HOUSE AMENDMENT Bill No. SB 2568
1	CHAMBER ACTION
2	Senate House
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12	Representatives Fiorentino and Domino offered the following:
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14	Amendment (with title amendment)
15	Remove everything after the enacting clause,
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17	and insert:
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19	Section 1. Section 393.506, Florida Statutes, is created
20	to read:
21	393.506 Administration of medication.--
22	(1) Notwithstanding the provisions of part I of chapter
23	464, the Nurse Practice Act, unlicensed direct care service
24	staff providing services to persons with developmental
25	disabilities may administer oral, transdermal, inhaled, or
26	topical prescription medications as provided in this section.
27	(a) For day programs, as defined in s. 393.063, the
28	director of the facility or program shall designate in writing
29	unlicensed direct care services staff who are eligible to be
30	trained to assist in the administration of or to administer
31	medication.
32	(b) For intermediate care facilities for the
33	developmentally disabled licensed pursuant to part XI of chapter
34	400, unlicensed staff designated by the director may provide
35	medication assistance under the general supervision of a
36	registered nurse licensed pursuant to chapter 464.
37	(2) Each facility, institution, or program must include in
38	its policies and procedures a plan for training designated staff
39	to ensure the safe handling, storage, and administration of
40	prescription medication. These policies and procedures must be
41	approved by the department before unlicensed direct care
42	services staff assist with medication.
43	(3) The policies and procedures must include, at a
44	minimum, the following provisions:
45	(a) An expressed and informed consent for each client.
46	(b) The director of the facility, program, or provider
47	must maintain a copy of the written prescription, and that
48	prescription must include the name of the medication, the dosage
49	and administration schedule, the reason for the prescription,
50	and the termination date.
51	(c) Each prescribed medication shall be kept in its
52	original container and in a secure location.
53	(4) The training required in this section shall be
54	conducted by a registered nurse or a physician licensed pursuant
55	to chapter 458 or chapter 459.
56	Section 2. Section 400.9685, Florida Statutes, is created
57	to read:
58	400.9685 Administration of medication.--
59	(1) Notwithstanding the provisions of the Nurse Practice
60	Act, part I of chapter 464, unlicensed direct care services
61	staff who are providing services to clients in Intermediate Care
62	Facilities for the Developmentally Disabled, licensed pursuant
63	to this part, may administer prescribed, prepackaged, pre-
64	measured medications under the general supervision of a
65	registered nurse as provided in this section and applicable
66	rules. Training required by this section and applicable rules
67	must be conducted by a registered nurse licensed pursuant to
68	chapter 464, or a physician licensed pursuant to chapter 458 or
69	chapter 459.
70	(2) Each facility that allows unlicensed direct care
71	service staff to administer medications pursuant to this section
72	must:
73	(a) Develop and implement policies and procedures that
74	include a plan to ensure the safe handling, storage, and
75	administration of prescription medication.
76	(b) Maintain written evidence of the expressed and
77	informed consent for each client.
78	(c) Maintain a copy of the written prescription including
79	the name of the medication, the dosage, and administration
80	schedule.
81	(d) Maintain documentation regarding the prescription
82	including the name, dosage, and administration schedule, reason
83	for prescription, and the termination date.
84	(e) Maintain documentation of compliance with required
85	training.
86	(3) Agency rules shall specify the following as it relates
87	to the administration of medications by unlicensed staff:
88	(a) Medications authorized and packaging required.
89	(b) Acceptable methods of administration.
90	(c) A definition of "general supervision".
91	(d) Minimum educational requirements of staff.
92	(e) Criteria of required training and competency that must
93	be demonstrated prior to the administration of medications by
94	unlicensed staff including in-service training.
95	(f) Requirements for safe handling, storage, and
96	administration of medications.
97	Section 3. Subsection (2) of section 394.74, Florida
98	Statutes, is amended, and subsection (6) is added to said
99	section, to read:
100	394.74 Contracts for provision of local substance abuse
101	and mental health programs.--
102	(2)(a) Contracts for service shall be consistent with the
103	approved district plan.
104	(b) Notwithstanding s. 394.76(3)(a) and (c), the
105	department may use unit cost methods of payment in contracts for
106	purchasing mental health and substance abuse services. The unit
107	cost contracting system must account for those patient fees that
108	are paid on behalf of a specific client and those that are
109	earned and used by the provider for those services funded in
110	whole or in part by the department. The department may also use
111	a fee-for-service arrangement, case rates, or a capitation
112	arrangement in order to account for those services.
113	(c) The department may reimburse actual expenditures for
114	startup contracts and fixed capital outlay contracts in
115	accordance with contract specifications.
116	(6) The department may use a fee-for-service arrangement,
117	case rates, or capitation in order to account for mental health
118	and substance abuse services.
119	Section 4. Subsections (1) and (26) of section 415.102,
120	Florida Statutes, are amended to read:
121	415.102 Definitions of terms used in ss. 415.101-
122	415.113.--As used in ss. 415.101-415.113, the term:
123	(1) "Abuse" means any willful act or threatened act by a
124	caregiverthat causes or is likely to cause significant
125	impairment to a vulnerable adult's physical, mental, or
126	emotional health. Abuse includes acts and omissions.
127	(26) "Vulnerable adult" means a person 18 years of age or
128	older whose ability to perform the normal activities of daily
129	living or to provide for his or her own care or protection is
130	impaired due to a mental, emotional, long-termphysical, or
131	developmental disability or dysfunctioning, or brain damage, or
132	the infirmities of aging.
133	Section 5. Paragraph (h) is added to subsection (1) of
134	section 765.401, Florida Statutes, to read:
135	765.401 The proxy.--
136	(1) If an incapacitated or developmentally disabled
137	patient has not executed an advance directive, or designated a
138	surrogate to execute an advance directive, or the designated or
139	alternate surrogate is no longer available to make health care
140	decisions, health care decisions may be made for the patient by
141	any of the following individuals, in the following order of
142	priority, if no individual in a prior class is reasonably
143	available, willing, or competent to act:
144	(h) A clinical social worker licensed pursuant to chapter
145	491, or who is a graduate of a court-approved guardianship
146	program. Such a proxy must be selected by the provider’s
147	bioethics committee and must not be employed by the provider. If
148	the provider does not have a bioethics committee, then such a
149	proxy may be chosen through an arrangement with the bioethics
150	committee of another provider. The proxy will be notified that
151	upon request, the provider shall make available a second
152	physician, not involved in the patient’s care to assist the
153	proxy in evaluating treatment. Decisions to withhold or withdraw
154	life-prolonging procedures will be reviewed by the facility’s
155	bioethics committee. Documentation of efforts to locate proxies
156	from prior classes must be recorded in the patient record.
157	Section 6. Subsection (15) of section 744.102, Florida
158	Statutes, is amended to read:
159	744.102 Definitions.--As used in this chapter, the term:
160	(15) "Professional guardian" means any guardian who
161	receives or has at any time received compensation for services
162	rendered to more than two wards as their guardian. A person
163	serving as a guardian for two or more relatives as defined in s.
164	744.309(2) is not considered a professional guardian. A public
165	guardian shall be considered a professional guardian for
166	purposes of regulation, education, and registration.
167	Section 7. Subsection (8) is added to section 744.108,
168	Florida Statutes, to read:
169	744.108 Guardian’s and attorney’s fees and expenses.—
170	(8) When court proceedings are instituted to review or
171	determine a guardian’s or an attorney’s fees under subsection
172	(2), such proceedings are part of the guardianship
173	administration process and the costs, including fees for the
174	guardian’s attorney, shall be determined by the court and paid
175	from the assets of the guardianship estate unless the court
176	finds the requested compensation under subsection (2) to be
177	substantially unreasonable.
178	Section 8. Section 744.1083, Florida Statutes, is amended
179	to read:
180	744.1083 Professional guardian registration.--
181	(1) Effective January 1, 2003,A professional guardian
182	must register with the Statewide Public Guardianship Office
183	established in part IX of this chapter. The Statewide Public
184	Guardianship Office may contract with the clerk of the court in
185	each county to perform the administrative functions associated
186	with registering professional guardians.
187	(2) Annual registration shall be made on forms furnished
188	by the Statewide Public Guardianship Office and accompanied by
189	the applicable registration fee as determined by rule. Such fee
190	shall not exceed $100$25.
191	(3) Registration must include the following:
192	(a) If the professional guardian is a natural person, the
193	name, address, date of birth, and employer identification or
194	social security number of the professional guardian.
195	(b) If the professional guardian is a partnership or
196	association, the name, address, and date of birth of every
197	member, and the employer identification number of the
198	partnership or association.
199	(c) If the professional guardian is a corporation, the
200	name, address, and employer identification number of the
201	corporation; the name, address, and date of birth of each of its
202	directors and officers; the name of its resident agent; and the
203	name, address, and date of birth of each person having at least
204	a 10-percent interest in the corporation.
205	(d) The name, address, date of birth, and employer
206	identification number, if applicable, of each person providing
207	guardian-delegated financial or personal guardianship services
208	for wards.
209	(e) Documentation that the bonding and educational
210	requirements of s. 744.1085 have been met, and that background
211	screening has been conducted pursuant to s. 744.3135. Compliance
212	with this section shall constitute compliance with the
213	attestation requirement of s. 435.04(5).
214	(f) Sufficient information to distinguish a guardian
215	providing guardianship services as a public guardian,
216	individually, through partnership, corporation, or any other
217	business organization.
218	(4) The Department of Elderly AffairsStatewide Public
219	Guardianship Officemay adopt rules necessary to administer this
220	section.
221	(5) A trust company, a state banking corporation or state
222	savings association authorized and qualified to exercise
223	fiduciary powers in this state, or a national banking
224	association or federal savings and loan association authorized
225	and qualified to exercise fiduciary powers in this state, may,
226	but shall not be required to, register as a professional
227	guardian under this section. If a trust company, state banking
228	corporation, state savings association, national banking
229	association, or federal savings and loan association described
230	in this subsection elects to register as a professional guardian
231	under this subsection, the requirements of subsection (3) shall
232	not apply and the registration shall include only the name,
233	address, and employer identification number of the registrant,
234	the name and address of its registered agent, if any, and the
235	documentation described in paragraph (3)(e).
236	(6) The Department of Elderly Affairs may contract with
237	the Florida Guardianship Foundation or other not-for-profit
238	entity to register professional guardians.
239	(7) The department or its contractor shall ensure that the
240	clerks of the court and the Chief Judge of each judicial circuit
241	receive information about each registered professional guardian.
242	(8) A state college or university or an independent
243	college or university as described pursuant to s. 1009.98(3)(a),
244	may, but shall not be required to, register as a professional
245	guardian under this section. If a state college or university or
246	independent college or university elects to register as a
247	professional guardian under this subsection, the requirements of
248	subsection (3) shall not apply and the registration shall
249	include only the name, address, and employer identification
250	number of the registrant.
251	Section 9. Subsection (3) of section 744.1085, Florida
252	Statutes, is amended and subsections (4) through (10) are added
253	to said section to read:
254	744.1085 Regulation of professional guardians;
255	application; bond required; educational requirements.--
256	(3) Each professional guardian defined in s. 744.102(15)
257	and public guardian, on October 1, 1997,must receive a minimum
258	of 40 hours of instruction and training by October 1, 1998, or
259	within 1 year after becoming a professional guardian, whichever
260	occurs later. Each professional guardian must receive a minimum
261	of 16 hours of continuing education every 2 calendar years after
262	the year in which the initial 40-hour educational requirement is
263	met. The instruction and education must be completed through a
264	course approved or offered by the Statewide Public Guardianship
265	Office. The expenses incurred to satisfy the educational
266	requirements prescribed in this section may not be paid with the
267	assets of any ward. This subsection does not apply to any
268	attorney who is licensed to practice law in this state.
269	(4) Each professional guardian must allow, at the
270	guardian’s expense, an investigation of the guardian’s credit
271	history, and the credit history of employees of the guardian, in
272	a manner prescribed by the Department of Elderly Affairs.
273	(5) As required in s. 744.3135, each professional guardian
274	shall allow a level 2 background screening of the guardian and
275	employees of the guardian in accordance with the provisions of
276	s. 435.04.
277	(6) After July 1, 2005, each professional guardian shall
278	be required to demonstrate competency to act as a professional
279	guardian by taking an examination approved by the Department of
280	Elderly Affairs.
281	(a) The Department of Elderly Affairs shall determine the
282	minimum examination score necessary for passage of guardianship
283	examinations.
284	(b) The Department of Elderly Affairs shall determine the
285	procedure for administration of the examination.
286	(c) The Department of Elderly Affairs or its contractor
287	shall charge an examination fee for the actual costs of the
288	development and the administration of the examination, not to
289	exceed $500.
290	(d) The Department of Elderly Affairs may recognize
291	passage of a national guardianship examination in lieu of all or
292	part of the examination approved by the Department of Elderly
293	Affairs, except that all professional guardians must take and
294	pass an approved examination section related to Florida law and
295	procedure.
296	(7) The Department of Elderly Affairs shall set the
297	minimum score necessary to demonstrate professional guardianship
298	competency.
299	(8) The Department of Elderly Affairs shall waive the
300	examination requirement in paragraph (6) if a professional
301	guardian can provide:
302	(a) Proof that the guardian has actively acted as a
303	professional guardian for 5 years or more; and
304	(b) A letter from a circuit judge before whom the
305	professional guardian practiced at least 1 year which states
306	that the professional guardian had demonstrated to the court
307	competency as a professional guardian.
308	(9) After July 1, 2004, the court shall not appoint any
309	professional guardian who has not met the requirements of this
310	section and s. 744.1083.
311	(10) This section does not apply to a professional
312	guardian or the employees of that professional guardian when
313	that guardian is a trust company, a state banking corporation,
314	state savings association authorized and qualified to exercise
315	fiduciary powers in this state, or a national banking
316	association or federal savings and loan association authorized
317	and qualified to exercise fiduciary powers in this state.
318	Section 10. Section 744.3135, Florida Statutes, is amended
319	to read:
320	744.3135 Credit and criminal investigation.--The court may
321	require a nonprofessional guardian and shall require a
322	professional or public guardian, and all employees of a
323	professional guardian who have a fiduciary responsibility to a
324	ward, to submit, at their own expense, to an investigation of
325	the guardian's credit history and to undergo level 2 background
326	screening as required under s. 435.04. The clerk of the court
327	shall obtain fingerprint cards from the Federal Bureau of
328	Investigation and make them available to guardians. Any guardian
329	who is so required shall have his or her fingerprints taken and
330	forward the proper fingerprint card along with the necessary fee
331	to the Florida Department of Law Enforcement for processing. The
332	professional guardian shall pay to the clerk of the court a fee
333	of $5 for handling and processing professional guardian files.
334	The results of the fingerprint checks shall be forwarded to the
335	clerk of court who shall maintain the results in a guardian file
336	and shall make the results available to the court. If credit or
337	criminal investigations are required, the court must consider
338	the results of the investigations in appointing a guardian.
339	Professionalguardians and all employees of a professional
340	guardian who have a fiduciary responsibility to a ward, so
341	appointed, must resubmit, at their own expense, to an
342	investigation of credit history, and undergo level 1 background
343	screening as required under s. 435.03, at leastevery 2 years
344	after the date of their appointment. At any time, the court may
345	require guardians or their employees to submit to an
346	investigation of credit history and undergo level 1 background
347	screening as required under s. 435.03.The court must consider
348	the results of these investigations in reappointing a guardian.
349	This section shall not apply to a professional guardian, or to
350	the employees of a professional guardian, that is a trust
351	company, a state banking corporation or state savings
352	association authorized and qualified to exercise fiduciary
353	powers in this state, or a national banking association or
354	federal savings and loan association authorized and qualified to
355	exercise fiduciary powers in this state.
356	Section 11. Section 744.3145, Florida Statutes, is amended
357	to read:
358	744.3145 Guardian education requirements.--
359	(1) Each ward is entitled to a guardian competent to
360	perform the duties of a guardian necessary to protect the
361	interests of the ward.
362	(2) Each person appointed by the court to be a guardian,
363	other than a parent who is the guardian of the property of a
364	minor child,must receive a minimum of 8 hours of instruction
365	and training which covers:
366	(a) The legal duties and responsibilities of the guardian;
367	(b) The rights of the ward;
368	(c) The availability of local resources to aid the ward;
369	and
370	(d) The preparation of habilitation plans and annual
371	guardianship reports, including financial accounting for the
372	ward's property.
373	(3) Each person appointed by the court to be the guardian
374	of the property of his or her minor child must receive a minimum
375	of 4 hours of instruction and training that covers:
376	(a) The legal duties and responsibilities of the guardian
377	of the property;
378	(b) The preparation of the initial inventory and annual
379	guardianship accountings for the ward’s property; and
380	(c) Use of guardianship assets.
381	(4)(3)Each person appointed by the court to be a guardian
382	must complete the required number of8hours of instruction and
383	education within 1 year after his or her appointment as
384	guardian. The instruction and education must be completed
385	through a course approved by the chief judge of the circuit
386	court and taught by a court-approved organization. Court-
387	approved organizations may include, but are not limited to,
388	community or junior colleges, guardianship organizations, and
389	the local bar association or The Florida Bar.
390	(5)(4)Expenses incurred by the guardian to satisfy the
391	education requirement may be paid from the ward's estate, unless
392	the court directs that such expenses be paid by the guardian
393	individually.
394	(6)(5)The court may, in its discretion, waive some or all
395	of the requirements of this section or impose additional
396	requirements. The court shall make its decision on a case-by-
397	case basis and, in making its decision, shall consider the
398	experience and education of the guardian, the duties assigned to
399	the guardian, and the needs of the ward.
400	(7)(6)The provisions of this section do not apply to
401	professional guardians.
402	Section 12. Subsection (13) of section 744.444, Florida
403	Statutes, is amended, and subsections (16) and (17) are added to
404	said section to read:
405	744.444 Power of guardian without court approval.--Without
406	obtaining court approval, a plenary guardian of the property, or
407	a limited guardian of the property within the powers granted by
408	the order appointing the guardian or an approved annual or
409	amended guardianship report, may:
410	(13) When reasonably necessary, employ persons, including
411	attorneys, auditors, investment advisers, care managers,or
412	agents, even if they are associated with the guardian, to advise
413	or assist the guardian in the performance of his or her duties.
414	(16) Pay or reimburse costs incurred and reasonable fees
415	or compensation to persons, including attorneys, employed by the
416	guardian pursuant to subsection (13) from the assets of the
417	guardianship estate, subject to obtaining court approval of the
418	annual accounting.
419	(17) Provide confidential information about a ward that is
420	related to an investigation arising under part I of chapter 400
421	to a local or state ombudsman council member conducting such an
422	investigation. Any such ombudsman shall have a duty to maintain
423	the confidentiality of such information.
424	Section 13. Paragraph (c) of subsection (2) of section
425	744.534, Florida Statutes, is amended to read:
426	744.534 Disposition of unclaimed funds held by guardian.--
427	(2)
428	(c) Within 5 years from the date of deposit with the State
429	Treasurer, on written petition to the court that directed the
430	deposit of the funds and informal notice to the Department of
431	Legal Affairs, and after proof of his or her right to them, any
432	person entitled to the funds, before or after payment to the
433	State Treasurer and deposit as provided for in paragraph (a),
434	may obtain a court order directing the payment of the funds to
435	him or her. All funds deposited with the State Treasurer and not
436	claimed within 5 years from the date of deposit shall escheat to
437	the state to be deposited in the Department of Elderly Affairs
438	Administrative Trust Fund to be used solely for the benefit of
439	public guardianship as determined by the Secretary of Elderly
440	AffairsStatewide Public Guardianship Office established in part
441	IX of this chapter.
442	Section 14. Section 744.7021, Florida Statutes, is amended
443	to read:
444	744.7021 Statewide Public Guardianship Office.--There is
445	hereby created the Statewide Public Guardianship Office within
446	the Department of Elderly Affairs. The Department of Elderly
447	Affairs shall provide administrative support and service to the
448	office to the extent requested by the executive director within
449	the available resources of the department. The Statewide Public
450	Guardianship Office may request the assistance of the Inspector
451	General of the Department of Elderly Affairs in providing
452	auditing services, and the Office of General Counsel of the
453	department may provide assistance in rulemaking and other
454	matters as needed to assist the Statewide Public Guardianship
455	Office. The Statewide Public Guardianship Office shall not be
456	subject to control, supervision, or direction by the Department
457	of Elderly Affairs in the performance of its duties.
458	(1) The Secretary of Elderly Affairs shall appoint the
459	executive director, who shall be thehead of the Statewide
460	Public Guardianship Office is the executive director, who shall
461	be appointed by the Governor. The executive director must be a
462	member of The Florida Bar, knowledgeable oflicensed attorney
463	with a background in guardianship law and knowledge of the
464	social services available to meet the needs of incapacitated
465	persons, shall serve on a full-time basis, and shall personally,
466	or through representatives of the office, carry out the purposes
467	and functions of the Statewide Public Guardianship Office in
468	accordance with state and federal law. The executive director
469	shall serve at the pleasure of and report to the Secretary
470	Governor.
471	(2) The executive directorStatewide Public Guardianship
472	Officeshall, within available resources, have oversight
473	responsibilities for all public guardians.
474	(a) The executive directorofficeshall review the current
475	public guardian programs in Florida and other states.
476	(b) The executive directoroffice, in consultation with
477	local guardianship offices, shall develop statewide performance
478	measures and standards.
479	(c) The executive directorofficeshall review the various
480	methods of funding guardianship programs, the kinds of services
481	being provided by such programs, and the demographics of the
482	wards. In addition, the executive directorofficeshall review
483	and make recommendations regarding the feasibility of recovering
484	a portion or all of the costs of providing public guardianship
485	services from the assets or income of the wards.
486	(d) No later than October 1, 2000, the office shall submit
487	to the Governor, the President of the Senate, the Speaker of the
488	House of Representatives, and the Chief Justice of the Supreme
489	Court an interim report describing the progress of the office in
490	meeting the goals as described in this section. No later than
491	October 1, 2001, the office shall submit to the Governor, the
492	President of the Senate, the Speaker of the House of
493	Representatives, and the Chief Justice of the Supreme Court a
494	proposed public guardianship plan including alternatives for
495	meeting the state's guardianship needs. This plan may include
496	recommendations for less than the entire state, may include a
497	phase-in system, and shall include estimates of the cost of each
498	of the alternatives.By January 1, 2004, and by January 1 of
499	each year thereafter, the executive directorofficeshall
500	provide a status report and provide further recommendations to
501	the Secretary thataddress the need for public guardianship
502	services and related issues.
503	(e) The executive directorofficemay provide assistance
504	to local governments or entities in pursuing grant
505	opportunities. The executive directorofficeshall review and
506	make recommendations in the annual report on the availability
507	and efficacy of seeking Medicaid matching funds. The executive
508	directorofficeshall diligently seek ways to use existing
509	programs and services to meet the needs of public wards.
510	(f) The executive director, in consultation with the
511	Florida Guardianship Foundation,officeshall develop a
512	guardianship training program curriculum that. The training
513	programmay be offered to all guardians whether public or
514	private. The office shall establish a curriculum committee to
515	develop the training program specified in this part. The
516	curriculum committee shall include, but not be limited to,
517	probate judges. A fee may be charged to private guardians in
518	order to defray the cost of providing the training. In addition,
519	a fee may be charged to any training provider for up to the
520	actual cost of the review and approval of their curriculum. Any
521	fees collected pursuant to this paragraph shall be deposited in
522	the Department of Elderly Affairs Administrative Trust Fund to
523	be used for the guardianship training program.
524	(3) The executive directorofficemay conduct or contract
525	for demonstration projects authorized by the Department of
526	Elderly Affairs, within funds appropriated or through gifts,
527	grants, or contributions for such purposes, to determine the
528	feasibility or desirability of new concepts of organization,
529	administration, financing, or service delivery designed to
530	preserve the civil and constitutional rights of persons of
531	marginal or diminished capacity. Any gifts, grants, or
532	contributions for such purposes shall be deposited in the
533	Department of Elderly Affairs Administrative Trust Fund.
534	(4) The Department of Elderly Affairsofficehas authority
535	to adopt rules pursuant to ss. 120.536(1) and 120.54 to carry
536	out the provisions of this section.
537	Section 15. Subsections (1) and (3) of section 744.704,
538	Florida Statutes, are amended to read:
539	744.704 Powers and duties.--
540	(1) A public guardian may serve as a guardian of a person
541	adjudicated incapacitated under this chapter:
542	(a)if there is no family member or friend, other person,
543	bank, or corporation willing and qualified to serve as guardian;
544	and
545	(b) If the assets of the ward do not exceed the asset
546	level for Medicaid eligibility, exclusive of homestead and
547	exempt property as defined in s. 4, Art. X of the State
548	Constitution, and the ward's income, from all sources, is less
549	than $4,000 per year. Income from public welfare programs,
550	supplemental security income, optional state supplement, a
551	disability pension, or a social security pension shall be
552	excluded in such computation. However, a ward whose total
553	income, counting excludable income, exceeds $30,000 a year may
554	not be served.
555	(3) The public guardian shall primarily serve
556	incapacitated persons who are of limited financial means, as
557	defined by contract or rule of the Department of Elderly
558	Affairs. The public guardian may serve incapacitated persons of
559	greater financial means to the extent the Department of Elderly
560	Affairs determines to be appropriateIf the public guardian
561	finds that the assets or the income of the ward exceeds the
562	amounts set forth in paragraph (1)(b), the public guardian shall
563	submit a resignation and petition the court for appointment of a
564	successor guardian. The public guardian shall not be dismissed
565	until such time that a private guardian is appointed. If a
566	qualified successor guardian is not available, the public
567	guardian may remain as guardian, provided the guardian makes
568	reasonable efforts to find a successor and reports to the court
569	every 6 months on efforts to obtain a successor.
570	Section 16. (1) There is created within the Department of
571	Elderly Affairs a Guardianship Task Force for the purpose of
572	examining guardianship and incapacity and making recommendations
573	to the Governor and the Legislature for the improvement of
574	processes and procedures related to guardianship and incapacity.
575	The department shall staff the task force, and the Secretary of
576	Elderly Affairs shall appoint the chair from among the task
577	force membership. The members of the task force shall serve
578	without compensation. Unless specified otherwise, task force
579	members shall be appointed by the organizations they represent,
580	and the cost of members’ participation shall be borne by their
581	appointing organization. Any member who is a public employee is
582	entitled to reimbursement for per diem and travel expenses by
583	the appointing department.
584	(2) The Guardianship Task Force shall identify the
585	characteristics of Florida guardianship practice. It shall also
586	identify best practices and recommend specific statutory and
587	other changes for achieving such best practices and for
588	achieving citizen access to quality guardianship services. The
589	task force shall make a preliminary report to the Secretary of
590	Elderly Affairs no later than January 1, 2004, and its final
591	report to the secretary shall be made no later than January 1,
592	2005.
593	(3) The Guardianship Task Force shall consist of ten
594	members, including a judge with experience in guardianship
595	proceedings who is appointed by the Florida Conference of
596	Circuit Judges, a representative of the Association of Clerks of
597	Court, a professor of law with experience in elder issues
598	appointed by the Secretary of Elderly Affairs, a representative
599	of the Florida State Guardianship Association, a representative
600	of the Florida Guardianship Foundation, a representative of the
601	Real Property and Probate Section of The Florida Bar, a
602	representative of the Elder Law Section of The Florida Bar, a
603	professional as provided in s. 744.331(3), with experience
604	performing examinations and determining incapacity, a
605	representative of the Florida Banker’s Association, and a
606	citizen or consumer appointed by the Executive Director of the
607	Florida office of the American Association of Retired Persons.
608	(4) The Guardianship Task Force may appoint ex officio
609	members who possess needed expertise to assist the task force in
610	its work. The task force will cease to exist May 6, 2005.
611	Section 17. Notwithstanding the provisions of section 64
612	of chapter 95-228, Laws of Florida, the provisions of chapter
613	435, Florida Statutes, as created therein and as subsequently
614	amended, and any reference thereto, shall apply to all offenses
615	regardless of the date on which offenses referenced in chapter
616	435, Florida Statutes, were committed, unless specifically
617	provided otherwise in a provision other than section 64 of
618	chapter 95-228, Laws of Florida.
619	Section 18. Subsection (12) is added to section 400.071,
620	Florida Statutes, to read:
621	400.071 Application for license.--
622	(12) The applicant must provide the agency with proof of a
623	legal right to occupy the property before a license may be
624	issued. Proof may include, but is not limited to, copies of
625	warranty deeds, lease or rental agreements, contracts for deeds,
626	or quitclaim deeds.
627	Section 19. Subsection (1) of section 400.414, Florida
628	Statutes, is amended to read:
629	400.414 Denial, revocation, or suspension of license;
630	imposition of administrative fine; grounds.--
631	(1) The agency may deny, revoke, or suspend any license
632	issued under this part, or impose an administrative fine in the
633	manner provided in chapter 120, for any of the following actions
634	by an assisted living facility, for the actions ofany person
635	subject to level 2 background screening under s. 400.4174, or
636	for the actions ofany facility employee:
637	(a) An intentional or negligent act seriously affecting
638	the health, safety, or welfare of a resident of the facility.
639	(b) The determination by the agency that the owner lacks
640	the financial ability to provide continuing adequate care to
641	residents.
642	(c) Misappropriation or conversion of the property of a
643	resident of the facility.
644	(d) Failure to follow the criteria and procedures provided
645	under part I of chapter 394 relating to the transportation,
646	voluntary admission, and involuntary examination of a facility
647	resident.
648	(e) A citation of any of the following deficiencies as
649	defined in s. 400.419:
650	1. One or more cited class I deficiencies.
651	2. Three or more cited class II deficiencies.
652	3. Five or more cited class III deficiencies that have
653	been cited on a single survey and have not been corrected within
654	the times specifiedOne or more class I, three or more class II,
655	or five or more repeated or recurring identical or similar class
656	III violations that are similar or identical to violations which
657	were identified by the agency within the last 2 years.
658	(f) A determination that a person subject to level 2
659	background screening under s. 400.4174(1) does not meet the
660	screening standards of s. 435.04 or that the facility is
661	retaining an employee subject to level 1 background screening
662	standards under s. 400.4174(2) who does not meet the screening
663	standards of s. 435.03 and for whom exemptions from
664	disqualification have not been provided by the agency.
665	(g) A determination that an employee, volunteer,
666	administrator, or owner, or person who otherwise has access to
667	the residents of a facility does not meet the criteria specified
668	in s. 435.03(2), and the owner or administrator has not taken
669	action to remove the person. Exemptions from disqualification
670	may be granted as set forth in s. 435.07. No administrative
671	action may be taken against the facility if the person is
672	granted an exemption.
673	(h) Violation of a moratorium.
674	(i) Failure of the license applicant, the licensee during
675	relicensure, or a licensee that holds a provisional license to
676	meet the minimum license requirements of this part, or related
677	rules, at the time of license application or renewal.
678	(j) A fraudulent statement or omission of any material
679	fact on an application for a license or any other document
680	required by the agency, including the submission of a license
681	application that conceals the fact that any board member,
682	officer, or person owning 5 percent or more of the facility may
683	not meet the background screening requirements of s. 400.4174,
684	or that the applicant has been excluded, permanently suspended,
685	or terminated from the Medicaid or Medicare programs.
686	(k) An intentional or negligent life-threatening act in
687	violation of the uniform firesafety standards for assisted
688	living facilities or other firesafety standards that threatens
689	the health, safety, or welfare of a resident of a facility, as
690	communicated to the agency by the local authority having
691	jurisdiction or the State Fire Marshal.
692	(l) Exclusion, permanent suspension, or termination from
693	the Medicare or Medicaid programs.
694	(m) Knowingly operating any unlicensed facility or
695	providing without a license any service that must be licensed
696	under this chapter.
697	(n) Any act constituting a ground upon which application
698	for a license may be denied.
699
700	Administrative proceedings challenging agency action under this
701	subsection shall be reviewed on the basis of the facts and
702	conditions that resulted in the agency action.
703	Section 20. Subsection (1) of section 400.417, Florida
704	Statutes, is amended to read:
705	400.417 Expiration of license; renewal; conditional
706	license.--
707	(1) Biennial licenses, unless sooner suspended or revoked,
708	shall expire 2 years from the date of issuance. Limited nursing,
709	extended congregate care, and limited mental health licenses
710	shall expire at the same time as the facility's standard
711	license, regardless of when issued. The agency shall notify the
712	facility by certified mailat least 120 days prior to expiration
713	that a renewal license is necessary to continue operation. The
714	notification must be provided electronically or by mail
715	delivery.Ninety days prior to the expiration date, an
716	application for renewal shall be submitted to the agency. Fees
717	must be prorated. The failure to file a timely renewal
718	application shall result in a late fee charged to the facility
719	in an amount equal to 50 percent of the current fee.
720	Section 21. Section 400.419, Florida Statutes, is amended
721	to read:
722	400.419 Violations; imposition of administrative fines;
723	grounds.--
724	(1) The agency shall impose an administrative fine in the
725	manner provided in chapter 120 for any of the actions or
726	violations as set forth within this section by an assisted
727	living facility, for the actions of any person subject to level
728	2 background screening under s. 400.4174, for the actions of any
729	facility employee, or for an intentional or negligent act
730	seriously affecting the health, safety, or welfare of a resident
731	of the facility.
732	(2)(1)Each violation of this part and adopted rules shall
733	be classified according to the nature of the violation and the
734	gravity of its probable effect on facility residents. The agency
735	shall indicate the classification on the written notice of the
736	violation as follows:
737	(a) Class "I" violations are those conditions or
738	occurrences related to the operation and maintenance of a
739	facility or to the personal care of residents which the agency
740	determines present an imminent danger to the residents or guests
741	of the facility or a substantial probability that death or
742	serious physical or emotional harm would result therefrom. The
743	condition or practice constituting a class I violation shall be
744	abated or eliminated within 24 hours, unless a fixed period, as
745	determined by the agency, is required for correction. The agency
746	shall impose an administrative fine for a citedclass I
747	violation is subject to an administrative finein an amount not
748	less than $5,000 and not exceeding $10,000 for each violation. A
749	fine may be levied notwithstanding the correction of the
750	violation.
751	(b) Class "II" violations are those conditions or
752	occurrences related to the operation and maintenance of a
753	facility or to the personal care of residents which the agency
754	determines directly threaten the physical or emotional health,
755	safety, or security of the facility residents, other than class
756	I violations. The agency shall impose an administrative fine for
757	a cited class II violation is subject to an administrative fine
758	in an amount not less than $1,000 and not exceeding $5,000 for
759	each violation. A fine shall be levied notwithstanding the
760	correction of the violationA citation for a class II violation
761	must specify the time within which the violation is required to
762	be corrected.
763	(c) Class "III" violations are those conditions or
764	occurrences related to the operation and maintenance of a
765	facility or to the personal care of residents which the agency
766	determines indirectly or potentially threaten the physical or
767	emotional health, safety, or security of facility residents,
768	other than class I or class II violations. The agency shall
769	impose an administrative fine for a cited class III violation in
770	an amountis subject to an administrative fine ofnot less than
771	$500 and not exceeding $1,000 for each violation. A citation for
772	a class III violation must specify the time within which the
773	violation is required to be corrected. If a class III violation
774	is corrected within the time specified, no fine may be imposed,
775	unless it is a repeated offense.
776	(d) Class "IV" violations are those conditions or
777	occurrences related to the operation and maintenance of a
778	building or to required reports, forms, or documents that do not
779	have the potential of negatively affecting residents. These
780	violations are of a type that the agency determines do not
781	threaten the health, safety, or security of residents of the
782	facility. The agency shall impose an administrative fine for a
783	cited class IV violation in an amountA facility that does not
784	correct a class IV violation within the time specified in the
785	agency-approved corrective action plan is subject to an
786	administrative fine of not less than $100 and not exceedingnor
787	more than $200 for each violation. A citation for a class IV
788	violation must specify the time within which the violation is
789	required to be corrected. If a class IV violation is corrected
790	within the time specified, no fine shall be imposed.Any class
791	IV violation that is corrected during the time an agency survey
792	is being conducted will be identified as an agency finding and
793	not as a violation.
794	(3)(2)In determining if a penalty is to be imposed and in
795	fixing the amount of the fine, the agency shall consider the
796	following factors:
797	(a) The gravity of the violation, including the
798	probability that death or serious physical or emotional harm to
799	a resident will result or has resulted, the severity of the
800	action or potential harm, and the extent to which the provisions
801	of the applicable laws or rules were violated.
802	(b) Actions taken by the owner or administrator to correct
803	violations.
804	(c) Any previous violations.
805	(d) The financial benefit to the facility of committing or
806	continuing the violation.
807	(e) The licensed capacity of the facility.
808	(4)(3)Each day of continuing violation after the date
809	fixed for termination of the violation, as ordered by the
810	agency, constitutes an additional, separate, and distinct
811	violation.
812	(5)(4)Any action taken to correct a violation shall be
813	documented in writing by the owner or administrator of the
814	facility and verified through followup visits by agency
815	personnel. The agency may impose a fine and, in the case of an
816	owner-operated facility, revoke or deny a facility's license
817	when a facility administrator fraudulently misrepresents action
818	taken to correct a violation.
819	(6)(5)For fines that are upheld following administrative
820	or judicial review, the violator shall pay the fine, plus
821	interest at the rate as specified in s. 55.03, for each day
822	beyond the date set by the agency for payment of the fine.
823	(7)(6)Any unlicensed facility that continues to operate
824	after agency notification is subject to a $1,000 fine per day.
825	(8)(7)Any licensed facility whose owner or administrator
826	concurrently operates an unlicensed facility shall be subject to
827	an administrative fine of $5,000 per day.
828	(9)(8)Any facility whose owner fails to apply for a
829	change-of-ownership license in accordance with s. 400.412 and
830	operates the facility under the new ownership is subject to a
831	fine of $5,000.
832	(10)(9)In addition to any administrative fines imposed,
833	the agency may assess a survey fee, equal to the lesser of one
834	half of the facility's biennial license and bed fee or $500, to
835	cover the cost of conducting initial complaint investigations
836	that result in the finding of a violation that was the subject
837	of the complaint or monitoring visits conducted under s.
838	400.428(3)(c) to verify the correction of the violations.
839	(11)(10)The agency, as an alternative to or in
840	conjunction with an administrative action against a facility for
841	violations of this part and adopted rules, shall make a
842	reasonable attempt to discuss each violation and recommended
843	corrective action with the owner or administrator of the
844	facility, prior to written notification. The agency, instead of
845	fixing a period within which the facility shall enter into
846	compliance with standards, may request a plan of corrective
847	action from the facility which demonstrates a good faith effort
848	to remedy each violation by a specific date, subject to the
849	approval of the agency.
850	(12)(11)Administrative fines paid by any facility under
851	this section shall be deposited into the Health Care Trust Fund
852	and expended as provided in s. 400.418.
853	(13)(12)The agency shall develop and disseminate an
854	annual list of all facilities sanctioned or fined $5,000 or more
855	for violations of state standards, the number and class of
856	violations involved, the penalties imposed, and the current
857	status of cases. The list shall be disseminated, at no charge,
858	to the Department of Elderly Affairs, the Department of Health,
859	the Department of Children and Family Services, the area
860	agencies on aging, the Florida Statewide Advocacy Council, and
861	the state and local ombudsman councils. The Department of
862	Children and Family Services shall disseminate the list to
863	service providers under contract to the department who are
864	responsible for referring persons to a facility for residency.
865	The agency may charge a fee commensurate with the cost of
866	printing and postage to other interested parties requesting a
867	copy of this list.
868	Section 22. Subsections (1) and (2) of section 400.0239,
869	Florida Statutes, are amended to read:
870	400.0239 Quality of Long-Term Care Facility Improvement
871	Trust Fund.--
872	(1) There is created within the Agency for Health Care
873	Administration a Quality of Long-Term Care Facility Improvement
874	Trust Fund to support activities and programs directly related
875	to improvement of the care of nursing home and assisted living
876	facility residents. The trust fund shall be funded through
877	proceeds generated pursuant to ss. 400.0238 and 400.4298,
878	through funds specifically appropriated by the Legislature, and
879	through gifts, endowments, and other charitable contributions
880	allowed under federal and state law, and through federal nursing
881	home civil monetary penalties collected by the Centers for
882	Medicare and Medicaid Services and returned to the state. These
883	funds must be utilized in accordance with federal requirements.
884	(2) Expenditures from the trust fund shall be allowable
885	for direct support of the following:
886	(a) Development and operation of a mentoring program, in
887	consultation with the Department of Health and the Department of
888	Elderly Affairs, for increasing the competence, professionalism,
889	and career preparation of long-term care facility direct care
890	staff, including nurses, nursing assistants, and social service
891	and dietary personnel.
892	(b) Development and implementation of specialized training
893	programs for long-term care facility personnel who provide
894	direct care for residents with Alzheimer's disease and other
895	dementias, residents at risk of developing pressure sores, and
896	residents with special nutrition and hydration needs.
897	(c) Addressing areas of deficient practice identified
898	through regulation or state monitoring.
899	(d)(c)Provision of economic and other incentives to
900	enhance the stability and career development of the nursing home
901	direct care workforce, including paid sabbaticals for exemplary
902	direct care career staff to visit facilities throughout the
903	state to train and motivate younger workers to commit to careers
904	in long-term care.
905	(e)(d)Promotion and support for the formation and active
906	involvement of resident and family councils in the improvement
907	of nursing home care.
908	(f) Evaluation of special residents' needs in long-term
909	care facilities, including challenges in meeting special
910	residents' needs, appropriateness of placement and setting, and
911	cited deficiencies related to caring for special needs.
912	(g) Other initiatives authorized by the Centers for
913	Medicare and Medicaid Services for the use of federal civil
914	monetary penalties, including projects recommended through the
915	Medicaid "Up-or-Out" Quality of Care Contract Management Program
916	pursuant to s. 400.148.
917	Section 23. Subsection (15) of section 400.141, Florida
918	Statutes, is amended to read:
919	400.141 Administration and management of nursing home
920	facilities.--Every licensed facility shall comply with all
921	applicable standards and rules of the agency and shall:
922	(15) Submit semiannually to the agency, or more frequently
923	if requested by the agency, information regarding facility
924	staff-to-resident ratios, staff turnover, and staff stability,
925	including information regarding certified nursing assistants,
926	licensed nurses, the director of nursing, and the facility
927	administrator. For purposes of this reporting:
928	(a) Staff-to-resident ratios must be reported in the
929	categories specified in s. 400.23(3)(a) and applicable rules.
930	The ratio must be reported as an average for the most recent
931	calendar quarter.
932	(b) Staff turnover must be reported for the most recent
933	12-month period ending on the last workday of the most recent
934	calendar quarter prior to the date the information is submitted.
935	The turnover rate must be computed quarterly, with the annual
936	rate being the cumulative sum of the quarterly rates. The
937	turnover rate is the total number of terminations or separations
938	experienced during the quarter, excluding any employee
939	terminated during a probationary period of 3 months or less,
940	divided by the total number of staff employed at the end of the
941	period for which the rate is computed, and expressed as a
942	percentage.
943	(c) The formula for determining staff stability is the
944	total number of employees that have been employed for more than
945	12 months, divided by the total number of employees employed at
946	the end of the most recent calendar quarter, and expressed as a
947	percentage.
948	(d) A nursing facility that has failed to comply with
949	state minimum-staffing requirements for 2 consecutive days is
950	prohibited from accepting new admissions until the facility has
951	achieved the minimum-staffing requirements for a period of 6
952	consecutive days. For the purposes of this paragraph, any person
953	who was a resident of the facility and was absent from the
954	facility for the purpose of receiving medical care at a separate
955	location or was on a leave of absence is not considered a new
956	admission. Failure to impose such an admissions moratorium
957	constitutes a class II deficiency.
958	(e) A nursing facility which does not have a conditional
959	license may be cited for failure to comply with the standards in
960	s. 400.23(3)(a) only if it has failed to meet those standards on
961	2 consecutive days or if it has failed to meet at least 97
962	percent of those standards on any one day.
963	(f) A facility which has a conditional license must be in
964	compliance with the standards in s. 400.23(3)(a) at all times.
965
966	Nothing in this section shall limit the agency's ability to
967	impose a deficiency or take other actions if a facility does not
968	have enough staff to meet the residents' needs.
969
970	Facilities that have been awarded a Gold Seal under the program
971	established in s. 400.235 may develop a plan to provide
972	certified nursing assistant training as prescribed by federal
973	regulations and state rules and may apply to the agency for
974	approval of their program.
975	Section 24. Paragraph (b) of subsection (5) of section
976	400.235, Florida Statutes, is amended to read:
977	400.235 Nursing home quality and licensure status; Gold
978	Seal Program.--
979	(5) Facilities must meet the following additional criteria
980	for recognition as a Gold Seal Program facility:
981	(b) Evidence financial soundness and stability according
982	to standards adopted by the agency in administrative rule. Such
983	standards must include, but not be limited to, criteria for the
984	use of financial statements that are prepared in accordance with
985	generally accepted accounting principles and that are reviewed
986	or audited by certified public accountants.
987
988	A facility assigned a conditional licensure status may not
989	qualify for consideration for the Gold Seal Program until after
990	it has operated for 30 months with no class I or class II
991	deficiencies and has completed a regularly scheduled relicensure
992	survey.
993	Section 25. Subsections (1), (2), (7), (8), and (9) of
994	section 400.452, Florida Statutes, are amended to read:
995	400.452 Staff training and educational programs; core
996	educational requirement.--
997	(1) The department shall ensure thatprovide, or cause to
998	be provided, training and educational programs forthe
999	administrators and other assisted living facility staff have met
1000	training and education requirements thatto betterenable them
1001	to appropriately respond to the needs of residents, to maintain
1002	resident care and facility standards, and to meet licensure
1003	requirements.
1004	(2) The department shall alsoestablish a core educational
1005	requirement to be used in these programs. Successful completion
1006	of the core educational requirement must include successful
1007	completion of a competency test. Programs must be provided by
1008	the department or by a provider approved by the department at
1009	least quarterly.The core educational requirement must cover at
1010	least the following topics:
1011	(a) State law and rules relating to assisted living
1012	facilities.
1013	(b) Resident rights and identifying and reporting abuse,
1014	neglect, and exploitation.
1015	(c) Special needs of elderly persons, persons with mental
1016	illness, and persons with developmental disabilities and how to
1017	meet those needs.
1018	(d) Nutrition and food service, including acceptable
1019	sanitation practices for preparing, storing, and serving food.
1020	(e) Medication management, recordkeeping, and proper
1021	techniques for assisting residents with self-administered
1022	medication.
1023	(f) Firesafety requirements, including fire evacuation
1024	drill procedures and other emergency procedures.
1025	(g) Care of persons with Alzheimer's disease and related
1026	disorders.
1027	(7) A facility that does not have any residents who
1028	receive monthly optional supplementation payments must pay a
1029	reasonable fee for such training and education programs. A
1030	facility that has one or more such residents shall pay a reduced
1031	fee that is proportional to the percentage of such residents in
1032	the facility. Any facility more than 90 percent of whose
1033	residents receive monthly optional state supplementation
1034	payments is not required to pay for the training and continuing
1035	education programs required under this section.
1036	(7)(8)If the department or the agency determines that
1037	there are problems in a facility that could be reduced through
1038	specific staff training or education beyond that already
1039	required under this section, the department or the agency may
1040	require, and provide, or cause to be provided, the training or
1041	education of any personal care staff in the facility.
1042	(8)(9)The department shall adopt rules to establish
1043	training programs, standards and curriculum for training, staff
1044	training requirements, procedures for approving training
1045	programs, and training fees.
1046	Section 26. Subsections (7), (8), and (9) are added to
1047	section 430.502, Florida Statutes, to read:
1048	430.502 Alzheimer's disease; memory disorder clinics and
1049	day care and respite care programs.--
1050	(7) The Agency for Health Care Administration and the
1051	department shall seek a federal waiver to implement a Medicaid
1052	home and community-based waiver targeted to persons with
1053	Alzheimer's disease to test the effectiveness of Alzheimer’s
1054	specific interventions to delay or to avoid institutional
1055	placement.
1056	(8) The department will implement the waiver program
1057	specified in subsection (7). The agency and the department shall
1058	ensure that providers are selected that have a history of
1059	successfully serving persons with Alzheimer's disease. The
1060	department and the agency shall develop specialized standards
1061	for providers and services tailored to persons in the early,
1062	middle, and late stages of Alzheimer's disease and designate a
1063	level of care determination process and standard that is most
1064	appropriate to this population. The department and the agency
1065	shall include in the waiver services designed to assist the
1066	caregiver in continuing to provide in-home care. The department
1067	shall implement this waiver program subject to a specific
1068	appropriation or as provided in the General Appropriations Act.
1069	The department and the agency shall submit their program design
1070	to the President of the Senate and the Speaker of the House of
1071	Representatives for consultation during the development process.
1072	(9) Authority to continue the waiver program specified in
1073	subsection (7) shall be automatically eliminated at the close of
1074	the 2008 Regular Session of the Legislature unless further
1075	legislative action is taken to continue it prior to such time.
1076	Section 27. Subsection (1) of section 400.557, Florida
1077	Statutes, is amended to read:
1078	400.557 Expiration of license; renewal; conditional
1079	license or permit.--
1080	(1) A license issued for the operation of an adult day
1081	care center, unless sooner suspended or revoked, expires 2 years
1082	after the date of issuance. The agency shall notify a licensee
1083	by certified mail, return receipt requested,at least 120 days
1084	before the expiration date that license renewal is required to
1085	continue operation. The notification must be provided
1086	electronically or by mail delivery.At least 90 days prior to
1087	the expiration date, an application for renewal must be
1088	submitted to the agency. A license shall be renewed, upon the
1089	filing of an application on forms furnished by the agency, if
1090	the applicant has first met the requirements of this part and of
1091	the rules adopted under this part. The applicant must file with
1092	the application satisfactory proof of financial ability to
1093	operate the center in accordance with the requirements of this
1094	part and in accordance with the needs of the participants to be
1095	served and an affidavit of compliance with the background
1096	screening requirements of s. 400.5572.
1097	Section 28. Subsection (3) of section 400.619, Florida
1098	Statutes, is amended to read:
1099	400.619 Licensure application and renewal.--
1100	(3) The agency shall notify a licensee at least 120 days
1101	before the expiration date that license renewal is required to
1102	continue operation. The notification must be provided
1103	electronically or by mail delivery.Application for a license or
1104	annual license renewal must be made on a form provided by the
1105	agency, signed under oath, and must be accompanied by a
1106	licensing fee of $100 per year.
1107	Section 29. Subsection (4) of section 400.980, Florida
1108	Statutes, is reenacted and amended to read:
1109	400.980 Health care services pools.--
1110	(4) Each applicant for registration must comply with the
1111	following requirements:
1112	(a) Upon receipt of a completed, signed, and dated
1113	application, the agency shall require background screening, in
1114	accordance with the level 1 standards for screening set forth in
1115	chapter 435, of every individual who will have contact with
1116	patients. The agency shall require background screening of the
1117	managing employee or other similarly titled individual who is
1118	responsible for the operation of the entity, and of the
1119	financial officer or other similarly titled individual who is
1120	responsible for the financial operation of the entity, including
1121	billings for services in accordance with the level 2 standards
1122	for background screening as set forth in chapter 435.
1123	(b) The agency may require background screening of any
1124	other individual who is affiliated with the applicant if the
1125	agency has a reasonable basis for believing that he or she has
1126	been convicted of a crime or has committed any other offense
1127	prohibited under the level 2 standards for screening set forth
1128	in chapter 435.
1129	(c) Proof of compliance with the level 2 background
1130	screening requirements of chapter 435 which has been submitted
1131	within the previous 5 years in compliance with any other health
1132	care or assisted living licensure requirements of this state is
1133	acceptable in fulfillment of paragraph (a).
1134	(d) A provisional registration may be granted to an
1135	applicant when each individual required by this section to
1136	undergo background screening has met the standards for the
1137	Department of Law Enforcement background check but the agency
1138	has not yet received background screening results from the
1139	Federal Bureau of Investigation. A standard registration may be
1140	granted to the applicant upon the agency's receipt of a report
1141	of the results of the Federal Bureau of Investigation background
1142	screening for each individual required by this section to
1143	undergo background screening which confirms that all standards
1144	have been met, or upon the granting of a disqualification
1145	exemption by the agency as set forth in chapter 435. Any other
1146	person who is required to undergo level 2 background screening
1147	may serve in his or her capacity pending the agency's receipt of
1148	the report from the Federal Bureau of Investigation. However,
1149	the person may not continue to serve if the report indicates any
1150	violation of background screening standards and if a
1151	disqualification exemption has not been requested of and granted
1152	by the agency as set forth in chapter 435.
1153	(e) Each applicant must submit to the agency, with its
1154	application, a description and explanation of any exclusions,
1155	permanent suspensions, or terminations of the applicant from the
1156	Medicare or Medicaid programs. Proof of compliance with the
1157	requirements for disclosure of ownership and controlling
1158	interests under the Medicaid or Medicare programs may be
1159	accepted in lieu of this submission.
1160	(f) Each applicant must submit to the agency a description
1161	and explanation of any conviction of an offense prohibited under
1162	the level 2 standards of chapter 435 which was committed by a
1163	member of the board of directors of the applicant, its officers,
1164	or any individual owning 5 percent or more of the applicant.
1165	This requirement does not apply to a director of a not-for-
1166	profit corporation or organization who serves solely in a
1167	voluntary capacity for the corporation or organization, does not
1168	regularly take part in the day-to-day operational decisions of
1169	the corporation or organization, receives no remuneration for
1170	his or her services on the corporation's or organization's board
1171	of directors, and has no financial interest and no family
1172	members having a financial interest in the corporation or
1173	organization, if the director and the not-for-profit corporation
1174	or organization include in the application a statement affirming
1175	that the director's relationship to the corporation satisfies
1176	the requirements of this paragraph.
1177	(g) A registration may not be granted to an applicant if
1178	the applicant or managing employee has been found guilty of,
1179	regardless of adjudication, or has entered a plea of nolo
1180	contendere or guilty to, any offense prohibited under the level
1181	2 standards for screening set forth in chapter 435, unless an
1182	exemption from disqualification has been granted by the agency
1183	as set forth in chapter 435.
1184	(h) The provisions of this section which require an
1185	applicant for registration to undergo background screening shall
1186	stand repealed on June 30, 2001, unless reviewed and saved from
1187	repeal through reenactment by the Legislature.
1188	(h)(i)Failure to provide all required documentation
1189	within 30 days after a written request from the agency will
1190	result in denial of the application for registration.
1191	(i)(j)The agency must take final action on an application
1192	for registration within 60 days after receipt of all required
1193	documentation.
1194	(j)(k)The agency may deny, revoke, or suspend the
1195	registration of any applicant or registrant who:
1196	1. Has falsely represented a material fact in the
1197	application required by paragraph (e) or paragraph (f), or has
1198	omitted any material fact from the application required by
1199	paragraph (e) or paragraph (f); or
1200	2. Has had prior action taken against the applicant under
1201	the Medicaid or Medicare program as set forth in paragraph (e).
1202	3. Fails to comply with this section or applicable rules.
1203	4. Commits an intentional, reckless, or negligent act that
1204	materially affects the health or safety of a person receiving
1205	services.
1206	Section 30. Section 408.061, Florida Statutes, is amended
1207	to read:
1208	408.061 Data collection; uniform systems of financial
1209	reporting; information relating to physician charges;
1210	confidential information; immunity.--
1211	(1) The agency may require the submission by health care
1212	facilities, health care providers, and health insurers of data
1213	necessary to carry out the agency's duties. Specifications for
1214	data to be collected under this section shall be developed by
1215	the agency with the assistance of technical advisory panels
1216	including representatives of affected entities, consumers,
1217	purchasers, and such other interested parties as may be
1218	determined by the agency.
1219	(a) Data to be submitted by health care facilities may
1220	include, but are not limited to: case-mix data, patient
1221	admission or discharge data with patient and provider-specific
1222	identifiers included, actual charge data by diagnostic groups,
1223	financial data, accounting data, operating expenses, expenses
1224	incurred for rendering services to patients who cannot or do not
1225	pay, interest charges, depreciation expenses based on the
1226	expected useful life of the property and equipment involved, and
1227	demographic data. Data may be obtained from documents such as,
1228	but not limited to: leases, contracts, debt instruments,
1229	itemized patient bills, medical record abstracts, and related
1230	diagnostic information.
1231	(b) Data to be submitted by health care providers may
1232	include, but are not limited to: Medicare and Medicaid
1233	participation, types of services offered to patients, amount of
1234	revenue and expenses of the health care provider, and such other
1235	data which are reasonably necessary to study utilization
1236	patterns.
1237	(c) Data to be submitted by health insurers may include,
1238	but are not limited to: claims, premium, administration, and
1239	financial information.
1240	(d) Data required to be submitted by health care
1241	facilities, health care providers, or health insurers shall not
1242	include specific provider contract reimbursement information.
1243	However, such specific provider reimbursement data shall be
1244	reasonably available for onsite inspection by the agency as is
1245	necessary to carry out the agency's regulatory duties. Any such
1246	data obtained by the agency as a result of onsite inspections
1247	may not be used by the state for purposes of direct provider
1248	contracting and are confidential and exempt from the provisions
1249	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
1250	(e) A requirement to submit data shall be adopted by rule
1251	if the submission of data is being required of all members of
1252	any type of health care facility, health care provider, or
1253	health insurer. Rules are not required, however, for the
1254	submission of data for a special study mandated by the
1255	Legislature or when information is being requested for a single
1256	health care facility, health care provider, or health insurer.
1257	(2) The agency shall, by rule, after consulting with
1258	appropriate professional and governmental advisory bodies and
1259	holding public hearings and considering existing and proposed
1260	systems of accounting and reporting utilized by health care
1261	facilities, specify a uniform system of financial reporting for
1262	each type of facility based on a uniform chart of accounts
1263	developed after considering any chart of accounts developed by
1264	the national association for such facilities and generally
1265	accepted accounting principles. Such systems shall, to the
1266	extent feasible, use existing accounting systems and shall
1267	minimize the paperwork required of facilities. This provision
1268	shall not be construed to authorize the agency to require health
1269	care facilities to adopt a uniform accounting system. As a part
1270	of such uniform system of financial reporting, the agency may
1271	require the filing of any information relating to the cost to
1272	the provider and the charge to the consumer of any service
1273	provided in such facility, except the cost of a physician's
1274	services which is billed independently of the facility.
1275	(3) When more than one licensed facility is operated by
1276	the reporting organization, the information required by this
1277	section shall be reported for each facility separately.
1278	(4)(a)Within 120 days after the end of its fiscal year,
1279	each health care facility, excluding continuing care facilities
1280	and nursing homes as defined in s. 408.07(14) and (36),shall
1281	file with the agency, on forms adopted by the agency and based
1282	on the uniform system of financial reporting, its actual
1283	financial experience for that fiscal year, including
1284	expenditures, revenues, and statistical measures. Such data may
1285	be based on internal financial reports which are certified to be
1286	complete and accurate by the provider. However, hospitals'
1287	actual financial experience shall be their audited actual
1288	experience. Nursing homes that do not participate in the
1289	Medicare or Medicaid programs shall also submit audited actual
1290	experience.Every nursing home shall submit to the agency, in a
1291	format designated by the agency, a statistical profile of the
1292	nursing home residents. The agency, in conjunction with the
1293	Department of Elderly Affairs and the Department of Health,
1294	shall review these statistical profiles and develop
1295	recommendations for the types of residents who might more
1296	appropriately be placed in their homes or other noninstitutional
1297	settings.
1298	(b) Each nursing home shall also submit a schedule of the
1299	charges in effect at the beginning of the fiscal year and any
1300	changes that were made during the fiscal year. A nursing home
1301	which is certified under Title XIX of the Social Security Act
1302	and files annual Medicaid cost reports may substitute copies of
1303	such reports and any Medicaid audits to the agency in lieu of a
1304	report and audit required under this subsection. For such
1305	facilities, the agency may require only information in
1306	compliance with this chapter that is not contained in the
1307	Medicaid cost report. Facilities that are certified under Title
1308	XVIII, but not Title XIX, of the Social Security Act must submit
1309	a report as developed by the agency. This report shall be
1310	substantially the same as the Medicaid cost report and shall not
1311	require any more information than is contained in the Medicare
1312	cost report unless that information is required of all nursing
1313	homes. The audit under Title XVIII shall satisfy the audit
1314	requirement under this subsection.
1315	(5) In addition to information submitted in accordance
1316	with subsection (4), each nursing home shall track and file with
1317	the agency, on a form adopted by the agency, data related to
1318	each resident's admission, discharge, or conversion to Medicaid;
1319	health and functional status; plan of care; and other
1320	information pertinent to the resident's placement in a nursing
1321	home.
1322	(6) Any nursing home which assesses residents a separate
1323	charge for personal laundry services shall submit to the agency
1324	data on the monthly charge for such services, excluding
1325	drycleaning. For facilities that charge based on the amount of
1326	laundry, the most recent schedule of charges and the average
1327	monthly charge shall be submitted to the agency.
1328	(6)(7)The agency may require other reports based on the
1329	uniform system of financial reporting necessary to accomplish
1330	the purposes of this chapter.
1331	(7)(8)Portions of patient records obtained or generated
1332	by the agency containing the name, residence or business
1333	address, telephone number, social security or other identifying
1334	number, or photograph of any person or the spouse, relative, or
1335	guardian of such person, or any other identifying information
1336	which is patient-specific or otherwise identifies the patient,
1337	either directly or indirectly, are confidential and exempt from
1338	the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
1339	Constitution.
1340	(8)(9)The identity of any health care provider, health
1341	care facility, or health insurer who submits any data which is
1342	proprietary business information to the agency pursuant to the
1343	provisions of this section shall remain confidential and exempt
1344	from the provisions of s. 119.07(1) and s. 24(a), Art. I of the
1345	State Constitution. As used in this section, "proprietary
1346	business information" shall include, but not be limited to,
1347	information relating to specific provider contract reimbursement
1348	information; information relating to security measures, systems,
1349	or procedures; and information concerning bids or other
1350	contractual data, the disclosure of which would impair efforts
1351	to contract for goods or services on favorable terms or would
1352	injure the affected entity's ability to compete in the
1353	marketplace. Notwithstanding the provisions of this subsection,
1354	any information obtained or generated pursuant to the provisions
1355	of former s. 407.61, either by the former Health Care Cost
1356	Containment Board or by the Agency for Health Care
1357	Administration upon transfer to that agency of the duties and
1358	functions of the former Health Care Cost Containment Board, is
1359	not confidential and exempt from the provisions of s. 119.07(1)
1360	and s. 24(a), Art. I of the State Constitution. Such proprietary
1361	business information may be used in published analyses and
1362	reports or otherwise made available for public disclosure in
1363	such manner as to preserve the confidentiality of the identity
1364	of the provider. This exemption shall not limit the use of any
1365	information used in conjunction with investigation or
1366	enforcement purposes under the provisions of s. 456.073.
1367	(9)(10)No health care facility, health care provider,
1368	health insurer, or other reporting entity or its employees or
1369	agents shall be held liable for civil damages or subject to
1370	criminal penalties either for the reporting of patient data to
1371	the agency or for the release of such data by the agency as
1372	authorized by this chapter.
1373	(10)(11)The agency shall be the primary source for
1374	collection and dissemination of health care data. No other
1375	agency of state government may gather data from a health care
1376	provider licensed or regulated under this chapter without first
1377	determining if the data is currently being collected by the
1378	agency and affirmatively demonstrating that it would be more
1379	cost-effective for an agency of state government other than the
1380	agency to gather the health care data. The director shall ensure
1381	that health care data collected by the divisions within the
1382	agency is coordinated. It is the express intent of the
1383	Legislature that all health care data be collected by a single
1384	source within the agency and that other divisions within the
1385	agency, and all other agencies of state government, obtain data
1386	for analysis, regulation, and public dissemination purposes from
1387	that single source. Confidential information may be released to
1388	other governmental entities or to parties contracting with the
1389	agency to perform agency duties or functions as needed in
1390	connection with the performance of the duties of the receiving
1391	entity. The receiving entity or party shall retain the
1392	confidentiality of such information as provided for herein.
1393	(11)(12)The agency shall cooperate with local health
1394	councils and the state health planning agency with regard to
1395	health care data collection and dissemination and shall
1396	cooperate with state agencies in any efforts to establish an
1397	integrated health care database.
1398	(12)(13)It is the policy of this state that philanthropic
1399	support for health care should be encouraged and expanded,
1400	especially in support of experimental and innovative efforts to
1401	improve the health care delivery system.
1402	(13)(14)For purposes of determining reasonable costs of
1403	services furnished by health care facilities, unrestricted
1404	grants, gifts, and income from endowments shall not be deducted
1405	from any operating costs of such health care facilities, and, in
1406	addition, the following items shall not be deducted from any
1407	operating costs of such health care facilities:
1408	(a) An unrestricted grant or gift, or income from such a
1409	grant or gift, which is not available for use as operating funds
1410	because of its designation by the health care facility's
1411	governing board.
1412	(b) A grant or similar payment which is made by a
1413	governmental entity and which is not available, under the terms
1414	of the grant or payment, for use as operating funds.
1415	(c) The sale or mortgage of any real estate or other
1416	capital assets of the health care facility which the health care
1417	facility acquired through a gift or grant and which is not
1418	available for use as operating funds under the terms of the gift
1419	or grant or because of its designation by the health care
1420	facility's governing board, except for recovery of the
1421	appropriate share of gains and losses realized from the disposal
1422	of depreciable assets.
1423	Section 31. Section 408.062, Florida Statutes, is amended
1424	to read:
1425	408.062 Research, analyses, studies, and reports.--
1426	(1) The agency shall have the authority to conduct
1427	research, analyses, and studies relating to health care costs
1428	and access to and quality of health care services as access and
1429	quality are affected by changes in health care costs. Such
1430	research, analyses, and studies shall include, but not be
1431	limited to, research and analysis relating to:
1432	(a) The financial status of any health care facility or
1433	facilities subject to the provisions of this chapter.
1434	(b) The impact of uncompensated charity care on health
1435	care facilities and health care providers.
1436	(c) The state's role in assisting to fund indigent care.
1437	(d) The availability and affordability of health insurance
1438	for small businesses.
1439	(e) Total health care expenditures in the state according
1440	to the sources of payment and the type of expenditure.
1441	(f) The quality of health services, using techniques such
1442	as small area analysis, severity adjustments, and risk-adjusted
1443	mortality rates.
1444	(g) The development of physician payment systems which are
1445	capable of taking into account the amount of resources consumed
1446	and the outcomes produced in the delivery of care.
1447	(h) The impact of subacute admissions on hospital revenues
1448	and expenses for purposes of calculating adjusted admissions as
1449	defined in s. 408.07.
1450	(2) The agency shall evaluate data from nursing home
1451	financial reports and shall document and monitor:
1452	(a) Total revenues, annual change in revenues, and
1453	revenues by source and classification, including contributions
1454	for a resident's care from the resident's resources and from the
1455	family and contributions not directed toward any specific
1456	resident's care.
1457	(b) Average resident charges by geographic region, payor,
1458	and type of facility ownership.
1459	(c) Profit margins by geographic region and type of
1460	facility ownership.
1461	(d) Amount of charity care provided by geographic region
1462	and type of facility ownership.
1463	(e) Resident days by payor category.
1464	(f) Experience related to Medicaid conversion as reported
1465	under s. 408.061.
1466	(g) Other information pertaining to nursing home revenues
1467	and expenditures.
1468
1469	The findings of the agency shall be included in an annual report
1470	to the Governor and Legislature by January 1 each year.
1471	(2)(3)The agency may assess annually the caesarean
1472	section rate in Florida hospitals using the analysis methodology
1473	that the agency determines most appropriate. To assist the
1474	agency in determining the impact of this chapter on Florida
1475	hospitals' caesarean section rates, each provider hospital, as
1476	defined in s. 383.336, shall notify the agency of the date of
1477	implementation of the practice parameters and the date of the
1478	first meeting of the hospital peer review board created pursuant
1479	to this chapter. The agency shall use these dates in monitoring
1480	any change in provider hospital caesarean section rates. An
1481	annual report based on this monitoring and assessment shall be
1482	submitted to the Governor, the Speaker of the House of
1483	Representatives, and the President of the Senate by the agency,
1484	with the first annual report due January 1, 1993.
1485	(3)(4)The agency may also prepare such summaries and
1486	compilations or other supplementary reports based on the
1487	information analyzed by the agency under this section, as will
1488	advance the purposes of this chapter.
1489	(4)(5)(a) The agency may conduct data-based studies and
1490	evaluations and make recommendations to the Legislature and the
1491	Governor concerning exemptions, the effectiveness of limitations
1492	of referrals, restrictions on investment interests and
1493	compensation arrangements, and the effectiveness of public
1494	disclosure. Such analysis may include, but need not be limited
1495	to, utilization of services, cost of care, quality of care, and
1496	access to care. The agency may require the submission of data
1497	necessary to carry out this duty, which may include, but need
1498	not be limited to, data concerning ownership, Medicare and
1499	Medicaid, charity care, types of services offered to patients,
1500	revenues and expenses, patient-encounter data, and other data
1501	reasonably necessary to study utilization patterns and the
1502	impact of health care provider ownership interests in health-
1503	care-related entities on the cost, quality, and accessibility of
1504	health care.
1505	(b) The agency may collect such data from any health
1506	facility as a special study.
1507	Section 32. Subsection (2) of section 408.831, Florida
1508	Statutes, is renumbered as subsection (3) and a new subsection
1509	(2) is added to said section to read:
1510	408.831 Denial, suspension, or revocation of a license,
1511	registration, certificate, or application.--
1512	(2) In reviewing any application requesting a change of
1513	ownership or change of the licensee, registrant, or certificate
1514	holder, the transferor shall, prior to agency approval of the
1515	change, repay or make arrangements to repay any amounts owed to
1516	the agency. Should the transferor fail to repay or make
1517	arrangements to repay the amounts owed to the agency, the
1518	issuance of a license, registration, or certificate to the
1519	transferee shall be delayed until repayment or until
1520	arrangements for repayment are made.
1521	Section 33. Subsection (1) of section 409.9116, Florida
1522	Statutes, is amended to read:
1523	409.9116 Disproportionate share/financial assistance
1524	program for rural hospitals.--In addition to the payments made
1525	under s. 409.911, the Agency for Health Care Administration
1526	shall administer a federally matched disproportionate share
1527	program and a state-funded financial assistance program for
1528	statutory rural hospitals. The agency shall make
1529	disproportionate share payments to statutory rural hospitals
1530	that qualify for such payments and financial assistance payments
1531	to statutory rural hospitals that do not qualify for
1532	disproportionate share payments. The disproportionate share
1533	program payments shall be limited by and conform with federal
1534	requirements. Funds shall be distributed quarterly in each
1535	fiscal year for which an appropriation is made. Notwithstanding
1536	the provisions of s. 409.915, counties are exempt from
1537	contributing toward the cost of this special reimbursement for
1538	hospitals serving a disproportionate share of low-income
1539	patients.
1540	(1) The following formula shall be used by the agency to
1541	calculate the total amount earned for hospitals that participate
1542	in the rural hospital disproportionate share program or the
1543	financial assistance program:
1544
1545	TAERH = (CCD + MDD)/TPD
1546
1547	Where:
1548	CCD = total charity care-other, plus charity care-Hill-
1549	Burton, minus 50 percent of unrestricted tax revenue from local
1550	governments, and restricted funds for indigent care, divided by
1551	gross revenue per adjusted patient day; however, if CCD is less
1552	than zero, then zero shall be used for CCD.
1553	MDD = Medicaid inpatient days plus Medicaid HMO inpatient
1554	days.
1555	TPD = total inpatient days.
1556	TAERH = total amount earned by each rural hospital.
1557
1558	In computing the total amount earned by each rural hospital, the
1559	agency must use the most recent actual data reported in
1560	accordance with s. 408.061(4)(a).
1561	Section 34. This act shall take effect upon becoming a
1562	law.
1563
1564
1565
1566	================= T I T L E A M E N D M E N T =================
1567
1568	Remove the entire title,
1569
1570	and insert:
1571
1572	A bill to be entitled
1573	An act relating to the protection and delivery of services
1574	to persons who are disabled, vulnerable, or elderly;
1575	creating s. 393.506, F.S.; allowing administration of
1576	medication by certain unlicensed staff for persons with
1577	developmental disabilities; providing requirements for
1578	such administration; creating s. 400.9685, F.S.; allowing
1579	administration of medication by certain unlicensed staff
1580	in nursing homes and related health care facilities for
1581	persons with developmental disabilities; providing
1582	requirements for such administration; amending s. 394.74,
1583	F.S.; providing for alternative payment methods for
1584	contracts for provision of local substance abuse and
1585	mental health programs; amending s. 415.102, F.S.;
1586	clarifying definitions; amending s. 765.401, F.S.;
1587	providing additional persons which may be given a proxy
1588	for the making of health care decisions; amending s.
1589	744.102, F.S.; providing that a public guardian shall be
1590	considered a professional guardian for certain purposes;
1591	amending s. 744.108, F.S.; providing that certain costs
1592	relating to determination of certain fees shall be payable
1593	from the guardianship estate; amending s. 744.1083, F.S.;
1594	deleting obsolete language; increasing the maximum annual
1595	fee for registration as a professional guardian; requiring
1596	additional information for registration; transferring
1597	certain rule adoption authority and registration
1598	responsibilities from the Statewide Public Guardianship
1599	Office to the Department of Elderly Affairs; authorizing
1600	the Department of Elderly Affairs to contract with a not-
1601	for-profit entity to register professional guardians;
1602	providing that certain educational institutions may act as
1603	professional guardians without registering; amending s.
1604	744.1085, F.S.; providing for additional regulation of
1605	professional guardians; providing for a professional
1606	examination as a condition of registration; providing
1607	additional requirements for registration as a professional
1608	guardian; providing that certain financial institutions
1609	are exempt from the regulations governing professional
1610	guardians; amending s. 744.3135, F.S.; limiting certain
1611	requirements to professional guardians; authorizing the
1612	court to require guardians to submit to credit history
1613	investigations and background screening; amending s.
1614	744.3145, F.S.; providing training requirements for
1615	parents appointed as guardians of the property of their
1616	minor children; amending s. 744.444, F.S.; allowing
1617	guardians to employ care managers and disclose
1618	confidential information to an ombudsman without court
1619	approval; providing that such information shall remain
1620	confidential; authorizing the payment of certain costs;
1621	amending ss. 744.534 and 744.7021, F.S.; providing that
1622	the executive director of the Statewide Public
1623	Guardianship Office shall be appointed by the Secretary of
1624	Elderly Affairs, rather than by the Governor; transferring
1625	certain responsibilities from the Statewide Public
1626	Guardianship Office to the Department of Elderly Affairs;
1627	amending s. 744.704, F.S.; removing a limitation on what
1628	wards a public guardian may serve; creating the
1629	Guardianship Task Force to examine and make
1630	recommendations regarding guardianship in this state;
1631	providing for membership; providing for appointment;
1632	providing for term of existence; providing that certain
1633	prior offenses shall be considered in conducting
1634	employment screening, notwithstanding the provisions of
1635	section 64 of ch. 95-228, Laws of Florida; amending s.
1636	400.071, F.S.; requiring applicants for licensure as a
1637	nursing home to provide proof of a legal right to occupy
1638	the property; amending s. 400.414, F.S.; delineating the
1639	types and number of deficiencies justifying denial,
1640	revocation, or suspension of a license as an assisted
1641	living facility; amending s. 400.417, F.S.; providing an
1642	alternative method of providing notice to an assisted
1643	living facility that a license must be renewed; amending
1644	s. 400.419, F.S.; providing that administrative fines for
1645	assisted living facilities or its personnel shall be
1646	imposed by the Agency for Health Care Administration in
1647	the manner provided in ch. 120, F.S.; amending s.
1648	400.0239, F.S.; providing for deposit of civil monetary
1649	fines in the Quality of Long-Term Care Facility
1650	Improvement Trust Fund; providing for additional purposes
1651	for which funds from such trust fund may be expended;
1652	amending s. 400.141, F.S; providing for enforcement of
1653	minimum staffing standards for a nursing facility within a
1654	range; amending s. 400.235, F.S.; allowing reviewed
1655	financial statements to be submitted for the Gold Seal
1656	program; amending s. 400.452, F.S.; revising training and
1657	education requirements of the Department of Elderly
1658	Affairs for assisted living facilities; deleting a
1659	requirement that fees for training and education programs
1660	be based on the percentage of residents receiving monthly
1661	optional supplementation payments; amending s. 430.502,
1662	F.S.; requiring the Agency for Health Care Administration
1663	and the Department of Health to seek and implement a
1664	Medicaid home and community-based waiver for persons with
1665	Alzheimer's disease; requiring the development of waiver
1666	program standards; providing for consultation with the
1667	presiding officers of the Legislature; providing for a
1668	contingent future repeal of such waiver program; amending
1669	s. 400.557, F.S.; providing an alternative method of
1670	providing notice to an adult day care center that a
1671	license must be renewed; amending s. 400.619, F.S.;
1672	requiring that the Agency for Health Care Administration
1673	provide advance notice to an adult family-care home that a
1674	license must be renewed; reenacting and amending s.
1675	400.980, F.S.; providing that the provisions governing
1676	background screening of persons involved with health care
1677	services pools shall not stand repealed; amending s.
1678	408.061, F.S.; exempting nursing homes and continuing care
1679	facilities from certain financial reporting requirements;
1680	amending s. 408.062, F.S.; providing that the Agency for
1681	Health Care Administration is not required to evaluate
1682	financial reports of nursing homes; amending s. 408.831,
1683	F.S.; requiring that licensees of the Agency for Health
1684	Care Administration pay or arrange for payment of amounts
1685	owed to the agency by the licensee prior to transfer of
1686	the license or issuance of a license to a transferee;
1687	amending s. 409.9116, F.S.; correcting a cross reference;
1688	providing an effective date.