HB 1891 2003
1	CHAMBER ACTION
2
3
4
5
6	The Committee on Appropriations recommends the following:
7
8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to the protection and delivery of services
12	to persons who are disabled, vulnerable, or elderly;
13	creating s. 393.506, F.S.; allowing administration of
14	medication by certain unlicensed staff for persons with
15	developmental disabilities; providing requirements for
16	such administration; creating s. 400.9685, F.S.; allowing
17	administration of medication by certain unlicensed staff
18	in nursing homes and related health care facilities for
19	persons with developmental disabilities; providing
20	requirements for such administration; amending s. 394.74,
21	F.S.; providing for alternative payment methods for
22	contracts for provision of local substance abuse and
23	mental health programs; amending s. 415.102, F.S.;
24	clarifying definitions; amending s. 765.401, F.S.;
25	providing additional persons which may be given a proxy
26	for the making of health care decisions; amending s.
27	744.102, F.S.; providing that a public guardian shall be
28	considered a professional guardian for certain purposes;
29	amending s. 744.108, F.S.; providing that certain costs
30	relating to determination of certain fees shall be payable
31	from the guardianship estate; amending s. 744.1083, F.S.;
32	deleting obsolete language; increasing the maximum annual
33	fee for registration as a professional guardian; requiring
34	additional information for registration; transferring
35	certain rule adoption authority and registration
36	responsibilities from the Statewide Public Guardianship
37	Office to the Department of Elderly Affairs; authorizing
38	the Department of Elderly Affairs to contract with a not-
39	for-profit entity to register professional guardians;
40	providing that certain educational institutions may act as
41	professional guardians without registering; amending s.
42	744.1085, F.S.; providing for additional regulation of
43	professional guardians; providing for a professional
44	examination as a condition of registration; providing
45	additional requirements for registration as a professional
46	guardian; providing that certain financial institutions
47	are exempt from the regulations governing professional
48	guardians; amending s. 744.3135, F.S.; limiting certain
49	requirements to professional guardians; authorizing the
50	court to require guardians to submit to credit history
51	investigations and background screening; amending s.
52	744.3145, F.S.; providing training requirements for
53	parents appointed as guardians of the property of their
54	minor children; amending s. 744.444, F.S.; allowing
55	guardians to employ care managers and disclose
56	confidential information to an ombudsman without court
57	approval; providing that such information shall remain
58	confidential; authorizing the payment of certain costs;
59	amending ss. 744.534 and 744.7021, F.S.; providing that
60	the executive director of the Statewide Public
61	Guardianship Office shall be appointed by the Secretary of
62	Elderly Affairs, rather than by the Governor; transferring
63	certain responsibilities from the Statewide Public
64	Guardianship Office to the Department of Elderly Affairs;
65	amending s. 744.704, F.S.; removing a limitation on what
66	wards a public guardian may serve; creating the
67	Guardianship Task Force to examine and make
68	recommendations regarding guardianship in this state;
69	providing for membership; providing for appointment;
70	providing for term of existence; providing that certain
71	prior offenses shall be considered in conducting
72	employment screening, notwithstanding the provisions of
73	section 64 of ch. 95-228, Laws of Florida; amending s.
74	400.071, F.S.; requiring applicants for licensure as a
75	nursing home to provide proof of a legal right to occupy
76	the property; amending s. 400.414, F.S.; delineating the
77	types and number of deficiencies justifying denial,
78	revocation, or suspension of a license as an assisted
79	living facility; amending s. 400.417, F.S.; providing an
80	alternative method of providing notice to an assisted
81	living facility that a license must be renewed; amending
82	s. 400.419, F.S.; providing that administrative fines for
83	assisted living facilities or its personnel shall be
84	imposed by the Agency for Health Care Administration in
85	the manner provided in ch. 120, F.S.; amending s.
86	400.0239, F.S.; providing for deposit of civil monetary
87	fines in the Quality of Long-Term Care Facility
88	Improvement Trust Fund; providing for additional purposes
89	for which funds from such trust fund may be expended;
90	amending s. 400.141, F.S; providing for enforcement of
91	minimum staffing standards for a nursing facility within a
92	range; amending s. 400.235, F.S.; allowing reviewed
93	financial statements to be submitted for the Gold Seal
94	program; amending s. 400.452, F.S.; revising training and
95	education requirements of the Department of Elderly
96	Affairs for assisted living facilities; deleting a
97	requirement that fees for training and education programs
98	be based on the percentage of residents receiving monthly
99	optional supplementation payments; amending s. 430.502,
100	F.S.; requiring the Agency for Health Care Administration
101	and the Department of Health to seek and implement a
102	Medicaid home and community-based waiver for persons with
103	Alzheimer's disease; requiring the development of waiver
104	program standards; providing for consultation with the
105	presiding officers of the Legislature; providing for a
106	contingent future repeal of such waiver program; amending
107	s. 400.557, F.S.; providing an alternative method of
108	providing notice to an adult day care center that a
109	license must be renewed; amending s. 400.619, F.S.;
110	requiring that the Agency for Health Care Administration
111	provide advance notice to an adult family-care home that a
112	license must be renewed; reenacting and amending s.
113	400.980, F.S.; providing that the provisions governing
114	background screening of persons involved with health care
115	services pools shall not stand repealed; amending s.
116	408.061, F.S.; exempting nursing homes and continuing care
117	facilities from certain financial reporting requirements;
118	amending s. 408.062, F.S.; providing that the Agency for
119	Health Care Administration is not required to evaluate
120	financial reports of nursing homes; amending s. 408.831,
121	F.S.; requiring that licensees of the Agency for Health
122	Care Administration pay or arrange for payment of amounts
123	owed to the agency by the licensee prior to transfer of
124	the license or issuance of a license to a transferee;
125	amending s. 409.9116, F.S.; correcting a cross reference;
126	providing an effective date.
127
128	Be It Enacted by the Legislature of the State of Florida:
129
130	Section 1. Section 393.506, Florida Statutes, is created
131	to read:
132	393.506 Administration of medication.--
133	(1) Notwithstanding the provisions of part I of chapter
134	464, the Nurse Practice Act, unlicensed direct care service
135	staff providing services to persons with developmental
136	disabilities may administer oral, transdermal, inhaled, or
137	topical prescription medications as provided in this section.
138	(a) For day programs, as defined in s. 393.063, the
139	director of the facility or program shall designate in writing
140	unlicensed direct care services staff who are eligible to be
141	trained to assist in the administration of or to administer
142	medication.
143	(b) For intermediate care facilities for the
144	developmentally disabled licensed pursuant to part XI of chapter
145	400, unlicensed staff designated by the director may provide
146	medication assistance under the general supervision of a
147	registered nurse licensed pursuant to chapter 464.
148	(2) Each facility, institution, or program must include in
149	its policies and procedures a plan for training designated staff
150	to ensure the safe handling, storage, and administration of
151	prescription medication. These policies and procedures must be
152	approved by the department before unlicensed direct care
153	services staff assist with medication.
154	(3) The policies and procedures must include, at a
155	minimum, the following provisions:
156	(a) An expressed and informed consent for each client.
157	(b) The director of the facility, program, or provider
158	must maintain a copy of the written prescription, and that
159	prescription must include the name of the medication, the dosage
160	and administration schedule, the reason for the prescription,
161	and the termination date.
162	(c) Each prescribed medication shall be kept in its
163	original container and in a secure location.
164	(4) The training required in this section shall be
165	conducted by a registered nurse or a physician licensed pursuant
166	to chapter 458 or chapter 459.
167	Section 2. Section 400.9685, Florida Statutes, is created
168	to read:
169	400.9685 Administration of medication.--
170	(1) Notwithstanding the provisions of the Nurse Practice
171	Act, part I of chapter 464, unlicensed direct care services
172	staff who are providing services to clients in Intermediate Care
173	Facilities for the Developmentally Disabled, licensed pursuant
174	to this part, may administer prescribed, prepackaged, pre-
175	measured medications under the general supervision of a
176	registered nurse as provided in this section and applicable
177	rules. Training required by this section and applicable rules
178	must be conducted by a registered nurse licensed pursuant to
179	chapter 464, or a physician licensed pursuant to chapter 458 or
180	chapter 459.
181	(2) Each facility that allows unlicensed direct care
182	service staff to administer medications pursuant to this section
183	must:
184	(a) Develop and implement policies and procedures that
185	include a plan to ensure the safe handling, storage, and
186	administration of prescription medication.
187	(b) Maintain written evidence of the expressed and
188	informed consent for each client.
189	(c) Maintain a copy of the written prescription including
190	the name of the medication, the dosage, and administration
191	schedule.
192	(d) Maintain documentation regarding the prescription
193	including the name, dosage, and administration schedule, reason
194	for prescription, and the termination date.
195	(e) Maintain documentation of compliance with required
196	training.
197	(3) Agency rules shall specify the following as it relates
198	to the administration of medications by unlicensed staff:
199	(a) Medications authorized and packaging required.
200	(b) Acceptable methods of administration.
201	(c) A definition of "general supervision".
202	(d) Minimum educational requirements of staff.
203	(e) Criteria of required training and competency that must
204	be demonstrated prior to the administration of medications by
205	unlicensed staff including in-service training.
206	(f) Requirements for safe handling, storage, and
207	administration of medications.
208	Section 3. Subsection (2) of section 394.74, Florida
209	Statutes, is amended, and subsection (6) is added to said
210	section, to read:
211	394.74 Contracts for provision of local substance abuse
212	and mental health programs.--
213	(2)(a) Contracts for service shall be consistent with the
214	approved district plan.
215	(b) Notwithstanding s. 394.76(3)(a) and (c), the
216	department may use unit cost methods of payment in contracts for
217	purchasing mental health and substance abuse services. The unit
218	cost contracting system must account for those patient fees that
219	are paid on behalf of a specific client and those that are
220	earned and used by the provider for those services funded in
221	whole or in part by the department. The department may also use
222	a fee-for-service arrangement, case rates, or a capitation
223	arrangement in order to account for those services.
224	(c) The department may reimburse actual expenditures for
225	startup contracts and fixed capital outlay contracts in
226	accordance with contract specifications.
227	(6) The department may use a fee-for-service arrangement,
228	case rates, or capitation in order to account for mental health
229	and substance abuse services.
230	Section 4. Subsections (1) and (26) of section 415.102,
231	Florida Statutes, are amended to read:
232	415.102 Definitions of terms used in ss. 415.101-
233	415.113.--As used in ss. 415.101-415.113, the term:
234	(1) "Abuse" means any willful act or threatened act by a
235	caregiverthat causes or is likely to cause significant
236	impairment to a vulnerable adult's physical, mental, or
237	emotional health. Abuse includes acts and omissions.
238	(26) "Vulnerable adult" means a person 18 years of age or
239	older whose ability to perform the normal activities of daily
240	living or to provide for his or her own care or protection is
241	impaired due to a long-termmental, emotional, physical, or
242	developmental disability or dysfunctioning, or brain damage, or
243	the infirmities of aging.
244	Section 5. Paragraph (h) is added to subsection (1) of
245	section 765.401, Florida Statutes, to read:
246	765.401 The proxy.--
247	(1) If an incapacitated or developmentally disabled
248	patient has not executed an advance directive, or designated a
249	surrogate to execute an advance directive, or the designated or
250	alternate surrogate is no longer available to make health care
251	decisions, health care decisions may be made for the patient by
252	any of the following individuals, in the following order of
253	priority, if no individual in a prior class is reasonably
254	available, willing, or competent to act:
255	(h) A clinical social worker licensed pursuant to chapter
256	491, or who is a graduate of a court-approved guardianship
257	program. Such a proxy must be selected by the provider’s
258	bioethics committee and must not be employed by the provider. If
259	the provider does not have a bioethics committee, then such a
260	proxy may be chosen through an arrangement with the bioethics
261	committee of another provider. The proxy will be notified that
262	upon request, the provider shall make available a second
263	physician, not involved in the patient’s care to assist the
264	proxy in evaluating treatment. Decisions to withhold or withdraw
265	life-prolonging procedures will be reviewed by the facility’s
266	bioethics committee. Documentation of efforts to locate proxies
267	from prior classes must be recorded in the patient record.
268	Section 6. Subsection (15) of section 744.102, Florida
269	Statutes, is amended to read:
270	744.102 Definitions.--As used in this chapter, the term:
271	(15) "Professional guardian" means any guardian who
272	receives or has at any time received compensation for services
273	rendered to more than two wards as their guardian. A person
274	serving as a guardian for two or more relatives as defined in s.
275	744.309(2) is not considered a professional guardian. A public
276	guardian shall be considered a professional guardian for
277	purposes of regulation, education, and registration.
278	Section 7. Subsection (8) is added to section 744.108,
279	Florida Statutes, to read:
280	744.108 Guardian’s and attorney’s fees and expenses.—
281	(8) When court proceedings are instituted to review or
282	determine a guardian’s or an attorney’s fees under subsection
283	(2), such proceedings are part of the guardianship
284	administration process and the costs, including fees for the
285	guardian’s attorney, shall be determined by the court and paid
286	from the assets of the guardianship estate unless the court
287	finds the requested compensation under subsection (2) to be
288	substantially unreasonable.
289	Section 8. Section 744.1083, Florida Statutes, is amended
290	to read:
291	744.1083 Professional guardian registration.--
292	(1) Effective January 1, 2003,A professional guardian
293	must register with the Statewide Public Guardianship Office
294	established in part IX of this chapter. The Statewide Public
295	Guardianship Office may contract with the clerk of the court in
296	each county to perform the administrative functions associated
297	with registering professional guardians.
298	(2) Annual registration shall be made on forms furnished
299	by the Statewide Public Guardianship Office and accompanied by
300	the applicable registration fee as determined by rule. Such fee
301	shall not exceed $100$25.
302	(3) Registration must include the following:
303	(a) If the professional guardian is a natural person, the
304	name, address, date of birth, and employer identification or
305	social security number of the professional guardian.
306	(b) If the professional guardian is a partnership or
307	association, the name, address, and date of birth of every
308	member, and the employer identification number of the
309	partnership or association.
310	(c) If the professional guardian is a corporation, the
311	name, address, and employer identification number of the
312	corporation; the name, address, and date of birth of each of its
313	directors and officers; the name of its resident agent; and the
314	name, address, and date of birth of each person having at least
315	a 10-percent interest in the corporation.
316	(d) The name, address, date of birth, and employer
317	identification number, if applicable, of each person providing
318	guardian-delegated financial or personal guardianship services
319	for wards.
320	(e) Documentation that the bonding and educational
321	requirements of s. 744.1085 have been met, and that background
322	screening has been conducted pursuant to s. 744.3135. Compliance
323	with this section shall constitute compliance with the
324	attestation requirement of s. 435.04(5).
325	(f) Sufficient information to distinguish a guardian
326	providing guardianship services as a public guardian,
327	individually, through partnership, corporation, or any other
328	business organization.
329	(4) The Department of Elderly AffairsStatewide Public
330	Guardianship Officemay adopt rules necessary to administer this
331	section.
332	(5) A trust company, a state banking corporation or state
333	savings association authorized and qualified to exercise
334	fiduciary powers in this state, or a national banking
335	association or federal savings and loan association authorized
336	and qualified to exercise fiduciary powers in this state, may,
337	but shall not be required to, register as a professional
338	guardian under this section. If a trust company, state banking
339	corporation, state savings association, national banking
340	association, or federal savings and loan association described
341	in this subsection elects to register as a professional guardian
342	under this subsection, the requirements of subsection (3) shall
343	not apply and the registration shall include only the name,
344	address, and employer identification number of the registrant,
345	the name and address of its registered agent, if any, and the
346	documentation described in paragraph (3)(e).
347	(6) The Department of Elderly Affairs may contract with
348	the Florida Guardianship Foundation or other not-for-profit
349	entity to register professional guardians.
350	(7) The department or its contractor shall ensure that the
351	clerks of the court and the Chief Judge of each judicial circuit
352	receive information about each registered professional guardian.
353	(8) A state college or university or an independent
354	college or university as described pursuant to s. 1009.98(3)(a),
355	may, but shall not be required to, register as a professional
356	guardian under this section. If a state college or university or
357	independent college or university elects to register as a
358	professional guardian under this subsection, the requirements of
359	subsection (3) shall not apply and the registration shall
360	include only the name, address, and employer identification
361	number of the registrant.
362	Section 9. Subsection (3) of section 744.1085, Florida
363	Statutes, is amended and subsections (4) through (10) are added
364	to said section to read:
365	744.1085 Regulation of professional guardians;
366	application; bond required; educational requirements.--
367	(3) Each professional guardian defined in s. 744.102(15)
368	and public guardian, on October 1, 1997,must receive a minimum
369	of 40 hours of instruction and training by October 1, 1998, or
370	within 1 year after becoming a professional guardian, whichever
371	occurs later. Each professional guardian must receive a minimum
372	of 16 hours of continuing education every 2 calendar years after
373	the year in which the initial 40-hour educational requirement is
374	met. The instruction and education must be completed through a
375	course approved or offered by the Statewide Public Guardianship
376	Office. The expenses incurred to satisfy the educational
377	requirements prescribed in this section may not be paid with the
378	assets of any ward. This subsection does not apply to any
379	attorney who is licensed to practice law in this state.
380	(4) Each professional guardian must allow, at the
381	guardian’s expense, an investigation of the guardian’s credit
382	history, and the credit history of employees of the guardian, in
383	a manner prescribed by the Department of Elderly Affairs.
384	(5) As required in s. 744.3135, each professional guardian
385	shall allow a level 2 background screening of the guardian and
386	employees of the guardian in accordance with the provisions of
387	s. 435.04.
388	(6) After July 1, 2005, each professional guardian shall
389	be required to demonstrate competency to act as a professional
390	guardian by taking an examination approved by the Department of
391	Elderly Affairs.
392	(a) The Department of Elderly Affairs shall determine the
393	minimum examination score necessary for passage of guardianship
394	examinations.
395	(b) The Department of Elderly Affairs shall determine the
396	procedure for administration of the examination.
397	(c) The Department of Elderly Affairs or its contractor
398	shall charge an examination fee for the actual costs of the
399	development and the administration of the examination, not to
400	exceed $500.
401	(d) The Department of Elderly Affairs may recognize
402	passage of a national guardianship examination in lieu of all or
403	part of the examination approved by the Department of Elderly
404	Affairs, except that all professional guardians must take and
405	pass an approved examination section related to Florida law and
406	procedure.
407	(7) The Department of Elderly Affairs shall set the
408	minimum score necessary to demonstrate professional guardianship
409	competency.
410	(8) The Department of Elderly Affairs shall waive the
411	examination requirement in paragraph (6) if a professional
412	guardian can provide:
413	(a) Proof that the guardian has actively acted as a
414	professional guardian for 5 years or more; and
415	(b) A letter from a circuit judge before whom the
416	professional guardian practiced at least 1 year which states
417	that the professional guardian had demonstrated to the court
418	competency as a professional guardian.
419	(9) After July 1, 2004, the court shall not appoint any
420	professional guardian who has not met the requirements of this
421	section and s. 744.1083.
422	(10) This section does not apply to a professional
423	guardian or the employees of that professional guardian when
424	that guardian is a trust company, a state banking corporation,
425	state savings association authorized and qualified to exercise
426	fiduciary powers in this state, or a national banking
427	association or federal savings and loan association authorized
428	and qualified to exercise fiduciary powers in this state.
429	Section 10. Section 744.3135, Florida Statutes, is amended
430	to read:
431	744.3135 Credit and criminal investigation.--The court may
432	require a nonprofessional guardian and shall require a
433	professional or public guardian, and all employees of a
434	professional guardian who have a fiduciary responsibility to a
435	ward, to submit, at their own expense, to an investigation of
436	the guardian's credit history and to undergo level 2 background
437	screening as required under s. 435.04. The clerk of the court
438	shall obtain fingerprint cards from the Federal Bureau of
439	Investigation and make them available to guardians. Any guardian
440	who is so required shall have his or her fingerprints taken and
441	forward the proper fingerprint card along with the necessary fee
442	to the Florida Department of Law Enforcement for processing. The
443	professional guardian shall pay to the clerk of the court a fee
444	of $5 for handling and processing professional guardian files.
445	The results of the fingerprint checks shall be forwarded to the
446	clerk of court who shall maintain the results in a guardian file
447	and shall make the results available to the court. If credit or
448	criminal investigations are required, the court must consider
449	the results of the investigations in appointing a guardian.
450	Professionalguardians and all employees of a professional
451	guardian who have a fiduciary responsibility to a ward, so
452	appointed, must resubmit, at their own expense, to an
453	investigation of credit history, and undergo level 1 background
454	screening as required under s. 435.03, at leastevery 2 years
455	after the date of their appointment. At any time, the court may
456	require guardians or their employees to submit to an
457	investigation of credit history and undergo level 1 background
458	screening as required under s. 435.03.The court must consider
459	the results of these investigations in reappointing a guardian.
460	This section shall not apply to a professional guardian, or to
461	the employees of a professional guardian, that is a trust
462	company, a state banking corporation or state savings
463	association authorized and qualified to exercise fiduciary
464	powers in this state, or a national banking association or
465	federal savings and loan association authorized and qualified to
466	exercise fiduciary powers in this state.
467	Section 11. Section 744.3145, Florida Statutes, is amended
468	to read:
469	744.3145 Guardian education requirements.--
470	(1) Each ward is entitled to a guardian competent to
471	perform the duties of a guardian necessary to protect the
472	interests of the ward.
473	(2) Each person appointed by the court to be a guardian,
474	other than a parent who is the guardian of the property of a
475	minor child,must receive a minimum of 8 hours of instruction
476	and training which covers:
477	(a) The legal duties and responsibilities of the guardian;
478	(b) The rights of the ward;
479	(c) The availability of local resources to aid the ward;
480	and
481	(d) The preparation of habilitation plans and annual
482	guardianship reports, including financial accounting for the
483	ward's property.
484	(3) Each person appointed by the court to be the guardian
485	of the property of his or her minor child must receive a minimum
486	of 4 hours of instruction and training that covers:
487	(a) The legal duties and responsibilities of the guardian
488	of the property;
489	(b) The preparation of the initial inventory and annual
490	guardianship accountings for the ward’s property; and
491	(c) Use of guardianship assets.
492	(4)(3)Each person appointed by the court to be a guardian
493	must complete the required number of8hours of instruction and
494	education within 1 year after his or her appointment as
495	guardian. The instruction and education must be completed
496	through a course approved by the chief judge of the circuit
497	court and taught by a court-approved organization. Court-
498	approved organizations may include, but are not limited to,
499	community or junior colleges, guardianship organizations, and
500	the local bar association or The Florida Bar.
501	(5)(4)Expenses incurred by the guardian to satisfy the
502	education requirement may be paid from the ward's estate, unless
503	the court directs that such expenses be paid by the guardian
504	individually.
505	(6)(5)The court may, in its discretion, waive some or all
506	of the requirements of this section or impose additional
507	requirements. The court shall make its decision on a case-by-
508	case basis and, in making its decision, shall consider the
509	experience and education of the guardian, the duties assigned to
510	the guardian, and the needs of the ward.
511	(7)(6)The provisions of this section do not apply to
512	professional guardians.
513	Section 12. Subsection (13) of section 744.444, Florida
514	Statutes, is amended, and subsections (16) and (17) are added to
515	said section to read:
516	744.444 Power of guardian without court approval.--Without
517	obtaining court approval, a plenary guardian of the property, or
518	a limited guardian of the property within the powers granted by
519	the order appointing the guardian or an approved annual or
520	amended guardianship report, may:
521	(13) When reasonably necessary, employ persons, including
522	attorneys, auditors, investment advisers, care managers,or
523	agents, even if they are associated with the guardian, to advise
524	or assist the guardian in the performance of his or her duties.
525	(16) Pay or reimburse costs incurred and reasonable fees
526	or compensation to persons, including attorneys, employed by the
527	guardian pursuant to subsection (13) from the assets of the
528	guardianship estate, subject to obtaining court approval of the
529	annual accounting.
530	(17) Provide confidential information about a ward that is
531	related to an investigation arising under part I of chapter 400
532	to a local or state ombudsman council member conducting such an
533	investigation. Any such ombudsman shall have a duty to maintain
534	the confidentiality of such information.
535	Section 13. Paragraph (c) of subsection (2) of section
536	744.534, Florida Statutes, is amended to read:
537	744.534 Disposition of unclaimed funds held by guardian.--
538	(2)
539	(c) Within 5 years from the date of deposit with the State
540	Treasurer, on written petition to the court that directed the
541	deposit of the funds and informal notice to the Department of
542	Legal Affairs, and after proof of his or her right to them, any
543	person entitled to the funds, before or after payment to the
544	State Treasurer and deposit as provided for in paragraph (a),
545	may obtain a court order directing the payment of the funds to
546	him or her. All funds deposited with the State Treasurer and not
547	claimed within 5 years from the date of deposit shall escheat to
548	the state to be deposited in the Department of Elderly Affairs
549	Administrative Trust Fund to be used solely for the benefit of
550	public guardianship as determined by the Secretary of Elderly
551	AffairsStatewide Public Guardianship Office established in part
552	IX of this chapter.
553	Section 14. Section 744.7021, Florida Statutes, is amended
554	to read:
555	744.7021 Statewide Public Guardianship Office.--There is
556	hereby created the Statewide Public Guardianship Office within
557	the Department of Elderly Affairs. The Department of Elderly
558	Affairs shall provide administrative support and service to the
559	office to the extent requested by the executive director within
560	the available resources of the department. The Statewide Public
561	Guardianship Office may request the assistance of the Inspector
562	General of the Department of Elderly Affairs in providing
563	auditing services, and the Office of General Counsel of the
564	department may provide assistance in rulemaking and other
565	matters as needed to assist the Statewide Public Guardianship
566	Office. The Statewide Public Guardianship Office shall not be
567	subject to control, supervision, or direction by the Department
568	of Elderly Affairs in the performance of its duties.
569	(1) The Secretary of Elderly Affairs shall appoint the
570	executive director, who shall be thehead of the Statewide
571	Public Guardianship Office is the executive director, who shall
572	be appointed by the Governor. The executive director must be a
573	member of The Florida Bar, knowledgeable oflicensed attorney
574	with a background in guardianship law and knowledge of the
575	social services available to meet the needs of incapacitated
576	persons, shall serve on a full-time basis, and shall personally,
577	or through representatives of the office, carry out the purposes
578	and functions of the Statewide Public Guardianship Office in
579	accordance with state and federal law. The executive director
580	shall serve at the pleasure of and report to the Secretary
581	Governor.
582	(2) The executive directorStatewide Public Guardianship
583	Officeshall, within available resources, have oversight
584	responsibilities for all public guardians.
585	(a) The executive directorofficeshall review the current
586	public guardian programs in Florida and other states.
587	(b) The executive directoroffice, in consultation with
588	local guardianship offices, shall develop statewide performance
589	measures and standards.
590	(c) The executive directorofficeshall review the various
591	methods of funding guardianship programs, the kinds of services
592	being provided by such programs, and the demographics of the
593	wards. In addition, the executive directorofficeshall review
594	and make recommendations regarding the feasibility of recovering
595	a portion or all of the costs of providing public guardianship
596	services from the assets or income of the wards.
597	(d) No later than October 1, 2000, the office shall submit
598	to the Governor, the President of the Senate, the Speaker of the
599	House of Representatives, and the Chief Justice of the Supreme
600	Court an interim report describing the progress of the office in
601	meeting the goals as described in this section. No later than
602	October 1, 2001, the office shall submit to the Governor, the
603	President of the Senate, the Speaker of the House of
604	Representatives, and the Chief Justice of the Supreme Court a
605	proposed public guardianship plan including alternatives for
606	meeting the state's guardianship needs. This plan may include
607	recommendations for less than the entire state, may include a
608	phase-in system, and shall include estimates of the cost of each
609	of the alternatives.By January 1, 2004, and by January 1 of
610	each year thereafter, the executive directorofficeshall
611	provide a status report and provide further recommendations to
612	the Secretary thataddress the need for public guardianship
613	services and related issues.
614	(e) The executive directorofficemay provide assistance
615	to local governments or entities in pursuing grant
616	opportunities. The executive directorofficeshall review and
617	make recommendations in the annual report on the availability
618	and efficacy of seeking Medicaid matching funds. The executive
619	directorofficeshall diligently seek ways to use existing
620	programs and services to meet the needs of public wards.
621	(f) The executive director, in consultation with the
622	Florida Guardianship Foundation,officeshall develop a
623	guardianship training program curriculum that. The training
624	programmay be offered to all guardians whether public or
625	private. The office shall establish a curriculum committee to
626	develop the training program specified in this part. The
627	curriculum committee shall include, but not be limited to,
628	probate judges. A fee may be charged to private guardians in
629	order to defray the cost of providing the training. In addition,
630	a fee may be charged to any training provider for up to the
631	actual cost of the review and approval of their curriculum. Any
632	fees collected pursuant to this paragraph shall be deposited in
633	the Department of Elderly Affairs Administrative Trust Fund to
634	be used for the guardianship training program.
635	(3) The executive directorofficemay conduct or contract
636	for demonstration projects authorized by the Department of
637	Elderly Affairs, within funds appropriated or through gifts,
638	grants, or contributions for such purposes, to determine the
639	feasibility or desirability of new concepts of organization,
640	administration, financing, or service delivery designed to
641	preserve the civil and constitutional rights of persons of
642	marginal or diminished capacity. Any gifts, grants, or
643	contributions for such purposes shall be deposited in the
644	Department of Elderly Affairs Administrative Trust Fund.
645	(4) The Department of Elderly Affairsofficehas authority
646	to adopt rules pursuant to ss. 120.536(1) and 120.54 to carry
647	out the provisions of this section.
648	Section 15. Subsections (1) and (3) of section 744.704,
649	Florida Statutes, are amended to read:
650	744.704 Powers and duties.--
651	(1) A public guardian may serve as a guardian of a person
652	adjudicated incapacitated under this chapter:
653	(a)if there is no family member or friend, other person,
654	bank, or corporation willing and qualified to serve as guardian;
655	and
656	(b) If the assets of the ward do not exceed the asset
657	level for Medicaid eligibility, exclusive of homestead and
658	exempt property as defined in s. 4, Art. X of the State
659	Constitution, and the ward's income, from all sources, is less
660	than $4,000 per year. Income from public welfare programs,
661	supplemental security income, optional state supplement, a
662	disability pension, or a social security pension shall be
663	excluded in such computation. However, a ward whose total
664	income, counting excludable income, exceeds $30,000 a year may
665	not be served.
666	(3) The public guardian shall primarily serve
667	incapacitated persons who are of limited financial means, as
668	defined by contract or rule of the Department of Elderly
669	Affairs. The public guardian may serve incapacitated persons of
670	greater financial means to the extent the Department of Elderly
671	Affairs determines to be appropriateIf the public guardian
672	finds that the assets or the income of the ward exceeds the
673	amounts set forth in paragraph (1)(b), the public guardian shall
674	submit a resignation and petition the court for appointment of a
675	successor guardian. The public guardian shall not be dismissed
676	until such time that a private guardian is appointed. If a
677	qualified successor guardian is not available, the public
678	guardian may remain as guardian, provided the guardian makes
679	reasonable efforts to find a successor and reports to the court
680	every 6 months on efforts to obtain a successor.
681	Section 16. (1) There is created within the Department of
682	Elderly Affairs a Guardianship Task Force for the purpose of
683	examining guardianship and incapacity and making recommendations
684	to the Governor and the Legislature for the improvement of
685	processes and procedures related to guardianship and incapacity.
686	The department shall staff the task force, and the Secretary of
687	Elderly Affairs shall appoint the chair from among the task
688	force membership. The members of the task force shall serve
689	without compensation. Unless specified otherwise, task force
690	members shall be appointed by the organizations they represent,
691	and the cost of members’ participation shall be borne by their
692	appointing organization. Any member who is a public employee is
693	entitled to reimbursement for per diem and travel expenses by
694	the appointing department.
695	(2) The Guardianship Task Force shall identify the
696	characteristics of Florida guardianship practice. It shall also
697	identify best practices and recommend specific statutory and
698	other changes for achieving such best practices and for
699	achieving citizen access to quality guardianship services. The
700	task force shall make a preliminary report to the Secretary of
701	Elderly Affairs no later than January 1, 2004, and its final
702	report to the secretary shall be made no later than January 1,
703	2005.
704	(3) The Guardianship Task Force shall consist of ten
705	members, including a judge with experience in guardianship
706	proceedings who is appointed by the Florida Conference of
707	Circuit Judges, a representative of the Association of Clerks of
708	Court, a professor of law with experience in elder issues
709	appointed by the Secretary of Elderly Affairs, a representative
710	of the Florida State Guardianship Association, a representative
711	of the Florida Guardianship Foundation, a representative of the
712	Real Property and Probate Section of The Florida Bar, a
713	representative of the Elder Law Section of The Florida Bar, a
714	professional as provided in s. 744.331(3), with experience
715	performing examinations and determining incapacity, a
716	representative of the Florida Banker’s Association, and a
717	citizen or consumer appointed by the Executive Director of the
718	Florida office of the American Association of Retired Persons.
719	(4) The Guardianship Task Force may appoint ex officio
720	members who possess needed expertise to assist the task force in
721	its work. The task force will cease to exist May 6, 2005.
722	Section 17. Notwithstanding the provisions of section 64
723	of chapter 95-228, Laws of Florida, the provisions of chapter
724	435, Florida Statutes, as created therein and as subsequently
725	amended, and any reference thereto, shall apply to all offenses
726	regardless of the date on which offenses referenced in chapter
727	435, Florida Statutes, were committed, unless specifically
728	provided otherwise in a provision other than section 64 of
729	chapter 95-228, Laws of Florida.
730	Section 18. Subsection (12) is added to section 400.071,
731	Florida Statutes, to read:
732	400.071 Application for license.--
733	(12) The applicant must provide the agency with proof of a
734	legal right to occupy the property before a license may be
735	issued. Proof may include, but is not limited to, copies of
736	warranty deeds, lease or rental agreements, contracts for deeds,
737	or quitclaim deeds.
738	Section 19. Subsection (1) of section 400.414, Florida
739	Statutes, is amended to read:
740	400.414 Denial, revocation, or suspension of license;
741	imposition of administrative fine; grounds.--
742	(1) The agency may deny, revoke, or suspend any license
743	issued under this part, or impose an administrative fine in the
744	manner provided in chapter 120, for any of the following actions
745	by an assisted living facility, for the actions ofany person
746	subject to level 2 background screening under s. 400.4174, or
747	for the actions ofany facility employee:
748	(a) An intentional or negligent act seriously affecting
749	the health, safety, or welfare of a resident of the facility.
750	(b) The determination by the agency that the owner lacks
751	the financial ability to provide continuing adequate care to
752	residents.
753	(c) Misappropriation or conversion of the property of a
754	resident of the facility.
755	(d) Failure to follow the criteria and procedures provided
756	under part I of chapter 394 relating to the transportation,
757	voluntary admission, and involuntary examination of a facility
758	resident.
759	(e) A citation of any of the following deficiencies as
760	defined in s. 400.419:
761	1. One or more cited class I deficiencies.
762	2. Three or more cited class II deficiencies.
763	3. Five or more cited class III deficiencies that have
764	been cited on a single survey and have not been corrected within
765	the times specifiedOne or more class I, three or more class II,
766	or five or more repeated or recurring identical or similar class
767	III violations that are similar or identical to violations which
768	were identified by the agency within the last 2 years.
769	(f) A determination that a person subject to level 2
770	background screening under s. 400.4174(1) does not meet the
771	screening standards of s. 435.04 or that the facility is
772	retaining an employee subject to level 1 background screening
773	standards under s. 400.4174(2) who does not meet the screening
774	standards of s. 435.03 and for whom exemptions from
775	disqualification have not been provided by the agency.
776	(g) A determination that an employee, volunteer,
777	administrator, or owner, or person who otherwise has access to
778	the residents of a facility does not meet the criteria specified
779	in s. 435.03(2), and the owner or administrator has not taken
780	action to remove the person. Exemptions from disqualification
781	may be granted as set forth in s. 435.07. No administrative
782	action may be taken against the facility if the person is
783	granted an exemption.
784	(h) Violation of a moratorium.
785	(i) Failure of the license applicant, the licensee during
786	relicensure, or a licensee that holds a provisional license to
787	meet the minimum license requirements of this part, or related
788	rules, at the time of license application or renewal.
789	(j) A fraudulent statement or omission of any material
790	fact on an application for a license or any other document
791	required by the agency, including the submission of a license
792	application that conceals the fact that any board member,
793	officer, or person owning 5 percent or more of the facility may
794	not meet the background screening requirements of s. 400.4174,
795	or that the applicant has been excluded, permanently suspended,
796	or terminated from the Medicaid or Medicare programs.
797	(k) An intentional or negligent life-threatening act in
798	violation of the uniform firesafety standards for assisted
799	living facilities or other firesafety standards that threatens
800	the health, safety, or welfare of a resident of a facility, as
801	communicated to the agency by the local authority having
802	jurisdiction or the State Fire Marshal.
803	(l) Exclusion, permanent suspension, or termination from
804	the Medicare or Medicaid programs.
805	(m) Knowingly operating any unlicensed facility or
806	providing without a license any service that must be licensed
807	under this chapter.
808	(n) Any act constituting a ground upon which application
809	for a license may be denied.
810
811	Administrative proceedings challenging agency action under this
812	subsection shall be reviewed on the basis of the facts and
813	conditions that resulted in the agency action.
814	Section 20. Subsection (1) of section 400.417, Florida
815	Statutes, is amended to read:
816	400.417 Expiration of license; renewal; conditional
817	license.--
818	(1) Biennial licenses, unless sooner suspended or revoked,
819	shall expire 2 years from the date of issuance. Limited nursing,
820	extended congregate care, and limited mental health licenses
821	shall expire at the same time as the facility's standard
822	license, regardless of when issued. The agency shall notify the
823	facility by certified mailat least 120 days prior to expiration
824	that a renewal license is necessary to continue operation. The
825	notification must be provided electronically or by mail
826	delivery.Ninety days prior to the expiration date, an
827	application for renewal shall be submitted to the agency. Fees
828	must be prorated. The failure to file a timely renewal
829	application shall result in a late fee charged to the facility
830	in an amount equal to 50 percent of the current fee.
831	Section 21. Section 400.419, Florida Statutes, is amended
832	to read:
833	400.419 Violations; imposition of administrative fines;
834	grounds.--
835	(1) The agency shall impose an administrative fine in the
836	manner provided in chapter 120 for any of the actions or
837	violations as set forth within this section by an assisted
838	living facility, for the actions of any person subject to level
839	2 background screening under s. 400.4174, for the actions of any
840	facility employee, or for an intentional or negligent act
841	seriously affecting the health, safety, or welfare of a resident
842	of the facility.
843	(2)(1)Each violation of this part and adopted rules shall
844	be classified according to the nature of the violation and the
845	gravity of its probable effect on facility residents. The agency
846	shall indicate the classification on the written notice of the
847	violation as follows:
848	(a) Class "I" violations are those conditions or
849	occurrences related to the operation and maintenance of a
850	facility or to the personal care of residents which the agency
851	determines present an imminent danger to the residents or guests
852	of the facility or a substantial probability that death or
853	serious physical or emotional harm would result therefrom. The
854	condition or practice constituting a class I violation shall be
855	abated or eliminated within 24 hours, unless a fixed period, as
856	determined by the agency, is required for correction. The agency
857	shall impose an administrative fine for a citedclass I
858	violation is subject to an administrative finein an amount not
859	less than $5,000 and not exceeding $10,000 for each violation. A
860	fine may be levied notwithstanding the correction of the
861	violation.
862	(b) Class "II" violations are those conditions or
863	occurrences related to the operation and maintenance of a
864	facility or to the personal care of residents which the agency
865	determines directly threaten the physical or emotional health,
866	safety, or security of the facility residents, other than class
867	I violations. The agency shall impose an administrative fine for
868	a cited class II violation is subject to an administrative fine
869	in an amount not less than $1,000 and not exceeding $5,000 for
870	each violation. A fine shall be levied notwithstanding the
871	correction of the violationA citation for a class II violation
872	must specify the time within which the violation is required to
873	be corrected.
874	(c) Class "III" violations are those conditions or
875	occurrences related to the operation and maintenance of a
876	facility or to the personal care of residents which the agency
877	determines indirectly or potentially threaten the physical or
878	emotional health, safety, or security of facility residents,
879	other than class I or class II violations. The agency shall
880	impose an administrative fine for a cited class III violation in
881	an amountis subject to an administrative fine ofnot less than
882	$500 and not exceeding $1,000 for each violation. A citation for
883	a class III violation must specify the time within which the
884	violation is required to be corrected. If a class III violation
885	is corrected within the time specified, no fine may be imposed,
886	unless it is a repeated offense.
887	(d) Class "IV" violations are those conditions or
888	occurrences related to the operation and maintenance of a
889	building or to required reports, forms, or documents that do not
890	have the potential of negatively affecting residents. These
891	violations are of a type that the agency determines do not
892	threaten the health, safety, or security of residents of the
893	facility. The agency shall impose an administrative fine for a
894	cited class IV violation in an amountA facility that does not
895	correct a class IV violation within the time specified in the
896	agency-approved corrective action plan is subject to an
897	administrative fine of not less than $100 and not exceedingnor
898	more than $200 for each violation. A citation for a class IV
899	violation must specify the time within which the violation is
900	required to be corrected. If a class IV violation is corrected
901	within the time specified, no fine shall be imposed.Any class
902	IV violation that is corrected during the time an agency survey
903	is being conducted will be identified as an agency finding and
904	not as a violation.
905	(3)(2)In determining if a penalty is to be imposed and in
906	fixing the amount of the fine, the agency shall consider the
907	following factors:
908	(a) The gravity of the violation, including the
909	probability that death or serious physical or emotional harm to
910	a resident will result or has resulted, the severity of the
911	action or potential harm, and the extent to which the provisions
912	of the applicable laws or rules were violated.
913	(b) Actions taken by the owner or administrator to correct
914	violations.
915	(c) Any previous violations.
916	(d) The financial benefit to the facility of committing or
917	continuing the violation.
918	(e) The licensed capacity of the facility.
919	(4)(3)Each day of continuing violation after the date
920	fixed for termination of the violation, as ordered by the
921	agency, constitutes an additional, separate, and distinct
922	violation.
923	(5)(4)Any action taken to correct a violation shall be
924	documented in writing by the owner or administrator of the
925	facility and verified through followup visits by agency
926	personnel. The agency may impose a fine and, in the case of an
927	owner-operated facility, revoke or deny a facility's license
928	when a facility administrator fraudulently misrepresents action
929	taken to correct a violation.
930	(6)(5)For fines that are upheld following administrative
931	or judicial review, the violator shall pay the fine, plus
932	interest at the rate as specified in s. 55.03, for each day
933	beyond the date set by the agency for payment of the fine.
934	(7)(6)Any unlicensed facility that continues to operate
935	after agency notification is subject to a $1,000 fine per day.
936	(8)(7)Any licensed facility whose owner or administrator
937	concurrently operates an unlicensed facility shall be subject to
938	an administrative fine of $5,000 per day.
939	(9)(8)Any facility whose owner fails to apply for a
940	change-of-ownership license in accordance with s. 400.412 and
941	operates the facility under the new ownership is subject to a
942	fine of $5,000.
943	(10)(9)In addition to any administrative fines imposed,
944	the agency may assess a survey fee, equal to the lesser of one
945	half of the facility's biennial license and bed fee or $500, to
946	cover the cost of conducting initial complaint investigations
947	that result in the finding of a violation that was the subject
948	of the complaint or monitoring visits conducted under s.
949	400.428(3)(c) to verify the correction of the violations.
950	(11)(10)The agency, as an alternative to or in
951	conjunction with an administrative action against a facility for
952	violations of this part and adopted rules, shall make a
953	reasonable attempt to discuss each violation and recommended
954	corrective action with the owner or administrator of the
955	facility, prior to written notification. The agency, instead of
956	fixing a period within which the facility shall enter into
957	compliance with standards, may request a plan of corrective
958	action from the facility which demonstrates a good faith effort
959	to remedy each violation by a specific date, subject to the
960	approval of the agency.
961	(12)(11)Administrative fines paid by any facility under
962	this section shall be deposited into the Health Care Trust Fund
963	and expended as provided in s. 400.418.
964	(13)(12)The agency shall develop and disseminate an
965	annual list of all facilities sanctioned or fined $5,000 or more
966	for violations of state standards, the number and class of
967	violations involved, the penalties imposed, and the current
968	status of cases. The list shall be disseminated, at no charge,
969	to the Department of Elderly Affairs, the Department of Health,
970	the Department of Children and Family Services, the area
971	agencies on aging, the Florida Statewide Advocacy Council, and
972	the state and local ombudsman councils. The Department of
973	Children and Family Services shall disseminate the list to
974	service providers under contract to the department who are
975	responsible for referring persons to a facility for residency.
976	The agency may charge a fee commensurate with the cost of
977	printing and postage to other interested parties requesting a
978	copy of this list.
979	Section 22. Subsections (1) and (2) of section 400.0239,
980	Florida Statutes, are amended to read:
981	400.0239 Quality of Long-Term Care Facility Improvement
982	Trust Fund.--
983	(1) There is created within the Agency for Health Care
984	Administration a Quality of Long-Term Care Facility Improvement
985	Trust Fund to support activities and programs directly related
986	to improvement of the care of nursing home and assisted living
987	facility residents. The trust fund shall be funded through
988	proceeds generated pursuant to ss. 400.0238 and 400.4298,
989	through funds specifically appropriated by the Legislature, and
990	through gifts, endowments, and other charitable contributions
991	allowed under federal and state law, and through federal nursing
992	home civil monetary penalties collected by the Centers for
993	Medicare and Medicaid Services and returned to the state. These
994	funds must be utilized in accordance with federal requirements.
995	(2) Expenditures from the trust fund shall be allowable
996	for direct support of the following:
997	(a) Development and operation of a mentoring program, in
998	consultation with the Department of Health and the Department of
999	Elderly Affairs, for increasing the competence, professionalism,
1000	and career preparation of long-term care facility direct care
1001	staff, including nurses, nursing assistants, and social service
1002	and dietary personnel.
1003	(b) Development and implementation of specialized training
1004	programs for long-term care facility personnel who provide
1005	direct care for residents with Alzheimer's disease and other
1006	dementias, residents at risk of developing pressure sores, and
1007	residents with special nutrition and hydration needs.
1008	(c) Addressing areas of deficient practice identified
1009	through regulation or state monitoring.
1010	(d)(c)Provision of economic and other incentives to
1011	enhance the stability and career development of the nursing home
1012	direct care workforce, including paid sabbaticals for exemplary
1013	direct care career staff to visit facilities throughout the
1014	state to train and motivate younger workers to commit to careers
1015	in long-term care.
1016	(e)(d)Promotion and support for the formation and active
1017	involvement of resident and family councils in the improvement
1018	of nursing home care.
1019	(f) Evaluation of special residents' needs in long-term
1020	care facilities, including challenges in meeting special
1021	residents' needs, appropriateness of placement and setting, and
1022	cited deficiencies related to caring for special needs.
1023	(g) Other initiatives authorized by the Centers for
1024	Medicare and Medicaid Services for the use of federal civil
1025	monetary penalties, including projects recommended through the
1026	Medicaid "Up-or-Out" Quality of Care Contract Management Program
1027	pursuant to s. 400.148.
1028	Section 23. Paragraph (d) of subsection (15) of section
1029	400.141, Florida Statutes, is amended, and a new paragraph (e)
1030	is added to said subsection, to read:
1031	400.141 Administration and management of nursing home
1032	facilities.--Every licensed facility shall comply with all
1033	applicable standards and rules of the agency and shall:
1034	(15) Submit semiannually to the agency, or more frequently
1035	if requested by the agency, information regarding facility
1036	staff-to-resident ratios, staff turnover, and staff stability,
1037	including information regarding certified nursing assistants,
1038	licensed nurses, the director of nursing, and the facility
1039	administrator. For purposes of this reporting:
1040	(d) A nursing facility that has failed to maintain
1041	certified nursing assistant staffing of at least 95 percent of
1042	thecomply with state minimum-staffing requirements on any day
1043	or has certified nursing assistant staffing that is below the
1044	minimum requirements provided in s. 400.23(3)(a)for 2
1045	consecutive days is prohibited from accepting new admissions
1046	until the facility has achieved the minimum-staffing
1047	requirements for a period of 6 consecutive days. For the
1048	purposes of this paragraph, any person who was a resident of the
1049	facility and was absent from the facility for the purpose of
1050	receiving medical care at a separate location or was on a leave
1051	of absence is not considered a new admission. Failure to impose
1052	such an admissions moratorium constitutes a class II deficiency.
1053	(e) A nursing facility may be cited for failure to comply
1054	with the standards for certified nursing assistants in s.
1055	400.23(3)(a) only if it has failed to meet those standards on 2
1056	consecutive days or if it has failed to meet at least 95 percent
1057	of those standards on any one day. Nothing in this section shall
1058	limit the agency’s ability to impose a deficiency or take other
1059	actions if a facility does not have enough staff to meet the
1060	residents’ needs.
1061
1062	Facilities that have been awarded a Gold Seal under the program
1063	established in s. 400.235 may develop a plan to provide
1064	certified nursing assistant training as prescribed by federal
1065	regulations and state rules and may apply to the agency for
1066	approval of their program.
1067	Section 24. Paragraph (b) of subsection (5) of section
1068	400.235, Florida Statutes, is amended to read:
1069	400.235 Nursing home quality and licensure status; Gold
1070	Seal Program.--
1071	(5) Facilities must meet the following additional criteria
1072	for recognition as a Gold Seal Program facility:
1073	(b) Evidence financial soundness and stability according
1074	to standards adopted by the agency in administrative rule. Such
1075	standards must include, but not be limited to, criteria for the
1076	use of financial statements that are prepared in accordance with
1077	generally accepted accounting principles and that are reviewed
1078	or audited by certified public accountants.
1079
1080	A facility assigned a conditional licensure status may not
1081	qualify for consideration for the Gold Seal Program until after
1082	it has operated for 30 months with no class I or class II
1083	deficiencies and has completed a regularly scheduled relicensure
1084	survey.
1085	Section 25. Subsections (1), (2), (7), (8), and (9) of
1086	section 400.452, Florida Statutes, are amended to read:
1087	400.452 Staff training and educational programs; core
1088	educational requirement.--
1089	(1) The department shall ensure thatprovide, or cause to
1090	be provided, training and educational programs forthe
1091	administrators and other assisted living facility staff have met
1092	training and education requirements thatto betterenable them
1093	to appropriately respond to the needs of residents, to maintain
1094	resident care and facility standards, and to meet licensure
1095	requirements.
1096	(2) The department shall alsoestablish a core educational
1097	requirement to be used in these programs. Successful completion
1098	of the core educational requirement must include successful
1099	completion of a competency test. Programs must be provided by
1100	the department or by a provider approved by the department at
1101	least quarterly.The core educational requirement must cover at
1102	least the following topics:
1103	(a) State law and rules relating to assisted living
1104	facilities.
1105	(b) Resident rights and identifying and reporting abuse,
1106	neglect, and exploitation.
1107	(c) Special needs of elderly persons, persons with mental
1108	illness, and persons with developmental disabilities and how to
1109	meet those needs.
1110	(d) Nutrition and food service, including acceptable
1111	sanitation practices for preparing, storing, and serving food.
1112	(e) Medication management, recordkeeping, and proper
1113	techniques for assisting residents with self-administered
1114	medication.
1115	(f) Firesafety requirements, including fire evacuation
1116	drill procedures and other emergency procedures.
1117	(g) Care of persons with Alzheimer's disease and related
1118	disorders.
1119	(7) A facility that does not have any residents who
1120	receive monthly optional supplementation payments must pay a
1121	reasonable fee for such training and education programs. A
1122	facility that has one or more such residents shall pay a reduced
1123	fee that is proportional to the percentage of such residents in
1124	the facility. Any facility more than 90 percent of whose
1125	residents receive monthly optional state supplementation
1126	payments is not required to pay for the training and continuing
1127	education programs required under this section.
1128	(7)(8)If the department or the agency determines that
1129	there are problems in a facility that could be reduced through
1130	specific staff training or education beyond that already
1131	required under this section, the department or the agency may
1132	require, and provide, or cause to be provided, the training or
1133	education of any personal care staff in the facility.
1134	(8)(9)The department shall adopt rules to establish
1135	training programs, standards and curriculum for training, staff
1136	training requirements, procedures for approving training
1137	programs, and training fees.
1138	Section 26. Subsections (7), (8), and (9) are added to
1139	section 430.502, Florida Statutes, to read:
1140	430.502 Alzheimer's disease; memory disorder clinics and
1141	day care and respite care programs.--
1142	(7) The Agency for Health Care Administration and the
1143	department shall seek a federal waiver to implement a Medicaid
1144	home and community-based waiver targeted to persons with
1145	Alzheimer's disease to test the effectiveness of Alzheimer’s
1146	specific interventions to delay or to avoid institutional
1147	placement.
1148	(8) The department will implement the waiver program
1149	specified in subsection (7). The agency and the department shall
1150	ensure that providers are selected that have a history of
1151	successfully serving persons with Alzheimer's disease. The
1152	department and the agency shall develop specialized standards
1153	for providers and services tailored to persons in the early,
1154	middle, and late stages of Alzheimer's disease and designate a
1155	level of care determination process and standard that is most
1156	appropriate to this population. The department and the agency
1157	shall include in the waiver services designed to assist the
1158	caregiver in continuing to provide in-home care. The department
1159	shall implement this waiver program subject to a specific
1160	appropriation or as provided in the General Appropriations Act.
1161	The department and the agency shall submit their program design
1162	to the President of the Senate and the Speaker of the House of
1163	Representatives for consultation during the development process.
1164	(9) Authority to continue the waiver program specified in
1165	subsection (7) shall be automatically eliminated at the close of
1166	the 2008 Regular Session of the Legislature unless further
1167	legislative action is taken to continue it prior to such time.
1168	Section 27. Subsection (1) of section 400.557, Florida
1169	Statutes, is amended to read:
1170	400.557 Expiration of license; renewal; conditional
1171	license or permit.--
1172	(1) A license issued for the operation of an adult day
1173	care center, unless sooner suspended or revoked, expires 2 years
1174	after the date of issuance. The agency shall notify a licensee
1175	by certified mail, return receipt requested,at least 120 days
1176	before the expiration date that license renewal is required to
1177	continue operation. The notification must be provided
1178	electronically or by mail delivery.At least 90 days prior to
1179	the expiration date, an application for renewal must be
1180	submitted to the agency. A license shall be renewed, upon the
1181	filing of an application on forms furnished by the agency, if
1182	the applicant has first met the requirements of this part and of
1183	the rules adopted under this part. The applicant must file with
1184	the application satisfactory proof of financial ability to
1185	operate the center in accordance with the requirements of this
1186	part and in accordance with the needs of the participants to be
1187	served and an affidavit of compliance with the background
1188	screening requirements of s. 400.5572.
1189	Section 28. Subsection (3) of section 400.619, Florida
1190	Statutes, is amended to read:
1191	400.619 Licensure application and renewal.--
1192	(3) The agency shall notify a licensee at least 120 days
1193	before the expiration date that license renewal is required to
1194	continue operation. The notification must be provided
1195	electronically or by mail delivery.Application for a license or
1196	annual license renewal must be made on a form provided by the
1197	agency, signed under oath, and must be accompanied by a
1198	licensing fee of $100 per year.
1199	Section 29. Subsection (4) of section 400.980, Florida
1200	Statutes, is reenacted and amended to read:
1201	400.980 Health care services pools.--
1202	(4) Each applicant for registration must comply with the
1203	following requirements:
1204	(a) Upon receipt of a completed, signed, and dated
1205	application, the agency shall require background screening, in
1206	accordance with the level 1 standards for screening set forth in
1207	chapter 435, of every individual who will have contact with
1208	patients. The agency shall require background screening of the
1209	managing employee or other similarly titled individual who is
1210	responsible for the operation of the entity, and of the
1211	financial officer or other similarly titled individual who is
1212	responsible for the financial operation of the entity, including
1213	billings for services in accordance with the level 2 standards
1214	for background screening as set forth in chapter 435.
1215	(b) The agency may require background screening of any
1216	other individual who is affiliated with the applicant if the
1217	agency has a reasonable basis for believing that he or she has
1218	been convicted of a crime or has committed any other offense
1219	prohibited under the level 2 standards for screening set forth
1220	in chapter 435.
1221	(c) Proof of compliance with the level 2 background
1222	screening requirements of chapter 435 which has been submitted
1223	within the previous 5 years in compliance with any other health
1224	care or assisted living licensure requirements of this state is
1225	acceptable in fulfillment of paragraph (a).
1226	(d) A provisional registration may be granted to an
1227	applicant when each individual required by this section to
1228	undergo background screening has met the standards for the
1229	Department of Law Enforcement background check but the agency
1230	has not yet received background screening results from the
1231	Federal Bureau of Investigation. A standard registration may be
1232	granted to the applicant upon the agency's receipt of a report
1233	of the results of the Federal Bureau of Investigation background
1234	screening for each individual required by this section to
1235	undergo background screening which confirms that all standards
1236	have been met, or upon the granting of a disqualification
1237	exemption by the agency as set forth in chapter 435. Any other
1238	person who is required to undergo level 2 background screening
1239	may serve in his or her capacity pending the agency's receipt of
1240	the report from the Federal Bureau of Investigation. However,
1241	the person may not continue to serve if the report indicates any
1242	violation of background screening standards and if a
1243	disqualification exemption has not been requested of and granted
1244	by the agency as set forth in chapter 435.
1245	(e) Each applicant must submit to the agency, with its
1246	application, a description and explanation of any exclusions,
1247	permanent suspensions, or terminations of the applicant from the
1248	Medicare or Medicaid programs. Proof of compliance with the
1249	requirements for disclosure of ownership and controlling
1250	interests under the Medicaid or Medicare programs may be
1251	accepted in lieu of this submission.
1252	(f) Each applicant must submit to the agency a description
1253	and explanation of any conviction of an offense prohibited under
1254	the level 2 standards of chapter 435 which was committed by a
1255	member of the board of directors of the applicant, its officers,
1256	or any individual owning 5 percent or more of the applicant.
1257	This requirement does not apply to a director of a not-for-
1258	profit corporation or organization who serves solely in a
1259	voluntary capacity for the corporation or organization, does not
1260	regularly take part in the day-to-day operational decisions of
1261	the corporation or organization, receives no remuneration for
1262	his or her services on the corporation's or organization's board
1263	of directors, and has no financial interest and no family
1264	members having a financial interest in the corporation or
1265	organization, if the director and the not-for-profit corporation
1266	or organization include in the application a statement affirming
1267	that the director's relationship to the corporation satisfies
1268	the requirements of this paragraph.
1269	(g) A registration may not be granted to an applicant if
1270	the applicant or managing employee has been found guilty of,
1271	regardless of adjudication, or has entered a plea of nolo
1272	contendere or guilty to, any offense prohibited under the level
1273	2 standards for screening set forth in chapter 435, unless an
1274	exemption from disqualification has been granted by the agency
1275	as set forth in chapter 435.
1276	(h) The provisions of this section which require an
1277	applicant for registration to undergo background screening shall
1278	stand repealed on June 30, 2001, unless reviewed and saved from
1279	repeal through reenactment by the Legislature.
1280	(h)(i)Failure to provide all required documentation
1281	within 30 days after a written request from the agency will
1282	result in denial of the application for registration.
1283	(i)(j)The agency must take final action on an application
1284	for registration within 60 days after receipt of all required
1285	documentation.
1286	(j)(k)The agency may deny, revoke, or suspend the
1287	registration of any applicant or registrant who:
1288	1. Has falsely represented a material fact in the
1289	application required by paragraph (e) or paragraph (f), or has
1290	omitted any material fact from the application required by
1291	paragraph (e) or paragraph (f); or
1292	2. Has had prior action taken against the applicant under
1293	the Medicaid or Medicare program as set forth in paragraph (e).
1294	3. Fails to comply with this section or applicable rules.
1295	4. Commits an intentional, reckless, or negligent act that
1296	materially affects the health or safety of a person receiving
1297	services.
1298	Section 30. Section 408.061, Florida Statutes, is amended
1299	to read:
1300	408.061 Data collection; uniform systems of financial
1301	reporting; information relating to physician charges;
1302	confidential information; immunity.--
1303	(1) The agency may require the submission by health care
1304	facilities, health care providers, and health insurers of data
1305	necessary to carry out the agency's duties. Specifications for
1306	data to be collected under this section shall be developed by
1307	the agency with the assistance of technical advisory panels
1308	including representatives of affected entities, consumers,
1309	purchasers, and such other interested parties as may be
1310	determined by the agency.
1311	(a) Data to be submitted by health care facilities may
1312	include, but are not limited to: case-mix data, patient
1313	admission or discharge data with patient and provider-specific
1314	identifiers included, actual charge data by diagnostic groups,
1315	financial data, accounting data, operating expenses, expenses
1316	incurred for rendering services to patients who cannot or do not
1317	pay, interest charges, depreciation expenses based on the
1318	expected useful life of the property and equipment involved, and
1319	demographic data. Data may be obtained from documents such as,
1320	but not limited to: leases, contracts, debt instruments,
1321	itemized patient bills, medical record abstracts, and related
1322	diagnostic information.
1323	(b) Data to be submitted by health care providers may
1324	include, but are not limited to: Medicare and Medicaid
1325	participation, types of services offered to patients, amount of
1326	revenue and expenses of the health care provider, and such other
1327	data which are reasonably necessary to study utilization
1328	patterns.
1329	(c) Data to be submitted by health insurers may include,
1330	but are not limited to: claims, premium, administration, and
1331	financial information.
1332	(d) Data required to be submitted by health care
1333	facilities, health care providers, or health insurers shall not
1334	include specific provider contract reimbursement information.
1335	However, such specific provider reimbursement data shall be
1336	reasonably available for onsite inspection by the agency as is
1337	necessary to carry out the agency's regulatory duties. Any such
1338	data obtained by the agency as a result of onsite inspections
1339	may not be used by the state for purposes of direct provider
1340	contracting and are confidential and exempt from the provisions
1341	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
1342	(e) A requirement to submit data shall be adopted by rule
1343	if the submission of data is being required of all members of
1344	any type of health care facility, health care provider, or
1345	health insurer. Rules are not required, however, for the
1346	submission of data for a special study mandated by the
1347	Legislature or when information is being requested for a single
1348	health care facility, health care provider, or health insurer.
1349	(2) The agency shall, by rule, after consulting with
1350	appropriate professional and governmental advisory bodies and
1351	holding public hearings and considering existing and proposed
1352	systems of accounting and reporting utilized by health care
1353	facilities, specify a uniform system of financial reporting for
1354	each type of facility based on a uniform chart of accounts
1355	developed after considering any chart of accounts developed by
1356	the national association for such facilities and generally
1357	accepted accounting principles. Such systems shall, to the
1358	extent feasible, use existing accounting systems and shall
1359	minimize the paperwork required of facilities. This provision
1360	shall not be construed to authorize the agency to require health
1361	care facilities to adopt a uniform accounting system. As a part
1362	of such uniform system of financial reporting, the agency may
1363	require the filing of any information relating to the cost to
1364	the provider and the charge to the consumer of any service
1365	provided in such facility, except the cost of a physician's
1366	services which is billed independently of the facility.
1367	(3) When more than one licensed facility is operated by
1368	the reporting organization, the information required by this
1369	section shall be reported for each facility separately.
1370	(4)(a)Within 120 days after the end of its fiscal year,
1371	each health care facility, excluding continuing care facilities
1372	and nursing homes as defined in s. 408.07(14) and (36),shall
1373	file with the agency, on forms adopted by the agency and based
1374	on the uniform system of financial reporting, its actual
1375	financial experience for that fiscal year, including
1376	expenditures, revenues, and statistical measures. Such data may
1377	be based on internal financial reports which are certified to be
1378	complete and accurate by the provider. However, hospitals'
1379	actual financial experience shall be their audited actual
1380	experience. Nursing homes that do not participate in the
1381	Medicare or Medicaid programs shall also submit audited actual
1382	experience.Every nursing home shall submit to the agency, in a
1383	format designated by the agency, a statistical profile of the
1384	nursing home residents. The agency, in conjunction with the
1385	Department of Elderly Affairs and the Department of Health,
1386	shall review these statistical profiles and develop
1387	recommendations for the types of residents who might more
1388	appropriately be placed in their homes or other noninstitutional
1389	settings.
1390	(b) Each nursing home shall also submit a schedule of the
1391	charges in effect at the beginning of the fiscal year and any
1392	changes that were made during the fiscal year. A nursing home
1393	which is certified under Title XIX of the Social Security Act
1394	and files annual Medicaid cost reports may substitute copies of
1395	such reports and any Medicaid audits to the agency in lieu of a
1396	report and audit required under this subsection. For such
1397	facilities, the agency may require only information in
1398	compliance with this chapter that is not contained in the
1399	Medicaid cost report. Facilities that are certified under Title
1400	XVIII, but not Title XIX, of the Social Security Act must submit
1401	a report as developed by the agency. This report shall be
1402	substantially the same as the Medicaid cost report and shall not
1403	require any more information than is contained in the Medicare
1404	cost report unless that information is required of all nursing
1405	homes. The audit under Title XVIII shall satisfy the audit
1406	requirement under this subsection.
1407	(5) In addition to information submitted in accordance
1408	with subsection (4), each nursing home shall track and file with
1409	the agency, on a form adopted by the agency, data related to
1410	each resident's admission, discharge, or conversion to Medicaid;
1411	health and functional status; plan of care; and other
1412	information pertinent to the resident's placement in a nursing
1413	home.
1414	(6) Any nursing home which assesses residents a separate
1415	charge for personal laundry services shall submit to the agency
1416	data on the monthly charge for such services, excluding
1417	drycleaning. For facilities that charge based on the amount of
1418	laundry, the most recent schedule of charges and the average
1419	monthly charge shall be submitted to the agency.
1420	(6)(7)The agency may require other reports based on the
1421	uniform system of financial reporting necessary to accomplish
1422	the purposes of this chapter.
1423	(7)(8)Portions of patient records obtained or generated
1424	by the agency containing the name, residence or business
1425	address, telephone number, social security or other identifying
1426	number, or photograph of any person or the spouse, relative, or
1427	guardian of such person, or any other identifying information
1428	which is patient-specific or otherwise identifies the patient,
1429	either directly or indirectly, are confidential and exempt from
1430	the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
1431	Constitution.
1432	(8)(9)The identity of any health care provider, health
1433	care facility, or health insurer who submits any data which is
1434	proprietary business information to the agency pursuant to the
1435	provisions of this section shall remain confidential and exempt
1436	from the provisions of s. 119.07(1) and s. 24(a), Art. I of the
1437	State Constitution. As used in this section, "proprietary
1438	business information" shall include, but not be limited to,
1439	information relating to specific provider contract reimbursement
1440	information; information relating to security measures, systems,
1441	or procedures; and information concerning bids or other
1442	contractual data, the disclosure of which would impair efforts
1443	to contract for goods or services on favorable terms or would
1444	injure the affected entity's ability to compete in the
1445	marketplace. Notwithstanding the provisions of this subsection,
1446	any information obtained or generated pursuant to the provisions
1447	of former s. 407.61, either by the former Health Care Cost
1448	Containment Board or by the Agency for Health Care
1449	Administration upon transfer to that agency of the duties and
1450	functions of the former Health Care Cost Containment Board, is
1451	not confidential and exempt from the provisions of s. 119.07(1)
1452	and s. 24(a), Art. I of the State Constitution. Such proprietary
1453	business information may be used in published analyses and
1454	reports or otherwise made available for public disclosure in
1455	such manner as to preserve the confidentiality of the identity
1456	of the provider. This exemption shall not limit the use of any
1457	information used in conjunction with investigation or
1458	enforcement purposes under the provisions of s. 456.073.
1459	(9)(10)No health care facility, health care provider,
1460	health insurer, or other reporting entity or its employees or
1461	agents shall be held liable for civil damages or subject to
1462	criminal penalties either for the reporting of patient data to
1463	the agency or for the release of such data by the agency as
1464	authorized by this chapter.
1465	(10)(11)The agency shall be the primary source for
1466	collection and dissemination of health care data. No other
1467	agency of state government may gather data from a health care
1468	provider licensed or regulated under this chapter without first
1469	determining if the data is currently being collected by the
1470	agency and affirmatively demonstrating that it would be more
1471	cost-effective for an agency of state government other than the
1472	agency to gather the health care data. The director shall ensure
1473	that health care data collected by the divisions within the
1474	agency is coordinated. It is the express intent of the
1475	Legislature that all health care data be collected by a single
1476	source within the agency and that other divisions within the
1477	agency, and all other agencies of state government, obtain data
1478	for analysis, regulation, and public dissemination purposes from
1479	that single source. Confidential information may be released to
1480	other governmental entities or to parties contracting with the
1481	agency to perform agency duties or functions as needed in
1482	connection with the performance of the duties of the receiving
1483	entity. The receiving entity or party shall retain the
1484	confidentiality of such information as provided for herein.
1485	(11)(12)The agency shall cooperate with local health
1486	councils and the state health planning agency with regard to
1487	health care data collection and dissemination and shall
1488	cooperate with state agencies in any efforts to establish an
1489	integrated health care database.
1490	(12)(13)It is the policy of this state that philanthropic
1491	support for health care should be encouraged and expanded,
1492	especially in support of experimental and innovative efforts to
1493	improve the health care delivery system.
1494	(13)(14)For purposes of determining reasonable costs of
1495	services furnished by health care facilities, unrestricted
1496	grants, gifts, and income from endowments shall not be deducted
1497	from any operating costs of such health care facilities, and, in
1498	addition, the following items shall not be deducted from any
1499	operating costs of such health care facilities:
1500	(a) An unrestricted grant or gift, or income from such a
1501	grant or gift, which is not available for use as operating funds
1502	because of its designation by the health care facility's
1503	governing board.
1504	(b) A grant or similar payment which is made by a
1505	governmental entity and which is not available, under the terms
1506	of the grant or payment, for use as operating funds.
1507	(c) The sale or mortgage of any real estate or other
1508	capital assets of the health care facility which the health care
1509	facility acquired through a gift or grant and which is not
1510	available for use as operating funds under the terms of the gift
1511	or grant or because of its designation by the health care
1512	facility's governing board, except for recovery of the
1513	appropriate share of gains and losses realized from the disposal
1514	of depreciable assets.
1515	Section 31. Section 408.062, Florida Statutes, is amended
1516	to read:
1517	408.062 Research, analyses, studies, and reports.--
1518	(1) The agency shall have the authority to conduct
1519	research, analyses, and studies relating to health care costs
1520	and access to and quality of health care services as access and
1521	quality are affected by changes in health care costs. Such
1522	research, analyses, and studies shall include, but not be
1523	limited to, research and analysis relating to:
1524	(a) The financial status of any health care facility or
1525	facilities subject to the provisions of this chapter.
1526	(b) The impact of uncompensated charity care on health
1527	care facilities and health care providers.
1528	(c) The state's role in assisting to fund indigent care.
1529	(d) The availability and affordability of health insurance
1530	for small businesses.
1531	(e) Total health care expenditures in the state according
1532	to the sources of payment and the type of expenditure.
1533	(f) The quality of health services, using techniques such
1534	as small area analysis, severity adjustments, and risk-adjusted
1535	mortality rates.
1536	(g) The development of physician payment systems which are
1537	capable of taking into account the amount of resources consumed
1538	and the outcomes produced in the delivery of care.
1539	(h) The impact of subacute admissions on hospital revenues
1540	and expenses for purposes of calculating adjusted admissions as
1541	defined in s. 408.07.
1542	(2) The agency shall evaluate data from nursing home
1543	financial reports and shall document and monitor:
1544	(a) Total revenues, annual change in revenues, and
1545	revenues by source and classification, including contributions
1546	for a resident's care from the resident's resources and from the
1547	family and contributions not directed toward any specific
1548	resident's care.
1549	(b) Average resident charges by geographic region, payor,
1550	and type of facility ownership.
1551	(c) Profit margins by geographic region and type of
1552	facility ownership.
1553	(d) Amount of charity care provided by geographic region
1554	and type of facility ownership.
1555	(e) Resident days by payor category.
1556	(f) Experience related to Medicaid conversion as reported
1557	under s. 408.061.
1558	(g) Other information pertaining to nursing home revenues
1559	and expenditures.
1560
1561	The findings of the agency shall be included in an annual report
1562	to the Governor and Legislature by January 1 each year.
1563	(2)(3)The agency may assess annually the caesarean
1564	section rate in Florida hospitals using the analysis methodology
1565	that the agency determines most appropriate. To assist the
1566	agency in determining the impact of this chapter on Florida
1567	hospitals' caesarean section rates, each provider hospital, as
1568	defined in s. 383.336, shall notify the agency of the date of
1569	implementation of the practice parameters and the date of the
1570	first meeting of the hospital peer review board created pursuant
1571	to this chapter. The agency shall use these dates in monitoring
1572	any change in provider hospital caesarean section rates. An
1573	annual report based on this monitoring and assessment shall be
1574	submitted to the Governor, the Speaker of the House of
1575	Representatives, and the President of the Senate by the agency,
1576	with the first annual report due January 1, 1993.
1577	(3)(4)The agency may also prepare such summaries and
1578	compilations or other supplementary reports based on the
1579	information analyzed by the agency under this section, as will
1580	advance the purposes of this chapter.
1581	(4)(5)(a) The agency may conduct data-based studies and
1582	evaluations and make recommendations to the Legislature and the
1583	Governor concerning exemptions, the effectiveness of limitations
1584	of referrals, restrictions on investment interests and
1585	compensation arrangements, and the effectiveness of public
1586	disclosure. Such analysis may include, but need not be limited
1587	to, utilization of services, cost of care, quality of care, and
1588	access to care. The agency may require the submission of data
1589	necessary to carry out this duty, which may include, but need
1590	not be limited to, data concerning ownership, Medicare and
1591	Medicaid, charity care, types of services offered to patients,
1592	revenues and expenses, patient-encounter data, and other data
1593	reasonably necessary to study utilization patterns and the
1594	impact of health care provider ownership interests in health-
1595	care-related entities on the cost, quality, and accessibility of
1596	health care.
1597	(b) The agency may collect such data from any health
1598	facility as a special study.
1599	Section 32. Subsection (2) of section 408.831, Florida
1600	Statutes, is renumbered as subsection (3) and a new subsection
1601	(2) is added to said section to read:
1602	408.831 Denial, suspension, or revocation of a license,
1603	registration, certificate, or application.--
1604	(2) In reviewing any application requesting a change of
1605	ownership or change of the licensee, registrant, or certificate
1606	holder, the transferor shall, prior to agency approval of the
1607	change, repay or make arrangements to repay any amounts owed to
1608	the agency. Should the transferor fail to repay or make
1609	arrangements to repay the amounts owed to the agency, the
1610	issuance of a license, registration, or certificate to the
1611	transferee shall be delayed until repayment or until
1612	arrangements for repayment are made.
1613	Section 33. Subsection (1) of section 409.9116, Florida
1614	Statutes, is amended to read:
1615	409.9116 Disproportionate share/financial assistance
1616	program for rural hospitals.--In addition to the payments made
1617	under s. 409.911, the Agency for Health Care Administration
1618	shall administer a federally matched disproportionate share
1619	program and a state-funded financial assistance program for
1620	statutory rural hospitals. The agency shall make
1621	disproportionate share payments to statutory rural hospitals
1622	that qualify for such payments and financial assistance payments
1623	to statutory rural hospitals that do not qualify for
1624	disproportionate share payments. The disproportionate share
1625	program payments shall be limited by and conform with federal
1626	requirements. Funds shall be distributed quarterly in each
1627	fiscal year for which an appropriation is made. Notwithstanding
1628	the provisions of s. 409.915, counties are exempt from
1629	contributing toward the cost of this special reimbursement for
1630	hospitals serving a disproportionate share of low-income
1631	patients.
1632	(1) The following formula shall be used by the agency to
1633	calculate the total amount earned for hospitals that participate
1634	in the rural hospital disproportionate share program or the
1635	financial assistance program:
1636
1637	TAERH = (CCD + MDD)/TPD
1638
1639	Where:
1640	CCD = total charity care-other, plus charity care-Hill-
1641	Burton, minus 50 percent of unrestricted tax revenue from local
1642	governments, and restricted funds for indigent care, divided by
1643	gross revenue per adjusted patient day; however, if CCD is less
1644	than zero, then zero shall be used for CCD.
1645	MDD = Medicaid inpatient days plus Medicaid HMO inpatient
1646	days.
1647	TPD = total inpatient days.
1648	TAERH = total amount earned by each rural hospital.
1649
1650	In computing the total amount earned by each rural hospital, the
1651	agency must use the most recent actual data reported in
1652	accordance with s. 408.061(4)(a).
1653	Section 34. This act shall take effect upon becoming a
1654	law.
1655