II violations and no uncorrected
  139  class III violations; and
  140         c. No ombudsman council complaints that resulted in a
  141  citation for licensure.
  142         4. A facility that is licensed to provide extended
  143  congregate care services must:
  144         a. Demonstrate the capability to meet unanticipated
  145  resident service needs.
  146         b. Offer a physical environment that promotes a homelike
  147  setting, provides for resident privacy, promotes resident
  148  independence, and allows sufficient congregate space as defined
  149  by rule.
  150         c. Have sufficient staff available, taking into account the
  151  physical plant and firesafety features of the building, to
  152  assist with the evacuation of residents in an emergency.
  153         d. Adopt and follow policies and procedures that maximize
  154  resident independence, dignity, choice, and decisionmaking to
  155  permit residents to age in place, so that moves due to changes
  156  in functional status are minimized or avoided.
  157         e. Allow residents or, if applicable, a resident’s
  158  representative, designee, surrogate, guardian, or attorney in
  159  fact to make a variety of personal choices, participate in
  160  developing service plans, and share responsibility in
  161  decisionmaking.
  162         f. Implement the concept of managed risk.
  163         g. Provide, directly or through contract, the services of a
  164  person licensed under part I of chapter 464.
  165         h. In addition to the training mandated in s. 429.52,
  166  provide specialized training as defined by rule for facility
  167  staff.
  168         5. A facility that is licensed to provide extended
  169  congregate care services is exempt from the criteria for
  170  continued residency set forth in rules adopted under s. 429.41.
  171  A licensed facility must adopt its own requirements within
  172  guidelines for continued residency set forth by rule. However,
  173  the facility may not serve residents who require 24-hour nursing
  174  supervision. A licensed facility that provides extended
  175  congregate care services must also provide each resident with a
  176  written copy of facility policies governing admission and
  177  retention.
  178         6. Before the admission of an individual to a facility
  179  licensed to provide extended congregate care services, the
  180  individual must undergo a medical examination as provided in s.
  181  429.26(5) s. 429.26(4) and the facility must develop a
  182  preliminary service plan for the individual.
  183         7. If a facility can no longer provide or arrange for
  184  services in accordance with the resident’s service plan and
  185  needs and the facility’s policy, the facility must make
  186  arrangements for relocating the person in accordance with s.
  187  429.28(1)(k).
  188         (c) A limited nursing services license shall be issued to a
  189  facility that provides services beyond those authorized in
  190  paragraph (a) and as specified in this paragraph.
  191         1. In order for limited nursing services to be provided in
  192  a facility licensed under this part, the agency must first
  193  determine that all requirements established in law and rule are
  194  met and must specifically designate, on the facility’s license,
  195  that such services may be provided. This designation may be made
  196  at the time of initial licensure or licensure renewal, or upon
  197  request in writing by a licensee under this part and part II of
  198  chapter 408. Notification of approval or denial of such request
  199  shall be made in accordance with part II of chapter 408. An
  200  existing facility that qualifies to provide limited nursing
  201  services must have maintained a standard license and may not
  202  have been subject to administrative sanctions that affect the
  203  health, safety, and welfare of residents for the previous 2
  204  years or since initial licensure if the facility has been
  205  licensed for less than 2 years.
  206         2. A facility that is licensed to provide limited nursing
  207  services shall maintain a written progress report on each person
  208  who receives such nursing services from the facility’s staff.
  209  The report must describe the type, amount, duration, scope, and
  210  outcome of services that are rendered and the general status of
  211  the resident’s health. A registered nurse representing the
  212  agency shall visit the facility at least annually to monitor
  213  residents who are receiving limited nursing services and to
  214  determine if the facility is in compliance with applicable
  215  provisions of this part, part II of chapter 408, and related
  216  rules. The monitoring visits may be provided through contractual
  217  arrangements with appropriate community agencies. A registered
  218  nurse shall also serve as part of the team that inspects such
  219  facility. Visits may be in conjunction with other agency
  220  inspections. The agency may waive the required yearly monitoring
  221  visit for a facility that has:
  222         a. Had a limited nursing services license for at least 24
  223  months;
  224         b. No class I or class II violations and no uncorrected
  225  class III violations; and
  226         c. No ombudsman council complaints that resulted in a
  227  citation for licensure.
  228         3. A person who receives limited nursing services under
  229  this part must meet the admission criteria established by the
  230  agency for assisted living facilities. When a resident no longer
  231  meets the admission criteria for a facility licensed under this
  232  part, arrangements for relocating the person shall be made in
  233  accordance with s. 429.28(1)(k), unless the facility is licensed
  234  to provide extended congregate care services.
  235         Section 3. Subsection (7) of section 429.11, Florida
  236  Statutes, is amended to read:
  237         429.11 Initial application for license; provisional
  238  license.—
  239         (7) A county or municipality may not issue a business tax
  240  receipt an occupational license that is being obtained for the
  241  purpose of operating a facility regulated under this part
  242  without first ascertaining that the applicant has been licensed
  243  to operate such facility at the specified location or locations
  244  by the agency. The agency shall furnish to local agencies
  245  responsible for issuing business tax receipts occupational
  246  licenses sufficient instruction for making such determinations.
  247         Section 4. Section 429.176, Florida Statutes, is amended to
  248  read:
  249         429.176 Notice of change of administrator.—If, during the
  250  period for which a license is issued, the owner changes
  251  administrators, the owner must notify the agency of the change
  252  within 10 days and provide documentation within 90 days that the
  253  new administrator meets educational requirements and has
  254  completed the applicable core educational requirements under s.
  255  429.52. A facility may not be operated for more than 120
  256  consecutive days without an administrator who has completed the
  257  core educational requirements.
  258         Section 5. Subsections (3), (4), and (5) of section 429.23,
  259  Florida Statutes, are amended to read:
  260         429.23 Internal risk management and quality assurance
  261  program; adverse incidents and reporting requirements.—
  262         (3) Licensed facilities shall provide within 1 business day
  263  after the occurrence of an adverse incident, through the
  264  agency’s online portal or, if the portal is offline, by
  265  electronic mail, facsimile, or United States mail, a preliminary
  266  report to the agency on all adverse incidents specified under
  267  this section. The report must include information regarding the
  268  identity of the affected resident, the type of adverse incident,
  269  and the status of the facility’s investigation of the incident.
  270         (4) Licensed facilities shall provide within 15 days,
  271  through the agency’s online portal or, if the portal is offline,
  272  by electronic mail, facsimile, or United States mail, a full
  273  report to the agency on all adverse incidents specified in this
  274  section. The report must include the results of the facility’s
  275  investigation into the adverse incident.
  276         (5) Three business days before the deadline for the
  277  submission of the full report required under subsection (4), the
  278  agency shall send by electronic mail a reminder to the
  279  facility’s administrator and other specified facility contacts.
  280  Within 3 business days after the agency sends the reminder, a
  281  facility is not subject to any administrative or other agency
  282  action for failing to withdraw the preliminary report if the
  283  facility determines the event was not an adverse incident or for
  284  failing to file a full report if the facility determines the
  285  event was an adverse incident Each facility shall report monthly
  286  to the agency any liability claim filed against it. The report
  287  must include the name of the resident, the dates of the incident
  288  leading to the claim, if applicable, and the type of injury or
  289  violation of rights alleged to have occurred. This report is not
  290  discoverable in any civil or administrative action, except in
  291  such actions brought by the agency to enforce the provisions of
  292  this part.
  293         Section 6. Paragraphs (a) and (b) of subsection (1) of
  294  section 429.255, Florida Statutes, are amended, paragraph (d) is
  295  added to that subsection, and subsection (4) of that section is
  296  amended, to read:
  297         429.255 Use of personnel; emergency care.—
  298         (1)(a) Persons under contract to the facility, facility
  299  staff, or volunteers, who are licensed according to part I of
  300  chapter 464, or those persons exempt under s. 464.022(1), and
  301  others as defined by rule, may administer medications to
  302  residents, take residents’ vital signs, change residents
  303  bandages for minor cuts and abrasions, manage individual weekly
  304  pill organizers for residents who self-administer medication,
  305  give prepackaged enemas ordered by a physician, observe
  306  residents, document observations on the appropriate resident’s
  307  record, and report observations to the resident’s physician, and
  308  contract or allow residents or a resident’s representative,
  309  designee, surrogate, guardian, or attorney in fact to contract
  310  with a third party, provided residents meet the criteria for
  311  appropriate placement as defined in s. 429.26. Nursing
  312  assistants certified pursuant to part II of chapter 464 may take
  313  residents’ vital signs as directed by a licensed nurse or
  314  physician.
  315         (b) All staff of in facilities licensed under this part
  316  shall exercise their professional responsibility to observe
  317  residents, to document observations on the appropriate
  318  resident’s record, and to report the observations to the
  319  resident’s physician. However, the owner or administrator of the
  320  facility shall be responsible for determining that the resident
  321  receiving services is appropriate for residence in the facility.
  322         (d)A resident or his or her representative, designee,
  323  surrogate, guardian, or attorney in fact, as applicable, may
  324  contract for services with a third party, provided the resident
  325  meets the criteria for residency and continued residency as
  326  defined in s. 429.26. The third party must communicate with the
  327  facility regarding the resident’s condition and the services
  328  being provided in accordance with the facility’s policies. The
  329  facility must document that it received such communication.
  330         (4) Facility staff may withhold or withdraw cardiopulmonary
  331  resuscitation or the use of an automated external defibrillator
  332  if presented with an order not to resuscitate executed pursuant
  333  to s. 401.45. The agency shall adopt rules providing for the
  334  implementation of such orders. Facility staff and facilities may
  335  not be subject to criminal prosecution or civil liability, nor
  336  be considered to have engaged in negligent or unprofessional
  337  conduct, for withholding or withdrawing cardiopulmonary
  338  resuscitation or use of an automated external defibrillator
  339  pursuant to such an order and rules adopted by the agency. The
  340  absence of an order not to resuscitate executed pursuant to s.
  341  401.45 does not preclude a physician from withholding or
  342  withdrawing cardiopulmonary resuscitation or use of an automated
  343  external defibrillator as otherwise permitted by law.
  344         Section 7. Subsection (2), paragraph (b) of subsection (3),
  345  and paragraphs (e), (f), and (g) of subsection (4) of section
  346  429.256, Florida Statutes, are amended to read:
  347         429.256 Assistance with self-administration of medication.—
  348         (2) Residents who are capable of self-administering their
  349  own medications without assistance shall be encouraged and
  350  allowed to do so. However, an unlicensed person may, consistent
  351  with a dispensed prescription’s label or the package directions
  352  of an over-the-counter medication, assist a resident whose
  353  condition is medically stable with the self-administration of
  354  routine, regularly scheduled medications that are intended to be
  355  self-administered. Assistance with self-medication by an
  356  unlicensed person may occur only upon a documented request by,
  357  and the written informed consent of, a resident or the
  358  resident’s surrogate, guardian, or attorney in fact. For the
  359  purposes of this section, self-administered medications include
  360  both legend and over-the-counter oral dosage forms, topical
  361  dosage forms, transdermal patches, and topical ophthalmic, otic,
  362  and nasal dosage forms including solutions, suspensions, sprays,
  363  and inhalers.
  364         (3) Assistance with self-administration of medication
  365  includes:
  366         (b) In the presence of the resident, confirming that the
  367  medication is intended for that resident, orally advising the
  368  resident of the medication name and dosage reading the label,
  369  opening the container, removing a prescribed amount of
  370  medication from the container, and closing the container. The
  371  resident may sign a written waiver to opt out of being orally
  372  advised of the medication name and dosage. The waiver must
  373  identify all of the medications intended for the resident,
  374  including names and dosages of such medications, and must
  375  immediately be updated each time the resident’s medications or
  376  dosages change.
  377         (4) Assistance with self-administration does not include:
  378         (e) The use of irrigations or debriding agents used in the
  379  treatment of a skin condition.
  380         (f) Assisting with rectal, urethral, or vaginal
  381  preparations.
  382         (g) Assisting with medications ordered by the physician or
  383  health care professional with prescriptive authority to be given
  384  “as needed,” unless the order is written with specific
  385  parameters that preclude independent judgment on the part of the
  386  unlicensed person, and at the request of a competent resident
  387  requesting the medication is aware of his or her need for the
  388  medication and understands the purpose for taking the
  389  medication.
  390         Section 8. Section 429.26, Florida Statutes, is amended to
  391  read:
  392         429.26 Appropriateness of placements; examinations of
  393  residents.—
  394         (1) The owner or administrator of a facility is responsible
  395  for determining the appropriateness of admission of an
  396  individual to the facility and for determining the continued
  397  appropriateness of residence of an individual in the facility. A
  398  determination must shall be based upon an evaluation assessment
  399  of the strengths, needs, and preferences of the resident, a
  400  medical examination, the care and services offered or arranged
  401  for by the facility in accordance with facility policy, and any
  402  limitations in law or rule related to admission criteria or
  403  continued residency for the type of license held by the facility
  404  under this part. The following criteria apply to the
  405  determination of appropriateness for admission and continued
  406  residency of an individual in a facility:
  407         (a)A facility may admit or retain a resident who receives
  408  a health care service or treatment that is designed to be
  409  provided within a private residential setting if all
  410  requirements for providing that service or treatment are met by
  411  the facility or a third party.
  412         (b)A facility may admit or retain a resident who requires
  413  the use of assistive devices.
  414         (c)A facility may admit or retain an individual receiving
  415  hospice services if the arrangement is agreed to by the facility
  416  and the resident, additional care is provided by a licensed
  417  hospice, and the resident is under the care of a physician who
  418  agrees that the physical needs of the resident can be met at the
  419  facility. The resident must have a plan of care which delineates
  420  how the facility and the hospice will meet the scheduled and
  421  unscheduled needs of the resident, including, if applicable,
  422  staffing for nursing care.
  423         (d)1.Except for a resident who is receiving hospice
  424  services as provided in paragraph (c), a facility may not admit
  425  or retain a resident who is bedridden or who requires 24-hour
  426  nursing supervision. For purposes of this paragraph, the term
  427  “bedridden” means that a resident is confined to a bed because
  428  of the inability to:
  429         a.Move, turn, or reposition without total physical
  430  assistance;
  431         b.Transfer to a chair or wheelchair without total physical
  432  assistance; or
  433         c.Sit safely in a chair or wheelchair without personal
  434  assistance or a physical restraint.
  435         2.A resident may continue to reside in a facility if,
  436  during residency, he or she is bedridden for no more than 7
  437  consecutive days.
  438         3.If a facility is licensed to provide extended congregate
  439  care, a resident may continue to reside in a facility if, during
  440  residency, he or she is bedridden for no more than 14
  441  consecutive days.
  442         (2) A resident may not be moved from one facility to
  443  another without consultation with and agreement from the
  444  resident or, if applicable, the resident’s representative or
  445  designee or the resident’s family, guardian, surrogate, or
  446  attorney in fact. In the case of a resident who has been placed
  447  by the department or the Department of Children and Families,
  448  the administrator must notify the appropriate contact person in
  449  the applicable department.
  450         (3)(2) A physician, physician assistant, or advanced
  451  practice registered nurse practitioner who is employed by an
  452  assisted living facility to provide an initial examination for
  453  admission purposes may not have financial interests interest in
  454  the facility.
  455         (4)(3) Persons licensed under part I of chapter 464 who are
  456  employed by or under contract with a facility shall, on a
  457  routine basis or at least monthly, perform a nursing assessment
  458  of the residents for whom they are providing nursing services
  459  ordered by a physician, except administration of medication, and
  460  shall document such assessment, including any substantial
  461  changes in a resident’s status which may necessitate relocation
  462  to a nursing home, hospital, or specialized health care
  463  facility. Such records shall be maintained in the facility for
  464  inspection by the agency and shall be forwarded to the
  465  resident’s case manager, if applicable.
  466         (5)(a)(4)If possible, Each resident must shall have been
  467  examined by a licensed physician, a licensed physician
  468  assistant, or a licensed advanced practice registered nurse
  469  practitioner within 60 days before admission to the facility or
  470  within 30 days after admission to the facility, except as
  471  provided in s. 429.07. The information from the medical
  472  examination must be recorded on the practitioner’s form or on a
  473  form adopted by agency rule. The signed and completed medical
  474  examination form, signed only by the practitioner, must report
  475  shall be submitted to the owner or administrator of the
  476  facility, who shall use the information contained therein to
  477  assist in the determination of the appropriateness of the
  478  resident’s admission to or and continued residency stay in the
  479  facility.
  480         (b)The medical examination form may be used only to record
  481  the practitioner’s direct observation of the patient at the time
  482  of examination and must include the patient’s medical history.
  483  Such form does not guarantee admission to, continued residency
  484  in, or the delivery of services at the facility and must be used
  485  only as an informative tool to assist in the determination of
  486  the appropriateness of the resident’s admission to or continued
  487  residency in the facility. The medical examination form,
  488  reflecting the resident’s condition on the date the examination
  489  is performed, becomes report shall become a permanent part of
  490  the facility’s record of the resident at the facility and must
  491  shall be made available to the agency during inspection or upon
  492  request. An assessment that has been completed through the
  493  Comprehensive Assessment and Review for Long-Term Care Services
  494  (CARES) Program fulfills the requirements for a medical
  495  examination under this subsection and s. 429.07(3)(b)6.
  496         (c) The medical examination form must include all of the
  497  following information about the resident:
  498         1. Height, weight, and known allergies.
  499         2. Significant medical history and diagnoses.
  500         3. Physical or sensory limitations, including the need for
  501  fall precautions or recommended use of assistive devices.
  502         4. Cognitive or behavioral status and a brief description
  503  of any behavioral issues known or ascertained by the examining
  504  practitioner, including any known history of wandering or
  505  elopement.
  506         5. Nursing, treatment, or therapy service requirements.
  507         6. Whether the resident needs assistance for ambulating,
  508  eating, or transferring.
  509         7. Special dietary instructions.
  510         8.Whether the resident has any communicable diseases,
  511  including precautions that are necessary due to such diseases.
  512         9.Whether the resident is bedridden and the presence of
  513  any pressure sores.
  514         10.Whether the resident needs 24-hour nursing supervision
  515  or psychiatric care.
  516         11.A list of current prescribed medications as known or
  517  ascertained by the examining practitioner and whether the
  518  resident can self-administer medications, needs assistance with
  519  medications, or needs medication administration.
  520         (5) Except as provided in s. 429.07, if a medical
  521  examination has not been completed within 60 days before the
  522  admission of the resident to the facility, a licensed physician,
  523  licensed physician assistant, or licensed nurse practitioner
  524  shall examine the resident and complete a medical examination
  525  form provided by the agency within 30 days following the
  526  admission to the facility to enable the facility owner or
  527  administrator to determine the appropriateness of the admission.
  528  The medical examination form shall become a permanent part of
  529  the record of the resident at the facility and shall be made
  530  available to the agency during inspection by the agency or upon
  531  request.
  532         (6) Any resident accepted in a facility and placed by the
  533  department or the Department of Children and Families must shall
  534  have been examined by medical personnel within 30 days before
  535  placement in the facility. The examination must shall include an
  536  assessment of the appropriateness of placement in a facility.
  537  The findings of this examination must shall be recorded on the
  538  examination form provided by the agency. The completed form must
  539  shall accompany the resident and shall be submitted to the
  540  facility owner or administrator. Additionally, in the case of a
  541  mental health resident, the Department of Children and Families
  542  must provide documentation that the individual has been assessed
  543  by a psychiatrist, clinical psychologist, clinical social
  544  worker, or psychiatric nurse, or an individual who is supervised
  545  by one of these professionals, and determined to be appropriate
  546  to reside in an assisted living facility. The documentation must
  547  be in the facility within 30 days after the mental health
  548  resident has been admitted to the facility. An evaluation
  549  completed upon discharge from a state mental hospital meets the
  550  requirements of this subsection related to appropriateness for
  551  placement as a mental health resident, provided that providing
  552  it was completed within 90 days before prior to admission to the
  553  facility. The applicable Department of Children and Families
  554  shall provide to the facility administrator any information
  555  about the resident which that would help the administrator meet
  556  his or her responsibilities under subsection (1). Further,
  557  Department of Children and Families personnel shall explain to
  558  the facility operator any special needs of the resident and
  559  advise the operator whom to call should problems arise. The
  560  applicable Department of Children and Families shall advise and
  561  assist the facility administrator when where the special needs
  562  of residents who are recipients of optional state
  563  supplementation require such assistance.
  564         (7) The facility shall must notify a licensed physician
  565  when a resident exhibits signs of dementia or cognitive
  566  impairment or has a change of condition in order to rule out the
  567  presence of an underlying physiological condition that may be
  568  contributing to such dementia or impairment. The notification
  569  must occur within 30 days after the acknowledgment of such signs
  570  by facility staff. If an underlying condition is determined to
  571  exist, the facility must notify the resident’s representative or
  572  designee of the need for health care services and must assist in
  573  making appointments for shall arrange, with the appropriate
  574  health care provider, the necessary care and services to treat
  575  the condition. If the resident does not have a representative or
  576  designee or if the resident’s representative or designee cannot
  577  be located or is nonresponsive, the facility shall arrange with
  578  an appropriate health care provider for the necessary care and
  579  services to treat the condition.
  580         (8) The Department of Children and Families may require an
  581  examination for supplemental security income and optional state
  582  supplementation recipients residing in facilities at any time
  583  and shall provide the examination whenever a resident’s
  584  condition requires it. Any facility administrator; personnel of
  585  the agency, the department, or the Department of Children and
  586  Families; or a representative of the State Long-Term Care
  587  Ombudsman Program who believes a resident needs to be evaluated
  588  shall notify the resident’s case manager, who shall take
  589  appropriate action. A report of the examination findings must
  590  shall be provided to the resident’s case manager and the
  591  facility administrator to help the administrator meet his or her
  592  responsibilities under subsection (1).
  593         (9) A terminally ill resident who no longer meets the
  594  criteria for continued residency may remain in the facility if
  595  the arrangement is mutually agreeable to the resident and the
  596  facility; additional care is rendered through a licensed
  597  hospice, and the resident is under the care of a physician who
  598  agrees that the physical needs of the resident are being met.
  599         (9)(10) Facilities licensed to provide extended congregate
  600  care services shall promote aging in place by determining
  601  appropriateness of continued residency based on a comprehensive
  602  review of the resident’s physical and functional status; the
  603  ability of the facility, family members, friends, or any other
  604  pertinent individuals or agencies to provide the care and
  605  services required; and documentation that a written service plan
  606  consistent with facility policy has been developed and
  607  implemented to ensure that the resident’s needs and preferences
  608  are addressed.
  609         (11) No resident who requires 24-hour nursing supervision,
  610  except for a resident who is an enrolled hospice patient
  611  pursuant to part IV of chapter 400, shall be retained in a
  612  facility licensed under this part.
  613         Section 9. Paragraph (k) of subsection (1) and subsection
  614  (3) of section 429.28, Florida Statutes, are amended to read:
  615         429.28 Resident bill of rights.—
  616         (1) No resident of a facility shall be deprived of any
  617  civil or legal rights, benefits, or privileges guaranteed by
  618  law, the Constitution of the State of Florida, or the
  619  Constitution of the United States as a resident of a facility.
  620  Every resident of a facility shall have the right to:
  621         (k) At least 45 days’ notice of relocation or termination
  622  of residency from the facility unless, for medical reasons, the
  623  resident is certified by a physician to require an emergency
  624  relocation to a facility providing a more skilled level of care
  625  or the resident engages in a pattern of conduct that is harmful
  626  or offensive to other residents. In the case of a resident who
  627  has been adjudicated mentally incapacitated, the guardian shall
  628  be given at least 45 days’ notice of a nonemergency relocation
  629  or residency termination. Reasons for relocation must shall be
  630  set forth in writing and provided to the resident or the
  631  resident’s legal representative. In order for a facility to
  632  terminate the residency of an individual without notice as
  633  provided herein, the facility shall show good cause in a court
  634  of competent jurisdiction.
  635         (3)(a) The agency shall conduct a survey to determine
  636  whether the facility is complying with this part general
  637  compliance with facility standards and compliance with
  638  residents’ rights as a prerequisite to initial licensure or
  639  licensure renewal. The agency shall adopt rules for uniform
  640  standards and criteria that will be used to determine compliance
  641  with facility standards and compliance with residents’ rights.
  642         (b) In order to determine whether the facility is
  643  adequately protecting residents’ rights, the licensure renewal
  644  biennial survey must shall include private informal
  645  conversations with a sample of residents and consultation with
  646  the ombudsman council in the district in which the facility is
  647  located to discuss residents’ experiences within the facility.
  648         Section 10. Subsections (1) and (2) of section 429.31,
  649  Florida Statutes, are amended to read:
  650         429.31 Closing of facility; notice; penalty.—
  651         (1) In addition to the requirements of part II of chapter
  652  408, the facility shall inform, in writing, the agency and each
  653  resident or the next of kin, legal representative, or agency
  654  acting on each resident’s behalf, of the fact and the proposed
  655  time of discontinuance of operation, following the notification
  656  requirements provided in s. 429.28(1)(k). In the event a
  657  resident has no person to represent him or her, the facility
  658  shall be responsible for referral to an appropriate social
  659  service agency for placement.
  660         (2) Immediately upon the notice by the agency of the
  661  voluntary or involuntary termination of such operation, the
  662  agency shall inform the State Long-Term Care Ombudsman Program
  663  and monitor the transfer of residents to other facilities and
  664  ensure that residents’ rights are being protected. The agency,
  665  in consultation with the Department of Children and Families,
  666  shall specify procedures for ensuring that all residents who
  667  receive services are appropriately relocated.
  668         Section 11. Subsections (1), (2), and (5) of section
  669  429.41, Florida Statutes, are amended to read:
  670         429.41 Rules establishing standards.—
  671         (1) It is the intent of the Legislature that rules
  672  published and enforced pursuant to this section shall include
  673  criteria by which a reasonable and consistent quality of
  674  resident care and quality of life may be ensured and the results
  675  of such resident care may be demonstrated. Such rules shall also
  676  promote ensure a safe and sanitary environment that is
  677  residential and noninstitutional in design or nature and may
  678  allow for technological advances in the provision of care,
  679  safety, and security, including the use of devices, equipment,
  680  and other security measures related to wander management,
  681  emergency response, staff risk management, and the general
  682  safety and security of residents, staff, and the facility. It is
  683  further intended that reasonable efforts be made to accommodate
  684  the needs and preferences of residents to enhance the quality of
  685  life in a facility. Uniform firesafety standards for assisted
  686  living facilities shall be established by the State Fire Marshal
  687  pursuant to s. 633.206. The agency may adopt rules to administer
  688  part II of chapter 408. In order to provide safe and sanitary
  689  facilities and the highest quality of resident care
  690  accommodating the needs and preferences of residents, The
  691  agency, in consultation with the Department of Children and
  692  Families and the Department of Health, shall adopt rules,
  693  policies, and procedures to administer this part, which must
  694  include reasonable and fair minimum standards in relation to:
  695         (a) The requirements for and maintenance and the sanitary
  696  condition of facilities, not in conflict with, or duplicative
  697  of, the requirements in s. 381.006, s. 381.0072, chapter 553, or
  698  s. 633.206, relating to a safe and decent living environment,
  699  including furnishings for resident bedrooms or sleeping areas,
  700  locking devices, linens plumbing, heating, cooling, lighting,
  701  ventilation, living space, and other housing conditions relating
  702  to hazards, which will promote ensure the health, safety, and
  703  welfare comfort of residents suitable to the size of the
  704  structure. The rules must clearly delineate the respective
  705  responsibilities of the agency’s licensure and survey staff and
  706  the county health departments and ensure that inspections are
  707  not duplicative. The agency may collect fees for food service
  708  inspections conducted by county health departments and may
  709  transfer such fees to the Department of Health.
  710         1. Firesafety evacuation capability determination.—An
  711  evacuation capability evaluation for initial licensure shall be
  712  conducted within 6 months after the date of licensure.
  713         2. Firesafety requirements.—
  714         a. The National Fire Protection Association, Life Safety
  715  Code, NFPA 101 and 101A, current editions, shall be used in
  716  determining the uniform firesafety code adopted by the State
  717  Fire Marshal for assisted living facilities, pursuant to s.
  718  633.206.
  719         b. A local government or a utility may charge fees only in
  720  an amount not to exceed the actual expenses incurred by the
  721  local government or the utility relating to the installation and
  722  maintenance of an automatic fire sprinkler system in a licensed
  723  assisted living facility structure.
  724         c. All licensed facilities must have an annual fire
  725  inspection conducted by the local fire marshal or authority
  726  having jurisdiction.
  727         d. An assisted living facility that is issued a building
  728  permit or certificate of occupancy before July 1, 2016, may at
  729  its option and after notifying the authority having
  730  jurisdiction, remain under the provisions of the 1994 and 1995
  731  editions of the National Fire Protection Association, Life
  732  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  733  remain under such provisions may make repairs, modernizations,
  734  renovations, or additions to, or rehabilitate, the facility in
  735  compliance with NFPA 101, 1994 edition, and may utilize the
  736  alternative approaches to life safety in compliance with NFPA
  737  101A, 1995 edition. However, a facility for which a building
  738  permit or certificate of occupancy is issued before July 1,
  739  2016, that undergoes Level III building alteration or
  740  rehabilitation, as defined in the Florida Building Code, or
  741  seeks to utilize features not authorized under the 1994 or 1995
  742  editions of the Life Safety Code must thereafter comply with all
  743  aspects of the uniform firesafety standards established under s.
  744  633.206, and the Florida Fire Prevention Code, in effect for
  745  assisted living facilities as adopted by the State Fire Marshal.
  746         3. Resident elopement requirements.—Facilities are required
  747  to conduct a minimum of two resident elopement prevention and
  748  response drills per year. All administrators and direct care
  749  staff must participate in the drills, which shall include a
  750  review of procedures to address resident elopement. Facilities
  751  must document the implementation of the drills and ensure that
  752  the drills are conducted in a manner consistent with the
  753  facility’s resident elopement policies and procedures.
  754         (b) The preparation and annual update of a comprehensive
  755  emergency management plan. Such standards must be included in
  756  the rules adopted by the agency after consultation with the
  757  Division of Emergency Management. At a minimum, the rules must
  758  provide for plan components that address emergency evacuation
  759  transportation; adequate sheltering arrangements; postdisaster
  760  activities, including provision of emergency power, food, and
  761  water; postdisaster transportation; supplies; staffing;
  762  emergency equipment; individual identification of residents and
  763  transfer of records; communication with families; and responses
  764  to family inquiries. The comprehensive emergency management plan
  765  is subject to review and approval by the county local emergency
  766  management agency. During its review, the county local emergency
  767  management agency shall ensure that the following agencies, at a
  768  minimum, are given the opportunity to review the plan: the
  769  Department of Health, the Agency for Health Care Administration,
  770  and the Division of Emergency Management. Also, appropriate
  771  volunteer organizations must be given the opportunity to review
  772  the plan. The county local emergency management agency shall
  773  complete its review within 60 days and either approve the plan
  774  or advise the facility of necessary revisions. A facility must
  775  submit a comprehensive emergency management plan to the county
  776  emergency management agency within 30 days after issuance of a
  777  license.
  778         (c) The number, training, and qualifications of all
  779  personnel having responsibility for the care of residents. The
  780  rules must require adequate staff to provide for the safety of
  781  all residents. Facilities licensed for 17 or more residents are
  782  required to maintain an alert staff for 24 hours per day.
  783         (d) All sanitary conditions within the facility and its
  784  surroundings which will ensure the health and comfort of
  785  residents. The rules must clearly delineate the responsibilities
  786  of the agency’s licensure and survey staff, the county health
  787  departments, and the local authority having jurisdiction over
  788  firesafety and ensure that inspections are not duplicative. The
  789  agency may collect fees for food service inspections conducted
  790  by the county health departments and transfer such fees to the
  791  Department of Health.
  792         (d)(e) License application and license renewal, transfer of
  793  ownership, proper management of resident funds and personal
  794  property, surety bonds, resident contracts, refund policies,
  795  financial ability to operate, and facility and staff records.
  796         (e)(f) Inspections, complaint investigations, moratoriums,
  797  classification of deficiencies, levying and enforcement of
  798  penalties, and use of income from fees and fines.
  799         (f)(g) The enforcement of the resident bill of rights
  800  specified in s. 429.28.
  801         (g)(h) The care and maintenance of residents provided by
  802  the facility, which must include, but is not limited to:
  803         1. The supervision of residents;
  804         2. The provision of personal services;
  805         3. The provision of, or arrangement for, social and leisure
  806  activities;
  807         4. The assistance in making arrangements arrangement for
  808  appointments and transportation to appropriate medical, dental,
  809  nursing, or mental health services, as needed by residents;
  810         5. The management of medication stored within the facility
  811  and as needed by residents;
  812         6. The dietary nutritional needs of residents;
  813         7. Resident records; and
  814         8. Internal risk management and quality assurance.
  815         (h)(i) Facilities holding a limited nursing, extended
  816  congregate care, or limited mental health license.
  817         (i)(j) The establishment of specific criteria to define
  818  appropriateness of resident admission and continued residency in
  819  a facility holding a standard, limited nursing, extended
  820  congregate care, and limited mental health license.
  821         (j)(k) The use of physical or chemical restraints. The use
  822  of Posey restraints is prohibited. Other physical restraints may
  823  be used in accordance with agency rules when ordered is limited
  824  to half-bed rails as prescribed and documented by the resident’s
  825  physician and consented to by with the consent of the resident
  826  or, if applicable, the resident’s representative or designee or
  827  the resident’s surrogate, guardian, or attorney in fact. Such
  828  rules must specify requirements for care planning, staff
  829  monitoring, and periodic review by a physician. The use of
  830  chemical restraints is limited to prescribed dosages of
  831  medications authorized by the resident’s physician and must be
  832  consistent with the resident’s diagnosis. Residents who are
  833  receiving medications that can serve as chemical restraints must
  834  be evaluated by their physician at least annually to assess:
  835         1. The continued need for the medication.
  836         2. The level of the medication in the resident’s blood.
  837         3. The need for adjustments in the prescription.
  838         (k)(l) The establishment of specific resident elopement
  839  drill requirements and policies and procedures on resident
  840  elopement. Facilities shall conduct a minimum of two resident
  841  elopement drills each year. All administrators and direct care
  842  staff shall participate in the drills, which must include a
  843  review of the facility’s procedures to address resident
  844  elopement. Facilities shall document participation in the
  845  drills.
  846         (2) In adopting any rules pursuant to this part, the agency
  847  shall make distinct standards for facilities based upon facility
  848  size; the types of care provided; the physical and mental
  849  capabilities and needs of residents; the type, frequency, and
  850  amount of services and care offered; and the staffing
  851  characteristics of the facility. Rules developed pursuant to
  852  this section may not restrict the use of shared staffing and
  853  shared programming in facilities that are part of retirement
  854  communities that provide multiple levels of care and otherwise
  855  meet the requirements of law and rule. If a continuing care
  856  facility licensed under chapter 651 or a retirement community
  857  offering multiple levels of care licenses a building or part of
  858  a building designated for independent living for assisted
  859  living, staffing requirements established in rule apply only to
  860  residents who receive personal, limited nursing, or extended
  861  congregate care services under this part. Such facilities shall
  862  retain a log listing the names and unit number for residents
  863  receiving these services. The log must be available to surveyors
  864  upon request. Except for uniform firesafety standards, The
  865  agency shall adopt by rule separate and distinct standards for
  866  facilities with 16 or fewer beds and for facilities with 17 or
  867  more beds. The standards for facilities with 16 or fewer beds
  868  must be appropriate for a noninstitutional residential
  869  environment; however, the structure may not be more than two
  870  stories in height and all persons who cannot exit the facility
  871  unassisted in an emergency must reside on the first floor. The
  872  agency may make other distinctions among types of facilities as
  873  necessary to enforce this part. Where appropriate, the agency
  874  shall offer alternate solutions for complying with established
  875  standards, based on distinctions made by the agency relative to
  876  the physical characteristics of facilities and the types of care
  877  offered.
  878         (5) The agency may use an abbreviated biennial standard
  879  licensure inspection that consists of a review of key quality
  880  of-care standards in lieu of a full inspection in a facility
  881  that has a good record of past performance. However, a full
  882  inspection must be conducted in a facility that has a history of
  883  class I or class II violations;, uncorrected class III
  884  violations; or a class I, class II, or uncorrected class III
  885  violation resulting from a complaint referred by the State Long
  886  Term Care Ombudsman Program, confirmed ombudsman council
  887  complaints, or confirmed licensure complaints within the
  888  previous licensure period immediately preceding the inspection
  889  or if a potentially serious problem is identified during the
  890  abbreviated inspection. The agency shall adopt by rule develop
  891  the key quality-of-care standards with input from the State
  892  Long-Term Care Ombudsman Council and representatives of provider
  893  groups for incorporation into its rules.
  894         Section 12. Section 429.435, Florida Statutes, is created
  895  to read:
  896         429.435Uniform firesafety standards.—Uniform firesafety
  897  standards for assisted living facilities that are residential
  898  board and care occupancies shall be established by the State
  899  Fire Marshal pursuant to s. 633.206.
  900         (1)EVACUATION CAPABILITY.—A firesafety evacuation
  901  capability determination shall be conducted within 6 months
  902  after the date of initial licensure of an assisted living
  903  facility, if required.
  904         (2)FIRESAFETY REQUIREMENTS.—
  905         (a)The National Fire Protection Association, Life Safety
  906  Code, NFPA 101 and 101A, current editions, must be used in
  907  determining the uniform firesafety code adopted by the State
  908  Fire Marshal for assisted living facilities, pursuant to s.
  909  633.206.
  910         (b)A local government or a utility may charge fees that do
  911  not exceed the actual costs incurred by the local government or
  912  the utility for the installation and maintenance of an automatic
  913  fire sprinkler system in a licensed assisted living facility
  914  structure.
  915         (c)All licensed facilities must have an annual fire
  916  inspection conducted by the local fire marshal or authority
  917  having jurisdiction.
  918         (d)An assisted living facility that was issued a building
  919  permit or certificate of occupancy before July 1, 2016, at its
  920  option and after notifying the authority having jurisdiction,
  921  may remain under the provisions of the 1994 and 1995 editions of
  922  the National Fire Protection Association, Life Safety Code, NFPA
  923  101 and 101A. A facility opting to remain under such provisions
  924  may make repairs, modernizations, renovations, or additions to
  925  or rehabilitate the facility in compliance with NFPA 101, 1994
  926  edition, and may use the alternative approaches to life safety
  927  in compliance with NFPA 101A, 1995 edition. However, a facility
  928  for which a building permit or certificate of occupancy was
  929  issued before July 1, 2016, which undergoes Level III building
  930  alteration or rehabilitation, as defined in the Florida Building
  931  Code, or which seeks to use features not authorized under the
  932  1994 or 1995 editions of the Life Safety Code, shall thereafter
  933  comply with all aspects of the uniform firesafety standards
  934  established under s. 633.206 and the Florida Fire Prevention
  935  Code in effect for assisted living facilities as adopted by the
  936  State Fire Marshal.
  937         Section 13. Section 429.52, Florida Statutes, is amended to
  938  read:
  939         429.52 Staff training and educational requirements
  940  programs; core educational requirement.—
  941         (1) Effective October 1, 2015, Each new assisted living
  942  facility employee who has not previously completed core training
  943  must attend a preservice orientation provided by the facility
  944  before interacting with residents. The preservice orientation
  945  must be at least 2 hours in duration and cover topics that help
  946  the employee provide responsible care and respond to the needs
  947  of facility residents. Upon completion, the employee and the
  948  administrator of the facility must sign a statement that the
  949  employee completed the required preservice orientation. The
  950  facility must keep the signed statement in the employee’s
  951  personnel record.
  952         (2) Administrators and other assisted living facility staff
  953  must meet minimum training and education requirements
  954  established by the agency by rule. This training and education
  955  is intended to assist facilities to appropriately respond to the
  956  needs of residents, to maintain resident care and facility
  957  standards, and to meet licensure requirements.
  958         (3) The agency, in conjunction with providers, shall
  959  develop core training requirements for administrators consisting
  960  of core training learning objectives, a competency test, and a
  961  minimum required score to indicate successful passage completion
  962  of the core competency test training and educational
  963  requirements. The required core competency test training and
  964  education must cover at least the following topics:
  965         (a) State law and rules relating to assisted living
  966  facilities.
  967         (b) Resident rights and identifying and reporting abuse,
  968  neglect, and exploitation.
  969         (c) Special needs of elderly persons, persons with mental
  970  illness, and persons with developmental disabilities and how to
  971  meet those needs.
  972         (d) Nutrition and food service, including acceptable
  973  sanitation practices for preparing, storing, and serving food.
  974         (e) Medication management, recordkeeping, and proper
  975  techniques for assisting residents with self-administered
  976  medication.
  977         (f) Firesafety requirements, including fire evacuation
  978  drill procedures and other emergency procedures.
  979         (g) Care of persons with Alzheimer’s disease and related
  980  disorders.
  981         (4) A new facility administrator must complete the required
  982  core training and education, including the competency test,
  983  within 90 days after the date of employment as an administrator.
  984  Failure to do so is a violation of this part and subjects the
  985  violator to an administrative fine as prescribed in s. 429.19.
  986  Administrators licensed in accordance with part II of chapter
  987  468 are exempt from this requirement. Other licensed
  988  professionals may be exempted, as determined by the agency by
  989  rule.
  990         (5) Administrators are required to participate in
  991  continuing education for a minimum of 12 contact hours every 2
  992  years.
  993         (6) Staff involved with the management of medications and
  994  assisting with the self-administration of medications under s.
  995  429.256 must complete a minimum of 6 additional hours of
  996  training provided by a registered nurse or, a licensed
  997  pharmacist before providing assistance, or agency staff. Two
  998  hours of continuing education are required annually thereafter.
  999  The agency shall establish by rule the minimum requirements of
 1000  this additional training.
 1001         (7) Other Facility staff shall participate in inservice
 1002  training relevant to their job duties as specified by agency
 1003  rule of the agency. Topics covered during the preservice
 1004  orientation are not required to be repeated during inservice
 1005  training. A single certificate of completion which covers all
 1006  required inservice training topics may be issued to a
 1007  participating staff member if the training is provided in a
 1008  single training course.
 1009         (8) If the agency determines that there are problems in a
 1010  facility which could be reduced through specific staff training
 1011  or education beyond that already required under this section,
 1012  the agency may require, and provide, or cause to be provided,
 1013  the training or education of any personal care staff in the
 1014  facility.
 1015         (9) The agency shall adopt rules related to these training
 1016  and education requirements, the competency test, necessary
 1017  procedures, and competency test fees and shall adopt or contract
 1018  with another entity to develop and administer the competency
 1019  test. The agency shall adopt a curriculum outline with learning
 1020  objectives to be used by core trainers, which shall be used as
 1021  the minimum core training content requirements. The agency shall
 1022  consult with representatives of stakeholder associations and
 1023  agencies in the development of the curriculum outline.
 1024         (10) The core training required by this section other than
 1025  the preservice orientation must be conducted by persons
 1026  registered with the agency as having the requisite experience
 1027  and credentials to conduct the training. A person seeking to
 1028  register as a core trainer must provide the agency with proof of
 1029  completion of the minimum core training education requirements,
 1030  successful passage of the competency test established under this
 1031  section, and proof of compliance with the continuing education
 1032  requirement in subsection (5).
 1033         (11) A person seeking to register as a core trainer also
 1034  must also:
 1035         (a) Provide proof of completion of a 4-year degree from an
 1036  accredited college or university and must have worked in a
 1037  management position in an assisted living facility for 3 years
 1038  after being core certified;
 1039         (b) Have worked in a management position in an assisted
 1040  living facility for 5 years after being core certified and have
 1041  1 year of teaching experience as an educator or staff trainer
 1042  for persons who work in assisted living facilities or other
 1043  long-term care settings;
 1044         (c) Have been previously employed as a core trainer for the
 1045  agency or department; or
 1046         (d) Meet other qualification criteria as defined in rule,
 1047  which the agency is authorized to adopt.
 1048         (12) The agency shall adopt rules to establish core trainer
 1049  registration and removal requirements.
 1050         Section 14. This act shall take effect July 1, 2020.
 1051  
 1052  ================= T I T L E  A M E N D M E N T ================
 1053  And the title is amended as follows:
 1054         Delete everything before the enacting clause
 1055  and insert:
 1056                        A bill to be entitled                      
 1057         An act relating to assisted living facilities;
 1058         amending s. 429.02, F.S.; defining and revising terms;
 1059         amending s. 429.07, F.S.; requiring assisted living
 1060         facilities that provide certain services to maintain a
 1061         written progress report on each person receiving
 1062         services from the facility’s staff; conforming a
 1063         cross-reference; amending s. 429.11, F.S.; prohibiting
 1064         a county or municipality from issuing a business tax
 1065         receipt, rather than an occupational license, to a
 1066         facility under certain circumstances; amending s.
 1067         429.176, F.S.; requiring an owner of a facility to
 1068         provide certain documentation to the Agency for Health
 1069         Care Administration within a specified timeframe;
 1070         amending s. 429.23, F.S.; authorizing a facility to
 1071         send certain reports regarding adverse incidents
 1072         through the agency’s online portal; requiring the
 1073         agency to send reminders by electronic mail to certain
 1074         facility contacts regarding submission deadlines for
 1075         such reports within a specified timeframe; amending s.
 1076         429.255, F.S.; authorizing certain persons to change a
 1077         resident’s bandage for a minor cut or abrasion;
 1078         authorizing certain persons to contract with a third
 1079         party to provide services to a resident under certain
 1080         circumstances; providing requirements relating to the
 1081         third-party provider; clarifying that the absence of
 1082         an order not to resuscitate does not preclude a
 1083         physician from withholding or withdrawing
 1084         cardiopulmonary resuscitation or use of an automated
 1085         external defibrillator; amending s. 429.256, F.S.;
 1086         revising the types of medications that may be self
 1087         administered; revising provisions relating to
 1088         assistance with the self-administration of such
 1089         medications; requiring a person assisting with a
 1090         resident’s self-administration of medication to
 1091         confirm and advise the patient of specified
 1092         information; authorizing a resident to opt out of such
 1093         advisement through a signed waiver; providing
 1094         requirements for such waiver; revising provisions
 1095         relating to certain medications that are not self
 1096         administered with assistance; amending s. 429.26,
 1097         F.S.; including medical examinations in the criteria
 1098         used for admission to an assisted living facility;
 1099         providing specified criteria for determination of
 1100         appropriateness for admission to and continued
 1101         residency in an assisted living facility; prohibiting
 1102         such facility from admitting certain individuals;
 1103         defining the term “bedridden”; authorizing a facility
 1104         to retain certain individuals under certain
 1105         conditions; requiring that a resident receive a
 1106         medical examination within a specified timeframe after
 1107         admission to a facility; requiring that such
 1108         examination be recorded on a form; providing
 1109         limitations on the use of such form; providing
 1110         requirements for the content of the form; revising
 1111         provisions relating to the placement of residents by
 1112         the Department of Children and Families; requiring a
 1113         facility to notify a resident’s representative or
 1114         designee of specified information under certain
 1115         circumstances; requiring the facility to arrange with
 1116         an appropriate health care provider for the care and
 1117         services needed to treat a resident under certain
 1118         circumstances; removing provisions relating to the
 1119         retention of certain residents in a facility; amending
 1120         s. 429.28, F.S.; requiring facilities to provide
 1121         written notice of relocation or termination of
 1122         residency from a facility to the resident or the
 1123         resident’s legal guardian; revising provisions related
 1124         to a licensure survey required by the agency; deleting
 1125         a requirement that the agency adopt certain rules;
 1126         amending s. 429.31, F.S.; revising notice requirements
 1127         for facilities that are terminating operations;
 1128         requiring the agency to inform the State Long-Term
 1129         Ombudsman Program immediately upon notice of a
 1130         facility’s termination of operations; amending s.
 1131         429.41, F.S.; revising legislative intent; revising
 1132         provisions related to rules the agency, in
 1133         consultation with the Department of Children and
 1134         Families and the Department of Health, is required to
 1135         adopt regarding minimum standards of resident care;
 1136         requiring county emergency management agencies, rather
 1137         than local emergency management agencies, to review
 1138         and approve or disapprove of a facility’s
 1139         comprehensive emergency management plan; requiring a
 1140         facility to submit a comprehensive emergency
 1141         management plan to the county emergency management
 1142         agency within a specified timeframe; prohibiting the
 1143         use of Posey restraints; authorizing the use of other
 1144         restraints under certain circumstances; revising the
 1145         criteria under which a facility must be fully
 1146         inspected; creating s. 429.435, F.S.; requiring the
 1147         State Fire Marshall to establish uniform firesafety
 1148         standards for assisted living facilities; providing
 1149         for a firesafety evacuation capability determination
 1150         within a specified timeframe under certain
 1151         circumstances; requiring the State Fire Marshall to
 1152         use certain standards from a specified national
 1153         association to determine the uniform firesafety
 1154         standards to be adopted; authorizing local governments
 1155         and utilities to charge certain fees relating to fire
 1156         sprinkler systems; requiring licensed facilities to
 1157         have an annual fire inspection; specifying certain
 1158         code requirements for facilities that undergo a
 1159         specific alteration or rehabilitation; amending s.
 1160         429.52, F.S.; revising certain provisions relating to
 1161         facility staff training and educational requirements;
 1162         requiring the agency, in conjunction with providers,
 1163         to establish core training requirements for facility
 1164         administrators; revising the training and continuing
 1165         education requirements for facility staff who assist
 1166         residents with the self-administration of medications;
 1167         revising provisions relating to the training
 1168         responsibilities of the agency; requiring the agency
 1169         to contract with another entity to administer a
 1170         certain competency test; requiring the agency to adopt
 1171         a curriculum outline with learning objectives to be
 1172         used by core trainers; conforming provisions to
 1173         changes made by the act; providing an effective date.