Amendment

Bill No. 1062

Amendment No. 964733

CHAMBER ACTION
Senate		House
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1	Representative Murman offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Section 400.0712, Florida Statutes, is created
6	to read:
7	400.0712  Application for inactive license.--
8	(1)  As specified in this section, the agency may issue an
9	inactive license to a nursing home facility for all or a portion
10	of its beds. Any request by a licensee that a nursing home or
11	portion of a nursing home become inactive must be submitted to
12	the agency in the approved format. The facility may not initiate
13	any suspension of services, notify residents, or initiate
14	facility closure before receiving approval from the agency; and
15	a facility that violates this provision shall not be issued an
16	inactive license. Upon agency approval of an inactive license,
17	the nursing home shall notify residents of any necessary
18	discharge or transfer as provided in s. 400.0255.
19	(2)  The agency may issue an inactive license to a nursing
20	home that chooses to use an unoccupied contiguous portion of the
21	facility for an alternative use to meet the needs of elderly
22	persons through the use of less restrictive, less institutional
23	services.
24	(a)  An inactive license issued under this subsection may
25	be granted for a period not to exceed 12 months but may be
26	renewed annually by the agency for 12 months.
27	(b)  A request to extend the inactive license must be
28	submitted to the agency in the approved format and approved by
29	the agency in writing.
30	(c)  Nursing homes that receive an inactive license to
31	provide alternative services shall not receive preference for
32	participation in the Assisted Living for the Elderly Medicaid
33	waiver.
34	(3)  The agency may issue an inactive license to a nursing
35	home that will be temporarily unable to provide services but is
36	reasonably expected to resume services.
37	(a)  An inactive license issued under this subsection may
38	be issued for a period not to exceed 12 months and may be
39	renewed by the agency for an additional 6 months upon
40	demonstration of progress toward reopening.
41	(b)  All licensure fees must be current and paid in full,
42	and may be prorated as provided by agency rule, before the
43	inactive license is issued.
44	(c)  Reactivation of an inactive license requires that the
45	applicant pay all licensure fees and be inspected by the agency
46	to confirm that all of the requirements of this part and
47	applicable rules are met.
48	(4)  The agency shall adopt rules pursuant to ss.
49	120.536(1) and 120.54 necessary to implement this section.
50	Section 2.  Subsections (10), (11), and (12) of section
51	400.071, Florida Statutes, are amended to read:
52	400.071  Application for license.--
53	(10)  The agency may issue an inactive license to a nursing
54	home that will be temporarily unable to provide services but
55	that is reasonably expected to resume services. Such designation
56	may be made for a period not to exceed 12 months but may be
57	renewed by the agency for up to 6 additional months. Any request
58	by a licensee that a nursing home become inactive must be
59	submitted to the agency and approved by the agency prior to
60	initiating any suspension of service or notifying residents.
61	Upon agency approval, the nursing home shall notify residents of
62	any necessary discharge or transfer as provided in s. 400.0255.
63	(10)(11)  As a condition of licensure, each facility must
64	establish and submit with its application a plan for quality
65	assurance and for conducting risk management.
66	(11)(12)  The applicant must provide the agency with proof
67	of a legal right to occupy the property before a license may be
68	issued. Proof may include, but is not limited to, copies of
69	warranty deeds, lease or rental agreements, contracts for deeds,
70	or quitclaim deeds.
71	Section 3.  Subsection (17) of section 400.021, Florida
72	Statutes, is amended to read:
73	400.021  Definitions.--When used in this part, unless the
74	context otherwise requires, the term:
75	(17)  "Resident care plan" means a written plan developed,
76	maintained, and reviewed not less than quarterly by a registered
77	nurse, with participation from other facility staff and the
78	resident or his or her designee or legal representative, which
79	includes a comprehensive assessment of the needs of an
80	individual resident; the type and frequency of services required
81	to provide the necessary care for the resident to attain or
82	maintain the highest practicable physical, mental, and
83	psychosocial well-being; a listing of services provided within
84	or outside the facility to meet those needs; and an explanation
85	of service goals. The resident care plan must be signed by the
86	director of nursing or another registered nurse employed by the
87	facility to whom institutional responsibilities have been
88	delegated and by the resident, the resident's designee, or the
89	resident's legal representative. The facility may not use an
90	agency or temporary registered nurse to satisfy the foregoing
91	requirement and must document the institutional responsibilities
92	that have been delegated to the registered nurse.
93	Section 4.  Subsection (10) is added to section 400.23,
94	Florida Statutes, to read:
95	400.23  Rules; evaluation and deficiencies; licensure
96	status.--
97	(10)  Agency records, reports, ranking systems, Internet
98	information, and publications must be promptly updated to
99	reflect the most current agency actions.
100	Section 5.  Subsection (4) of section 400.211, Florida
101	Statutes, is amended to read:
102	400.211  Persons employed as nursing assistants;
103	certification requirement.--
104	(4)  When employed by a nursing home facility for a 12-
105	month period or longer, a nursing assistant, to maintain
106	certification, shall submit to a performance review every 12
107	months and must receive regular inservice education based on the
108	outcome of such reviews. The inservice training must:
109	(a)  Be sufficient to ensure the continuing competence of
110	nursing assistants and must meet the standard specified in s.
111	464.203(7), must be at least 18 hours per year, and may include
112	hours accrued under s. 464.203(8);
113	(b)  Include, at a minimum:
114	1.  Techniques for assisting with eating and proper
115	feeding;
116	2.  Principles of adequate nutrition and hydration;
117	3.  Techniques for assisting and responding to the
118	cognitively impaired resident or the resident with difficult
119	behaviors;
120	4.  Techniques for caring for the resident at the end-of-
121	life; and
122	5.  Recognizing changes that place a resident at risk for
123	pressure ulcers and falls; and
124	(c)  Address areas of weakness as determined in nursing
125	assistant performance reviews and may address the special needs
126	of residents as determined by the nursing home facility staff.
127
128	Costs associated with this training may not be reimbursed from
129	additional Medicaid funding through interim rate adjustments.
130	Section 6.  Subsection (5) of section 400.235, Florida
131	Statutes, is amended to read:
132	400.235  Nursing home quality and licensure status; Gold
133	Seal Program.--
134	(5)  Facilities must meet the following additional criteria
135	for recognition as a Gold Seal Program facility:
136	(a)  Had no class I or class II deficiencies within the 30
137	months preceding application for the program.
138	(b)  Evidence financial soundness and stability according
139	to standards adopted by the agency in administrative rule. Such
140	standards must include, but not be limited to, criteria for the
141	use of financial statements that are prepared in accordance with
142	generally accepted accounting principles and that are reviewed
143	or audited by certified public accountants. A nursing home that
144	is part of the same corporate entity as a continuing care
145	facility licensed under chapter 651 which meets the minimum
146	liquid reserve requirements specified in s. 651.035 and is
147	accredited by a recognized accrediting organization under s.
148	651.028 and rules of the Office of Insurance Regulation
149	satisfies this requirement as long as the accreditation is not
150	provisional. Facilities operated by a federal or state agency
151	are deemed to be financially stable for purposes of applying for
152	the Gold Seal.
153	(c)  Participate in a consumer satisfaction process, and
154	demonstrate that information is elicited from residents, family
155	members, and guardians about satisfaction with the nursing
156	facility, its environment, the services and care provided, the
157	staff's skills and interactions with residents, attention to
158	resident's needs, and the facility's efforts to act on
159	information gathered from the consumer satisfaction measures.
160	(d)  Evidence the involvement of families and members of
161	the community in the facility on a regular basis.
162	(e)  Have a stable workforce, as described in s. 400.141,
163	as evidenced by a relatively low rate of turnover among
164	certified nursing assistants and licensed nurses within the 30
165	months preceding application for the Gold Seal Program, and
166	demonstrate a continuing effort to maintain a stable workforce
167	and to reduce turnover of licensed nurses and certified nursing
168	assistants.
169	(f)  Evidence an outstanding record regarding the number
170	and types of substantiated complaints reported to the State
171	Long-Term Care Ombudsman Council within the 30 months preceding
172	application for the program.
173	(g)  Provide targeted inservice training provided to meet
174	training needs identified by internal or external quality
175	assurance efforts.
176
177	A facility assigned a conditional licensure status may not
178	qualify for consideration for the Gold Seal Program until after
179	it has operated for 30 months with no class I or class II
180	deficiencies and has completed a regularly scheduled relicensure
181	survey.
182	Section 7.  Paragraph (a) of subsection (1) of section
183	400.441, Florida Statutes, is amended to read:
184	400.441  Rules establishing standards.--
185	(1)  It is the intent of the Legislature that rules
186	published and enforced pursuant to this section shall include
187	criteria by which a reasonable and consistent quality of
188	resident care and quality of life may be ensured and the results
189	of such resident care may be demonstrated. Such rules shall also
190	ensure a safe and sanitary environment that is residential and
191	noninstitutional in design or nature. It is further intended
192	that reasonable efforts be made to accommodate the needs and
193	preferences of residents to enhance the quality of life in a
194	facility. In order to provide safe and sanitary facilities and
195	the highest quality of resident care accommodating the needs and
196	preferences of residents, the department, in consultation with
197	the agency, the Department of Children and Family Services, and
198	the Department of Health, shall adopt rules, policies, and
199	procedures to administer this part, which must include
200	reasonable and fair minimum standards in relation to:
201	(a)  The requirements for and maintenance of facilities,
202	not in conflict with the provisions of chapter 553, relating to
203	plumbing, heating, cooling, lighting, ventilation, living space,
204	and other housing conditions, which will ensure the health,
205	safety, and comfort of residents and protection from fire
206	hazard, including adequate provisions for fire alarm and other
207	fire protection suitable to the size of the structure. Uniform
208	firesafety standards shall be established and enforced by the
209	State Fire Marshal in cooperation with the agency, the
210	department, and the Department of Health.
211	1.  Evacuation capability determination.--
212	a.  The provisions of the National Fire Protection
213	Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
214	for determining the ability of the residents, with or without
215	staff assistance, to relocate from or within a licensed facility
216	to a point of safety as provided in the fire codes adopted
217	herein. An evacuation capability evaluation for initial
218	licensure shall be conducted within 6 months after the date of
219	licensure. For existing licensed facilities that are not
220	equipped with an automatic fire sprinkler system, the
221	administrator shall evaluate the evacuation capability of
222	residents at least annually. The evacuation capability
223	evaluation for each facility not equipped with an automatic fire
224	sprinkler system shall be validated, without liability, by the
225	State Fire Marshal, by the local fire marshal, or by the local
226	authority having jurisdiction over firesafety, before the
227	license renewal date. If the State Fire Marshal, local fire
228	marshal, or local authority having jurisdiction over firesafety
229	has reason to believe that the evacuation capability of a
230	facility as reported by the administrator may have changed, it
231	may, with assistance from the facility administrator, reevaluate
232	the evacuation capability through timed exiting drills.
233	Translation of timed fire exiting drills to evacuation
234	capability may be determined:
235	(I)  Three minutes or less: prompt.
236	(II)  More than 3 minutes, but not more than 13 minutes:
237	slow.
238	(III)  More than 13 minutes: impractical.
239	b.  The Office of the State Fire Marshal shall provide or
240	cause the provision of training and education on the proper
241	application of Chapter 5, NFPA 101A, 1995 edition, to its
242	employees, to staff of the Agency for Health Care Administration
243	who are responsible for regulating facilities under this part,
244	and to local governmental inspectors. The Office of the State
245	Fire Marshal shall provide or cause the provision of this
246	training within its existing budget, but may charge a fee for
247	this training to offset its costs. The initial training must be
248	delivered within 6 months after July 1, 1995, and as needed
249	thereafter.
250	c.  The Office of the State Fire Marshal, in cooperation
251	with provider associations, shall provide or cause the provision
252	of a training program designed to inform facility operators on
253	how to properly review bid documents relating to the
254	installation of automatic fire sprinklers. The Office of the
255	State Fire Marshal shall provide or cause the provision of this
256	training within its existing budget, but may charge a fee for
257	this training to offset its costs. The initial training must be
258	delivered within 6 months after July 1, 1995, and as needed
259	thereafter.
260	d.  The administrator of a licensed facility shall sign an
261	affidavit verifying the number of residents occupying the
262	facility at the time of the evacuation capability evaluation.
263	2.  Firesafety requirements.--
264	a.  Except for the special applications provided herein,
265	effective January 1, 1996, the provisions of the National Fire
266	Protection Association, Life Safety Code, NFPA 101, 1994
267	edition, Chapter 22 for new facilities and Chapter 23 for
268	existing facilities shall be the uniform fire code applied by
269	the State Fire Marshal for assisted living facilities, pursuant
270	to s. 633.022.
271	b.  Any new facility, regardless of size, that applies for
272	a license on or after January 1, 1996, must be equipped with an
273	automatic fire sprinkler system. The exceptions as provided in
274	section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein,
275	apply to any new facility housing eight or fewer residents. On
276	July 1, 1995, local governmental entities responsible for the
277	issuance of permits for construction shall inform, without
278	liability, any facility whose permit for construction is
279	obtained prior to January 1, 1996, of this automatic fire
280	sprinkler requirement. As used in this part, the term "a new
281	facility" does not mean an existing facility that has undergone
282	change of ownership.
283	c.  Notwithstanding any provision of s. 633.022 or of the
284	National Fire Protection Association, NFPA 101A, Chapter 5, 1995
285	edition, to the contrary, any existing facility housing eight or
286	fewer residents is not required to install an automatic fire
287	sprinkler system, nor to comply with any other requirement in
288	Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
289	requirements of NFPA 101, 1988 edition, that applies to this
290	size facility, unless the facility has been classified as
291	impractical to evacuate. Any existing facility housing eight or
292	fewer residents that is classified as impractical to evacuate
293	must install an automatic fire sprinkler system within the
294	timeframes granted in this section.
295	d.  Any existing facility that is required to install an
296	automatic fire sprinkler system under this paragraph need not
297	meet other firesafety requirements of Chapter 23, NFPA 101, 1994
298	edition, which exceed the provisions of NFPA 101, 1988 edition.
299	The mandate contained in this paragraph which requires certain
300	facilities to install an automatic fire sprinkler system
301	supersedes any other requirement.
302	e.  This paragraph does not supersede the exceptions
303	granted in NFPA 101, 1988 edition or 1994 edition.
304	f.  This paragraph does not exempt facilities from other
305	firesafety provisions adopted under s. 633.022 and local
306	building code requirements in effect before July 1, 1995.
307	g.  A local government may charge fees only in an amount
308	not to exceed the actual expenses incurred by local government
309	relating to the installation and maintenance of an automatic
310	fire sprinkler system in an existing and properly licensed
311	assisted living facility structure as of January 1, 1996.
312	h.  If a licensed facility undergoes major reconstruction
313	or addition to an existing building on or after January 1, 1996,
314	the entire building must be equipped with an automatic fire
315	sprinkler system. Major reconstruction of a building means
316	repair or restoration that costs in excess of 50 percent of the
317	value of the building as reported on the tax rolls, excluding
318	land, before reconstruction. Multiple reconstruction projects
319	within a 5-year period the total costs of which exceed 50
320	percent of the initial value of the building at the time the
321	first reconstruction project was permitted are to be considered
322	as major reconstruction. Application for a permit for an
323	automatic fire sprinkler system is required upon application for
324	a permit for a reconstruction project that creates costs that go
325	over the 50-percent threshold.
326	i.  Any facility licensed before January 1, 1996, that is
327	required to install an automatic fire sprinkler system shall
328	ensure that the installation is completed within the following
329	timeframes based upon evacuation capability of the facility as
330	determined under subparagraph 1.:
331	(I)  Impractical evacuation capability, 24 months.
332	(II)  Slow evacuation capability, 48 months.
333	(III)  Prompt evacuation capability, 60 months.
334
335	The beginning date from which the deadline for the automatic
336	fire sprinkler installation requirement must be calculated is
337	upon receipt of written notice from the local fire official that
338	an automatic fire sprinkler system must be installed. The local
339	fire official shall send a copy of the document indicating the
340	requirement of a fire sprinkler system to the Agency for Health
341	Care Administration.
342	j.  It is recognized that the installation of an automatic
343	fire sprinkler system may create financial hardship for some
344	facilities. The appropriate local fire official shall, without
345	liability, grant two 1-year extensions to the timeframes for
346	installation established herein, if an automatic fire sprinkler
347	installation cost estimate and proof of denial from two
348	financial institutions for a construction loan to install the
349	automatic fire sprinkler system are submitted. However, for any
350	facility with a class I or class II, or a history of uncorrected
351	class III, firesafety deficiencies, an extension must not be
352	granted. The local fire official shall send a copy of the
353	document granting the time extension to the Agency for Health
354	Care Administration.
355	k.  A facility owner whose facility is required to be
356	equipped with an automatic fire sprinkler system under Chapter
357	23, NFPA 101, 1994 edition, as adopted herein, must disclose to
358	any potential buyer of the facility that an installation of an
359	automatic fire sprinkler requirement exists. The sale of the
360	facility does not alter the timeframe for the installation of
361	the automatic fire sprinkler system.
362	l.  Existing facilities required to install an automatic
363	fire sprinkler system as a result of construction-type
364	restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
365	herein, or evacuation capability requirements shall be notified
366	by the local fire official in writing of the automatic fire
367	sprinkler requirement, as well as the appropriate date for final
368	compliance as provided in this subparagraph. The local fire
369	official shall send a copy of the document to the Agency for
370	Health Care Administration.
371	m.  Except in cases of life-threatening fire hazards, if an
372	existing facility experiences a change in the evacuation
373	capability, or if the local authority having jurisdiction
374	identifies a construction-type restriction, such that an
375	automatic fire sprinkler system is required, it shall be
376	afforded time for installation as provided in this subparagraph.
377
378	Facilities that are fully sprinkled and in compliance with other
379	firesafety standards are not required to conduct more than one
380	of the required fire drills between the hours of 11 p.m. and 7
381	a.m., per year. In lieu of the remaining drills, staff
382	responsible for residents during such hours may be required to
383	participate in a mock drill that includes a review of evacuation
384	procedures. Such standards must be included or referenced in the
385	rules adopted by the State Fire Marshal. Pursuant to s.
386	633.022(1)(b), the State Fire Marshal is the final
387	administrative authority for firesafety standards established
388	and enforced pursuant to this section. All licensed facilities
389	must have an annual fire inspection conducted by the local fire
390	marshal or authority having jurisdiction.
391	3.  Resident elopement requirements.--Facilities are
392	required to conduct a minimum of two resident elopement
393	prevention and response drills per year. All administrators and
394	direct care staff must participate in the drills which shall
395	include a review of procedures to address resident elopement.
396	Facilities must document the implementation of the drills and
397	ensure that the drills are conducted in a manner consistent with
398	the facility's resident elopement policies and procedures.
399	Section 8.  Subsection (13) of section 400.619, Florida
400	Statutes, is amended to read:
401	400.619  Licensure application and renewal.--
402	(13)  All moneys collected under this section must be
403	deposited into the Department of Elderly Affairs Administrative
404	Trust Fund and used to offset the expenses of departmental
405	training and education for adult family-care home providers.
406	Section 9.  Subsection (5) of section 408.034, Florida
407	Statutes, is amended to read:
408	408.034  Duties and responsibilities of agency; rules.--
409	(5)  The agency shall establish by rule a nursing-home-bed-
410	need methodology that has a goal of maintaining a subdistrict
411	average occupancy rate of 94 percent and that reduces the
412	community nursing home bed need for the areas of the state where
413	the agency establishes pilot community diversion programs
414	through the Title XIX aging waiver program.
415	Section 10.  Paragraphs (g) and (h) are added to subsection
416	(2) of section 408.036, Florida Statutes, paragraph (p) of
417	subsection (3) is amended, paragraphs (u) and (v) are added to
418	subsection (3) of said section, and subsection (4) is reenacted
419	to read:
420	408.036  Projects subject to review; exemptions.--
421	(2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
422	pursuant to subsection (3), projects subject to an expedited
423	review shall include, but not be limited to:
424	(g)  Replacement of a nursing home within the same
425	district, provided the proposed project site is located within a
426	geographic area that contains at least 65 percent of the
427	facility's current residents and is within a 30-mile radius of
428	the replaced nursing home.
429	(h)  Relocation of a portion of a nursing home's licensed
430	beds to a facility within the same district, provided the
431	relocation is within a 30-mile radius of the existing facility
432	and the total number of nursing home beds in the district does
433	not increase.
434
435	The agency shall develop rules to implement the provisions for
436	expedited review, including time schedule, application content
437	which may be reduced from the full requirements of s.
438	408.037(1), and application processing.
439	(3)  EXEMPTIONS.--Upon request, the following projects are
440	subject to exemption from the provisions of subsection (1):
441	(p)  For the addition of nursing home beds licensed under
442	chapter 400 in a number not exceeding 10 total beds or 10
443	percent of the number of beds licensed in the facility being
444	expanded, whichever is greater, or for the addition of nursing
445	home beds licensed under chapter 400 at a facility that has been
446	designated as a Gold Seal nursing home under s. 400.235 in a
447	number not exceeding 20 total beds or 10 percent of the number
448	of beds licensed in the facility being expanded, whichever is
449	greater.
450	1.  In addition to any other documentation required by the
451	agency, a request for exemption submitted under this paragraph
452	must:
453	a.  Effective until June 30, 2001, Certify that the
454	facility has not had any class I or class II deficiencies within
455	the 30 months preceding the request for addition.
456	b.  Effective on July 1, 2001, certify that the facility
457	has been designated as a Gold Seal nursing home under s.
458	400.235.
459	b.c.  Certify that the prior 12-month average occupancy
460	rate for the nursing home beds at the facility meets or exceeds
461	96 percent.
462	c.d.  Certify that any beds authorized for the facility
463	under this paragraph before the date of the current request for
464	an exemption have been licensed and operational for at least 12
465	months.
466	2.  The timeframes and monitoring process specified in s.
467	408.040(2)(a)-(c) apply to any exemption issued under this
468	paragraph.
469	3.  The agency shall count beds authorized under this
470	paragraph as approved beds in the published inventory of nursing
471	home beds until the beds are licensed.
472	(u)  For replacement of a licensed nursing home on the same
473	site, or within 3 miles of the same site, provided the number of
474	licensed beds does not increase.
475	(v)  For consolidation or combination of licensed nursing
476	homes or transfer of beds between licensed nursing homes within
477	the same planning subdistrict, by providers that operate
478	multiple nursing homes within that planning subdistrict,
479	provided there is no increase in the planning subdistrict total
480	of nursing home beds and the relocation does not exceed 30 miles
481	from the original location.
482	(4)  A request for exemption under subsection (3) may be
483	made at any time and is not subject to the batching requirements
484	of this section. The request shall be supported by such
485	documentation as the agency requires by rule. The agency shall
486	assess a fee of $250 for each request for exemption submitted
487	under subsection (3).
488	Section 11.  Section 430.701, Florida Statutes, is amended
489	to read:
490	430.701  Legislative findings and intent.--
491	(1)  The Legislature finds that state expenditures for
492	long-term care services continue to increase at a rapid rate and
493	that Florida faces increasing pressure in its efforts to meet
494	the long-term care needs of the public. It is the intent of the
495	Legislature that the Department of Elderly Affairs, in
496	consultation with the Agency for Health Care Administration,
497	implement long-term care community diversion pilot projects to
498	test the effectiveness of managed care and outcome-based
499	reimbursement principles when applied to long-term care.
500	(2)  The agency may seek federal approval in advance of its
501	formal waiver application to limit the diversion provider
502	network by freezing enrollment of providers at current levels
503	when an area already has three or more providers or, in an
504	expansion area, when enrollment reaches a level of three
505	providers. This subsection does not prevent the department from
506	approving a provider to expand service to additional counties
507	within a planning and service area for which the provider is
508	already approved to serve.
509	Section 12.  Section 52 of chapter 2001-45, Laws of
510	Florida, as amended by section 1693 of chapter 2003-261, Laws of
511	Florida, is amended to read:
512	Section 52.  (1)  Notwithstanding the establishment of need
513	as provided for in chapter 408, Florida Statutes, no certificate
514	of need for additional community nursing home beds shall be
515	approved by the agency until July 1, 2006.
516	(2)  The Legislature finds that the continued growth in the
517	Medicaid budget for nursing home care has constrained the
518	ability of the state to meet the needs of its elderly residents
519	through the use of less restrictive and less institutional
520	methods of long-term care. It is therefore the intent of the
521	Legislature to limit the increase in Medicaid nursing home
522	expenditures in order to provide funds to invest in long-term
523	care that is community-based and provides supportive services in
524	a manner that is both more cost-effective and more in keeping
525	with the wishes of the elderly residents of this state.
526	(3)  This moratorium on certificates of need shall not
527	apply to sheltered nursing home beds in a continuing care
528	retirement community certified by the former Department of
529	Insurance or by the Office of Insurance Regulation pursuant to
530	chapter 651, Florida Statutes.
531	(4)(a)  The moratorium on certificates of need does not
532	apply and a certificate of need for additional community nursing
533	home beds may be approved for a county that meets the following
534	circumstances:
535	1.  The county has no community nursing home beds; and
536	2.  The lack of community nursing home beds occurs because
537	all nursing home beds in the county that were licensed on July
538	1, 2001, have subsequently closed.
539	(b)  The certificate-of-need review for such circumstances
540	shall be subject to the comparative review process consistent
541	with the provisions of s. 408.039, Florida Statutes, and the
542	number of beds may not exceed the number of beds lost by the
543	county after July 1, 2001.
544
545	This subsection shall be repealed upon the expiration of the
546	moratorium established in subsection (1).
547	(5)  The moratorium on certificates of need does not apply
548	for the addition of nursing home beds licensed under chapter
549	400, Florida Statutes, to a nursing home located in a county
550	having up to 50,000 residents, in a number not exceeding 10
551	total beds or 10 percent of the number of beds licensed in the
552	facility being expanded, whichever is greater. In addition to
553	any other documentation required by the agency, a request
554	submitted under this subsection must:
555	(a)  Certify that the facility has not had any class I or
556	class II deficiencies within the 30 months preceding the request
557	for addition.
558	(b)  Certify that the prior 12-month average occupancy rate
559	for the nursing home beds at the facility meets or exceeds 94
560	percent.
561	(c)  For a facility that has been licensed for less than 24
562	months, certify that the prior 6-month average occupancy rate
563	for the nursing home beds at the facility meets or exceeds 94
564	percent and that the facility has not had any class I or class
565	II deficiencies since its initial licensure.
566
567	This subsection shall be repealed upon the expiration of the
568	moratorium established in subsection (1).
569	Section 13.  Subsection (7) of section 651.118, Florida
570	Statutes, is amended to read:
571	651.118  Agency for Health Care Administration;
572	certificates of need; sheltered beds; community beds.--
573	(7)  Notwithstanding the provisions of subsection (2), at
574	the discretion of the continuing care provider, sheltered
575	nursing home beds may be used for persons who are not residents
576	of the continuing care facility and who are not parties to a
577	continuing care contract for a period of up to 5 years after the
578	date of issuance of the initial nursing home license. A provider
579	whose 5-year period has expired or is expiring may request the
580	Agency for Health Care Administration for an extension, not to
581	exceed 30 percent of the total sheltered nursing home beds, if
582	the utilization by residents of the nursing home facility in the
583	sheltered beds will not generate sufficient income to cover
584	nursing home facility expenses, as evidenced by one of the
585	following:
586	(a)  The nursing home facility has a net loss for the most
587	recent fiscal year as determined under generally accepted
588	accounting principles, excluding the effects of extraordinary or
589	unusual items, as demonstrated in the most recently audited
590	financial statement; or
591	(b)  The nursing home facility would have had a pro forma
592	loss for the most recent fiscal year, excluding the effects of
593	extraordinary or unusual items, if revenues were reduced by the
594	amount of revenues from persons in sheltered beds who were not
595	residents, as reported on by a certified public accountant.
596
597	The agency shall be authorized to grant an extension to the
598	provider based on the evidence required in this subsection. The
599	agency may request a continuing care facility to use up to 25
600	percent of the patient days generated by new admissions of
601	nonresidents during the extension period to serve Medicaid
602	recipients for those beds authorized for extended use if there
603	is a demonstrated need in the respective service area and if
604	funds are available. A provider who obtains an extension is
605	prohibited from applying for additional sheltered beds under the
606	provision of subsection (2), unless additional residential units
607	are built or the provider can demonstrate need by continuing
608	care facility residents to the Agency for Health Care
609	Administration. The 5-year limit does not apply to up to five
610	sheltered beds designated for inpatient hospice care as part of
611	a contractual arrangement with a hospice licensed under part VI
612	of chapter 400. A continuing care facility that uses such beds
613	after the 5-year period shall report such use to the Agency for
614	Health Care Administration. For purposes of this subsection,
615	"resident" means a person who, upon admission to the continuing
616	care facility, initially resides in a part of the continuing
617	care facility not licensed under part II of chapter 400.
618	Section 14.  Subsections (3) and (4) of section 400.9905,
619	Florida Statutes, are renumbered as subsections (4) and (5),
620	respectively, and amended, and new subsections (3), (6), and (7)
621	are added to said section, to read:
622	400.9905  Definitions.--
623	(3)  "Chief financial officer" means an individual who has
624	a bachelor's degree from an accredited university in accounting
625	or finance, or a related field, and who is the person
626	responsible for the preparation of a clinic's billing.
627	(4)(3)  "Clinic" means an entity at which health care
628	services are provided to individuals and which tenders charges
629	for reimbursement for such services, including a mobile clinic
630	and a portable equipment provider. For purposes of this part,
631	the term does not include and the licensure requirements of this
632	part do not apply to:
633	(a)  Entities licensed or registered by the state under
634	chapter 395; or entities licensed or registered by the state and
635	providing only health care services within the scope of services
636	authorized under their respective licenses granted under s.
637	383.30-383.335, chapter 390, chapter 394, chapter 395, chapter
638	397, this chapter except part XIII, chapter 463, chapter 465,
639	chapter 466, chapter 478, part I of chapter 483 chapter 480,
640	chapter 484, or chapter 651; end-stage renal disease providers
641	authorized under 42 C.F.R. part 405, subpart U; or providers
642	certified under 42 C.F.R. part 485, subpart B or subpart H, or
643	any entity that provides neonatal or pediatric hospital-based
644	healthcare services by licensed practitioners solely within a
645	hospital licensed under chapter 395.
646	(b)  Entities that own, directly or indirectly, entities
647	licensed or registered by the state pursuant to chapter 395; or
648	entities that own, directly or indirectly, entities licensed or
649	registered by the state and providing only health care services
650	within the scope of services authorized pursuant to their
651	respective licenses granted under s. 383.30-383.335, chapter
652	390, chapter 394, chapter 395, chapter 397, this chapter except
653	part XIII, chapter 463, chapter 465, chapter 466, chapter 478,
654	part I of chapter 483 chapter 480, chapter 484, or chapter 651,
655	end-stage renal disease providers authorized under 42 C.F.R.
656	part 405, subpart U, or providers certified under 42 C.F.R. part
657	485, subpart B or subpart H, or any entity that provides
658	neonatal or pediatric hospital-based healthcare services by
659	licensed practitioners solely within a hospital licensed under
660	chapter 395.
661	(c)  Entities that are owned, directly or indirectly, by an
662	entity licensed or registered by the state pursuant to chapter
663	395; or entities that are owned, directly or indirectly, by an
664	entity licensed or registered by the state and providing only
665	health care services within the scope of services authorized
666	pursuant to their respective licenses granted under s. 383.30-
667	383.335, chapter 390, chapter 394, chapter 395, chapter 397,
668	this chapter except part XIII, chapter 463, chapter 465, chapter
669	466, chapter 478, part I of chapter 483 chapter 480, chapter
670	484, or chapter 651; end-stage renal disease providers
671	authorized under 42 C.F.R. part 405, subpart U; or providers
672	certified under 42 C.F.R. part 485, subpart B or subpart H, or
673	any entity that provides neonatal or pediatric hospital-based
674	healthcare services by licensed practitioners solely within a
675	hospital under chapter 395.
676	(d)  Entities that are under common ownership, directly or
677	indirectly, with an entity licensed or registered by the state
678	pursuant to chapter 395; or entities that are under common
679	ownership, directly or indirectly, with an entity licensed or
680	registered by the state and providing only health care services
681	within the scope of services authorized pursuant to their
682	respective licenses granted under s. 383.30-383.335, chapter
683	390, chapter 394, chapter 395, chapter 397, this chapter except
684	part XIII, chapter 463, chapter 465, chapter 466, chapter 478,
685	part I of chapter 483 480, chapter 484, or chapter 651; end-
686	stage renal disease providers authorized under 42 C.F.R. part
687	405, subpart U; or providers certified under 42 C.F.R. part 485,
688	subpart B or subpart H or any entity that provides neonatal or
689	pediatric hospital-based healthcare services by licensed
690	practitioners solely within a hospital licensed under chapter
691	395.
692	(e)  An entity that is exempt from federal taxation under
693	26 U.S.C. s. 501(c)(3) or s. 501(c)(4) and any community college
694	or university clinic, and any entity owned or operated by
695	federal or state government, including agencies, subdivisions,
696	or municipalities thereof.
697	(f) A sole proprietorship, group practice, partnership, or
698	corporation that provides health care services by physicians
699	covered by s. 627.419, that is directly supervised by one or
700	more of such physicians, and that is wholly owned by one or more
701	of those physicians or by a physician and the spouse, child, or
702	sibling of that physician.
703	(g)(f)  A sole proprietorship, group practice, partnership,
704	or corporation that provides health care services by licensed
705	health care practitioners under chapter 457, chapter 458,
706	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
707	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
708	chapter 490, chapter 491, or part I, part III, part X, part
709	XIII, or part XIV of chapter 468, or s. 464.012, which are
710	wholly owned by one or more a licensed health care practitioners
711	practitioner, or the licensed health care practitioners set
712	forth in this paragraph practitioner and the spouse, parent, or
713	child, or sibling of a licensed health care practitioner, so
714	long as one of the owners who is a licensed health care
715	practitioner is supervising the business activities services
716	performed therein and is legally responsible for the entity's
717	compliance with all federal and state laws. However, a health
718	care practitioner may not supervise services beyond the scope of
719	the practitioner's license, except that, for the purposes of
720	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
721	provides only services authorized pursuant to s. 456.053(3)(b)
722	may be supervised by a licensee specified in s. 456.053(3)(b).
723	(h)(g)  Clinical facilities affiliated with an accredited
724	medical school at which training is provided for medical
725	students, residents, or fellows.
726	(i)  Entities that provide only oncology or radiation
727	therapy services by physicians licensed under chapter 458 or
728	chapter 459.
729	(5)(4)  "Medical director" means a physician who is
730	employed or under contract with a clinic and who maintains a
731	full and unencumbered physician license in accordance with
732	chapter 458, chapter 459, chapter 460, or chapter 461. However,
733	if the clinic does not provide services pursuant to the
734	respective physician practices acts listed in this subsection,
735	it is limited to providing health care services pursuant to
736	chapter 457, chapter 484, chapter 486, chapter 490, or chapter
737	491 or part I, part III, part X, part XIII, or part XIV of
738	chapter 468, the clinic may appoint a Florida-licensed health
739	care practitioner who does not provide services pursuant to the
740	respective physician practices acts listed in this subsection
741	licensed under that chapter to serve as a clinic director who is
742	responsible for the clinic's activities. A health care
743	practitioner may not serve as the clinic director if the
744	services provided at the clinic are beyond the scope of that
745	practitioner's license, except that a licensee specified in s.
746	456.053(3)(b) who provides only services authorized pursuant to
747	s. 456.053(3)(b) may serve as clinic director of an entity
748	providing services as specified in s. 456.053(3)(b).
749	(6)  "Mobile clinic" means a movable or detached self-
750	contained health care unit within or from which direct health
751	care services are provided to individuals and which otherwise
752	meets the definition of a clinic in subsection (4).
753	(7)  "Portable equipment provider" means an entity that
754	contracts with or employs persons to provide portable equipment
755	to multiple locations performing treatment or diagnostic testing
756	of individuals, that bills third-party payors for those
757	services, and that otherwise meets the definition of a clinic in
758	subsection (4).
759	Section 15.  The creation of s. 400.9905(4)(i), Florida
760	Statutes, by this act is intended to clarify the legislative
761	intent of this provision as it existed at the time the
762	provisions initially took effect as ss. 456.0375(1)(b) and
763	400.9905(4)(i), Florida Statutes, as created by this act, shall
764	operate retroactively to October 1, 2001. Nothing in this
765	section shall be construed as amending, modifying, limiting, or
766	otherwise affecting in any way the legislative intent, scope,
767	terms, prohibition, or requirements of s. 456.053, Florida
768	Statutes.
769	Section 16.  Effective upon this act becoming a law and
770	applicable retroactively to March 1, 2004, subsections (1), (2),
771	and (3) and paragraphs (a) and (b) of subsection (7) of section
772	400.991, Florida Statutes, are amended to read:
773	400.991  License requirements; background screenings;
774	prohibitions.--
775	(1)(a)  Each clinic, as defined in s. 400.9905, must be
776	licensed and shall at all times maintain a valid license with
777	the agency. Each clinic location shall be licensed separately
778	regardless of whether the clinic is operated under the same
779	business name or management as another clinic.
780	(b)  Each mobile clinic must obtain a separate health care
781	clinic license and clinics must provide to the agency, at least
782	quarterly, its their projected street location locations to
783	enable the agency to locate and inspect such clinic clinics. A
784	portable equipment provider must obtain a health care clinic
785	license for a single administrative office and is not required
786	to submit quarterly projected street locations.
787	(2)  The initial clinic license application shall be filed
788	with the agency by all clinics, as defined in s. 400.9905, on or
789	before July March 1, 2004. A clinic license must be renewed
790	biennially.
791	(3)  Applicants that submit an application on or before
792	July March 1, 2004, which meets all requirements for initial
793	licensure as specified in this section shall receive a temporary
794	license until the completion of an initial inspection verifying
795	that the applicant meets all requirements in rules authorized in
796	s. 400.9925. However, a clinic engaged in magnetic resonance
797	imaging services may not receive a temporary license unless it
798	presents evidence satisfactory to the agency that such clinic is
799	making a good faith effort and substantial progress in seeking
800	accreditation required under s. 400.9935.
801	(7)  Each applicant for licensure shall comply with the
802	following requirements:
803	(a)  As used in this subsection, the term "applicant" means
804	individuals owning or controlling, directly or indirectly, 5
805	percent or more of an interest in a clinic; the medical or
806	clinic director, or a similarly titled person who is responsible
807	for the day-to-day operation of the licensed clinic; the
808	financial officer or similarly titled individual who is
809	responsible for the financial operation of the clinic; and
810	licensed health care practitioners medical providers at the
811	clinic.
812	(b)  Upon receipt of a completed, signed, and dated
813	application, the agency shall require background screening of
814	the applicant, in accordance with the level 2 standards for
815	screening set forth in chapter 435. Proof of compliance with the
816	level 2 background screening requirements of chapter 435 which
817	has been submitted within the previous 5 years in compliance
818	with any other health care licensure requirements of this state
819	is acceptable in fulfillment of this paragraph. Applicants who
820	own less than 10 percent of a health care clinic are not
821	required to submit fingerprints under this section.
822	Section 17.  Paragraph (g) of subsection (1), subsection
823	(9), and paragraph (b) of subsection (11) of section 400.9935,
824	Florida Statutes, are amended to read:
825	400.9935  Clinic responsibilities.--
826	(1)  Each clinic shall appoint a medical director or clinic
827	director who shall agree in writing to accept legal
828	responsibility for the following activities on behalf of the
829	clinic. The medical director or the clinic director shall:
830	(g)  Conduct systematic reviews of clinic billings to
831	ensure that the billings are not fraudulent or unlawful. Upon
832	discovery of an unlawful charge, the medical director or clinic
833	director shall take immediate corrective action. If the clinic
834	performs only the technical component of magnetic resonance
835	imaging, static radiographs, computed tomography, or positron
836	emission tomography and provides the professional interpretation
837	of such services, in a fixed facility that is accredited by the
838	Joint Commission on Accreditation of Healthcare Organizations or
839	the Accreditation Association for Ambulatory Health Care and the
840	American College of Radiology, and if, in the preceding quarter,
841	the percentage of scans performed by that clinic that were
842	billed to a personal injury protection insurance carrier was
843	less than 15 percent, the chief financial officer of the clinic
844	may, in a written acknowledgment provided to the agency, assume
845	the responsibility for the conduct of the systematic reviews of
846	clinic billings to ensure that the billings are not fraudulent
847	or unlawful.
848	(9)  Any person or entity providing health care services
849	which is not a clinic, as defined under s. 400.9905, may
850	voluntarily apply for a certificate of exemption from licensure
851	under its exempt status with the agency on a form that sets
852	forth its name or names and addresses, a statement of the
853	reasons why it cannot be defined as a clinic, and other
854	information deemed necessary by the agency. An exemption is not
855	transferable. The agency may charge an applicant for a
856	certificate of exemption in an amount equal to $100 or the
857	actual cost of processing the certificate, whichever is less.
858	(11)
859	(b)  The agency may deny disallow the application or revoke
860	the license of any entity formed for the purpose of avoiding
861	compliance with the accreditation provisions of this subsection
862	and whose principals were previously principals of an entity
863	that was unable to meet the accreditation requirements within
864	the specified timeframes. The agency may adopt rules as to the
865	accreditation of magnetic resonance imaging clinics.
866	Section 18.  Subsections (1) and (3) of section 400.995,
867	Florida Statutes, are amended, and a new subsection (10) is
868	added to said section, to read:
869	400.995  Agency administrative penalties.--
870	(1)  The agency may deny the application for a license
871	renewal, revoke or suspend the license, and impose
872	administrative fines penalties against clinics of up to $5,000
873	per violation for violations of the requirements of this part or
874	rules of the agency. In determining if a penalty is to be
875	imposed and in fixing the amount of the fine, the agency shall
876	consider the following factors:
877	(a)  The gravity of the violation, including the
878	probability that death or serious physical or emotional harm to
879	a patient will result or has resulted, the severity of the
880	action or potential harm, and the extent to which the provisions
881	of the applicable laws or rules were violated.
882	(b)  Actions taken by the owner, medical director, or
883	clinic director to correct violations.
884	(c)  Any previous violations.
885	(d)  The financial benefit to the clinic of committing or
886	continuing the violation.
887	(3)  Any action taken to correct a violation shall be
888	documented in writing by the owner, medical director, or clinic
889	director of the clinic and verified through followup visits by
890	agency personnel. The agency may impose a fine and, in the case
891	of an owner-operated clinic, revoke or deny a clinic's license
892	when a clinic medical director or clinic director knowingly
893	fraudulently misrepresents actions taken to correct a violation.
894	(10)  If the agency issues a notice of intent to deny a
895	license application after a temporary license has been issued
896	pursuant to s. 400.991(3), the temporary license shall expire on
897	the date of the notice and may not be extended during any
898	proceeding for administrative or judicial review pursuant to
899	chapter 120.
900	Section 19.  The Agency for Health Care Administration is
901	directed to make refunds to applicants that submitted their
902	health care clinic licensure fees and applications but were
903	subsequently exempted from licensure by this act as follows:
904	(1)  Seventy-five percent of the application fee if the
905	temporary license has not been issued;
906	(2)  Fifty percent of the application fee if the temporary
907	license has been issued but the inspection has not been
908	completed; or
909	(3)  No refund if the inspection has been completed.
910	Section 20.  Any person or entity defined as a clinic under
911	s. 400.9905, Florida Statutes, shall not be in violation of part
912	XIII of chapter 400, Florida Statutes, due to failure to apply
913	for a clinic license by March 1, 2004, as previously required by
914	s. 400.991, Florida Statutes. Payment to any such person or
915	entity by an insurer or other person liable for payment to such
916	person or entity may not be denied on the grounds that the
917	person or entity failed to apply for or obtain a clinic license
918	before March 1, 2004.
919	Section 21.  This act shall take effect upon becoming a
920	law.
921
922	================= T I T L E  A M E N D M E N T =================
923	Remove the entire title and insert:
924	A bill to be entitled
925	An act relating to health care facilities; creating s. 400.0712,
926	F.S.; authorizing the Agency for Health Care Administration to
927	issue inactive licenses to nursing homes for all or a portion of
928	their beds under certain circumstances; providing requirements
929	for application for and issuance of such licenses; providing
930	rulemaking authority; amending s. 400.071, F.S.; deleting a
931	provision relating to issuance of inactive licenses, to conform;
932	amending s. 400.021, F.S.; redefining the term "resident care
933	plan," as used in part II of ch. 400, F.S.; amending s. 400.23,
934	F.S.; providing that certain information from the agency must be
935	promptly updated to reflect the most current agency actions;
936	amending s. 400.211, F.S.; revising inservice training
937	requirements for persons employed as nursing assistants in a
938	nursing home facility; amending s. 400.235, F.S.; providing for
939	financial stability for Gold Seal for certain nursing
940	facilities; amending s. 400.441, F.S.; requiring facilities to
941	conduct resident elopement prevention and response drills;
942	providing documentation thereof; amending s. 400.619, F.S.;
943	removing the requirement that certain moneys deposited into the
944	Department of Elderly Affairs Administrative Trust Fund be used
945	to offset the expenses of departmental training and education
946	for adult family-care home providers; amending s. 408.034, F.S.;
947	requiring the nursing-home-bed-need methodology established by
948	the agency by rule to include a goal of maintaining a specified
949	subdistrict average occupancy rate; amending s. 408.036, F.S.,
950	relating to health-care-related projects subject to review for a
951	certificate of need; subjecting certain projects relating to
952	replacement of a nursing home and relocation of nursing home
953	beds to expedited review; revising requirements for certain
954	projects relating to the addition of nursing home beds which are
955	exempt from review; exempting from review certain projects
956	relating to replacement of a licensed nursing home bed on the
957	same site or nearby and consolidation or combination of licensed
958	nursing homes or transfer of beds between licensed nursing homes
959	within the same planning subdistrict; providing rulemaking
960	authority; providing for assessment of exemption-request fees;
961	amending s. 430.701, F.S.; authorizing the agency to seek
962	federal approval prior to seeking a certain waiver relating to
963	the long-term care diversion provider network; amending s. 52,
964	ch. 2001-45, Laws of Florida; specifying nonapplication of a
965	moratorium on certificates of need and authorizing approval of
966	certain certificates of need for certain counties; specifying
967	nonapplication of the moratorium for the addition of nursing
968	home beds in certain counties; providing requirements and
969	limitations; providing for repeal upon expiration of the
970	moratorium; amending s. 651.118, F.S.; revising provisions
971	relating to use of sheltered nursing home beds at a continuing
972	care facility by persons who are not residents of the continuing
973	care facility; amending s. 400.9905, F.S.; revising and
974	providing definitions; amending s. 400.991, F.S.; revising
975	health care clinic licensing requirements; requiring separate
976	licenses for each mobile clinic; providing licensing
977	requirements for portable equipment providers; providing for
978	retroactive effect; amending s. 400.9935, F.S.; providing that a
979	chief financial officer may assume responsibility for clinic
980	billings under certain circumstances; providing that an
981	exemption is not transferable; authorizing a fee for a
982	certificate of exemption; allowing the agency to deny or revoke
983	a license; amending s. 400.995, F.S.; allowing the agency to
984	deny the renewal of a license or to revoke or suspend a license;
985	prohibiting extension of a temporary license under certain
986	circumstances; requiring the Agency for Health Care
987	Administration to refund certain application fees; providing
988	exceptions for certain late filed applications; providing an
989	effective date.

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