Senate Bill sb1680
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Florida Senate - 2004 SB 1680
By Senator Saunders
37-768A-04
1 A bill to be entitled
2 An act relating to the licensure of health care
3 providers; creating ss. 408.801-408.819, F.S.;
4 providing a short title; providing legislative
5 findings and intent; providing applicability;
6 providing definitions; prohibiting the
7 provision of certain services without obtaining
8 a license from the Agency for Health Care
9 Administration; requiring that the license be
10 displayed; requiring that licensure fees cover
11 the agency's cost of the licensure, inspection,
12 and regulation of providers; authorizing the
13 agency to adopt rules; providing requirements
14 for license application; providing for late
15 fees; providing duties of the agency, including
16 requirements for inspections; authorizing the
17 electronic submission of information to the
18 agency; providing requirements for licensure
19 upon a change of ownership of a provider;
20 specifying license categories; requiring
21 background screening of a licensee,
22 administrator, financial officer, or
23 controlling interest; providing minimum
24 licensure requirements; providing requirements
25 for a licensee that discontinues operation;
26 requiring that notice be provided to clients;
27 requiring a licensee to inform clients of
28 certain rights; requiring an applicant for
29 licensure to provide proof of liability
30 insurance and financial ability to operate;
31 authorizing the agency to make inspections and
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1 investigations; prohibiting certain unlicensed
2 activity; providing penalties; providing for
3 administrative fines; authorizing the agency to
4 impose a moratorium under certain
5 circumstances; specifying grounds under which
6 the agency may deny or revoke a license;
7 authorizing the agency to institute proceedings
8 for an injunction against a provider; requiring
9 that fees and fines be deposited into the
10 Health Care Trust Fund and used for
11 administering the laws and rules governing
12 providers; providing rulemaking authority;
13 amending s. 112.045, F.S., relating to the
14 Drug-Free Workplace Act; requiring drug-testing
15 laboratories to be in compliance with ss.
16 408.801-408.819, F.S.; deleting obsolete and
17 repetitive provisions; providing for rules and
18 licensure fees; amending ss. 383.301, 383.305,
19 383.309, 383.315, 383.324, 383.33, and 383.335,
20 F.S., and repealing ss. 383.304, 383.325,
21 383.331, and 383.332, F.S., relating to the
22 Birth Center Licensure Act; requiring birth
23 centers to be in compliance with ss.
24 408.801-408.819, F.S.; providing for licensure
25 fees; authorizing the agency to adopt rules;
26 providing for administrative fines; conforming
27 provisions with the requirements of ss.
28 408.801-408.819, F.S.; amending ss. 390.011,
29 390.012, 390.014, and 390.018, F.S., and
30 repealing ss. 390.013, 390.015, 390.016,
31 390.017, 390.019, and 390.021, F.S., relating
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1 to the regulation of abortion clinics;
2 requiring abortion clinics to be in compliance
3 with ss. 408.801-408.819, F.S.; providing for
4 licensure fees; authorizing the agency to adopt
5 rules; providing for administrative fines;
6 conforming provisions with the requirements of
7 ss. 408.801-408.819, F.S.; amending s. 394.455,
8 F.S., relating to the Florida Mental Health
9 Act; clarifying a definition; amending ss.
10 394.67, 394.875, 394.877, 394.878, 394.879,
11 394.90, and 394.902, F.S., and repealing s.
12 394.876, F.S., relating to the Community
13 Substance Abuse and Mental Health Services Act;
14 defining the term "short-term residential
15 treatment facility"; requiring substance abuse
16 or mental health facilities, programs, and
17 services to be in compliance with ss.
18 408.801-408.819, F.S.; providing for licensure
19 fees; authorizing the agency to adopt rules;
20 providing for administrative penalties;
21 conforming provisions with the requirements of
22 ss. 408.801-408.819, F.S.; amending ss.
23 395.003, 395.004, 395.0161, 395.0163, 395.0199,
24 395.1046, 395.1055, and 395.1065, F.S., and
25 repealing ss. 395.002(4), 395.0055, and
26 395.0162, F.S., relating to hospitals and other
27 licensed facilities; requiring hospitals and
28 other licensed facilities to be in compliance
29 with ss. 408.801-408.819, F.S.; providing for
30 licensure fees; authorizing the agency to adopt
31 rules; providing for administrative fines;
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1 conforming provisions with the requirements of
2 ss. 408.801-408.819, F.S.; amending ss.
3 395.10973, 395.10974, and 395.10975, F.S.,
4 relating to health care risk managers;
5 requiring health care risk managers to comply
6 with ss. 408.801-408.819, F.S.; providing for
7 fees; authorizing the agency to adopt rules;
8 providing for administrative fines; conforming
9 provisions with the requirements of ss.
10 408.801-408.819, F.S.; amending ss. 400.022,
11 400.051, 400.062, 400.063, 400.071, 400.102,
12 400.111, 400.1183, 400.121, 400.141, 400.17,
13 400.179, 400.18, 400.19, 400.191, 400.20,
14 400.211, and 400.23, F.S., and repealing ss.
15 400.021(5) and (20), 400.125, and 400.241(1)
16 and (2), F.S., relating to nursing homes;
17 requiring nursing homes to be in compliance
18 with ss. 408.801-408.819, F.S.; providing for
19 licensure fees; authorizing the agency to adopt
20 rules; providing for administrative fines;
21 revising reporting requirements; conforming
22 provisions with the requirements of ss.
23 408.801-408.819, F.S.; amending ss. 400.402,
24 400.407, 400.4075, 400.408, 400.411, 400.412,
25 400.414, 400.417, 400.4174, 400.4176, 400.418,
26 400.419, 400.42, 400.424, 400.4255, 400.4256,
27 400.427, 400.4275, 400.431, 400.434, 400.441,
28 400.442, 400.444, 400.452, and 400.454, F.S.,
29 and repealing ss. 400.415, 400.4178(7),
30 400.435(1), 400.447(1), (2), and (3), and
31 400.451, F.S., relating to assisted living
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1 facilities; requiring assisted living
2 facilities to be in compliance with ss.
3 408.801-408.819, F.S.; providing for licensure
4 fees; authorizing the agency to adopt rules;
5 providing for administrative fines; conforming
6 provisions with the requirements of ss.
7 408.801-408.819, F.S.; amending ss. 400.464,
8 400.471, 400.474, 400.484, 400.494, 400.495,
9 400.497, 400.506, 400.509, and 400.512, F.S.,
10 and repealing s. 400.515, F.S., relating to
11 home health agencies and nurse registries;
12 requiring home health agencies and nurse
13 registries to be in compliance with ss.
14 408.801-408.819, F.S.; providing for licensure
15 fees; authorizing the agency to adopt rules;
16 providing for administrative fines; conforming
17 provisions with the requirements of ss.
18 408.801-408.819, F.S.; amending ss. 400.551,
19 400.554, 400.555, 400.556, 400.5565, 400.557,
20 400.5572, 400.559, 400.56, and 400.562, F.S.,
21 and repealing ss. 400.5575, 400.558, and
22 400.564, F.S., relating to adult day care
23 centers; requiring adult day care centers to be
24 in compliance with ss. 408.801-408.819, F.S.;
25 providing for licensure fees; authorizing the
26 agency to adopt rules; providing for
27 administrative fines; conforming provisions
28 with the requirements of ss. 408.801-408.819,
29 F.S.; amending ss. 400.602, 400.605, 400.606,
30 400.6065, 400.607, and 400.6095, F.S., relating
31 to hospices; requiring hospices to be in
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1 compliance with ss. 408.801-408.819, F.S.;
2 providing for licensure fees; authorizing the
3 agency to adopt rules; providing for
4 administrative fines; conforming provisions
5 with the requirements of ss. 408.801-408.819,
6 F.S.; amending ss. 400.617, 400.619, 400.6194,
7 400.6196, 400.621, 400.6211, and 400.625, F.S.,
8 and repealing s. 400.622, F.S., relating to
9 adult family-care homes; requiring adult
10 family-care homes to be in compliance with ss.
11 408.801-408.819, F.S.; providing for licensure
12 fees; authorizing the agency to adopt rules;
13 providing for administrative fines; conforming
14 provisions with the requirements of ss.
15 408.801-408.819, F.S.; amending ss. 400.801 and
16 400.805, F.S., relating to homes for special
17 services and transitional living facilities;
18 requiring such homes and facilities to be in
19 compliance with ss. 408.801-408.819, F.S.;
20 providing for licensure fees; authorizing the
21 agency to adopt rules; providing for
22 administrative fines; conforming provisions
23 with the requirements of ss. 408.801-408.819,
24 F.S.; amending ss. 400.902, 400.903, 400.905,
25 400.907, 400.908, 400.912, 400.914, and
26 400.915, F.S., and repealing ss. 400.906,
27 400.910, 400.911, 400.913, 400.916, and
28 400.917, F.S., relating to prescribed pediatric
29 extended care centers; requiring such centers
30 to be in compliance with ss. 408.801-408.819,
31 F.S.; providing for licensure fees; authorizing
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1 the agency to adopt rules; providing for
2 administrative fines; conforming provisions
3 with the requirements of ss. 408.801-408.819,
4 F.S.; amending ss. 400.925, 400.93, 400.931,
5 400.932, 400.933, and 400.935, F.S., and
6 repealing ss. 400.95, 400.953(2), 400.955(4),
7 and 400.956, F.S., relating to home medical
8 equipment providers; requiring home medical
9 equipment providers to be in compliance with
10 ss. 408.801-408.819, F.S.; providing for
11 licensure fees; authorizing the agency to adopt
12 rules; providing for administrative fines;
13 conforming provisions with the requirements of
14 ss. 408.801-408.819, F.S.; amending ss.
15 400.960, 400.962, 400.967, 400.968, and
16 400.969, F.S., and repealing ss. 400.963 and
17 400.965, F.S., relating to intermediate care
18 facilities for the developmentally disabled;
19 requiring such facilities to be in compliance
20 with ss. 408.801-408.819, F.S.; providing for
21 licensure fees; authorizing the agency to adopt
22 rules; providing for administrative fines;
23 conforming provisions with the requirements of
24 ss. 408.801-408.819, F.S.; amending s. 400.908,
25 F.S.; requiring health care services pools to
26 be in compliance with ss. 408.801-408.819,
27 F.S.; providing for licensure fees; authorizing
28 the agency to adopt rules; providing for
29 administrative fines; conforming provisions
30 with the requirements of ss. 408.801-408.819,
31 F.S.; amending ss. 400.991, 400.9915, 400.992,
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1 400.9925, 400.993, 400.9935, and 400.995, F.S.,
2 and repealing ss. 400.9905(2), 400.994, and
3 400.9945, F.S., relating to health care
4 clinics; requiring health care clinics to be in
5 compliance with ss. 408.801-408.819, F.S.;
6 providing for licensure fees; authorizing the
7 agency to adopt rules; providing for
8 administrative fines; conforming provisions
9 with the requirements of ss. 408.801-408.819,
10 F.S.; amending s. 408.831, F.S., relating to
11 the authority of the Agency for Health Care
12 Administration to impose certain penalties
13 against a regulated or licensed entity;
14 conforming provisions to changes made by the
15 act; amending s. 440.102, F.S., relating to the
16 drug-free workplace program; requiring
17 laboratories to be in compliance with the
18 requirements of ss. 408.801-408.819; conforming
19 provisions to changes made by the act; amending
20 ss. 483.035, 483.051, 483.061, 483.091,
21 483.101, 483.111, 483.172, 483.201, 483.221,
22 and 483.23, F.S., and repealing ss. 483.131 and
23 483.25, F.S., relating to clinical
24 laboratories; requiring clinical laboratories
25 to be in compliance with ss. 408.801-408.819,
26 F.S.; providing for licensure fees; authorizing
27 the agency to adopt rules; providing for
28 administrative fines; conforming provisions
29 with the requirements of ss. 408.801-408.819,
30 F.S.; amending ss. 483.291, 483.294, 483.30,
31 483.302, and 483.32, F.S., and repealing ss.
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1 483.311, 483.317(1), 483.322(1), and 483.328,
2 F.S., relating to multiphasic health testing
3 centers; requiring such centers to be in
4 compliance with ss. 408.801-408.819, F.S.;
5 providing for licensure fees; authorizing the
6 agency to adopt rules; providing for
7 administrative fines; conforming provisions
8 with the requirements of ss. 408.801-408.819,
9 F.S.; providing for ss. 408.801-408.819, F.S.,
10 to prevail in the case of a conflict with other
11 laws governing the licensure of health care
12 providers by the agency; authorizing the agency
13 to issue a license for less than a specified
14 period and to charge a prorated fee; providing
15 an effective date.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Sections 408.801 through 408.819, Florida
20 Statutes, are created to read:
21 408.801 Short title; purpose.--
22 (1) Sections 408.801-408.819 may be cited as the
23 "Health Care Licensing Procedures Act."
24 (2) The Legislature finds that there is unnecessary
25 duplication and variation in the requirements for licensure by
26 the Agency for Health Care Administration, brought about by
27 the historical pattern of legislative action focused
28 exclusively on a single type of regulated provider. It is the
29 intent of the Legislature to provide a streamlined and
30 consistent set of basic licensing requirements for all such
31 providers in order to minimize confusion, standardize
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1 terminology, and include issues that are otherwise not
2 adequately addressed in the statutes pertaining to specific
3 providers.
4 408.802 Applicability.--The provisions of ss.
5 408.801-408.819 apply to the provision of services that
6 necessitate licensure as defined in ss. 408.801-408.819 and to
7 the following entities licensed or registered by the Agency
8 for Health Care Administration, as further described in
9 chapters 112, 383, 390, 394, 395, 400, 440, and 483:
10 (1) Laboratories authorized to perform testing under
11 the Drug-Free Workplace Act, as provided under ss. 112.0455
12 and 440.102.
13 (2) Birth centers, as provided under chapter 383.
14 (3) Abortion clinics, as provided under chapter 390.
15 (4) Crisis stabilization units, as provided under
16 parts I and IV of chapter 394.
17 (5) Short-term residential treatment units, as
18 provided under parts I and IV of chapter 394.
19 (6) Residential treatment facilities, as provided
20 under part IV of chapter 394.
21 (7) Residential treatment centers for children and
22 adolescents, as provided under part IV of chapter 394.
23 (8) Hospitals, as provided under part I of chapter
24 395.
25 (9) Ambulatory surgical centers, as provided under
26 part I of chapter 395.
27 (10) Mobile surgical facilities, as provided under
28 part I of chapter 395.
29 (11) Private review agents, as provided under part I
30 of chapter 395.
31
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1 (12) Health care risk managers, as provided under part
2 I of chapter 395.
3 (13) Nursing homes, as provided under part II of
4 chapter 400.
5 (14) Assisted living facilities, as provided under
6 part III of chapter 400.
7 (15) Home health agencies, as provided under part IV
8 of chapter 400.
9 (16) Nurse registries, as provided under part IV of
10 chapter 400.
11 (17) Companion services or homemaker services
12 providers, as provided under part IV of chapter 400.
13 (18) Adult day care centers, as provided under part V
14 of chapter 400.
15 (19) Hospices, as provided under part VI of chapter
16 400.
17 (20) Adult family-care homes, as provided under part
18 VII of chapter 400.
19 (21) Homes for special services, as provided under
20 part VIII of chapter 400.
21 (22) Transitional living facilities, as provided under
22 part VIII of chapter 400.
23 (23) Prescribed pediatric extended care centers, as
24 provided under part IX of chapter 400.
25 (24) Home medical equipment providers, as provided
26 under part X of chapter 400.
27 (25) Intermediate care facilities for the
28 developmentally disabled, as provided under part XI of chapter
29 400.
30 (26) Health care services pools, as provided under
31 part XII of chapter 400.
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1 (27) Health care clinics, as provided under part XIII
2 of chapter 400.
3 (28) Clinical laboratories, as provided under part I
4 of chapter 483.
5 (29) Multiphasic health testing centers, as provided
6 under part II of chapter 483.
7 408.803 Definitions.--As used in ss. 408.801-408.819,
8 the term:
9 (1) "Agency" means the Agency for Health Care
10 Administration, which is the licensing agency under ss.
11 408.801-408.819.
12 (2) "Applicant" means an individual, corporation,
13 partnership, firm, association, or governmental entity that
14 submits an application to the agency for a license.
15 (3) "Authorizing statute" means the statute
16 authorizing the licensed operation of a provider listed in s.
17 408.802.
18 (4) "Certification" means certification as a Medicare
19 or Medicaid provider of the services that necessitate
20 licensure or certification pursuant to the federal Clinical
21 Laboratory Improvement Amendments (CLIA).
22 (5) "Change of ownership" means an event in which the
23 licensee changes to a different legal entity or in which 45
24 percent or more of the ownership, voting shares, or
25 controlling interest is transferred or assigned, including the
26 final transfer or assignment of multiple transfers or
27 assignments over a 2-year period which cumulatively total 45
28 percent or greater. However, a change solely in the management
29 company is not a change of ownership.
30 (6) "Client" means any person receiving services from
31 a provider listed in s. 408.802.
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1 (7) "Controlling interest" means:
2 (a) The applicant for licensure or a licensee;
3 (b) A person or entity that serves as an officer of,
4 is on the board of directors of, or has a 5 percent or greater
5 ownership interest in the applicant or licensee; or
6 (c) A person or entity that serves as an officer of,
7 is on the board of directors of, or has a 5 percent or greater
8 ownership interest in the management company or other entity,
9 related or unrelated, which the applicant or licensee may
10 contract with to operate the provider.
11
12 The term does not include a voluntary board member.
13 (8) "License" means any permit, registration,
14 certificate, or license issued by the agency.
15 (9) "Licensee" means an individual, corporation,
16 partnership, firm, association, or governmental entity that is
17 issued a permit, registration, certificate, or license by the
18 agency. The licensee is legally responsible for all aspects of
19 the provider operation.
20 (10) "Moratorium" means a prohibition on the
21 acceptance of new clients.
22 (11) "Provider" means any activity, service, agency,
23 or facility regulated by the agency and listed in s. 408.802.
24 (12) "Services that necessitate licensure" means those
25 services, including residential services, which require a
26 valid license before those services may be provided in
27 accordance with authorizing statutes and agency rules.
28 (13) "Voluntary board member" means a director of a
29 not-for-profit corporation or organization who serves solely
30 in a voluntary capacity for the licensee, does not receive any
31 remuneration for his or her services on the board of
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1 directors, and has no financial interest in the corporation or
2 organization. The agency shall recognize a person as a
3 voluntary board member following submission of a statement to
4 the agency by the director and the not-for-profit corporation
5 or organization which affirms that the director conforms to
6 this definition. The statement affirming the status of the
7 director must be submitted to the agency on a form provided by
8 the agency.
9 408.804 License required; display.--
10 (1) It is unlawful to provide services that
11 necessitate licensure, or operate or maintain a provider
12 offering or providing services that necessitate licensure,
13 without first obtaining from the agency a license authorizing
14 such operation.
15 (2) A license must be displayed in a conspicuous place
16 readily visible to clients who enter at the address that
17 appears on the license and is valid only in the hands of the
18 individual, firm, partnership, association, or corporation to
19 whom it is issued and may not be sold, assigned, or otherwise
20 transferred, voluntarily or involuntarily. The license is
21 valid only for the licensee, provider, and location for which
22 the license is originally issued.
23 408.805 Fees required; adjustments.--Unless otherwise
24 limited by authorizing statutes, license fees must be
25 reasonably calculated by the agency to cover its costs in
26 carrying out its responsibilities under ss. 408.801-408.819,
27 authorizing statutes, and applicable rules, including the cost
28 of licensure, inspection, and regulation of providers, and
29 must be of such amount that the total fees collected do not
30 exceed the cost of administering and enforcing compliance with
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1 ss. 408.801-408.819, authorizing statutes, and applicable
2 rules.
3 (1) Licensure fees shall be adjusted for biennial
4 licensure in agency rules.
5 (2) The agency shall annually adjust licensure fees,
6 including fees paid per bed, by not more than the change in
7 the consumer price index based on the 12 months immediately
8 preceding the increase.
9 (3) The agency may, by rule, adjust licensure fees to
10 cover the cost of regulation under ss. 408.801-408.819,
11 authorizing statutes, and applicable rules.
12 (4) An inspection fee must be paid as required in
13 authorizing statutes.
14 (5) Licensure and inspection fees are nonrefundable.
15 (6) When a change is reported which requires issuance
16 of a license, a fee must be assessed. The fee must be based on
17 the actual cost of processing and issuing the license.
18 (7) A fee may be charged to a licensee requesting a
19 duplicate license. The fee may not exceed the actual cost of
20 duplication and postage.
21 (8) Total fees collected may not exceed the cost of
22 carrying out the provisions of ss. 408.801-408.819,
23 authorizing statutes, or applicable rules.
24 408.806 License application process.--
25 (1) An application for licensure must be made to the
26 agency on forms furnished by the agency, submitted under oath,
27 and accompanied by the appropriate license fee in order to be
28 accepted and considered timely. The application must contain
29 information required by authorizing statutes and applicable
30 rules and must include:
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1 (a) The name, address, and social security number of
2 the applicant and each controlling interest if the applicant
3 or controlling interest is an individual.
4 (b) The name, address, and federal employer
5 identification number or taxpayer identification number of the
6 applicant and each controlling interest if the applicant or
7 controlling interest is not an individual.
8 (c) The name by which the provider is to be known.
9 (d) The total number of beds or capacity requested, as
10 applicable.
11 (e) The location of the provider for which application
12 is made, a report or letter from the zoning authority
13 indicating the location is zoned appropriately for its use,
14 and a satisfactory fire safety report from the local authority
15 having jurisdiction or the state fire marshal. If the provider
16 is a community residential home under chapter 419, the zoning
17 requirement must be satisfied by proof of compliance with
18 chapter 419.
19 (f) The name of the person or persons under whose
20 management or supervision the provider will be operated and
21 the name of the administrator if required.
22 (g) Any information that the agency finds is necessary
23 to determine the ability of the applicant to carry out its
24 responsibilities under ss. 408.801-408.819 and authorizing
25 statutes, as specified in rule.
26 (2)(a) The applicant for a renewal license must submit
27 the application at least 60 days prior to the expiration of
28 the current license.
29 (b) The applicant for initial licensure due to a
30 change of ownership must submit the application at least 60
31 days prior to the date of change of ownership.
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1 (c) The applicant for initial licensure must submit a
2 complete application at least 90 days prior to the date the
3 provider would be available for inspection.
4 (d) For any other application or request, the
5 applicant must submit the application or request at least 60
6 days prior to the requested effective date, unless otherwise
7 specified in authorizing statutes or rules.
8 (3) Upon receipt of an application for a license, the
9 agency shall examine the application and, within 30 days after
10 receipt, notify the applicant of any apparent errors or
11 omissions and request any additional information required.
12 (4) Requested information omitted from an application
13 for licensure, license renewal, or change of ownership must be
14 filed with the agency within 21 days after the agency's
15 request for omitted information, or the application shall be
16 deemed incomplete, and shall be withdrawn from further
17 consideration and the fees forfeited.
18 (5) Licensees subject to the provisions of ss.
19 408.801-408.819 shall be issued biennial licenses unless
20 conditions of the license category specify a shorter license
21 period. The agency may issue an initial license for less than
22 the full 2-year period by charging a prorated licensure fee
23 and specifying a different renewal date than would otherwise
24 be required for biennial licensure. Failure to apply for the
25 renewal of a license prior to the expiration date renders the
26 license null and void and the former licensee may not be
27 issued a license unless the licensee reapplies for an initial
28 license and meets all current qualifications for licensure,
29 including construction standards for facilities where
30 applicable.
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1 (6) The failure to file a timely application and
2 license fee shall result in a late fee charged to the licensee
3 in an amount equal to 50 percent of the licensure fee.
4 (7) Within 60 days after the receipt of a complete
5 application, the agency shall:
6 (a) Approve or deny the application; or
7 (b) Authorize an inspection be conducted if required
8 by the authorizing statute.
9 (8) Each license issued shall indicate the name of the
10 licensee, the provider or service that the licensee is
11 required or authorized to operate or offer, the date the
12 license is issued, the expiration date of the license, the
13 maximum capacity of the licensed premises if applicable, and
14 any other information required by authorizing statutes or
15 deemed necessary by the agency.
16 (9)(a) Upon authorization under subsection (7) for an
17 inspection, the agency shall contact the applicant to schedule
18 an inspection. An initial survey is not required for companion
19 services or homemaker services providers, as provided under
20 part IV of chapter 400 or for health care services pools, as
21 provided under part XII of chapter 400.
22 (b) If an inspection is required by the authorizing
23 statute for a license application other than an initial
24 application, the inspection must be unannounced. This
25 paragraph does not apply to inspections required pursuant to
26 s. 483.035.
27 (c) A final decision on the application for licensure
28 shall be rendered within 90 days after authorization of the
29 inspection.
30
31
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1 (d) If a provider is not available when an inspection
2 is attempted, the application shall be withdrawn from further
3 consideration.
4 (10) The agency may establish procedures for the
5 electronic submission of required information, including, but
6 not limited to:
7 (a) Licensure applications and required signatures.
8 (b) Payment of fees.
9 (c) Notarization of applications.
10
11 Requirements for electronic submission of any documents
12 required by ss. 408.801-408.819 or authorizing statutes may be
13 established by rule.
14 408.807 Change of ownership.--Whenever a change of
15 ownership occurs:
16 (1) The transferor shall notify the agency in writing
17 at least 60 days before the anticipated date of transfer of
18 ownership.
19 (2) The transferee shall make application to the
20 agency for a license within the timeframes required in s.
21 408.806.
22 (3) The transferor shall be responsible and liable
23 for:
24 (a) The lawful operation of the provider and the
25 welfare of the clients served until the date the transferee is
26 licensed by the agency.
27 (b) Any and all penalties imposed against the
28 transferee for violations occurring before the date of change
29 of ownership.
30
31
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1 (4) Any restriction on licensure, including a
2 conditional license existing at the time of a change of
3 ownership, shall remain in effect until removed by the agency.
4 (5) The transferee shall maintain records of the
5 transferor as required in ss. 408.801-408.819, authorizing
6 statutes, and applicable rules including:
7 (a) All client records.
8 (b) Inspection reports.
9 (c) All records required to be maintained pursuant to
10 409.913, if applicable.
11 408.808 License categories.--
12 (1) STANDARD LICENSE.--A standard license may be
13 issued at the time of initial licensure, license renewal, or
14 change of ownership. A standard license shall be issued when
15 the applicant is in compliance with all statutory requirements
16 and agency rules. Unless sooner revoked, a standard license
17 expires 2 years following the date of issue.
18 (2) PROVISIONAL LICENSE.--A provisional license may be
19 issued:
20 (a) Pursuant to s. 408.809(3).
21 (b) When the applicant is in substantial compliance
22 with statutory requirements and applicable rules. A
23 provisional license for this purpose shall be issued for a
24 maximum of 1 year and may not be renewed.
25 (c) When a denial or revocation proceeding is pending,
26 a provision license for this purpose is effective until final
27 agency disposition of the proceeding. If judicial relief is
28 sought from the final agency disposition, the court having
29 jurisdiction may require the agency to issue a temporary
30 license for the duration of the judicial proceeding.
31
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1 (3) INACTIVE LICENSE.--An inactive license may be
2 issued to a health care provider subject to the
3 certificate-of-need provisions in ss. 408.031-408.045 when the
4 provider will be temporarily unable to provide services but is
5 reasonably expected to resume services within 12 months. Such
6 designation may be made for a period not to exceed 12 months
7 but may be renewed by the agency for up to 6 additional months
8 upon demonstration by the licensee of the provider's progress
9 toward reopening. Any request by a licensee for an inactive
10 license or to extend the previously approved inactive period
11 must be submitted to the agency, accompanied by written
12 justification for the inactive license with the beginning and
13 ending dates of inactivity, including a plan for the transfer
14 of any clients to other providers, and the appropriate
15 licensure fees. The agency may not accept a request that is
16 submitted after initiating closure, after any suspension of
17 service, or after notifying clients of closure or suspension
18 of service. Upon agency approval, the provider shall notify
19 clients of any necessary discharge or transfer as required by
20 authorizing statutes. The beginning of the inactive license
21 shall be the date the provider ceases operations. The end of
22 the inactive period shall become the license expiration date
23 and all licensure fees must be current, paid in full, and may
24 be prorated. Reactivation of an inactive license requires the
25 approval of a renewal application, including payment of
26 licensure fees and agency inspections indicating compliance
27 with all requirements of ss. 408.801-408.819, authorizing
28 statutes, and applicable rules.
29 (4) OTHER LICENSES.--Other licensure types may be
30 issued pursuant to authorizing statutes.
31 408.809 Background screening; prohibited offenses.--
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1 (1) Level 2 background screening pursuant to chapter
2 435 must be conducted through the agency on each of the
3 following persons, who shall be considered an employee for the
4 purposes of conducting screening under chapter 435:
5 (a) The licensee if an individual;
6 (b) The administrator or a similarly titled person who
7 is responsible for the day-to-day operation of the provider;
8 (c) The financial officer or similarly titled
9 individual who is responsible for the financial operation of
10 the licensee or provider; and
11 (d) Any controlling interest if the agency has reason
12 to believe that such person has been convicted of any offense
13 prohibited by s. 435.04. For each controlling interest who has
14 been convicted of any such offense, the licensee shall submit
15 to the agency a description and explanation of the conviction
16 at the time of license application.
17 (2) Proof of compliance with level 2 screening
18 standards submitted within the previous 5 years to meet any
19 provider or professional licensure requirements of the agency,
20 the Department of Health, or the Department of Children and
21 Family Services satisfies the requirements of this section,
22 provided that such proof is accompanied, under penalty of
23 perjury, by an affidavit of compliance with the provisions of
24 chapter 435. Proof of compliance with the background screening
25 requirements of the Department of Insurance for an applicant
26 for a certificate of authority to operate a continuing care
27 retirement community under chapter 651, submitted within the
28 previous 5 years, satisfies the Department of Law Enforcement
29 and Federal Bureau of Investigation portions of a level 2
30 background check.
31
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1 (3) A provisional license may be granted to an
2 applicant when each individual required by this section to
3 undergo background screening has met the standards for the
4 Department of Law Enforcement background check, but the agency
5 has not yet received background screening results from the
6 Federal Bureau of Investigation. A standard license may be
7 granted to the licensee upon the agency's receipt of a report
8 of the results of the Federal Bureau of Investigation
9 background screening for each individual required by this
10 section to undergo background screening which confirms that
11 all standards have been met, or upon the granting of a
12 disqualification exemption by the agency as set forth in
13 chapter 435. Any other person who is required to undergo level
14 2 background screening may serve in his or her capacity
15 pending the agency's receipt of the report from the Federal
16 Bureau of Investigation. However, the person may not continue
17 to serve if the report indicates any violation of background
18 screening standards and a disqualification exemption has not
19 been requested of or granted by the agency as set forth in
20 chapter 435.
21 (4) When a change in the administrator of a provider
22 occurs, the licensee must notify the agency of the change
23 within the time period specified in the authorizing statute or
24 rules and must provide evidence of compliance with background
25 screening requirements of this section; except that an
26 administrator who has met the standards for the Department of
27 Law Enforcement background check, but for whom background
28 screening results from the Federal Bureau of Investigation
29 have not yet been received, may be employed pending a receipt
30 of the Federal Bureau of Investigation background screening
31 report. An individual may not continue to serve as
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1 administrator if the Federal Bureau of Investigation
2 background screening report indicates any violation of
3 background screening standards.
4 (5) Background screening is not required to obtain a
5 certificate of exemption issued under s. 483.106.
6 408.810 Minimum licensure requirements.--In addition
7 to the licensure requirements specified in chapter 112,
8 chapter 383, chapter 390, chapter 394, chapter 395, chapter
9 400, chapter 440, or chapter 483, each applicant for licensure
10 by the Agency for Health Care Administration must comply with
11 the requirements of this section in order to obtain and
12 maintain a license.
13 (1) An applicant for licensure must comply with
14 background screening requirements of s. 408.809.
15 (2) An applicant for licensure must provide a
16 description and explanation of any exclusions, suspensions, or
17 terminations of the applicant from the Medicare, Medicaid, or
18 federal Clinical Laboratory Improvement Amendments (CLIA)
19 programs.
20 (3) Unless otherwise specified in ss. 408.801-408.819,
21 authorizing statutes, or applicable rules, any information
22 required to be reported to the agency must be submitted within
23 10 calendar days after the report period or effective date of
24 the information.
25 (4) Whenever a licensee discontinues operation of a
26 provider:
27 (a) The licensee must inform the agency not less than
28 30 days prior to the discontinuance of operation and inform
29 clients of discharge as required by authorizing statutes.
30 Immediately upon discontinuance of operation of a provider,
31
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1 the licensee shall surrender the license to the agency and the
2 license shall be canceled.
3 (b) Upon final discharge of clients, each client shall
4 be given his or her records. Upon closure of a provider, the
5 licensee shall remain responsible for retaining and
6 appropriately distributing all records within the timeframes
7 prescribed in authorizing statutes and applicable rules. In
8 addition, the licensee shall make arrangements to forward
9 records for each client to one of the following, based upon
10 the client's choice: the client or the client's legal
11 representative, the client's attending physician, or the
12 health care provider where the client currently receives
13 services. Failure to comply is a misdemeanor of the second
14 degree, punishable as provided in s. 775.083. In the event of
15 death or dissolution of a licensee, the estate or agent of the
16 licensee shall cause a notice to be published in the newspaper
17 of greatest general circulation in the county where the
18 provider was located which advises clients of the licensee's
19 death or dissolution. The notice must inform clients that they
20 may obtain copies of their records and specify the name,
21 address, and telephone number of the person from whom the
22 copies of records may be obtained. The notice must appear at
23 least once a week for four consecutive weeks.
24 (5)(a) On or before the first day services are
25 provided to a client, a licensee must inform the client and
26 his or her immediate family or representative, if appropriate,
27 of the right to report:
28 1. Complaints. The statewide toll-free telephone
29 number for reporting complaints to the agency must be provided
30 to clients in a manner that is clearly legible and must
31
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1 include the words: "To report a complaint regarding the
2 services you receive, please call toll free (phone number)".
3 2. Abusive, neglectful, or exploitative practices. The
4 statewide toll-free telephone number for the central abuse
5 hotline must be provided to clients in a manner that is
6 clearly legible and must include the words: "To report abuse,
7 neglect, or exploitation, please call toll-free (phone
8 number)."
9
10 The agency shall publish a minimum of a 90-day advance notice
11 of a change in the toll-free telephone numbers.
12 (b) Each licensee shall establish appropriate policies
13 and procedures for providing such notice to clients.
14 (6) An applicant must provide the agency with proof of
15 the applicant's legal right to occupy the property before a
16 license may be issued. Proof may include, but need not be
17 limited to, copies of warranty deeds, lease or rental
18 agreements, contracts for deeds, quitclaim deeds, or other
19 such documentation.
20 (7) An applicant shall provide proof of liability
21 insurance as defined in chapter 624, unless defined otherwise
22 in authorizing statute.
23 (8) Upon application for initial licensure or
24 change-of-ownership licensure, the applicant shall furnish
25 satisfactory proof of the applicant's financial ability to
26 operate in accordance with the requirements of ss.
27 408.801-408.819, authorizing statutes, and applicable rules.
28 The agency shall establish standards for this purpose,
29 including information concerning the applicant's controlling
30 interests. The agency also shall establish documentation
31 requirements, to be completed by each applicant, that show
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1 anticipated provider revenues and expenditures, the basis for
2 financing the anticipated cash-flow requirements of the
3 provider, and an applicant's access to contingency financing.
4 A current certificate of authority, pursuant to chapter 651,
5 may be provided as proof of financial ability to operate. The
6 agency may require a licensee to provide proof of financial
7 ability to operate at any time if there is evidence of
8 financial instability, including, but not limited to, unpaid
9 expenses necessary for the basic operations of the provider.
10 (9) A licensee or controlling interest may not
11 withhold from the agency any evidence of financial
12 instability, including, but not limited to, checks returned
13 due to insufficient funds, delinquent accounts, nonpayment of
14 withholding taxes, unpaid utility expenses, nonpayment for
15 essential services, or adverse court action concerning the
16 financial viability of the provider or any other provider
17 licensed under ss. 408.801-408.819 which is under the control
18 of the licensee. Any person found guilty of violating this
19 subsection commits a misdemeanor of the second degree,
20 punishable as provided in s. 775.083. Each day of continuing
21 violation is a separate offense.
22 (10) The agency may not issue a license to a health
23 care provider subject to the certificate of need provisions in
24 ss. 408.031-408.045 if the licensee has not been issued a
25 certificate of need or an exemption. Upon initial licensure of
26 any such provider, the authorization contained in the
27 certificate of need shall be considered fully implemented and
28 merged into the license, and shall have no force and effect
29 upon termination of the license for any reason.
30 408.811 Right of inspection; copies; inspection
31 reports.--
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1 (1) An authorized officer or employee of the agency
2 may make or cause to be made any inspections and
3 investigations as the agency deems necessary to determine the
4 state of compliance with ss. 408.801-408.819, authorizing
5 statutes, and applicable rules. The right of inspection
6 extends to any business that the agency has reason to believe
7 is being operated as a provider without a license, but
8 inspection of any business suspected of being operated without
9 the appropriate license may not be made without the permission
10 of the owner or person in charge unless a warrant is first
11 obtained from a circuit court. Any application for a license
12 issued under ss. 408.801-408.819, authorizing statutes, or
13 applicable rules constitutes permission for an appropriate
14 inspection to verify the information submitted on or in
15 connection with the application.
16 (a) All inspections shall be unannounced, except for
17 inspections required for initial licensure or pursuant to s.
18 483.035.
19 (b) Inspections for relicensure shall be conducted
20 biennially unless otherwise specified by authorizing statutes
21 or applicable rules.
22 (2) Inspections conducted in conjunction with
23 certification may be accepted in lieu of a complete licensure
24 inspection. However, a licensure inspection may also be
25 conducted to review any licensure requirements that are not
26 also requirements of certification.
27 (3) The agency shall have access to and the licensee
28 shall provide copies of all provider records required during
29 an inspection at no cost to the agency.
30 (4)(a) Unless exempt from s. 119.07(1), each licensee
31 shall maintain as public information, available upon request,
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1 records of all inspection reports pertaining to that provider
2 which have been filed with, or issued by, any governmental
3 agency. Copies of such reports shall be retained in the
4 records of the provider for at least 5 years following the
5 date the reports are filed and issued, regardless of a change
6 of ownership.
7 (b) A licensee shall, upon the request of any person
8 who has completed a written application with intent to be
9 admitted by such provider or any person who is a patient of
10 such provider, or any relative, spouse, or guardian of any
11 such person, furnish to the requester a copy of the last
12 inspection report issued by the agency or an accrediting
13 organization if applicable, whichever is most recent,
14 pertaining to the licensed provider.
15 408.812 Unlicensed activity.--
16 (1) A person may not offer or advertise to the public
17 services as defined by ss. 408.801-408.819, authorizing
18 statutes, or application rules without obtaining a valid
19 license from the Agency for Health Care Administration. The
20 holder of a license may not advertise or hold out to the
21 public that he or she holds a license for other than that for
22 which he or she actually holds a license.
23 (2) The operation or maintenance of an unlicensed
24 provider or the performance of any services that necessitate
25 licensure is a violation of ss. 408.801-408.819 and
26 authorizing statutes. Unlicensed activity constitutes harm
27 that materially affects the health, safety, and welfare of
28 clients. The agency, or any state attorney, may, in addition
29 to other remedies provided in ss. 408.801-408.819, bring an
30 action for an injunction to restrain such violation, or to
31 enjoin the future operation or maintenance of any such
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1 provider or the provision of services that necessitate
2 licensure in violation of ss. 408.801-408.819 and authorizing
3 statutes, until compliance with ss. 408.801-408.819,
4 authorizing statutes, and agency rules, has been demonstrated
5 to the satisfaction of the agency.
6 (3) Any person who owns, operates, or maintains an
7 unlicensed provider and who, after receiving notification from
8 the agency, fails to cease operation and apply for a license
9 under this part and authorizing statutes commits a felony of
10 the third degree, punishable as provided in s. 775.082, s.
11 775.083, or s. 775.084. Each day of continued operation is a
12 separate offense.
13 (4) Any person found guilty of violating subsection
14 (3) a second or subsequent time commits a felony of the second
15 degree, punishable as provided under s. 775.082, s. 775.083,
16 or s. 775.084. Each day of continued operation is a separate
17 offense.
18 (5) Any provider that fails to cease operation after
19 agency notification may be fined $1,000 for each day of
20 noncompliance.
21 (6) When a licensee has an interest in more than one
22 provider and fails to license any provider rendering services
23 that necessitate licensure, the agency may revoke all
24 licenses, impose moratoriums, or impose a fine of $1,000
25 unless otherwise specified by authorizing statutes against the
26 licensee until such time as the licensee becomes appropriately
27 licensed.
28 (7) In addition to injunctive relief pursuant to
29 subsection (2), if the agency determines that an owner is
30 operating or maintaining a provider without obtaining a
31 license and determines that a condition exists that poses a
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1 threat to the health, safety, or welfare of a client of the
2 provider, the owner is subject to the same actions and fines
3 imposed against a licensed provider as specified in ss.
4 408.801-408.819, the authorizing statute, and agency rules.
5 (8) Any person aware of the operation of an unlicensed
6 provider must report that provider and operation to the
7 agency.
8 408.813 Administrative fines.--As a penalty for any
9 violation of ss. 408.801-408.819, authorizing statutes, or
10 applicable rules, the agency may impose an administrative
11 fine. Unless the amount of the fine is prescribed by
12 authorizing statutes or applicable rules, the agency may
13 establish criteria for the amount of administrative fines
14 applicable to ss. 408.801-408.819, authorizing statutes, and
15 applicable rules. Each day of violation constitutes a separate
16 violation and is subject to a separate fine. For fines that
17 are upheld following administrative or judicial review, the
18 violator shall pay the fine, plus interest at the rate as
19 specified in s. 55.03 for each day beyond the date set by the
20 agency for payment of the fine.
21 408.814 Moratoriums.--
22 (1) The agency may impose an immediate moratorium on
23 any provider if the agency determines that any condition
24 related to the provider presents a threat to the health,
25 safety, or welfare of the clients.
26 (2) A provider, the license of which is denied or
27 revoked, may be subject to immediate imposition of a
28 moratorium to run concurrently with licensure denial,
29 revocation, or injunction.
30 (3) A moratorium remains in effect after a change of
31 ownership, unless the agency has determined that the
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1 conditions that created the moratorium or denial of licensure
2 have been corrected.
3 (4) When a moratorium is placed on a provider, notice
4 of the moratorium shall be posted and visible to the public at
5 the location of the provider until the moratorium is lifted.
6 (5) The agency may by rule establish conditions that
7 constitute grounds for imposing a moratorium on a provider and
8 procedures for imposing and lifting a moratorium as necessary
9 to administer this section.
10 408.815 License denial; revocation.--
11 (1) In addition to grounds in authorizing statutes,
12 grounds for denying or revoking a license or application
13 include any of the following actions by a controlling
14 interest:
15 (a) False representation of a material fact in the
16 license application or omission of any material fact from the
17 application.
18 (b) An intentional or negligent act materially
19 affecting the health or safety of clients of the provider.
20 (c) A violation of ss. 408.801-408.819, authorizing
21 statutes, or applicable rules.
22 (d) A demonstrated pattern of deficient performance.
23 (e) The applicant, licensee, or controlling interest
24 has been or is currently excluded, suspended, terminated from,
25 or has involuntarily withdrawn from participation in the state
26 Medicaid program, the Medicaid program of any other state, or
27 the Medicare program or any other governmental or private
28 health care or health insurance program.
29 (2) If a licensee lawfully continues to operate while
30 a denial or revocation is pending in litigation, the licensee
31 must continue to meet all other requirements of ss.
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1 408.801-408.819, authorizing statutes, and applicable rules,
2 and must file subsequent renewal applications for licensure,
3 including licensure fees. Notwithstanding chapter 120, the
4 agency may withhold a final decision on any application or
5 request filed during this period until final agency action.
6 (3) A moratorium or denial of the license of the
7 transferee license may be grounds for denial of a
8 change-of-ownership application of the transferor.
9 408.816 Injunctions.--
10 (1) In addition to the other powers provided by ss.
11 408.801-408.819 and authorizing statutes, the agency may:
12 (a) Institute injunction proceedings in a court of
13 competent jurisdiction to restrain or prevent the
14 establishment or operation of a provider that does not have a
15 license or is in violation of any provision of ss.
16 408.801-408.819, authorizing statutes, or applicable rules.
17 The agency may also institute injunction proceedings in a
18 court of competent jurisdiction when a violation of ss.
19 408.801-408.819, authorizing statutes, or applicable rules
20 constitutes an emergency affecting the immediate health and
21 safety of a client.
22 (b) Enforce the provisions of ss. 408.801-408.819,
23 authorizing statutes, or any minimum standard, rule, or order
24 issued or entered into pursuant thereto when the attempt by
25 the agency to correct a violation through administrative
26 sanctions has failed or when the violation materially affects
27 the health, safety, or welfare of clients or involves any
28 operation of an unlicensed provider.
29 (c) Terminate the operation of a provider when a
30 violation of any provision of ss. 408.801-408.819, authorizing
31 statutes, or any standard or rule adopted pursuant thereto
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1 exist that materially affect the health, safety, or welfare of
2 clients.
3 (2) Such injunctive relief may be temporary or
4 permanent.
5 (3) If action is necessary to protect clients of
6 providers from immediate, life-threatening situations, the
7 court may allow a temporary injunction without bond upon
8 proper proof being made. If it appears by competent evidence
9 or a sworn, substantiated affidavit that a temporary
10 injunction should be issued, the court, pending the
11 determination on final hearing, shall enjoin the operation of
12 the provider.
13 408.817 Administrative proceedings.--Administrative
14 proceedings challenging agency licensure enforcement action
15 shall be reviewed on the basis of the facts and conditions
16 that resulted in the agency action.
17 408.818 Health Care Trust Fund.--Unless otherwise
18 prescribed by authorizing statutes, all fees and fines
19 collected pursuant to ss. 408.801-408.819, authorizing
20 statutes, and applicable rules shall be deposited into the
21 Health Care Trust Fund, created in s. 408.16, and used to pay
22 the costs of the agency in administering the provider program
23 paying the fees or fines.
24 408.819 Rules.--The agency may adopt rules necessary
25 to administer ss. 408.801-408.819. Any licensed provider that
26 is in operation at the time of adoption of any applicable rule
27 under ss. 408.801-408.819 or authorizing statutes shall be
28 given a reasonable time under the particular circumstances,
29 not to exceed 6 months after the date of such adoption, within
30 which to comply with such rule, unless otherwise specified by
31 rule.
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1 Section 2. Subsection (12), paragraph (a) of
2 subsection (13), and subsection (17) of section 112.0455,
3 Florida Statutes, are amended to read:
4 112.0455 Drug-Free Workplace Act.--
5 (12) DRUG-TESTING STANDARDS; LABORATORIES.--
6 (a) The requirements of ss. 408.801-408.819 apply to
7 the provision of services that necessitate licensure pursuant
8 to this section and ss. 408.801-408.819 and to entities
9 licensed by or applying for such licensure from the Agency for
10 Health Care Administration pursuant to this section.
11 (b)(a) A laboratory may analyze initial or
12 confirmation drug specimens only if:
13 1. The laboratory is licensed and approved by the
14 Agency for Health Care Administration using criteria
15 established by the United States Department of Health and
16 Human Services as general guidelines for modeling the state
17 drug testing program and in accordance with ss.
18 408.801-408.819. Each applicant for licensure must comply with
19 all requirements of ss. 408.801-408.819, with the exception of
20 s. 408.810(5)-(10). the following requirements:
21 a. Upon receipt of a completed, signed, and dated
22 application, the agency shall require background screening, in
23 accordance with the level 2 standards for screening set forth
24 in chapter 435, of the managing employee, or other similarly
25 titled individual responsible for the daily operation of the
26 laboratory, and of the financial officer, or other similarly
27 titled individual who is responsible for the financial
28 operation of the laboratory, including billings for services.
29 The applicant must comply with the procedures for level 2
30 background screening as set forth in chapter 435, as well as
31 the requirements of s. 435.03(3).
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1 b. The agency may require background screening of any
2 other individual who is an applicant if the agency has
3 probable cause to believe that he or she has been convicted of
4 an offense prohibited under the level 2 standards for
5 screening set forth in chapter 435.
6 c. Proof of compliance with the level 2 background
7 screening requirements of chapter 435 which has been submitted
8 within the previous 5 years in compliance with any other
9 health care licensure requirements of this state is acceptable
10 in fulfillment of screening requirements.
11 d. A provisional license may be granted to an
12 applicant when each individual required by this section to
13 undergo background screening has met the standards for the
14 Department of Law Enforcement background check, but the agency
15 has not yet received background screening results from the
16 Federal Bureau of Investigation, or a request for a
17 disqualification exemption has been submitted to the agency as
18 set forth in chapter 435, but a response has not yet been
19 issued. A license may be granted to the applicant upon the
20 agency's receipt of a report of the results of the Federal
21 Bureau of Investigation background screening for each
22 individual required by this section to undergo background
23 screening which confirms that all standards have been met, or
24 upon the granting of a disqualification exemption by the
25 agency as set forth in chapter 435. Any other person who is
26 required to undergo level 2 background screening may serve in
27 his or her capacity pending the agency's receipt of the report
28 from the Federal Bureau of Investigation. However, the person
29 may not continue to serve if the report indicates any
30 violation of background screening standards and a
31
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1 disqualification exemption has not been requested of and
2 granted by the agency as set forth in chapter 435.
3 e. Each applicant must submit to the agency, with its
4 application, a description and explanation of any exclusions,
5 permanent suspensions, or terminations of the applicant from
6 the Medicare or Medicaid programs. Proof of compliance with
7 the requirements for disclosure of ownership and control
8 interests under the Medicaid or Medicare programs shall be
9 accepted in lieu of this submission.
10 f. Each applicant must submit to the agency a
11 description and explanation of any conviction of an offense
12 prohibited under the level 2 standards of chapter 435 by a
13 member of the board of directors of the applicant, its
14 officers, or any individual owning 5 percent or more of the
15 applicant. This requirement does not apply to a director of a
16 not-for-profit corporation or organization if the director
17 serves solely in a voluntary capacity for the corporation or
18 organization, does not regularly take part in the day-to-day
19 operational decisions of the corporation or organization,
20 receives no remuneration for his or her services on the
21 corporation or organization's board of directors, and has no
22 financial interest and has no family members with a financial
23 interest in the corporation or organization, provided that the
24 director and the not-for-profit corporation or organization
25 include in the application a statement affirming that the
26 director's relationship to the corporation satisfies the
27 requirements of this sub-subparagraph.
28 g. A license may not be granted to any applicant if
29 the applicant or managing employee has been found guilty of,
30 regardless of adjudication, or has entered a plea of nolo
31 contendere or guilty to, any offense prohibited under the
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1 level 2 standards for screening set forth in chapter 435,
2 unless an exemption from disqualification has been granted by
3 the agency as set forth in chapter 435.
4 h. The agency may deny or revoke licensure if the
5 applicant:
6 (I) Has falsely represented a material fact in the
7 application required by sub-subparagraph e. or
8 sub-subparagraph f., or has omitted any material fact from the
9 application required by sub-subparagraph e. or
10 sub-subparagraph f.; or
11 (II) Has had prior action taken against the applicant
12 under the Medicaid or Medicare program as set forth in
13 sub-subparagraph e.
14 i. An application for license renewal must contain the
15 information required under sub-subparagraphs e. and f.
16 2. The laboratory has written procedures to ensure
17 chain of custody.
18 3. The laboratory follows proper quality control
19 procedures, including, but not limited to:
20 a. The use of internal quality controls including the
21 use of samples of known concentrations which are used to check
22 the performance and calibration of testing equipment, and
23 periodic use of blind samples for overall accuracy.
24 b. An internal review and certification process for
25 drug test results, conducted by a person qualified to perform
26 that function in the testing laboratory.
27 c. Security measures implemented by the testing
28 laboratory to preclude adulteration of specimens and drug test
29 results.
30 d. Other necessary and proper actions taken to ensure
31 reliable and accurate drug test results.
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1 (c)(b) A laboratory shall disclose to the employer a
2 written test result report within 7 working days after receipt
3 of the sample. All laboratory reports of a drug test result
4 shall, at a minimum, state:
5 1. The name and address of the laboratory which
6 performed the test and the positive identification of the
7 person tested.
8 2. Positive results on confirmation tests only, or
9 negative results, as applicable.
10 3. A list of the drugs for which the drug analyses
11 were conducted.
12 4. The type of tests conducted for both initial and
13 confirmation tests and the minimum cutoff levels of the tests.
14 5. Any correlation between medication reported by the
15 employee or job applicant pursuant to subparagraph (8)(b)2.
16 and a positive confirmed drug test result.
17
18 No report shall disclose the presence or absence of any drug
19 other than a specific drug and its metabolites listed pursuant
20 to this section.
21 (d)(c) The laboratory shall submit to the Agency for
22 Health Care Administration a monthly report with statistical
23 information regarding the testing of employees and job
24 applicants. The reports shall include information on the
25 methods of analyses conducted, the drugs tested for, the
26 number of positive and negative results for both initial and
27 confirmation tests, and any other information deemed
28 appropriate by the Agency for Health Care Administration. No
29 monthly report shall identify specific employees or job
30 applicants.
31
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1 (e)(d) Laboratories shall provide technical assistance
2 to the employer, employee, or job applicant for the purpose of
3 interpreting any positive confirmed test results which could
4 have been caused by prescription or nonprescription medication
5 taken by the employee or job applicant.
6 (13) RULES.--
7 (a) The Agency for Health Care Administration may
8 adopt additional rules to support this law and ss.
9 408.801-408.819, using criteria established by the United
10 States Department of Health and Human Services as general
11 guidelines for modeling drug-free workplace laboratories the
12 state drug-testing program, concerning, but not limited to:
13 1. Standards for drug-testing laboratory licensing and
14 denial, suspension, and revocation of a license.
15 2. Urine, hair, blood, and other body specimens and
16 minimum specimen amounts which are appropriate for drug
17 testing, not inconsistent with other provisions established by
18 law.
19 3. Methods of analysis and procedures to ensure
20 reliable drug-testing results, including standards for initial
21 tests and confirmation tests, not inconsistent with other
22 provisions established by law.
23 4. Minimum cutoff detection levels for drugs or their
24 metabolites for the purposes of determining a positive test
25 result, not inconsistent with other provisions established by
26 law.
27 5. Chain-of-custody procedures to ensure proper
28 identification, labeling, and handling of specimens being
29 tested, not inconsistent with other provisions established by
30 law.
31
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1 6. Retention, storage, and transportation procedures
2 to ensure reliable results on confirmation tests and retests.
3 7. A list of the most common medications by brand name
4 or common name, as applicable, as well as by chemical name,
5 which may alter or affect a drug test.
6 (17) LICENSE FEE.--Fees from licensure of drug-testing
7 laboratories shall be sufficient to carry out the
8 responsibilities of the Agency for Health Care Administration
9 for the regulation of drug-testing laboratories. In accordance
10 with s. 408.805, an applicant or licensee shall pay a fee for
11 each license application submitted under this part and ss.
12 408.801-408.819. The fee may not be less than $16,000 or more
13 than $20,000 per biennium and shall be established by rule.
14 The Agency for Health Care Administration shall collect fees
15 for all licenses issued under this part. Each nonrefundable
16 fee shall be due at the time of application and shall be
17 payable to the Agency for Health Care Administration to be
18 deposited in a trust fund administered by the Agency for
19 Health Care Administration and used only for the purposes of
20 this section. The fee schedule is as follows: For licensure
21 as a drug-testing laboratory, an annual fee of not less than
22 $8,000 or more than $10,000 per fiscal year; for late filing
23 of an application for renewal, an additional fee of $500 per
24 day shall be charged.
25 Section 3. Section 383.301, Florida Statutes, is
26 amended to read:
27 383.301 Licensure and regulation of birth centers;
28 legislative intent.--It is the intent of the Legislature to
29 provide for the protection of public health and safety in the
30 establishment, maintenance, and operation of birth centers by
31 providing for licensure of birth centers and for the
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1 development, establishment, and enforcement of minimum
2 standards with respect to birth centers. The requirements of
3 ss. 408.801-408.819 apply to the provision of services that
4 necessitate licensure pursuant to ss. 383.30-383.335 and ss.
5 408.801-408.819 and to entities licensed by or applying for
6 such licensure from the Agency for Health Care Administration
7 pursuant to ss. 383.30-383.335.
8 Section 4. Section 383.304, Florida Statutes, is
9 repealed.
10 Section 5. Section 383.305, Florida Statutes, is
11 amended to read:
12 383.305 Licensure; issuance, renewal, denial,
13 suspension, revocation; fees; background screening.--
14 (1) In accordance with s. 408.805, an applicant or
15 licensee shall pay a fee for each license application
16 submitted under this part and ss. 408.801-408.819. The amount
17 of the fee shall be established by rule.
18 (1)(a) Upon receipt of an application for a license
19 and the license fee, the agency shall issue a license if the
20 applicant and facility have received all approvals required by
21 law and meet the requirements established under ss.
22 383.30-383.335 and by rules promulgated hereunder.
23 (b) A provisional license may be issued to any birth
24 center that is in substantial compliance with ss.
25 383.30-383.335 and with the rules of the agency. A
26 provisional license may be granted for a period of no more
27 than 1 year from the effective date of rules adopted by the
28 agency, shall expire automatically at the end of its term, and
29 may not be renewed.
30 (c) A license, unless sooner suspended or revoked,
31 automatically expires 1 year from its date of issuance and is
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1 renewable upon application for renewal and payment of the fee
2 prescribed, provided the applicant and the birth center meet
3 the requirements established under ss. 383.30-383.335 and by
4 rules promulgated hereunder. A complete application for
5 renewal of a license shall be made 90 days prior to expiration
6 of the license on forms provided by the agency.
7 (2) An application for a license, or renewal thereof,
8 shall be made to the agency upon forms provided by it and
9 shall contain such information as the agency reasonably
10 requires, which may include affirmative evidence of ability to
11 comply with applicable laws and rules.
12 (3)(a) Each application for a birth center license, or
13 renewal thereof, shall be accompanied by a license fee. Fees
14 shall be established by rule of the agency. Such fees are
15 payable to the agency and shall be deposited in a trust fund
16 administered by the agency, to be used for the sole purpose of
17 carrying out the provisions of ss. 383.30-383.335.
18 (b) The fees established pursuant to ss.
19 383.30-383.335 shall be based on actual costs incurred by the
20 agency in the administration of its duties under such
21 sections.
22 (4) Each license is valid only for the person or
23 governmental unit to whom or which it is issued; is not
24 subject to sale, assignment, or other transfer, voluntary or
25 involuntary; and is not valid for any premises other than
26 those for which it was originally issued.
27 (5) Each license shall be posted in a conspicuous
28 place on the licensed premises.
29 (6) Whenever the agency finds that there has been a
30 substantial failure to comply with the requirements
31 established under ss. 383.30-383.335 or in rules adopted under
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1 those sections, it is authorized to deny, suspend, or revoke a
2 license.
3 (2)(7) Each applicant for licensure must comply with
4 the following requirements of ss. 408.801-408.819, with the
5 exception of s. 408.810(7)-(10).:
6 (a) Upon receipt of a completed, signed, and dated
7 application, the agency shall require background screening, in
8 accordance with the level 2 standards for screening set forth
9 in chapter 435, of the managing employee, or other similarly
10 titled individual who is responsible for the daily operation
11 of the center, and of the financial officer, or other
12 similarly titled individual who is responsible for the
13 financial operation of the center, including billings for
14 patient care and services. The applicant must comply with the
15 procedures for level 2 background screening as set forth in
16 chapter 435 as well as the requirements of s. 435.03(3).
17 (b) The agency may require background screening of any
18 other individual who is an applicant if the agency has
19 probable cause to believe that he or she has been convicted of
20 a crime or has committed any other offense prohibited under
21 the level 2 standards for screening set forth in chapter 435.
22 (c) Proof of compliance with the level 2 background
23 screening requirements of chapter 435 which has been submitted
24 within the previous 5 years in compliance with any other
25 health care licensure requirements of this state is acceptable
26 in fulfillment of the requirements of paragraph (a).
27 (d) A provisional license may be granted to an
28 applicant when each individual required by this section to
29 undergo background screening has met the standards for the
30 Department of Law Enforcement background check, but the agency
31 has not yet received background screening results from the
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1 Federal Bureau of Investigation, or a request for a
2 disqualification exemption has been submitted to the agency as
3 set forth in chapter 435 but a response has not yet been
4 issued. A standard license may be granted to the applicant
5 upon the agency's receipt of a report of the results of the
6 Federal Bureau of Investigation background screening for each
7 individual required by this section to undergo background
8 screening which confirms that all standards have been met, or
9 upon the granting of a disqualification exemption by the
10 agency as set forth in chapter 435. Any other person who is
11 required to undergo level 2 background screening may serve in
12 his or her capacity pending the agency's receipt of the report
13 from the Federal Bureau of Investigation. However, the person
14 may not continue to serve if the report indicates any
15 violation of background screening standards and a
16 disqualification exemption has not been requested of and
17 granted by the agency as set forth in chapter 435.
18 (e) Each applicant must submit to the agency, with its
19 application, a description and explanation of any exclusions,
20 permanent suspensions, or terminations of the applicant from
21 the Medicare or Medicaid programs. Proof of compliance with
22 the requirements for disclosure of ownership and control
23 interests under the Medicaid or Medicare programs shall be
24 accepted in lieu of this submission.
25 (f) Each applicant must submit to the agency a
26 description and explanation of any conviction of an offense
27 prohibited under the level 2 standards of chapter 435 by a
28 member of the board of directors of the applicant, its
29 officers, or any individual owning 5 percent or more of the
30 applicant. This requirement does not apply to a director of a
31 not-for-profit corporation or organization if the director
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1 serves solely in a voluntary capacity for the corporation or
2 organization, does not regularly take part in the day-to-day
3 operational decisions of the corporation or organization,
4 receives no remuneration for his or her services on the
5 corporation or organization's board of directors, and has no
6 financial interest and has no family members with a financial
7 interest in the corporation or organization, provided that the
8 director and the not-for-profit corporation or organization
9 include in the application a statement affirming that the
10 director's relationship to the corporation satisfies the
11 requirements of this paragraph.
12 (g) A license may not be granted to an applicant if
13 the applicant or managing employee has been found guilty of,
14 regardless of adjudication, or has entered a plea of nolo
15 contendere or guilty to, any offense prohibited under the
16 level 2 standards for screening set forth in chapter 435,
17 unless an exemption from disqualification has been granted by
18 the agency as set forth in chapter 435.
19 (h) The agency may deny or revoke licensure if the
20 applicant:
21 1. Has falsely represented a material fact in the
22 application required by paragraph (e) or paragraph (f), or has
23 omitted any material fact from the application required by
24 paragraph (e) or paragraph (f); or
25 2. Has had prior action taken against the applicant
26 under the Medicaid or Medicare program as set forth in
27 paragraph (e).
28 (i) An application for license renewal must contain
29 the information required under paragraphs (e) and (f).
30 Section 6. Section 383.309, Florida Statutes, is
31 amended to read:
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1 383.309 Minimum standards for birth centers; rules and
2 enforcement.--
3 (1) The agency shall adopt and enforce rules to
4 administer ss. 383.30-383.335 and ss. 408.801-408.819, which
5 rules shall include, but are not limited to, reasonable and
6 fair minimum standards for ensuring that:
7 (a) Sufficient numbers and qualified types of
8 personnel and occupational disciplines are available at all
9 times to provide necessary and adequate patient care and
10 safety.
11 (b) Infection control, housekeeping, sanitary
12 conditions, disaster plan, and medical record procedures that
13 will adequately protect patient care and provide safety are
14 established and implemented.
15 (c) Licensed facilities are established, organized,
16 and operated consistent with established programmatic
17 standards.
18 (2) Any licensed facility that is in operation at the
19 time of adoption of any applicable rule under ss.
20 383.30-383.335 shall be given a reasonable time under the
21 particular circumstances, not to exceed 1 year after the date
22 of such adoption, within which to comply with such rule.
23 (2)(3) The agency may not establish any rule governing
24 the design, construction, erection, alteration, modification,
25 repair, or demolition of birth centers. It is the intent of
26 the Legislature to preempt that function to the Florida
27 Building Commission and the State Fire Marshal through
28 adoption and maintenance of the Florida Building Code and the
29 Florida Fire Prevention Code. However, the agency shall
30 provide technical assistance to the commission and the State
31 Fire Marshal in updating the construction standards of the
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1 Florida Building Code and the Florida Fire Prevention Code
2 which govern birth centers. In addition, the agency may
3 enforce the special-occupancy provisions of the Florida
4 Building Code and the Florida Fire Prevention Code which apply
5 to birth centers in conducting any inspection authorized under
6 this chapter.
7 Section 7. Subsection (1) of section 383.315, Florida
8 Statutes, is amended to read:
9 383.315 Agreements with consultants for advice or
10 services; maintenance.--
11 (1) A birth center shall maintain in writing a
12 consultation agreement, signed within the current license
13 period year, with each consultant who has agreed to provide
14 advice and services to the birth center as requested.
15 Section 8. Section 383.324, Florida Statutes, is
16 amended to read:
17 383.324 Inspections and investigations; Inspection
18 fees.--
19 (1) The agency shall make or cause to be made such
20 inspections and investigations as it deems necessary.
21 (2) Each facility licensed under s. 383.305 shall pay
22 to the agency, at the time of inspection, an inspection fee
23 established by rule of the agency.
24 (3) The agency shall coordinate all periodic
25 inspections for licensure made by the agency to ensure that
26 the cost to the facility of such inspections and the
27 disruption of services by such inspections is minimized.
28 Section 9. Section 383.325, Florida Statutes, is
29 repealed.
30 Section 10. Section 383.33, Florida Statutes, is
31 amended to read:
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1 383.33 Administrative fines penalties; emergency
2 orders; moratorium on admissions.--
3 (1)(a) In addition to the requirements of ss.
4 408.801-408.819, the agency may deny, revoke, or suspend a
5 license, or impose an administrative fine, not to exceed $500
6 per violation per day, for the violation of any provision of
7 ss. 383.30-383.335, ss. 408.801-408.819, or applicable rules
8 or any rule adopted under ss. 383.30-383.335. Each day of
9 violation constitutes a separate violation and is subject to a
10 separate fine.
11 (2)(b) In determining the amount of the fine to be
12 levied for a violation, as provided in paragraph (a), the
13 following factors shall be considered:
14 (a)1. The severity of the violation, including the
15 probability that death or serious harm to the health or safety
16 of any person will result or has resulted; the severity of the
17 actual or potential harm; and the extent to which the
18 provisions of ss. 383.30-383.335, ss. 408.801-408.819, or
19 applicable rules were violated.
20 (b)2. Actions taken by the licensee to correct the
21 violations or to remedy complaints.
22 (c)3. Any previous violations by the licensee.
23 (c) All amounts collected pursuant to this section
24 shall be deposited into a trust fund administered by the
25 agency to be used for the sole purpose of carrying out the
26 provisions of ss. 383.30-383.335.
27 (2) The agency may issue an emergency order
28 immediately suspending or revoking a license when it
29 determines that any condition in the licensed facility
30 presents a clear and present danger to the public health and
31 safety.
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1 (3) The agency may impose an immediate moratorium on
2 elective admissions to any licensed facility, building or
3 portion thereof, or service when the agency determines that
4 any condition in the facility presents a threat to the public
5 health or safety.
6 Section 11. Sections 383.331 and 383.332, Florida
7 Statutes, are repealed.
8 Section 12. Subsection (1) of section 383.335, Florida
9 Statutes, is amended to read:
10 383.335 Partial exemptions.--
11 (1) Any facility that which was providing obstetrical
12 and gynecological surgical services and was owned and operated
13 by a board-certified obstetrician on June 15, 1984, and that
14 which is otherwise subject to licensure under ss.
15 383.30-383.335 as a birth center, is exempt from the
16 provisions of ss. 383.30-383.335 and ss. 408.801-408.819 which
17 restrict the provision of surgical services and outlet forceps
18 delivery and the administration of anesthesia at birth
19 centers. The agency shall adopt rules specifically related to
20 the performance of such services and the administration of
21 anesthesia at such facilities.
22 Section 13. Subsection (5) of section 390.011, Florida
23 Statutes, is amended to read:
24 390.011 Definitions.--As used in this chapter, the
25 term:
26 (5) "Hospital" means a facility defined in s. 395.002
27 and licensed under chapter 395.
28 Section 14. Subsection (1) of section 390.012, Florida
29 Statutes, is amended to read:
30 390.012 Powers of agency; rules; disposal of fetal
31 remains.--
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1 (1) The agency may shall have the authority to develop
2 and enforce rules under ss. 390.001-390.021 and ss.
3 408.801-408.819 for the health, care, and treatment of persons
4 in abortion clinics and for the safe operation of such
5 clinics. These rules shall be comparable to rules which apply
6 to all surgical procedures requiring approximately the same
7 degree of skill and care as the performance of first trimester
8 abortions. The rules shall be reasonably related to the
9 preservation of maternal health of the clients. The rules
10 shall not impose a legally significant burden on a woman's
11 freedom to decide whether to terminate her pregnancy. The
12 rules shall provide for:
13 (a) The performance of pregnancy termination
14 procedures only by a licensed physician.
15 (b) The making, protection, and preservation of
16 patient records, which shall be treated as medical records
17 under chapter 458.
18 Section 15. Section 390.013, Florida Statutes, is
19 repealed.
20 Section 16. Section 390.014, Florida Statutes, is
21 amended to read:
22 390.014 Licenses; fees, display, etc.--
23 (1) The requirements of ss. 408.801-408.819 apply to
24 the provision of services that necessitate licensure pursuant
25 to ss. 390.011-390.021 and ss. 408.801-408.819 and to entities
26 licensed by or applying for such licensure from the Agency for
27 Health Care Administration pursuant to ss. 390.011-390.021.
28 However, an applicant for licensure is exempt from s.
29 408.810(7)-(10). No abortion clinic shall operate in this
30 state without a currently effective license issued by the
31 agency.
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1 (2) A separate license shall be required for each
2 clinic maintained on separate premises, even though it is
3 operated by the same management as another clinic; but a
4 separate license shall not be required for separate buildings
5 on the same premises.
6 (3) In accordance with s. 408.805, an applicant or
7 licensee shall pay a fee for each license application
8 submitted under this part and ss. 408.801-408.819. The fee
9 shall be established by rule and The annual license fee
10 required for a clinic shall be nonrefundable and shall be
11 reasonably calculated to cover the cost of regulation under
12 this chapter, but may not be less than $70 or $35 nor more
13 than $500 per biennium $250.
14 (4) Counties and municipalities applying for licenses
15 under this act shall be exempt from the payment of the license
16 fees.
17 (5) The license shall be displayed in a conspicuous
18 place inside the clinic.
19 (6) A license shall be valid only for the clinic to
20 which it is issued, and it shall not be subject to sale,
21 assignment, or other transfer, voluntary or involuntary. No
22 license shall be valid for any premises other than those for
23 which it was originally issued.
24 Section 17. Sections 390.015, 390.016, and 390.017,
25 Florida Statutes, are repealed.
26 Section 18. Section 390.018, Florida Statutes, is
27 amended to read:
28 390.018 Administrative fine penalty in lieu of
29 revocation or suspension.--In addition to the requirements of
30 ss. 408.801-408.819 If the agency finds that one or more
31 grounds exist for the revocation or suspension of a license
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1 issued to an abortion clinic, the agency may, in lieu of such
2 suspension or revocation, impose a fine upon the clinic in an
3 amount not to exceed $1,000 for each violation of any
4 provision of this part, ss. 408.801-408.819, or applicable
5 rules. The fine shall be paid to the agency within 60 days
6 from the date of entry of the administrative order. If the
7 licensee fails to pay the fine in its entirety to the agency
8 within the period allowed, the license of the licensee shall
9 stand suspended, revoked, or renewal or continuation may be
10 refused, as the case may be, upon expiration of such period
11 and without any further administrative or judicial
12 proceedings.
13 Section 19. Sections 390.019 and 390.021, Florida
14 Statutes, are repealed.
15 Section 20. Subsection (13) of section 394.455,
16 Florida Statutes, is amended to read:
17 394.455 Definitions.--As used in this part, unless the
18 context clearly requires otherwise, the term:
19 (13) "Hospital" means a facility defined in s. 395.002
20 and licensed under chapter 395.
21 Section 21. Section 394.67, Florida Statutes, is
22 amended to read:
23 394.67 Definitions.--As used in this part, the term:
24 (1) "Agency" means the Agency for Health Care
25 Administration.
26 (2) "Applicant" means an individual applicant, or any
27 officer, director, agent, managing employee, or affiliated
28 person, or any partner or shareholder having an ownership
29 interest equal to a 5-percent or greater interest in the
30 corporation, partnership, or other business entity.
31
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1 (2)(3) "Client" means any individual receiving
2 services in any substance abuse or mental health facility,
3 program, or service, which facility, program, or service is
4 operated, funded, or regulated by the agency and the
5 department or regulated by the agency.
6 (3)(4) "Crisis services" means short-term evaluation,
7 stabilization, and brief intervention services provided to a
8 person who is experiencing an acute mental or emotional
9 crisis, as defined in subsection (17) (18), or an acute
10 substance abuse crisis, as defined in subsection (18) (19), to
11 prevent further deterioration of the person's mental health.
12 Crisis services are provided in settings such as a crisis
13 stabilization unit, an inpatient unit, a short-term
14 residential treatment program, a detoxification facility, or
15 an addictions receiving facility; at the site of the crisis by
16 a mobile crisis response team; or at a hospital on an
17 outpatient basis.
18 (4)(5) "Crisis stabilization unit" means a program
19 that provides an alternative to inpatient hospitalization and
20 that provides brief, intensive services 24 hours a day, 7 days
21 a week, for mentally ill individuals who are in an acutely
22 disturbed state.
23 (5)(6) "Department" means the Department of Children
24 and Family Services.
25 (6)(7) "Director" means any member of the official
26 board of directors reported in the organization's annual
27 corporate report to the Florida Department of State, or, if no
28 such report is made, any member of the operating board of
29 directors. The term excludes members of separate, restricted
30 boards that serve only in an advisory capacity to the
31 operating board.
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1 (7)(8) "District administrator" means the person
2 appointed by the Secretary of Children and Family Services for
3 the purpose of administering a department service district as
4 set forth in s. 20.19.
5 (8)(9) "District plan" or "plan" means the combined
6 district substance abuse and mental health plan approved by
7 the district administrator and governing bodies in accordance
8 with this part.
9 (9)(10) "Federal funds" means funds from federal
10 sources for substance abuse or mental health facilities and
11 programs, exclusive of federal funds that are deemed eligible
12 by the Federal Government, and are eligible through state
13 regulation, for matching purposes.
14 (10)(11) "Governing body" means the chief legislative
15 body of a county, a board of county commissioners, or boards
16 of county commissioners in counties acting jointly, or their
17 counterparts in a charter government.
18 (11)(12) "Health and human services board" or "board"
19 means the board within a district or subdistrict of the
20 department which is established in accordance with s. 20.19
21 and designated in this part for the purpose of assessing the
22 substance abuse and mental health needs of the community and
23 developing a plan to address those needs.
24 (12)(13) "Licensed facility" means a facility licensed
25 in accordance with this chapter.
26 (13)(14) "Local matching funds" means funds received
27 from governing bodies of local government, including city
28 commissions, county commissions, district school boards,
29 special tax districts, private hospital funds, private gifts,
30 both individual and corporate, and bequests and funds received
31 from community drives or any other sources.
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1 (14)(15) "Managing employee" means the administrator
2 or other similarly titled individual who is responsible for
3 the daily operation of the facility.
4 (15)(16) "Mental health services" means those
5 therapeutic interventions and activities that help to
6 eliminate, reduce, or manage symptoms or distress for persons
7 who have severe emotional distress or a mental illness and to
8 effectively manage the disability that often accompanies a
9 mental illness so that the person can recover from the mental
10 illness, become appropriately self-sufficient for his or her
11 age, and live in a stable family or in the community. The term
12 also includes those preventive interventions and activities
13 that reduce the risk for or delay the onset of mental
14 disorders. The term includes the following types of services:
15 (a) Treatment services, such as psychiatric
16 medications and supportive psychotherapies, which are intended
17 to reduce or ameliorate the symptoms of severe distress or
18 mental illness.
19 (b) Rehabilitative services, which are intended to
20 reduce or eliminate the disability that is associated with
21 mental illness. Rehabilitative services may include assessment
22 of personal goals and strengths, readiness preparation,
23 specific skill training, and assistance in designing
24 environments that enable individuals to maximize their
25 functioning and community participation.
26 (c) Support services, which include services that
27 assist individuals in living successfully in environments of
28 their choice. Such services may include income supports,
29 social supports, housing supports, vocational supports, or
30 accommodations related to the symptoms or disabilities
31 associated with mental illness.
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1 (d) Case management services, which are intended to
2 assist individuals in obtaining the formal and informal
3 resources that they need to successfully cope with the
4 consequences of their illness. Resources may include treatment
5 or rehabilitative or supportive interventions by both formal
6 and informal providers. Case management may include an
7 assessment of client needs; intervention planning with the
8 client, his or her family, and service providers; linking the
9 client to needed services; monitoring service delivery;
10 evaluating the effect of services and supports; and advocating
11 on behalf of the client.
12
13 Mental health services may be delivered in a variety of
14 settings, such as inpatient, residential, partial hospital,
15 day treatment, outpatient, club house, or a drop-in or
16 self-help center, as well as in other community settings, such
17 as the client's residence or workplace. The types and
18 intensity of services provided shall be based on the client's
19 clinical status and goals, community resources, and
20 preferences. Services such as assertive community treatment
21 involve all four types of services which are delivered by a
22 multidisciplinary treatment team that is responsible for
23 identified individuals who have a serious mental illness.
24 (16)(17) "Patient fees" means compensation received by
25 a community substance abuse or mental health facility for
26 services rendered to a specific client from any source of
27 funds, including city, county, state, federal, and private
28 sources.
29 (17)(18) "Person who is experiencing an acute mental
30 or emotional crisis" means a child, adolescent, or adult who
31 is experiencing a psychotic episode or a high level of mental
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1 or emotional distress which may be precipitated by a traumatic
2 event or a perceived life problem for which the individual's
3 typical coping strategies are inadequate. The term includes an
4 individual who meets the criteria for involuntary examination
5 specified in s. 394.463(1).
6 (18)(19) "Person who is experiencing an acute
7 substance abuse crisis" means a child, adolescent, or adult
8 who is experiencing a medical or emotional crisis because of
9 the use of alcoholic beverages or any psychoactive or
10 mood-altering substance. The term includes an individual who
11 meets the criteria for involuntary admission specified in s.
12 397.675.
13 (19)(20) "Premises" means those buildings, beds, and
14 facilities located at the main address of the licensee and all
15 other buildings, beds, and facilities for the provision of
16 acute or residential care which are located in such reasonable
17 proximity to the main address of the licensee as to appear to
18 the public to be under the dominion and control of the
19 licensee.
20 (20)(21) "Program office" means the Mental Health
21 Program Office of the Department of Children and Family
22 Services.
23 (21)(22) "Residential treatment center for children
24 and adolescents" means a 24-hour residential program,
25 including a therapeutic group home, which provides mental
26 health services to emotionally disturbed children or
27 adolescents as defined in s. 394.492(5) or (6) and which is a
28 private for-profit or not-for-profit corporation under
29 contract with the department which offers a variety of
30 treatment modalities in a more restrictive setting.
31
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1 (22)(23) "Residential treatment facility" means a
2 facility providing residential care and treatment to
3 individuals exhibiting symptoms of mental illness who are in
4 need of a 24-hour-per-day, 7-day-a-week structured living
5 environment, respite care, or long-term community placement.
6 (23) "Short-term residential treatment facility" means
7 a program that provides an alternative to inpatient
8 hospitalization and that provides brief, intensive services 24
9 hours a day, 7 days a week, for mentally ill individuals who
10 are temporarily in need of a 24-hour-a-day structured
11 therapeutic setting in a less restrictive, but longer-stay
12 alternative to hospitalization.
13 (24) "Sliding fee scale" means a schedule of fees for
14 identified services delivered by a service provider which are
15 based on a uniform schedule of discounts deducted from the
16 service provider's usual and customary charges. These charges
17 must be consistent with the prevailing market rates in the
18 community for comparable services.
19 (25) "Substance abuse services" means services
20 designed to prevent or remediate the consequences of substance
21 abuse, improve an individual's quality of life and
22 self-sufficiency, and support long-term recovery. The term
23 includes the following service categories:
24 (a) Prevention services, which include information
25 dissemination; education regarding the consequences of
26 substance abuse; alternative drug-free activities; problem
27 identification; referral of persons to appropriate prevention
28 programs; community-based programs that involve members of
29 local communities in prevention activities; and environmental
30 strategies to review, change, and enforce laws that control
31 the availability of controlled and illegal substances.
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1 (b) Assessment services, which include the evaluation
2 of individuals and families in order to identify their
3 strengths and determine their required level of care,
4 motivation, and need for treatment and ancillary services.
5 (c) Intervention services, which include early
6 identification, short-term counseling and referral, and
7 outreach.
8 (d) Rehabilitation services, which include
9 residential, outpatient, day or night, case management,
10 in-home, psychiatric, and medical treatment, and methadone or
11 medication management.
12 (e) Ancillary services, which include self-help and
13 other support groups and activities; aftercare provided in a
14 structured, therapeutic environment; supported housing;
15 supported employment; vocational services; and educational
16 services.
17 Section 22. Section 394.875, Florida Statutes, is
18 amended to read:
19 394.875 Crisis stabilization units, short-term
20 residential treatment facilities, residential treatment
21 facilities, and residential treatment centers for children and
22 adolescents; authorized services; license required;
23 penalties.--
24 (1)(a) The purpose of a crisis stabilization unit is
25 to stabilize and redirect a client to the most appropriate and
26 least restrictive community setting available, consistent with
27 the client's needs. Crisis stabilization units may screen,
28 assess, and admit for stabilization persons who present
29 themselves to the unit and persons who are brought to the unit
30 under s. 394.463. Clients may be provided 24-hour
31 observation, medication prescribed by a physician or
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1 psychiatrist, and other appropriate services. Crisis
2 stabilization units shall provide services regardless of the
3 client's ability to pay and shall be limited in size to a
4 maximum of 30 beds.
5 (b) The purpose of a short-term residential treatment
6 unit is to provide intensive services in a 24-hour-a-day
7 structured therapeutic setting as a less restrictive, but
8 longer-stay alternative to hospitalization.
9 (c)(b) The purpose of a residential treatment facility
10 is to be a part of a comprehensive treatment program for
11 mentally ill individuals in a community-based residential
12 setting.
13 (d)(c) The purpose of a residential treatment center
14 for children and adolescents is to provide mental health
15 assessment and treatment services pursuant to ss. 394.491,
16 394.495, and 394.496 to children and adolescents who meet the
17 target population criteria specified in s. 394.493(1)(a), (b),
18 or (c).
19 (2) The requirements of ss. 408.801-408.819 apply to
20 the provision of services that necessitate licensure pursuant
21 to ss. 394.455-394.904 and ss. 408.801-408.819 and to entities
22 licensed by or applying for such licensure from the Agency for
23 Health Care Administration pursuant to ss. 394.455-394.904. It
24 is unlawful for any entity to hold itself out as a crisis
25 stabilization unit, a residential treatment facility, or a
26 residential treatment center for children and adolescents, or
27 to act as a crisis stabilization unit, a residential treatment
28 facility, or a residential treatment center for children and
29 adolescents, unless it is licensed by the agency pursuant to
30 this chapter.
31
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1 (3) Any person who violates subsection (2) is guilty
2 of a misdemeanor of the first degree, punishable as provided
3 in s. 775.082 or s. 775.083.
4 (4) The agency may maintain an action in circuit court
5 to enjoin the unlawful operation of a crisis stabilization
6 unit, a residential treatment facility, or a residential
7 treatment center for children and adolescents if the agency
8 first gives the violator 14 days' notice of its intention to
9 maintain such action and if the violator fails to apply for
10 licensure within such 14-day period.
11 (3)(5) The following entities are exempt from
12 licensure as required in ss. 394.455-394.904 Subsection (2)
13 does not apply to:
14 (a) Hospitals licensed under chapter 395 or programs
15 operated within such hospitals. Homes for special services
16 licensed under chapter 400; or
17 (b) Nursing homes licensed under chapter 400.
18 (c) Comprehensive transitional education programs
19 licensed under s. 393.067.
20 (4)(6) The department, in consultation with the
21 agency, may establish multiple license classifications for
22 residential treatment facilities.
23 (5)(7) The agency may not issue a license to a crisis
24 stabilization unit unless the unit receives state mental
25 health funds and is affiliated with a designated public
26 receiving facility.
27 (6)(8) The agency may issue a license for a crisis
28 stabilization unit or short-term residential treatment
29 facility, certifying the number of authorized beds for such
30 facility as indicated by existing need and available
31 appropriations. The agency may disapprove an application for
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1 such a license if it determines that a facility should not be
2 licensed pursuant to the provisions of this chapter. Any
3 facility operating beds in excess of those authorized by the
4 agency shall, upon demand of the agency, reduce the number of
5 beds to the authorized number, forfeit its license, or provide
6 evidence of a license issued pursuant to chapter 395 for the
7 excess beds.
8 (7)(9) A children's crisis stabilization unit which
9 does not exceed 20 licensed beds and which provides separate
10 facilities or a distinct part of a facility, separate
11 staffing, and treatment exclusively for minors may be located
12 on the same premises as a crisis stabilization unit serving
13 adults. The department, in consultation with the agency, shall
14 adopt rules governing facility construction, staffing and
15 licensure requirements, and the operation of such units for
16 minors.
17 (8)(10) The department, in consultation with the
18 agency, must adopt rules governing a residential treatment
19 center for children and adolescents which specify licensure
20 standards for: admission; length of stay; program and
21 staffing; discharge and discharge planning; treatment
22 planning; seclusion, restraints, and time-out; rights of
23 patients under s. 394.459; use of psychotropic medications;
24 and standards for the operation of such centers.
25 (9)(11) Notwithstanding the provisions of subsection
26 (6) (8), crisis stabilization units may not exceed their
27 licensed capacity by more than 10 percent, nor may they exceed
28 their licensed capacity for more than 3 consecutive working
29 days or for more than 7 days in 1 month.
30 (10)(12) Notwithstanding the other provisions of this
31 section, any facility licensed under former chapter 396 and
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1 chapter 397 for detoxification, residential level I care, and
2 outpatient treatment may elect to license concurrently all of
3 the beds at such facility both for that purpose and as a
4 long-term residential treatment facility pursuant to this
5 section, if all of the following conditions are met:
6 (a) The licensure application is received by the
7 department prior to January 1, 1993.
8 (b) On January 1, 1993, the facility was licensed
9 under former chapter 396 and chapter 397 as a facility for
10 detoxification, residential level I care, and outpatient
11 treatment of substance abuse.
12 (c) The facility restricted its practice to the
13 treatment of law enforcement personnel for a period of at
14 least 12 months beginning after January 1, 1992.
15 (d) The number of beds to be licensed under this
16 chapter is equal to or less than the number of beds licensed
17 under former chapter 396 and chapter 397 as of January 1,
18 1993.
19 (e) The licensee agrees in writing to a condition
20 placed upon the license that the facility will limit its
21 treatment exclusively to law enforcement personnel and their
22 immediate families who are seeking admission on a voluntary
23 basis and who are exhibiting symptoms of posttraumatic stress
24 disorder or other mental health problems, including drug or
25 alcohol abuse, which are directly related to law enforcement
26 work and which are amenable to verbal treatment therapies; the
27 licensee agrees to coordinate the provision of appropriate
28 postresidential care for discharged individuals; and the
29 licensee further agrees in writing that a failure to meet any
30 condition specified in this paragraph shall constitute grounds
31
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1 for a revocation of the facility's license as a residential
2 treatment facility.
3 (f) The licensee agrees that the facility will meet
4 all licensure requirements for a residential treatment
5 facility, including minimum standards for compliance with
6 lifesafety requirements, except those licensure requirements
7 which are in express conflict with the conditions and other
8 provisions specified in this subsection.
9 (g) The licensee agrees that the conditions stated in
10 this subsection must be agreed to in writing by any person
11 acquiring the facility by any means.
12
13 Any facility licensed under this subsection is not required to
14 provide any services to any persons except those included in
15 the specified conditions of licensure, and is exempt from any
16 requirements related to the 60-day or greater average length
17 of stay imposed on community-based residential treatment
18 facilities otherwise licensed under this chapter.
19 (13) Each applicant for licensure must comply with the
20 following requirements:
21 (a) Upon receipt of a completed, signed, and dated
22 application, the agency shall require background screening, in
23 accordance with the level 2 standards for screening set forth
24 in chapter 435, of the managing employee and financial
25 officer, or other similarly titled individual who is
26 responsible for the financial operation of the facility,
27 including billings for client care and services. The applicant
28 must comply with the procedures for level 2 background
29 screening as set forth in chapter 435, as well as the
30 requirements of s. 435.03(3).
31
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1 (b) The agency may require background screening of any
2 other individual who is an applicant if the agency has
3 probable cause to believe that he or she has been convicted of
4 a crime or has committed any other offense prohibited under
5 the level 2 standards for screening set forth in chapter 435.
6 (c) Proof of compliance with the level 2 background
7 screening requirements of chapter 435 which has been submitted
8 within the previous 5 years in compliance with any other
9 health care licensure requirements of this state is acceptable
10 in fulfillment of the requirements of paragraph (a).
11 (d) A provisional license may be granted to an
12 applicant when each individual required by this section to
13 undergo background screening has met the standards for the
14 Department of Law Enforcement background check, but the agency
15 has not yet received background screening results from the
16 Federal Bureau of Investigation, or a request for a
17 disqualification exemption has been submitted to the agency as
18 set forth in chapter 435, but a response has not yet been
19 issued. A standard license may be granted to the applicant
20 upon the agency's receipt of a report of the results of the
21 Federal Bureau of Investigation background screening for each
22 individual required by this section to undergo background
23 screening which confirms that all standards have been met, or
24 upon the granting of a disqualification exemption by the
25 agency as set forth in chapter 435. Any other person who is
26 required to undergo level 2 background screening may serve in
27 his or her capacity pending the agency's receipt of the report
28 from the Federal Bureau of Investigation. However, the person
29 may not continue to serve if the report indicates any
30 violation of background screening standards and a
31
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1 disqualification exemption has not been requested of and
2 granted by the agency as set forth in chapter 435.
3 (e) Each applicant must submit to the agency, with its
4 application, a description and explanation of any exclusions,
5 permanent suspensions, or terminations of the applicant from
6 the Medicare or Medicaid programs. Proof of compliance with
7 the requirements for disclosure of ownership and control
8 interests under the Medicaid or Medicare programs shall be
9 accepted in lieu of this submission.
10 (f) Each applicant must submit to the agency a
11 description and explanation of any conviction of an offense
12 prohibited under the level 2 standards of chapter 435 by a
13 member of the board of directors of the applicant, its
14 officers, or any individual owning 5 percent or more of the
15 applicant. This requirement does not apply to a director of a
16 not-for-profit corporation or organization if the director
17 serves solely in a voluntary capacity for the corporation or
18 organization, does not regularly take part in the day-to-day
19 operational decisions of the corporation or organization,
20 receives no remuneration for his or her services on the
21 corporation or organization's board of directors, and has no
22 financial interest and has no family members with a financial
23 interest in the corporation or organization, provided that the
24 director and the not-for-profit corporation or organization
25 include in the application a statement affirming that the
26 director's relationship to the corporation satisfies the
27 requirements of this paragraph.
28 (g) A license may not be granted to an applicant if
29 the applicant or managing employee has been found guilty of,
30 regardless of adjudication, or has entered a plea of nolo
31 contendere or guilty to, any offense prohibited under the
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1 level 2 standards for screening set forth in chapter 435,
2 unless an exemption from disqualification has been granted by
3 the agency as set forth in chapter 435.
4 (h) The agency may deny or revoke licensure if the
5 applicant:
6 1. Has falsely represented a material fact in the
7 application required by paragraph (e) or paragraph (f), or has
8 omitted any material fact from the application required by
9 paragraph (e) or paragraph (f); or
10 2. Has had prior action taken against the applicant
11 under the Medicaid or Medicare program as set forth in
12 paragraph (e).
13 (i) An application for license renewal must contain
14 the information required under paragraphs (e) and (f).
15 Section 23. Section 394.876, Florida Statutes, is
16 repealed.
17 Section 24. Section 394.877, Florida Statutes, is
18 amended to read:
19 394.877 Fees.--
20 (1) In accordance with s. 408.805, an applicant or
21 licensee shall pay a fee for each license application
22 submitted under this part and ss. 408.801-408.819. The amount
23 of the fee shall be established by rule. Each application for
24 licensure or renewal must be accompanied by a fee set by the
25 department, in consultation with the agency, by rule. Such
26 fees shall be reasonably calculated to cover only the cost of
27 regulation under this chapter.
28 (2) All fees collected under this section shall be
29 deposited in the Health Care Trust Fund.
30 Section 25. Section 394.878, Florida Statutes, is
31 amended to read:
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1 394.878 Issuance and renewal of licenses.--
2 (1) Upon review of the application for licensure and
3 receipt of appropriate fees, the agency shall issue an
4 original or renewal license to any applicant that meets the
5 requirements of this chapter.
6 (2) A license is valid for a period of 1 year. An
7 applicant for renewal of a license shall apply to the agency
8 no later than 90 days before expiration of the current
9 license.
10 (3) A license may not be transferred from one entity
11 to another and is valid only for the premises for which it was
12 originally issued. For the purposes of this subsection,
13 "transfer" includes, but is not limited to, transfer of a
14 majority of the ownership interests in a licensee or transfer
15 of responsibilities under the license to another entity by
16 contractual arrangement.
17 (4) Each license shall state the services which the
18 licensee is required or authorized to perform and the maximum
19 residential capacity of the licensed premises.
20 (1)(5) The agency may issue a probationary license to
21 an applicant that has completed the application requirements
22 of this chapter but has not, at the time of the application,
23 developed an operational crisis stabilization unit or
24 residential treatment facility. The probationary license
25 shall expire 90 days after issuance and may once be renewed
26 for an additional 90-day period. The agency may cancel a
27 probationary license at any time.
28 (2)(6) The agency may issue an interim license to an
29 applicant that has substantially completed all application
30 requirements and has initiated action to fully meet such
31 requirements. The interim license shall expire 90 days after
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1 issuance and, in cases of extreme hardship, may once be
2 renewed for an additional 90-day period.
3 (7) Any applicant which fails to file an application
4 for license renewal during the 90-day relicensure period shall
5 be considered unlicensed and subject to penalties pursuant to
6 s. 394.875.
7 Section 26. Subsections (1), (3), and (4) of section
8 394.879, Florida Statutes, are amended to read:
9 394.879 Rules; enforcement.--
10 (1) The agency, in consultation with the department,
11 may adopt rules to administer ss. 408.801-408.819. The
12 department, in consultation with the agency, shall adopt rules
13 pursuant to ss. 120.536(1) and 120.54 to implement the
14 provisions of this chapter, including, at a minimum, rules
15 providing standards to ensure that:
16 (a) Sufficient numbers and types of qualified
17 personnel are on duty and available at all times to provide
18 necessary and adequate client safety and care.
19 (b) Adequate space is provided each client of a
20 licensed facility.
21 (c) Licensed facilities are limited to an appropriate
22 number of beds.
23 (d) Each licensee establishes and implements adequate
24 infection control, housekeeping, sanitation, disaster
25 planning, and medical recordkeeping.
26 (e) Licensed facilities are established, organized,
27 and operated in accordance with programmatic standards of the
28 department.
29 (f) The operation and purposes of these facilities
30 assure individuals' health, safety, and welfare.
31
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1 (3) The department, in consultation with the agency,
2 shall allow any licensed facility in operation at the time of
3 adoption of any rule a reasonable period, not to exceed 1
4 year, to bring itself into compliance with department rules
5 such rule.
6 (4) In accordance with ss. 408.801-408.819, the agency
7 may impose an administrative penalty of no more than $500 per
8 day against any licensee that violates any rule adopted
9 pursuant to this section and may suspend or revoke the license
10 or deny the renewal application of such licensee. In imposing
11 such penalty, the agency shall consider the severity of the
12 violation, actions taken by the licensee to correct the
13 violation, and previous violations by the licensee. Fines
14 collected under this subsection shall be deposited in the
15 Mental Health Facility Licensing Trust Fund.
16 Section 27. Paragraph (a) of subsection (1) of section
17 394.90, Florida Statutes, is amended to read:
18 394.90 Inspection; right of entry; records.--
19 (1)(a) The department and the agency, in accordance
20 with s. 408.811, may enter and inspect at any time a licensed
21 facility to determine whether the facility is in compliance
22 with this chapter and applicable the rules of the department.
23 Section 28. Section 394.902, Florida Statutes, is
24 amended to read:
25 394.902 Denial, suspension, and revocation; other
26 remedies.--
27 (1) The agency may issue an emergency order suspending
28 or revoking a license if the agency determines that the
29 continued operation of the licensed facility presents a clear
30 and present danger to the public health or safety.
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1 (2) The agency may impose a moratorium on elective
2 admissions to a licensee or any program or portion of a
3 licensed facility if the agency determines that any condition
4 in the facility presents a threat to the public health or
5 safety.
6 (3) If the agency determines that an applicant or
7 licensee is not in compliance with this chapter or the rules
8 adopted under this chapter, the agency may deny, suspend, or
9 revoke the license or application or may suspend, revoke, or
10 impose reasonable restrictions on any portion of the license.
11 If a license is revoked, the licensee is barred from
12 submitting any application for licensure to the agency for a
13 period of 6 months following revocation.
14 (4) The agency may maintain an action in circuit court
15 to enjoin the operation of any licensed or unlicensed facility
16 in violation of this chapter or the rules adopted under this
17 chapter.
18 (5) License denial, suspension, or revocation
19 procedures shall be in accordance with chapter 120.
20 Section 29. Subsection (4) of section 395.002, Florida
21 Statutes, is repealed.
22 Section 30. Section 395.003, Florida Statutes, is
23 amended to read:
24 395.003 Licensure; issuance, renewal, denial,
25 modification, suspension, and revocation.--
26 (1)(a) The requirements of ss. 408.801-408.819 apply
27 to the provision of services that necessitate licensure
28 pursuant to ss. 395.001-395.1065 and ss.408.801-408.819 and to
29 entities licensed by or applying for such licensure from the
30 Agency for Health Care Administration pursuant to ss.
31 395.001-395.1065. No person shall establish, conduct, or
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1 maintain a hospital, ambulatory surgical center, or mobile
2 surgical facility in this state without first obtaining a
3 license under this part.
4 (2)(a)(b)1. A It is unlawful for any person may not to
5 use or advertise to the public, in any way or by any medium
6 whatsoever, any facility as a "hospital," "ambulatory surgical
7 center," or "mobile surgical facility" unless such facility
8 has first secured a license under the provisions of this part.
9 (b)2. Nothing in This part does not apply applies to
10 veterinary hospitals or to commercial business establishments
11 using the word "hospital," "ambulatory surgical center," or
12 "mobile surgical facility" as a part of a trade name if no
13 treatment of human beings is not performed on the premises of
14 such establishments.
15 (2)(a) Upon the receipt of an application for a
16 license and the license fee, the agency shall issue a license
17 if the applicant and facility have received all approvals
18 required by law and meet the requirements established under
19 this part and in rules. Such license shall include all beds
20 and services located on the premises of the facility.
21 (b) A provisional license may be issued to a new
22 facility or a facility that is in substantial compliance with
23 this part and with the rules of the agency. A provisional
24 license shall be granted for a period of no more than 1 year
25 and shall expire automatically at the end of its term. A
26 provisional license may not be renewed.
27 (c) A license, unless sooner suspended or revoked,
28 shall automatically expire 2 years from the date of issuance
29 and shall be renewable biennially upon application for renewal
30 and payment of the fee prescribed by s. 395.004(2), provided
31 the applicant and licensed facility meet the requirements
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1 established under this part and in rules. An application for
2 renewal of a license shall be made 90 days prior to expiration
3 of the license, on forms provided by the agency.
4 (3)(d) The agency shall, at the request of a licensee,
5 issue a single license to a licensee for facilities located on
6 separate premises. Such a license shall specifically state
7 the location of the facilities, the services, and the licensed
8 beds available on each separate premises. If a licensee
9 requests a single license, the licensee shall designate which
10 facility or office is responsible for receipt of information,
11 payment of fees, service of process, and all other activities
12 necessary for the agency to carry out the provisions of this
13 part.
14 (4)(e) The agency shall, at the request of a licensee
15 that is a teaching hospital as defined in s. 408.07(44), issue
16 a single license to a licensee for facilities that have been
17 previously licensed as separate premises, provided such
18 separately licensed facilities, taken together, constitute the
19 same premises as defined in s. 395.002(24). Such license for
20 the single premises shall include all of the beds, services,
21 and programs that were previously included on the licenses for
22 the separate premises. The granting of a single license under
23 this paragraph shall not in any manner reduce the number of
24 beds, services, or programs operated by the licensee.
25 (5)(f) Intensive residential treatment programs for
26 children and adolescents which have received accreditation
27 from the Joint Commission on Accreditation of Healthcare
28 Organizations and which meet the minimum standards developed
29 by rule of the agency for such programs shall be licensed by
30 the agency under this part.
31
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1 (3)(a) Each license shall be valid only for the person
2 to whom it is issued and shall not be sold, assigned, or
3 otherwise transferred, voluntarily or involuntarily. A
4 license is only valid for the premises for which it was
5 originally issued.
6 (b)1. An application for a new license is required if
7 ownership, a majority of the ownership, or controlling
8 interest of a licensed facility is transferred or assigned and
9 when a lessee agrees to undertake or provide services to the
10 extent that legal liability for operation of the facility
11 rests with the lessee. The application for a new license
12 showing such change shall be made at least 60 days prior to
13 the date of the sale, transfer, assignment, or lease.
14 (6)2. After a change of ownership has occurred, the
15 transferee shall be liable for any liability to the state,
16 regardless of when identified, resulting from changes to
17 allowable costs affecting provider reimbursement for Medicaid
18 participation or Public Medical Assistance Trust Fund
19 Assessments, and related administrative fines. The
20 transferee, simultaneously with the transfer of ownership,
21 shall pay or make arrangements to pay to the agency or the
22 department any amount owed to the agency or the department;
23 payment assurances may be in the form of an irrevocable credit
24 instrument or payment bond acceptable to the agency or the
25 department provided by or on behalf of the transferor. The
26 issuance of a license to the transferee shall be delayed
27 pending payment or until arrangement for payment acceptable to
28 the agency or the department is made.
29 (7)(4) The agency shall issue a license which
30 specifies the service categories and the number of hospital
31 beds in each bed category for which a license is received.
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1 Such information shall be listed on the face of the license.
2 All beds which are not covered by any specialty-bed-need
3 methodology shall be specified as general beds. A licensed
4 facility shall not operate a number of hospital beds greater
5 than the number indicated by the agency on the face of the
6 license without approval from the agency under conditions
7 established by rule.
8 (8)(5)(a) Adherence to patient rights, standards of
9 care, and examination and placement procedures provided under
10 part I of chapter 394 shall be a condition of licensure for
11 hospitals providing voluntary or involuntary medical or
12 psychiatric observation, evaluation, diagnosis, or treatment.
13 (b) Any hospital that provides psychiatric treatment
14 to persons under 18 years of age who have emotional
15 disturbances shall comply with the procedures pertaining to
16 the rights of patients prescribed in part I of chapter 394.
17 (9)(6) A No specialty hospital may not shall provide
18 any service or regularly serve any population group beyond
19 those services or groups specified in its license.
20 (7) Licenses shall be posted in a conspicuous place on
21 each of the licensed premises.
22 (10)(8) In addition to the requirements of ss.
23 408.801-408.819, whenever the agency finds that there has been
24 a substantial failure to comply with the requirements
25 established under this part or in rules, the agency is
26 authorized to deny, modify, suspend, or revoke:
27 (a) A license;
28 (b) That part of a license which is limited to a
29 separate premises, as designated on the license; or
30
31
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1 (c) Licensure approval limited to a facility,
2 building, or portion thereof, or a service, within a given
3 premises.
4 Section 31. Section 395.004, Florida Statutes, is
5 amended to read:
6 395.004 Application for license, Fees; expenses.--
7 (1) In accordance with s. 408.805, an applicant or
8 licensee shall pay a fee for each license application
9 submitted under this part and ss. 408.801-408.819. The amount
10 of the fee shall be established by rule An application for a
11 license or renewal thereof shall be made under oath to the
12 agency, upon forms provided by it, and shall contain such
13 information as the agency reasonably requires, which may
14 include affirmative evidence of ability to comply with
15 applicable laws and rules.
16 (2) Each application for a general hospital license,
17 specialty hospital license, ambulatory surgical center
18 license, or mobile surgical facility license, or renewal
19 thereof, shall be accompanied by a license fee, in accordance
20 with the following schedule:
21 (a) The biennial license, provisional license, and
22 license renewal fee required of a facility licensed under this
23 part shall be reasonably calculated to cover the cost of
24 regulation under this part and shall be established by rule at
25 the rate of not less than $9.50 per hospital bed, nor more
26 than $30 per hospital bed, except that the minimum license fee
27 shall be $1,500 and the total fees collected from all licensed
28 facilities may not exceed the cost of properly carrying out
29 the provisions of this part.
30 (b) Such fees shall be paid to the agency and shall be
31 deposited in the Planning and Regulation Trust Fund of the
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1 agency, which is hereby created, for the sole purpose of
2 carrying out the provisions of this part.
3 Section 32. Section 395.0055, Florida Statutes, is
4 repealed.
5 Section 33. Section 395.0161, Florida Statutes, is
6 amended to read:
7 395.0161 Licensure inspection.--
8 (1) In accordance with s. 408.811, the agency shall
9 make or cause to be made such inspections and investigations
10 as it deems necessary, including:
11 (a) Inspections directed by the Health Care Financing
12 Administration.
13 (b) Validation inspections.
14 (c) Lifesafety inspections.
15 (d) Licensure complaint investigations, including full
16 licensure investigations with a review of all licensure
17 standards as outlined in the administrative rules. Complaints
18 received by the agency from individuals, organizations, or
19 other sources are subject to review and investigation by the
20 agency.
21 (e) Emergency access complaint investigations.
22 (f) inspections of mobile surgical facilities at each
23 time a facility establishes a new location, prior to the
24 admission of patients. However, such inspections shall not be
25 required when a mobile surgical facility is moved temporarily
26 to a location where medical treatment will not be provided.
27 (2) The agency shall accept, in lieu of its own
28 periodic inspections for licensure, the survey or inspection
29 of an accrediting organization, provided the accreditation of
30 the licensed facility is not provisional and provided the
31 licensed facility authorizes release of, and the agency
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1 receives the report of, the accrediting organization. The
2 agency shall develop, and adopt by rule, criteria for
3 accepting survey reports of accrediting organizations in lieu
4 of conducting a state licensure inspection.
5 (3) In accordance with s. 408.805, an applicant or
6 licensee shall pay a fee for each license application
7 submitted under this part and ss. 408.801-408.819. The fee
8 schedule is as follows With the exception of state-operated
9 licensed facilities, each facility licensed under this part
10 shall pay to the agency, at the time of inspection, the
11 following fees:
12 (a) Inspection for licensure.--A fee shall be paid
13 which is not less than $8 per hospital bed, nor more than $12
14 per hospital bed, except that the minimum fee shall be $400
15 per facility.
16 (b) Inspection for lifesafety only.--A fee shall be
17 paid which is not less than 75 cents per hospital bed, nor
18 more than $1.50 per hospital bed, except that the minimum fee
19 shall be $40 per facility.
20 (4) The agency shall coordinate all periodic
21 inspections for licensure made by the agency to ensure that
22 the cost to the facility of such inspections and the
23 disruption of services by such inspections is minimized.
24 Section 34. Section 395.0162, Florida Statutes, is
25 repealed.
26 Section 35. Subsections (2) and (3) of section
27 395.0163, Florida Statutes, are amended to read:
28 395.0163 Construction inspections; plan submission and
29 approval; fees.--
30 (2)(a) The agency is authorized to charge an initial
31 fee of $2,000 for review of plans and construction on all
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1 projects, no part of which is refundable. The agency may also
2 collect a fee, not to exceed 1 percent of the estimated
3 construction cost or the actual cost of review, whichever is
4 less, for the portion of the review which encompasses initial
5 review through the initial revised construction document
6 review. The agency is further authorized to collect its
7 actual costs on all subsequent portions of the review and
8 construction inspections. The initial fee payment shall
9 accompany the initial submission of plans and specifications.
10 Any subsequent payment that is due is payable upon receipt of
11 the invoice from the agency.
12 (b) Notwithstanding any other provisions of law to the
13 contrary, all moneys received by the agency pursuant to the
14 provisions of this section shall be deposited in the Planning
15 and Regulation Trust Fund, as created by s. 395.004, to be
16 held and applied solely for the operations required under this
17 section.
18 (3) In accordance with s. 408.811, the agency shall
19 inspect a mobile surgical facility at initial licensure and at
20 each time the facility establishes a new location, prior to
21 admission of patients. However, such inspections shall not be
22 required when a mobile surgical facility is moved temporarily
23 to a location where medical treatment will not be provided.
24 Section 36. Section 395.0199, Florida Statutes, is
25 amended to read:
26 395.0199 Private utilization review.--
27 (1) The purpose of this section is to:
28 (a) Promote the delivery of quality health care in a
29 cost-effective manner.
30 (b) Foster greater coordination between providers and
31 health insurers performing utilization review.
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1 (c) Protect patients and insurance providers by
2 ensuring that private review agents are qualified to perform
3 utilization review activities and to make informed decisions
4 on the appropriateness of medical care.
5 (d) This section does not regulate the activities of
6 private review agents, health insurers, health maintenance
7 organizations, or hospitals, except as expressly provided
8 herein, or authorize regulation or intervention as to the
9 correctness of utilization review decisions of insurers or
10 private review agents.
11 (2) The requirements of ss. 408.801-408.819 apply to
12 the provision of services that necessitate registration or
13 licensure pursuant to this section and ss. 408.801-408.819 and
14 to persons registered by or applying for such registration
15 from the Agency for Health Care Administration pursuant to
16 this section. A private review agent conducting utilization
17 review as to health care services performed or proposed to be
18 performed in this state shall register with the agency in
19 accordance with this section.
20 (3) In accordance with s. 408.805, an applicant or
21 registrant shall pay a fee for each registration issued under
22 this part and ss. 408.801-408.819. The amount of the fee shall
23 be established by rule, Registration shall be made annually
24 with the agency on forms furnished by the agency and shall be
25 accompanied by the appropriate registration fee as set by the
26 agency. The fee shall be sufficient to pay for the
27 administrative costs of registering the agent, but may shall
28 not exceed $250. The agency may also charge reasonable fees,
29 reflecting actual costs, to persons requesting copies of
30 registration.
31
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1 (4) Each applicant for registration must comply with
2 the following requirements:
3 (a) Upon receipt of a completed, signed, and dated
4 application, the agency shall require background screening, in
5 accordance with the level 2 standards for screening set forth
6 in chapter 435, of the managing employee or other similarly
7 titled individual who is responsible for the operation of the
8 entity. The applicant must comply with the procedures for
9 level 2 background screening as set forth in chapter 435, as
10 well as the requirements of s. 435.03(3).
11 (b) The agency may require background screening of any
12 other individual who is an applicant, if the agency has
13 probable cause to believe that he or she has been convicted of
14 a crime or has committed any other offense prohibited under
15 the level 2 standards for screening set forth in chapter 435.
16 (c) Proof of compliance with the level 2 background
17 screening requirements of chapter 435 which has been submitted
18 within the previous 5 years in compliance with any other
19 health care licensure requirements of this state is acceptable
20 in fulfillment of the requirements of paragraph (a).
21 (d) A provisional registration may be granted to an
22 applicant when each individual required by this section to
23 undergo background screening has met the standards for the
24 Department of Law Enforcement background check, but the agency
25 has not yet received background screening results from the
26 Federal Bureau of Investigation, or a request for a
27 disqualification exemption has been submitted to the agency as
28 set forth in chapter 435 but a response has not yet been
29 issued. A standard registration may be granted to the
30 applicant upon the agency's receipt of a report of the results
31 of the Federal Bureau of Investigation background screening
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1 for each individual required by this section to undergo
2 background screening which confirms that all standards have
3 been met, or upon the granting of a disqualification exemption
4 by the agency as set forth in chapter 435. Any other person
5 who is required to undergo level 2 background screening may
6 serve in his or her capacity pending the agency's receipt of
7 the report from the Federal Bureau of Investigation. However,
8 the person may not continue to serve if the report indicates
9 any violation of background screening standards and a
10 disqualification exemption has not been requested of and
11 granted by the agency as set forth in chapter 435.
12 (e) Each applicant must submit to the agency, with its
13 application, a description and explanation of any exclusions,
14 permanent suspensions, or terminations of the applicant from
15 the Medicare or Medicaid programs. Proof of compliance with
16 the requirements for disclosure of ownership and control
17 interests under the Medicaid or Medicare programs shall be
18 accepted in lieu of this submission.
19 (f) Each applicant must submit to the agency a
20 description and explanation of any conviction of an offense
21 prohibited under the level 2 standards of chapter 435 by a
22 member of the board of directors of the applicant, its
23 officers, or any individual owning 5 percent or more of the
24 applicant. This requirement does not apply to a director of a
25 not-for-profit corporation or organization if the director
26 serves solely in a voluntary capacity for the corporation or
27 organization, does not regularly take part in the day-to-day
28 operational decisions of the corporation or organization,
29 receives no remuneration for his or her services on the
30 corporation or organization's board of directors, and has no
31 financial interest and has no family members with a financial
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1 interest in the corporation or organization, provided that the
2 director and the not-for-profit corporation or organization
3 include in the application a statement affirming that the
4 director's relationship to the corporation satisfies the
5 requirements of this paragraph.
6 (g) A registration may not be granted to an applicant
7 if the applicant or managing employee has been found guilty
8 of, regardless of adjudication, or has entered a plea of nolo
9 contendere or guilty to, any offense prohibited under the
10 level 2 standards for screening set forth in chapter 435,
11 unless an exemption from disqualification has been granted by
12 the agency as set forth in chapter 435.
13 (h) The agency may deny or revoke the registration if
14 any applicant:
15 1. Has falsely represented a material fact in the
16 application required by paragraph (e) or paragraph (f), or has
17 omitted any material fact from the application required by
18 paragraph (e) or paragraph (f); or
19 2. Has had prior action taken against the applicant
20 under the Medicaid or Medicare program as set forth in
21 paragraph (e).
22 (i) An application for registration renewal must
23 contain the information required under paragraphs (e) and (f).
24 (4)(5) Registration shall include the following:
25 (a) A description of the review policies and
26 procedures to be used in evaluating proposed or delivered
27 hospital care.
28 (b) The name, address, and telephone number of the
29 utilization review agent performing utilization review, who
30 shall be at least:
31
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1 1. A licensed practical nurse or licensed registered
2 nurse, or other similarly qualified medical records or health
3 care professionals, for performing initial review when
4 information is necessary from the physician or hospital to
5 determine the medical necessity or appropriateness of hospital
6 services; or
7 2. A licensed physician, or a licensed physician
8 practicing in the field of psychiatry for review of mental
9 health services, for an initial denial determination prior to
10 a final denial determination by the health insurer and which
11 shall include the written evaluation and findings of the
12 reviewing physician.
13 (c) A description of an appeal procedure for patients
14 or health care providers whose services are under review, who
15 may appeal an initial denial determination prior to a final
16 determination by the health insurer with whom the private
17 review agent has contracted. The appeal procedure shall
18 provide for review by a licensed physician, or by a licensed
19 physician practicing in the field of psychiatry for review of
20 mental health services, and shall include the written
21 evaluation and findings of the reviewing physician.
22 (d) A designation of the times when the staff of the
23 utilization review agent will be available by toll-free
24 telephone, which shall include at least 40 hours per week
25 during the normal business hours of the agent.
26 (e) An acknowledgment and agreement that any private
27 review agent which, as a general business practice, fails to
28 adhere to the policies, procedures, and representations made
29 in its application for registration shall have its
30 registration revoked.
31
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1 (f) Disclosure of any incentive payment provision or
2 quota provision which is contained in the agent's contract
3 with a health insurer and is based on reduction or denial of
4 services, reduction of length of stay, or selection of
5 treatment setting.
6 (g) Updates of any material changes to review policies
7 or procedures.
8 (6) The agency may impose fines or suspend or revoke
9 the registration of any private review agent in violation of
10 this section. Any private review agent failing to register or
11 update registration as required by this section shall be
12 deemed to be within the jurisdiction of the agency and subject
13 to an administrative penalty not to exceed $1,000. The agency
14 may bring actions to enjoin activities of private review
15 agents in violation of this section.
16 (5)(7) An No insurer may not shall knowingly contract
17 with or utilize a private review agent that which has failed
18 to register as required by this section or which has had a
19 registration revoked by the agency.
20 (6)(8) A private review agent that which operates
21 under contract with the federal or state government for
22 utilization review of patients eligible for hospital or other
23 services under Title XVIII or Title XIX of the Social Security
24 Act is exempt from the provisions of this section for services
25 provided under such contract. A private review agent that
26 which provides utilization review services to the federal or
27 state government and a private insurer shall not be exempt for
28 services provided to nonfederally funded patients. This
29 section shall not apply to persons who perform utilization
30 review services for medically necessary hospital services
31 provided to injured workers pursuant to chapter 440 and shall
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1 not apply to self-insurance funds or service companies
2 authorized pursuant to chapter 440 or part VII of chapter 626.
3 (7)(9) Facilities licensed under this chapter shall
4 promptly comply with the requests of utilization review agents
5 or insurers which are reasonably necessary to facilitate
6 prompt accomplishment of utilization review activities.
7 (8)(10) The agency shall adopt rules to implement the
8 provisions of this section.
9 Section 37. Subsection (1) of section 395.1046,
10 Florida Statutes, is amended to read:
11 395.1046 Complaint investigation procedures.--
12 (1) In accordance with s. 408.811, the agency shall
13 investigate any complaint against a hospital for any violation
14 of s. 395.1041 that the agency reasonably believes to be
15 legally sufficient. A complaint is legally sufficient if it
16 contains ultimate facts which show that a violation of this
17 chapter, or any rule adopted under this chapter by the agency,
18 has occurred. The agency may investigate, or continue to
19 investigate, and may take appropriate final action on a
20 complaint, even though the original complainant withdraws his
21 or her complaint or otherwise indicates his or her desire not
22 to cause it to be investigated to completion. When an
23 investigation of any person or facility is undertaken, the
24 agency shall notify such person in writing of the
25 investigation and inform the person or facility in writing of
26 the substance, the facts which show that a violation has
27 occurred, and the source of any complaint filed against him or
28 her. The agency may conduct an investigation without
29 notification to any person if the act under investigation is a
30 criminal offense. The agency shall have access to all records
31 necessary for the investigation of the complaint.
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1 Section 38. Subsections (1), (7), and (8) of section
2 395.1055, Florida Statutes, are amended to read:
3 395.1055 Rules and enforcement.--
4 (1) The agency shall adopt rules pursuant to ss.
5 120.536(1) and 120.54 to implement the provisions of this part
6 and ss. 408.801-408.819, which shall include reasonable and
7 fair minimum standards for ensuring that:
8 (a) Sufficient numbers and qualified types of
9 personnel and occupational disciplines are on duty and
10 available at all times to provide necessary and adequate
11 patient care and safety.
12 (b) Infection control, housekeeping, sanitary
13 conditions, and medical record procedures that will adequately
14 protect patient care and safety are established and
15 implemented.
16 (c) A comprehensive emergency management plan is
17 prepared and updated annually. Such standards must be
18 included in the rules adopted by the agency after consulting
19 with the Department of Community Affairs. At a minimum, the
20 rules must provide for plan components that address emergency
21 evacuation transportation; adequate sheltering arrangements;
22 postdisaster activities, including emergency power, food, and
23 water; postdisaster transportation; supplies; staffing;
24 emergency equipment; individual identification of residents
25 and transfer of records, and responding to family inquiries.
26 The comprehensive emergency management plan is subject to
27 review and approval by the local emergency management agency.
28 During its review, the local emergency management agency shall
29 ensure that the following agencies, at a minimum, are given
30 the opportunity to review the plan: the Department of Elderly
31 Affairs, the Department of Health, the Agency for Health Care
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1 Administration, and the Department of Community Affairs. Also,
2 appropriate volunteer organizations must be given the
3 opportunity to review the plan. The local emergency
4 management agency shall complete its review within 60 days and
5 either approve the plan or advise the facility of necessary
6 revisions.
7 (d) Licensed facilities are established, organized,
8 and operated consistent with established standards and rules.
9 (e) Licensed facility beds conform to minimum space,
10 equipment, and furnishings standards as specified by the
11 department.
12 (f) All hospitals submit such data as necessary to
13 conduct certificate-of-need reviews required under ss.
14 408.031-408.045. Such data shall include, but shall not be
15 limited to, patient origin data, hospital utilization data,
16 type of service reporting, and facility staffing data. The
17 agency shall not collect data that identifies or could
18 disclose the identity of individual patients. The agency shall
19 utilize existing uniform statewide data sources when available
20 and shall minimize reporting costs to hospitals.
21 (g) Each hospital has a quality improvement program
22 designed according to standards established by their current
23 accrediting organization. This program will enhance quality of
24 care and emphasize quality patient outcomes, corrective action
25 for problems, governing board review, and reporting to the
26 agency of standardized data elements necessary to analyze
27 quality of care outcomes. The agency shall use existing data,
28 when available, and shall not duplicate the efforts of other
29 state agencies in order to obtain such data.
30 (7) Any licensed facility which is in operation at the
31 time of promulgation of any applicable rules under this part
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1 shall be given a reasonable time, under the particular
2 circumstances, but not to exceed 1 year from the date of such
3 promulgation, within which to comply with such rules.
4 (7)(8) The agency may not adopt any rule governing the
5 design, construction, erection, alteration, modification,
6 repair, or demolition of any public or private hospital,
7 intermediate residential treatment facility, or ambulatory
8 surgical center. It is the intent of the Legislature to
9 preempt that function to the Florida Building Commission and
10 the State Fire Marshal through adoption and maintenance of the
11 Florida Building Code and the Florida Fire Prevention Code.
12 However, the agency shall provide technical assistance to the
13 commission and the State Fire Marshal in updating the
14 construction standards of the Florida Building Code and the
15 Florida Fire Prevention Code which govern hospitals,
16 intermediate residential treatment facilities, and ambulatory
17 surgical centers.
18 Section 39. Section 395.1065, Florida Statutes, is
19 amended to read:
20 395.1065 Criminal and administrative penalties;
21 injunctions; emergency orders; moratorium.--
22 (1) Any person establishing, conducting, managing, or
23 operating any facility without a license under this part is
24 guilty of a misdemeanor and, upon conviction, shall be fined
25 not more than $500 for the first offense and not more than
26 $1,000 for each subsequent offense, and each day of continuing
27 violation after conviction shall be considered a separate
28 offense.
29 (1)(2)(a) The agency may deny, revoke, or suspend a
30 license or impose an administrative fine, not to exceed $1,000
31 per violation, per day, for the violation of any provision of
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1 this part, ss.408.801-408.819, or applicable rules adopted
2 under this part. Each day of violation constitutes a separate
3 violation and is subject to a separate fine.
4 (b) In determining the amount of fine to be levied for
5 a violation, as provided in paragraph (a), the following
6 factors shall be considered:
7 1. The severity of the violation, including the
8 probability that death or serious harm to the health or safety
9 of any person will result or has resulted, the severity of the
10 actual or potential harm, and the extent to which the
11 provisions of this part were violated.
12 2. Actions taken by the licensee to correct the
13 violations or to remedy complaints.
14 3. Any previous violations of the licensee.
15 (c) All amounts collected pursuant to this section
16 shall be deposited into the Planning and Regulation Trust
17 Fund, as created by s. 395.004.
18 (c)(d) The agency may impose an administrative fine
19 for the violation of s. 641.3154 or, if sufficient claims due
20 to a provider from a health maintenance organization do not
21 exist to enable the take-back of an overpayment, as provided
22 under s. 641.3155(5), for the violation of s. 641.3155(5). The
23 administrative fine for a violation cited in this paragraph
24 shall be in the amounts specified in s. 641.52(5), and the
25 provisions of paragraph (a) do not apply.
26 (2)(3) Notwithstanding the existence or pursuit of any
27 other remedy, the agency may maintain an action in the name of
28 the state for injunction or other process to enforce the
29 provisions of this part, ss. 408.801-408.819, and applicable
30 rules promulgated hereunder.
31
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1 (4) The agency may issue an emergency order
2 immediately suspending or revoking a license when it
3 determines that any condition in the licensed facility
4 presents a clear and present danger to public health and
5 safety.
6 (5) The agency may impose an immediate moratorium on
7 elective admissions to any licensed facility, building, or
8 portion thereof, or service, when the agency determines that
9 any condition in the facility presents a threat to public
10 health or safety.
11 (3)(6) In seeking to impose penalties against a
12 facility as defined in s. 394.455 for a violation of part I of
13 chapter 394, the agency is authorized to rely on the
14 investigation and findings by the Department of Health in lieu
15 of conducting its own investigation.
16 Section 40. Subsection (1) of section 395.10973,
17 Florida Statutes, is amended to read:
18 395.10973 Powers and duties of the agency.--It is the
19 function of the agency to:
20 (1) Adopt rules pursuant to ss. 120.536(1) and 120.54
21 to implement the provisions of this part and ss.
22 408.801-408.819 conferring duties upon it.
23 Section 41. Section 395.10974, Florida Statutes, is
24 amended to read:
25 395.10974 Health care risk managers; qualifications,
26 licensure, fees.--
27 (1) The requirements of ss. 408.801-408.819 apply to
28 the provision of services that necessitate licensure pursuant
29 to ss. 395.10971-395.10976 and ss. 408.801-408.819 and to
30 entities licensed by or applying for such licensure from the
31 Agency for Health Care Administration pursuant to ss.
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1 395.10971-395.10976. Any person desiring to be licensed as a
2 health care risk manager shall submit an application on a form
3 provided by the agency. In order to qualify for licensure, the
4 applicant shall submit evidence satisfactory to the agency
5 which demonstrates the applicant's competence, by education or
6 experience, in the following areas:
7 (a) Applicable standards of health care risk
8 management.
9 (b) Applicable federal, state, and local health and
10 safety laws and rules.
11 (c) General risk management administration.
12 (d) Patient care.
13 (e) Medical care.
14 (f) Personal and social care.
15 (g) Accident prevention.
16 (h) Departmental organization and management.
17 (i) Community interrelationships.
18 (j) Medical terminology.
19
20 Each applicant for licensure must comply with all provisions
21 of ss. 408.801-408.819, with the exception of ss.
22 408.810(5)-(10), 408.811, and 408.812. The agency may require
23 such additional information, from the applicant or any other
24 person, as may be reasonably required to verify the
25 information contained in the application.
26 (2) The agency shall not grant or issue a license as a
27 health care risk manager to any individual unless from the
28 application it affirmatively appears that the applicant:
29 (a) Is 18 years of age or over;
30 (b) Is a high school graduate or equivalent; and
31
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1 (c)1. Has fulfilled the requirements of a 1-year
2 program or its equivalent in health care risk management
3 training which may be developed or approved by the agency;
4 2. Has completed 2 years of college-level studies
5 which would prepare the applicant for health care risk
6 management, to be further defined by rule; or
7 3. Has obtained 1 year of practical experience in
8 health care risk management.
9 (3) The agency shall issue a license to practice
10 health care risk management to any applicant who qualifies
11 under this section. In accordance with s. 408.805, an
12 applicant or licensee shall pay a fee for each license
13 application submitted under this part and ss. 408.801-408.819.
14 The amount of the fees shall be established by rule, as
15 follows: and submits an application fee of not more than $75,
16 a background-screening fingerprinting fee of not more than
17 $75, and a license fee of not more than $100. The agency shall
18 by rule establish fees and procedures for the issuance and
19 cancellation of licenses.
20 (4) The agency shall renew a health care risk manager
21 license upon receipt of a biennial renewal application and
22 fees. The agency shall by rule establish a procedure for the
23 biennial renewal of licenses.
24 Section 42. Section 395.10975, Florida Statutes, is
25 amended to read:
26 395.10975 Grounds for denial, suspension, or
27 revocation of a health care risk manager's license;
28 administrative fine.--
29 (1) The agency may, in its discretion, deny, suspend,
30 revoke, or refuse to renew or continue the license of any
31 health care risk manager or applicant, if it finds that as to
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1 such applicant or licensee any one or more of the following
2 grounds exist:
3 (a) Any cause for which issuance of the license could
4 have been refused had it then existed and been known to the
5 agency.
6 (b) Giving false or forged evidence to the agency for
7 the purpose of obtaining a license.
8 (c) Having been found guilty of, or having pleaded
9 guilty or nolo contendere to, a crime in this state or any
10 other state relating to the practice of risk management or the
11 ability to practice risk management, whether or not a judgment
12 or conviction has been entered.
13 (d) Having been found guilty of, or having pleaded
14 guilty or nolo contendere to, a felony, or a crime involving
15 moral turpitude punishable by imprisonment of 1 year or more
16 under the law of the United States, under the law of any
17 state, or under the law of any other country, without regard
18 to whether a judgment of conviction has been entered by the
19 court having jurisdiction of such cases.
20 (a)(e) Making or filing a report or record which the
21 licensee knows to be false; or intentionally failing to file a
22 report or record required by state or federal law; or
23 willfully impeding or obstructing, or inducing another person
24 to impede or obstruct, the filing of a report or record
25 required by state or federal law. Such reports or records
26 shall include only those which are signed in the capacity of a
27 licensed health care risk manager.
28 (b)(f) Fraud or deceit, negligence, incompetence, or
29 misconduct in the practice of health care risk management.
30
31
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1 (c)(g) Violation of any provision of this part or any
2 other law applicable to the business of health care risk
3 management.
4 (d)(h) Violation of any lawful order or rule of the
5 agency or failure to comply with a lawful subpoena issued by
6 the department.
7 (e)(i) Practicing with a revoked or suspended health
8 care risk manager license.
9 (f)(j) Repeatedly acting in a manner inconsistent with
10 the health and safety of the patients of the licensed facility
11 in which the licensee is the health care risk manager.
12 (g)(k) Being unable to practice health care risk
13 management with reasonable skill and safety to patients by
14 reason of illness; drunkenness; or use of drugs, narcotics,
15 chemicals, or any other material or substance or as a result
16 of any mental or physical condition. Any person affected
17 under this paragraph shall have the opportunity, at reasonable
18 intervals, to demonstrate that he or she can resume the
19 competent practices of health care risk manager with
20 reasonable skill and safety to patients.
21 (h)(l) Willfully permitting unauthorized disclosure of
22 information relating to a patient or a patient's records.
23 (i)(m) Discriminating in respect to patients,
24 employees, or staff on account of race, religion, color, sex,
25 or national origin.
26 (2) If the agency finds that one or more of the
27 grounds set forth in subsection (1) exist, it may, in lieu of
28 or in addition to denial suspension or revocation, enter an
29 order imposing one or more of the following penalties:
30 (a) Imposition of an administrative fine not to exceed
31 $2,500 for each count or separate offense.
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1 (b) Issuance of a reprimand.
2 (c) Placement of the licensee on probation for a
3 period of time and subject to such conditions as the agency
4 may specify, including requiring the licensee to attend
5 continuing education courses or to work under the supervision
6 of another licensee.
7 (3) The agency may reissue the license of a
8 disciplined licensee in accordance with the provisions of this
9 part.
10 Section 43. Subsections (5) and (20) of section
11 400.021, Florida Statutes, are repealed.
12 Section 44. Subsection (3) of section 400.022, Florida
13 Statutes, is amended to read:
14 400.022 Residents' rights.--
15 (3) Any violation of the resident's rights set forth
16 in this section shall constitute grounds for action by the
17 agency under the provisions of s. 400.102, s. 400.121, or ss.
18 408.801-408.819. In order to determine whether the licensee
19 is adequately protecting residents' rights, the licensure
20 annual inspection of the facility shall include private
21 informal conversations with a sample of residents to discuss
22 residents' experiences within the facility with respect to
23 rights specified in this section and general compliance with
24 standards, and consultation with the ombudsman council in the
25 local planning and service area of the Department of Elderly
26 Affairs in which the nursing home is located.
27 Section 45. Paragraph (b) of subsection (1) of section
28 400.051, Florida Statutes, is amended to read:
29 400.051 Homes or institutions exempt from the
30 provisions of this part.--
31
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1 (1) The following shall be exempt from the provisions
2 of this part:
3 (b) Any hospital, as defined in s. 395.002 s.
4 395.002(11), that is licensed under chapter 395.
5 Section 46. Section 400.062, Florida Statutes, is
6 amended to read:
7 400.062 License required; fee; disposition; display;
8 transfer.--
9 (1) The requirements of ss. 408.801-408.819 apply to
10 the provision of services that necessitate licensure pursuant
11 to this part and ss. 408.801-408.819 and to entities licensed
12 by or applying for such licensure from the Agency for Health
13 Care Administration pursuant to this part. It is unlawful to
14 operate or maintain a facility without first obtaining from
15 the agency a license authorizing such operation.
16 (2) Separate licenses shall be required for facilities
17 maintained in separate premises, even though operated under
18 the same management. However, a separate license shall not be
19 required for separate buildings on the same grounds.
20 (3) In accordance with s. 408.805, an applicant or
21 licensee shall pay a fee for each license application
22 submitted under this part and ss. 408.801-408.819. The annual
23 license fee required for each license issued under this part
24 shall be comprised of two parts. Part I of the license fee
25 shall be the basic license fee. The rate per bed for the basic
26 license fee shall be established biennially annually and shall
27 be $100 $50 per bed unless modified by rule. The agency may
28 adjust the per bed licensure fees by the Consumer Price Index
29 based on the 12 months immediately preceding the increase to
30 cover the cost of regulation under this part. Part II of the
31 license fee shall be the resident protection fee, which shall
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1 be at the rate of not less than 50 25 cents per bed. The rate
2 per bed shall be the minimum rate per bed, and such rate shall
3 remain in effect until the effective date of a rate per bed
4 adopted by rule by the agency pursuant to this part. At such
5 time as the amount on deposit in the Resident Protection Trust
6 Fund is less than $1 million, the agency may adopt rules to
7 establish a rate which may not exceed $20 $10 per bed. The
8 rate per bed shall revert back to the minimum rate per bed
9 when the amount on deposit in the Resident Protection Trust
10 Fund reaches $1 million, except that any rate established by
11 rule shall remain in effect until such time as the rate has
12 been equally required for each license issued under this part.
13 Any amount in the fund in excess of $2 million shall revert to
14 the Health Care Trust Fund and may not be expended without
15 prior approval of the Legislature. The agency may prorate the
16 biennial annual license fee for those licenses which it issues
17 under this part for less than 2 years 1 year. Funds generated
18 by license fees collected in accordance with this section
19 shall be deposited in the following manner:
20 (a) The basic license fee collected shall be deposited
21 in the Health Care Trust Fund, established for the sole
22 purpose of carrying out this part. When the balance of the
23 account established in the Health Care Trust Fund for the
24 deposit of fees collected as authorized under this section
25 exceeds one-third of the annual cost of regulation under this
26 part, the excess shall be used to reduce the licensure fees in
27 the next year.
28 (b) The resident protection fee collected shall be
29 deposited in the Resident Protection Trust Fund for the sole
30 purpose of paying, in accordance with the provisions of s.
31 400.063, for the appropriate alternate placement, care, and
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1 treatment of a resident removed from a nursing home facility
2 on a temporary, emergency basis or for the maintenance and
3 care of residents in a nursing home facility pending removal
4 and alternate placement.
5 (4) Counties or municipalities applying for licenses
6 under this part are exempt from license fees authorized under
7 this section.
8 (5) The license shall be displayed in a conspicuous
9 place inside the facility.
10 (6) A license shall be valid only in the hands of the
11 individual, firm, partnership, association, or corporation to
12 whom it is issued and shall not be subject to sale,
13 assignment, or other transfer, voluntary or involuntary, nor
14 shall a license be valid for any premises other than those for
15 which originally issued.
16 Section 47. Subsection (1) of section 400.063, Florida
17 Statutes, is amended to read:
18 400.063 Resident Protection Trust Fund.--
19 (1) A Resident Protection Trust Fund shall be
20 established for the purpose of collecting and disbursing funds
21 generated from the license fees and administrative fines as
22 provided for in ss. 393.0673(2), 400.062(3) 400.062(3)(b),
23 400.111(1), 400.121(2), and 400.23(8). Such funds shall be
24 for the sole purpose of paying for the appropriate alternate
25 placement, care, and treatment of residents who are removed
26 from a facility licensed under this part or a facility
27 specified in s. 393.0678(1) in which the agency determines
28 that existing conditions or practices constitute an immediate
29 danger to the health, safety, or security of the residents.
30 If the agency determines that it is in the best interest of
31 the health, safety, or security of the residents to provide
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1 for an orderly removal of the residents from the facility, the
2 agency may utilize such funds to maintain and care for the
3 residents in the facility pending removal and alternative
4 placement. The maintenance and care of the residents shall be
5 under the direction and control of a receiver appointed
6 pursuant to s. 393.0678(1) or s. 400.126(1). However, funds
7 may be expended in an emergency upon a filing of a petition
8 for a receiver, upon the declaration of a state of local
9 emergency pursuant to s. 252.38(3)(a)5., or upon a duly
10 authorized local order of evacuation of a facility by
11 emergency personnel to protect the health and safety of the
12 residents.
13 Section 48. Section 400.071, Florida Statutes, is
14 amended to read:
15 400.071 Application for license.--
16 (1) An application for a license as required by s.
17 400.062 shall be made to the agency on forms furnished by it
18 and shall be accompanied by the appropriate license fee.
19 (1)(2) The application shall be under oath and shall
20 contain the following:
21 (a) The name, address, and social security number of
22 the applicant if an individual; if the applicant is a firm,
23 partnership, or association, its name, address, and employer
24 identification number (EIN), and the name and address of any
25 controlling interest; and the name by which the facility is to
26 be known.
27 (b) The name of any person whose name is required on
28 the application under the provisions of paragraph (a) and who
29 owns at least a 10-percent interest in any professional
30 service, firm, association, partnership, or corporation
31 providing goods, leases, or services to the facility for which
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1 the application is made, and the name and address of the
2 professional service, firm, association, partnership, or
3 corporation in which such interest is held.
4 (c) The location of the facility for which a license
5 is sought and an indication, as in the original application,
6 that such location conforms to the local zoning ordinances.
7 (d) The name of the person or persons under whose
8 management or supervision the facility will be conducted and
9 the name of the administrator.
10 (a)(e) A signed affidavit disclosing any financial or
11 ownership interest that a controlling interest, as defined in
12 s. 408.803, person or entity described in paragraph (a) or
13 paragraph (d) has held in the last 5 years in any entity
14 licensed by this state or any other state to provide health or
15 residential care which has closed voluntarily or
16 involuntarily; has filed for bankruptcy; has had a receiver
17 appointed; has had a license denied, suspended, or revoked; or
18 has had an injunction issued against it which was initiated by
19 a regulatory agency. The affidavit must disclose the reason
20 any such entity was closed, whether voluntarily or
21 involuntarily.
22 (b)(f) The total number of beds and the total number
23 of Medicare and Medicaid certified beds.
24 (c)(g) Information relating to the number, experience,
25 and training of the employees of the facility and of the moral
26 character of the applicant and employees which the agency
27 requires by rule, including the name and address of any
28 nursing home with which the applicant or employees have been
29 affiliated through ownership or employment within 5 years of
30 the date of the application for a license and the record of
31 any criminal convictions involving the applicant and any
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1 criminal convictions involving an employee if known by the
2 applicant after inquiring of the employee. The applicant must
3 demonstrate that sufficient numbers of qualified staff, by
4 training or experience, will be employed to properly care for
5 the type and number of residents who will reside in the
6 facility.
7 (d)(h) Copies of any civil verdict or judgment
8 involving the applicant rendered within the 10 years preceding
9 the application, relating to medical negligence, violation of
10 residents' rights, or wrongful death. As a condition of
11 licensure, the licensee agrees to provide to the agency copies
12 of any new verdict or judgment involving the applicant,
13 relating to such matters, within 30 days after filing with the
14 clerk of the court. The information required in this
15 paragraph shall be maintained in the facility's licensure file
16 and in an agency database which is available as a public
17 record.
18 (3) The applicant shall submit evidence which
19 establishes the good moral character of the applicant,
20 manager, supervisor, and administrator. No applicant, if the
21 applicant is an individual; no member of a board of directors
22 or officer of an applicant, if the applicant is a firm,
23 partnership, association, or corporation; and no licensed
24 nursing home administrator shall have been convicted, or found
25 guilty, regardless of adjudication, of a crime in any
26 jurisdiction which affects or may potentially affect residents
27 in the facility.
28 (4) Each applicant for licensure must comply with the
29 following requirements:
30 (a) Upon receipt of a completed, signed, and dated
31 application, the agency shall require background screening of
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1 the applicant, in accordance with the level 2 standards for
2 screening set forth in chapter 435. As used in this
3 subsection, the term "applicant" means the facility
4 administrator, or similarly titled individual who is
5 responsible for the day-to-day operation of the licensed
6 facility, and the facility financial officer, or similarly
7 titled individual who is responsible for the financial
8 operation of the licensed facility.
9 (b) The agency may require background screening for a
10 member of the board of directors of the licensee or an officer
11 or an individual owning 5 percent or more of the licensee if
12 the agency has probable cause to believe that such individual
13 has been convicted of an offense prohibited under the level 2
14 standards for screening set forth in chapter 435.
15 (c) Proof of compliance with the level 2 background
16 screening requirements of chapter 435 which has been submitted
17 within the previous 5 years in compliance with any other
18 health care or assisted living licensure requirements of this
19 state is acceptable in fulfillment of paragraph (a). Proof of
20 compliance with background screening which has been submitted
21 within the previous 5 years to fulfill the requirements of the
22 Financial Services Commission and the Office of Insurance
23 Regulation pursuant to chapter 651 as part of an application
24 for a certificate of authority to operate a continuing care
25 retirement community is acceptable in fulfillment of the
26 Department of Law Enforcement and Federal Bureau of
27 Investigation background check.
28 (d) A provisional license may be granted to an
29 applicant when each individual required by this section to
30 undergo background screening has met the standards for the
31 Department of Law Enforcement background check, but the agency
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1 has not yet received background screening results from the
2 Federal Bureau of Investigation, or a request for a
3 disqualification exemption has been submitted to the agency as
4 set forth in chapter 435, but a response has not yet been
5 issued. A license may be granted to the applicant upon the
6 agency's receipt of a report of the results of the Federal
7 Bureau of Investigation background screening for each
8 individual required by this section to undergo background
9 screening which confirms that all standards have been met, or
10 upon the granting of a disqualification exemption by the
11 agency as set forth in chapter 435. Any other person who is
12 required to undergo level 2 background screening may serve in
13 his or her capacity pending the agency's receipt of the report
14 from the Federal Bureau of Investigation; however, the person
15 may not continue to serve if the report indicates any
16 violation of background screening standards and a
17 disqualification exemption has not been requested of and
18 granted by the agency as set forth in chapter 435.
19 (e) Each applicant must submit to the agency, with its
20 application, a description and explanation of any exclusions,
21 permanent suspensions, or terminations of the applicant from
22 the Medicare or Medicaid programs. Proof of compliance with
23 disclosure of ownership and control interest requirements of
24 the Medicaid or Medicare programs shall be accepted in lieu of
25 this submission.
26 (f) Each applicant must submit to the agency a
27 description and explanation of any conviction of an offense
28 prohibited under the level 2 standards of chapter 435 by a
29 member of the board of directors of the applicant, its
30 officers, or any individual owning 5 percent or more of the
31 applicant. This requirement shall not apply to a director of a
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1 not-for-profit corporation or organization if the director
2 serves solely in a voluntary capacity for the corporation or
3 organization, does not regularly take part in the day-to-day
4 operational decisions of the corporation or organization,
5 receives no remuneration for his or her services on the
6 corporation or organization's board of directors, and has no
7 financial interest and has no family members with a financial
8 interest in the corporation or organization, provided that the
9 director and the not-for-profit corporation or organization
10 include in the application a statement affirming that the
11 director's relationship to the corporation satisfies the
12 requirements of this paragraph.
13 (g) An application for license renewal must contain
14 the information required under paragraphs (e) and (f).
15 (5) The applicant shall furnish satisfactory proof of
16 financial ability to operate and conduct the nursing home in
17 accordance with the requirements of this part and all rules
18 adopted under this part, and the agency shall establish
19 standards for this purpose, including information reported
20 under paragraph (2)(e). The agency also shall establish
21 documentation requirements, to be completed by each applicant,
22 that show anticipated facility revenues and expenditures, the
23 basis for financing the anticipated cash-flow requirements of
24 the facility, and an applicant's access to contingency
25 financing.
26 (2)(6) If the applicant offers continuing care
27 agreements as defined in chapter 651, proof shall be furnished
28 that such applicant has obtained a certificate of authority as
29 required for operation under that chapter.
30 (3)(7) As a condition of licensure, each licensee,
31 except one offering continuing care agreements as defined in
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1 chapter 651, must agree to accept recipients of Title XIX of
2 the Social Security Act on a temporary, emergency basis. The
3 persons whom the agency may require such licensees to accept
4 are those recipients of Title XIX of the Social Security Act
5 who are residing in a facility in which existing conditions
6 constitute an immediate danger to the health, safety, or
7 security of the residents of the facility.
8 (4)(8) The agency may not issue a license to a nursing
9 home that fails to receive a certificate of need under the
10 provisions of ss. 408.031-408.045. It is the intent of the
11 Legislature that, in reviewing a certificate-of-need
12 application to add beds to an existing nursing home facility,
13 preference be given to the application of a licensee who has
14 been awarded a Gold Seal as provided for in s. 400.235, if the
15 applicant otherwise meets the review criteria specified in s.
16 408.035.
17 (5)(9) The agency may develop an abbreviated survey
18 for licensure renewal applicable to a licensee that has
19 continuously operated as a nursing facility since 1991 or
20 earlier, has operated under the same management for at least
21 the preceding 30 months, and has had during the preceding 30
22 months no class I or class II deficiencies.
23 (6)(10) The agency may issue an inactive license to a
24 nursing home that will be temporarily unable to provide
25 services but that is reasonably expected to resume services.
26 Such designation may be made for a period not to exceed 12
27 months but may be renewed by the agency for up to 6 additional
28 months upon demonstration by the licensee of the facility's
29 progress toward reopening. Any request by a licensee that a
30 nursing home become inactive or extend the inactive period
31 must be submitted to the agency, accompanied by appropriate
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1 licensure fees, and approved by the agency prior to initiating
2 any suspension of service or notifying residents. The agency
3 may not accept a request for an inactive license if the
4 facility has initiated any suspension of services, notified
5 residents, or initiated closure of the facility. Upon agency
6 approval, the nursing home shall notify residents of any
7 necessary discharge or transfer as provided in s. 400.0255.
8 The end of the inactive period is the licensure expiration
9 date and all licensure fees must be current, paid in full, and
10 may be prorated. Reactivation of an inactive license requires
11 the approval of a renewal application, including payment of
12 licensure fees and inspections by the agency which indicate
13 that all requirements of this part, ss. 408.801-408.819, and
14 applicable rules have been met.
15 (7)(11) As a condition of licensure, each facility
16 must establish and submit with its application a plan for
17 quality assurance and for conducting risk management.
18 (12) The applicant must provide the agency with proof
19 of a legal right to occupy the property before a license may
20 be issued. Proof may include, but is not limited to, copies of
21 warranty deeds, lease or rental agreements, contracts for
22 deeds, or quitclaim deeds.
23 Section 49. Section 400.102, Florida Statutes, is
24 amended to read:
25 400.102 Action by agency against licensee; grounds.--
26 (1) Any of the following conditions shall be grounds
27 for action by the agency against a licensee:
28 (a) An intentional or negligent act materially
29 affecting the health or safety of residents of the facility;
30 (1)(b) Misappropriation or conversion of the property
31 of a resident of the facility;
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1 (2)(c) Failure to follow the criteria and procedures
2 provided under part I of chapter 394 relating to the
3 transportation, voluntary admission, and involuntary
4 examination of a nursing home resident or;
5 (d) Violation of provisions of this part or rules
6 adopted under this part;
7 (3)(e) Fraudulent altering, defacing, or falsifying
8 any medical or nursing home records, or causing or procuring
9 any of these offenses to be committed. ; or
10 (f) Any act constituting a ground upon which
11 application for a license may be denied.
12 (2) If the agency has reasonable belief that any of
13 such conditions exist, it shall take the following action:
14 (a) In the case of an applicant for original
15 licensure, denial action as provided in s. 400.121.
16 (b) In the case of an applicant for relicensure or a
17 current licensee, administrative action as provided in s.
18 400.121 or injunctive action as authorized by s. 400.125.
19 (c) In the case of a facility operating without a
20 license, injunctive action as authorized in s. 400.125.
21 Section 50. Section 400.111, Florida Statutes, is
22 amended to read:
23 400.111 Renewal Expiration of license; renewal.--
24 (1) A license issued for the operation of a facility,
25 unless sooner suspended or revoked, shall expire on the date
26 set forth by the agency on the face of the license or 1 year
27 from the date of issuance, whichever occurs first. Ninety
28 days prior to the expiration date, an application for renewal
29 shall be submitted to the agency. A license shall be renewed
30 upon the filing of an application on forms furnished by the
31 agency if the applicant has first met the requirements
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1 established under this part and all rules adopted under this
2 part. The failure to file an application within the period
3 established in this subsection shall result in a late fee
4 charged to the licensee by the agency in an amount equal to 50
5 percent of the fee in effect on the last preceding regular
6 renewal date. A late fee shall be levied for each and every
7 day the filing of the license application is delayed, but in
8 no event shall such fine aggregate more than $5,000. If an
9 application is received after the required filing date and
10 exhibits a hand-canceled postmark obtained from a United
11 States Post Office dated on or before the required filing
12 date, no fine will be levied.
13 (2) A licensee against whom a revocation or suspension
14 proceeding, or any judicial proceeding instituted by the
15 agency under this part, is pending at the time of license
16 renewal may be issued a temporary license effective until
17 final disposition by the agency of such proceeding. If
18 judicial relief is sought from the aforesaid administrative
19 order, the court having jurisdiction may issue such orders
20 regarding the issuance of a temporary permit during the
21 pendency of the judicial proceeding.
22 (3) The agency may not renew a license if the
23 applicant has failed to pay any fines assessed by final order
24 of the agency or final order of the Health Care Financing
25 Administration under requirements for federal certification.
26 The agency may renew the license of an applicant following the
27 assessment of a fine by final order if such fine has been paid
28 into an escrow account pending an appeal of a final order.
29 (4) In addition to the requirements of ss.
30 408.801-408.819, the licensee shall submit a signed affidavit
31 disclosing any financial or ownership interest that a
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1 controlling interest licensee has held within the last 5 years
2 in any entity licensed by the state or any other state to
3 provide health or residential care which entity has closed
4 voluntarily or involuntarily; has filed for bankruptcy; has
5 had a receiver appointed; has had a license denied, suspended,
6 or revoked; or has had an injunction issued against it which
7 was initiated by a regulatory agency. The affidavit must
8 disclose the reason such entity was closed, whether
9 voluntarily or involuntarily.
10 Section 51. Subsections (2) and (5) of section
11 400.1183, Florida Statutes, are amended to read:
12 400.1183 Resident grievance procedures.--
13 (2) Each facility shall maintain records of all
14 grievances and shall report annually to the agency at the time
15 of relicensure the total number of grievances handled, a
16 categorization of the cases underlying the grievances, and the
17 final disposition of the grievances.
18 (5) The agency may impose an administrative fine, in
19 accordance with s. 400.121, against a nursing home facility
20 for noncompliance with this section.
21 Section 52. Section 400.121, Florida Statutes, is
22 amended to read:
23 400.121 Denial, suspension, revocation of license;
24 moratorium on admissions; Administrative fines; procedure;
25 order to increase staffing.--
26 (1) The agency may deny an application, revoke or
27 suspend a license, or impose an administrative fine, not to
28 exceed $500 per violation per day, against any applicant or
29 licensee for the following violations by the applicant,
30 licensee, or other controlling interest:
31 (a) A violation of any provision of s. 400.102(1);
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1 (b) A violation of any provision of this part, ss.
2 408.801-408.819, or applicable rule; or A demonstrated pattern
3 of deficient practice;
4 (c) Failure to pay any outstanding fines assessed by
5 final order of the agency or final order of the Health Care
6 Financing Administration pursuant to requirements for federal
7 certification. The agency may renew or approve the license of
8 an applicant following the assessment of a fine by final order
9 if such fine has been paid into an escrow account pending an
10 appeal of a final order;
11 (d) Exclusion from the Medicare or Medicaid program;
12 or
13 (b)(e) An adverse action by a regulatory agency
14 against any other licensed facility that has a common
15 controlling interest with the licensee or applicant against
16 whom the action under this section is being brought. If the
17 adverse action involves solely the management company, the
18 applicant or licensee shall be given 30 days to remedy before
19 final action is taken. If the adverse action is based solely
20 upon actions by a controlling interest, the applicant or
21 licensee may present factors in mitigation of any proposed
22 penalty based upon a showing that such penalty is
23 inappropriate under the circumstances.
24
25 All hearings shall be held within the county in which the
26 licensee or applicant operates or applies for a license to
27 operate a facility as defined herein.
28 (2) Except as provided in s. 400.23(8), a $500 fine
29 shall be imposed for each violation. Each day a violation of
30 this part occurs constitutes a separate violation and is
31 subject to a separate fine, but in no event may any fine
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1 aggregate more than $5,000. A fine may be levied pursuant to
2 this section in lieu of and notwithstanding the provisions of
3 s. 400.23. Fines paid shall be deposited in the Resident
4 Protection Trust Fund and expended as provided in s. 400.063.
5 (3) The agency shall revoke or deny a nursing home
6 license if the licensee or controlling interest operates a
7 facility in this state that:
8 (a) Has had two moratoria imposed by final order for
9 substandard quality of care, as defined by 42 C.F.R. part 483,
10 within any 30-month period;
11 (b) Is conditionally licensed for 180 or more
12 continuous days;
13 (c) Is cited for two class I deficiencies arising from
14 unrelated circumstances during the same survey or
15 investigation; or
16 (d) Is cited for two class I deficiencies arising from
17 separate surveys or investigations within a 30-month period.
18
19 The licensee may present factors in mitigation of revocation,
20 and the agency may make a determination not to revoke a
21 license based upon a showing that revocation is inappropriate
22 under the circumstances.
23 (4) The agency may issue an order immediately
24 suspending or revoking a license when it determines that any
25 condition in the facility presents a danger to the health,
26 safety, or welfare of the residents in the facility.
27 (5)(a) The agency may impose an immediate moratorium
28 on admissions to any facility when the agency determines that
29 any condition in the facility presents a threat to the health,
30 safety, or welfare of the residents in the facility.
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1 (4)(b) Where the agency has placed a moratorium on
2 admissions on any facility two times within a 7-year period,
3 the agency may revoke suspend the license of the nursing home
4 and the facility's management company, if any. During the
5 suspension, the agency shall take the facility into
6 receivership and shall operate the facility.
7 (5)(6) An action taken by the agency to deny, suspend,
8 or revoke a facility's license under this part shall be heard
9 by the Division of Administrative Hearings of the Department
10 of Management Services within 60 days after the assignment of
11 an administrative law judge, unless the time limitation is
12 waived by both parties. The administrative law judge must
13 render a decision within 30 days after receipt of a proposed
14 recommended order.
15 (6)(7) The agency is authorized to require a facility
16 to increase staffing beyond the minimum required by law, if
17 the agency has taken administrative action against the
18 facility for care-related deficiencies directly attributable
19 to insufficient staff. Under such circumstances, the facility
20 may request an expedited interim rate increase. The agency
21 shall process the request within 10 days after receipt of all
22 required documentation from the facility. A facility that
23 fails to maintain the required increased staffing is subject
24 to a fine of $500 per day for each day the staffing is below
25 the level required by the agency.
26 (8) An administrative proceeding challenging an action
27 taken by the agency pursuant to this section shall be reviewed
28 on the basis of the facts and conditions that resulted in such
29 agency action.
30 (7)(9) Notwithstanding any other provision of law to
31 the contrary, agency action in an administrative proceeding
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1 under this section may be overcome by the licensee upon a
2 showing by a preponderance of the evidence to the contrary.
3 (8)(10) In addition to any other sanction imposed
4 under this part, in any final order that imposes sanctions,
5 the agency may assess costs related to the investigation and
6 prosecution of the case. Payment of agency costs shall be
7 deposited into the Health Care Trust Fund.
8 Section 53. Section 400.125, Florida Statutes, is
9 repealed.
10 Section 54. Subsections (14), (15), (16), and (20) of
11 section 400.141, Florida Statutes, are amended to read:
12 400.141 Administration and management of nursing home
13 facilities.--Every licensed facility shall comply with all
14 applicable standards and rules of the agency and shall:
15 (14) Submit to the agency the information specified in
16 s. 400.071(1)(a) s. 400.071(2)(e) for a management company
17 within 30 days after the effective date of the management
18 agreement.
19 (15)(a) At the end of each calendar quarter, submit
20 semiannually to the agency, or more frequently if requested by
21 the agency, information regarding facility staff-to-resident
22 ratios, staff turnover, and staff stability, including
23 information regarding certified nursing assistants, licensed
24 nurses, the director of nursing, and the facility
25 administrator. For purposes of this reporting:
26 1.(a) Staff-to-resident ratios must be reported in the
27 categories specified in s. 400.23(3)(a) and applicable rules.
28 The ratio must be reported as an average for the most recent
29 calendar quarter.
30 2.(b) Staff turnover must be reported for the most
31 recent 12-month period ending on the last workday of the most
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1 recent calendar quarter prior to the date the information is
2 submitted. The turnover rate must be computed quarterly, with
3 the annual rate being the cumulative sum of the quarterly
4 rates. The turnover rate is the total number of terminations
5 or separations experienced during the quarter, excluding any
6 employee terminated during a probationary period of 3 months
7 or less, divided by the total number of staff employed at the
8 end of the period for which the rate is computed, and
9 expressed as a percentage.
10 3.(c) The formula for determining staff stability is
11 the total number of employees that have been employed for more
12 than 12 months, divided by the total number of employees
13 employed at the end of the most recent calendar quarter, and
14 expressed as a percentage.
15 (b)(d) A nursing facility that has failed to comply
16 with state minimum-staffing requirements for 2 consecutive
17 days is prohibited from accepting new admissions until the
18 facility has achieved the minimum-staffing requirements for a
19 period of 6 consecutive days. For the purposes of this
20 paragraph, any person who was a resident of the facility and
21 was absent from the facility for the purpose of receiving
22 medical care at a separate location or was on a leave of
23 absence is not considered a new admission. Failure to impose
24 such an admissions moratorium constitutes a class II
25 deficiency.
26 (c)(e) A nursing facility that which does not have a
27 conditional license may be cited for failure to comply with
28 the standards in s. 400.23(3)(a) only if it has failed to meet
29 those standards on 2 consecutive days or if it has failed to
30 meet at least 97 percent of those standards on any one day.
31
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1 (d)(f) A facility that which has a conditional license
2 must be in compliance with the standards in s. 400.23(3)(a) at
3 all times from the effective date of the conditional license
4 until the effective date of a subsequent standard license.
5
6 Nothing in this section shall limit the agency's ability to
7 impose a deficiency or take other actions if a facility does
8 not have enough staff to meet the residents' needs.
9 (16) Report monthly the number of vacant beds in the
10 facility which are available for resident occupancy on the
11 last day of the month information is reported.
12 (20) Maintain general and professional liability
13 insurance coverage in accordance with ss. 408.801-408.819
14 which that is in force at all times. In lieu of general and
15 professional liability insurance coverage, a state-designated
16 teaching nursing home and its affiliated assisted living
17 facilities created under s. 430.80 may demonstrate proof of
18 financial responsibility as provided in s. 430.80(3)(h); the
19 exception provided in this paragraph shall expire July 1,
20 2005.
21
22 Facilities that have been awarded a Gold Seal under the
23 program established in s. 400.235 may develop a plan to
24 provide certified nursing assistant training as prescribed by
25 federal regulations and state rules and may apply to the
26 agency for approval of their program.
27 Section 55. Subsections (4) and (5) of section 400.17,
28 Florida Statutes, are amended to read:
29 400.17 Bribes, kickbacks, certain solicitations
30 prohibited.--
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1 (4) Solicitation of contributions of any kind in a
2 threatening, coercive, or unduly forceful manner by or on
3 behalf of a nursing home by any agent, employee, owner, or
4 representative of a nursing home shall be grounds for denial,
5 suspension, or revocation of the license for any nursing home
6 on behalf of which such contributions were solicited.
7 (5) The admission, maintenance, or treatment of a
8 nursing home resident whose care is supported in whole or in
9 part by state funds may not be made conditional upon the
10 receipt of any manner of contribution or donation from any
11 person. However, this may not be construed to prohibit the
12 offer or receipt of contributions or donations to a nursing
13 home which are not related to the care of a specific resident.
14 Contributions solicited or received in violation of this
15 subsection shall be grounds for denial, suspension, or
16 revocation of a license for any nursing home on behalf of
17 which such contributions were solicited.
18 Section 56. Section 400.179, Florida Statutes, is
19 amended to read:
20 400.179 Sale or transfer of ownership of a nursing
21 facility; Liability for Medicaid underpayments and
22 overpayments.--
23 (1) It is the intent of the Legislature to protect the
24 rights of nursing home residents and the security of public
25 funds when a nursing facility is sold or the ownership is
26 transferred.
27 (2) Whenever a nursing facility is sold or the
28 ownership is transferred, including leasing, the transferee
29 shall make application to the agency for a new license at
30 least 90 days prior to the date of transfer of ownership.
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1 (3) The transferor shall notify the agency in writing
2 at least 90 days prior to the date of transfer of ownership.
3 The transferor shall be responsible and liable for the lawful
4 operation of the nursing facility and the welfare of the
5 residents domiciled in the facility until the date the
6 transferee is licensed by the agency. The transferor shall be
7 liable for any and all penalties imposed against the facility
8 for violations occurring prior to the date of transfer of
9 ownership.
10 (4) The transferor shall, prior to transfer of
11 ownership, repay or make arrangements to repay to the agency
12 or the Department of Children and Family Services any amounts
13 owed to the agency or the department. Should the transferor
14 fail to repay or make arrangements to repay the amounts owed
15 to the agency or the department prior to the transfer of
16 ownership, the issuance of a license to the transferee shall
17 be delayed until repayment or until arrangements for repayment
18 are made.
19 (2)(5) Because any transfer of a nursing facility may
20 expose the fact that Medicaid may have underpaid or overpaid
21 the transferor, and because in most instances, any such
22 underpayment or overpayment can only be determined following a
23 formal field audit, the liabilities for any such underpayments
24 or overpayments shall be as follows:
25 (a) The Medicaid program shall be liable to the
26 transferor for any underpayments owed during the transferor's
27 period of operation of the facility.
28 (b) Without regard to whether the transferor had
29 leased or owned the nursing facility, the transferor shall
30 remain liable to the Medicaid program for all Medicaid
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1 overpayments received during the transferor's period of
2 operation of the facility, regardless of when determined.
3 (c) Where the facility transfer takes any form of a
4 sale of assets, in addition to the transferor's continuing
5 liability for any such overpayments, if the transferor fails
6 to meet these obligations, the transferee shall be liable for
7 all liabilities that can be readily identifiable 90 days in
8 advance of the transfer. Such liability shall continue in
9 succession until the debt is ultimately paid or otherwise
10 resolved. It shall be the burden of the transferee to
11 determine the amount of all such readily identifiable
12 overpayments from the Agency for Health Care Administration,
13 and the agency shall cooperate in every way with the
14 identification of such amounts. Readily identifiable
15 overpayments shall include overpayments that will result from,
16 but not be limited to:
17 1. Medicaid rate changes or adjustments;
18 2. Any depreciation recapture;
19 3. Any recapture of fair rental value system indexing;
20 or
21 4. Audits completed by the agency.
22
23 The transferor shall remain liable for any such Medicaid
24 overpayments that were not readily identifiable 90 days in
25 advance of the nursing facility transfer.
26 (d) Where the transfer involves a facility that has
27 been leased by the transferor:
28 1. The transferee shall, as a condition to being
29 issued a license by the agency, acquire, maintain, and provide
30 proof to the agency of a bond with a term of 30 months,
31 renewable annually, in an amount not less than the total of 3
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1 months Medicaid payments to the facility computed on the basis
2 of the preceding 12-month average Medicaid payments to the
3 facility.
4 2. A leasehold licensee may meet the requirements of
5 subparagraph 1. by payment of a nonrefundable fee, paid at
6 initial licensure, paid at the time of any subsequent change
7 of ownership, and paid at the time of any subsequent change of
8 ownership, and paid annually thereafter at the time of any
9 subsequent annual license renewal, in the amount of 2 percent
10 of the total of 3 months' Medicaid payments to the facility
11 computed on the basis of the preceding 12-month average
12 Medicaid payments to the facility. If a preceding 12-month
13 average is not available, projected Medicaid payments may be
14 used. The fee shall be deposited into the Health Care Trust
15 Fund and shall be accounted for separately as a Medicaid
16 nursing home overpayment account. These fees shall be used at
17 the sole discretion of the agency to repay nursing home
18 Medicaid overpayments. Payment of this fee shall not release
19 the licensee from any liability for any Medicaid overpayments,
20 nor shall payment bar the agency from seeking to recoup
21 overpayments from the licensee and any other liable party. As
22 a condition of exercising this lease bond alternative,
23 licensees paying this fee must maintain an existing lease bond
24 through the end of the 30-month term period of that bond. The
25 agency is herein granted specific authority to promulgate all
26 rules pertaining to the administration and management of this
27 account, including withdrawals from the account, subject to
28 federal review and approval. This provision shall take effect
29 upon becoming law and shall apply to any leasehold license
30 application.
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1 a. The financial viability of the Medicaid nursing
2 home overpayment account shall be determined by the agency
3 through annual review of the account balance and the amount of
4 total outstanding, unpaid Medicaid overpayments owing from
5 leasehold licensees to the agency as determined by final
6 agency audits.
7 b. The agency, in consultation with the Florida Health
8 Care Association and the Florida Association of Homes for the
9 Aging, shall study and make recommendations on the minimum
10 amount to be held in reserve to protect against Medicaid
11 overpayments to leasehold licensees and on the issue of
12 successor liability for Medicaid overpayments upon sale or
13 transfer of ownership of a nursing facility. The agency shall
14 submit the findings and recommendations of the study to the
15 Governor, the President of the Senate, and the Speaker of the
16 House of Representatives by January 1, 2003.
17 3. The leasehold licensee may meet the bond
18 requirement through other arrangements acceptable to the
19 agency. The agency is herein granted specific authority to
20 promulgate rules pertaining to lease bond arrangements.
21 4. All existing nursing facility licensees, operating
22 the facility as a leasehold, shall acquire, maintain, and
23 provide proof to the agency of the 30-month bond required in
24 subparagraph 1., above, on and after July 1, 1993, for each
25 license renewal.
26 5. It shall be the responsibility of all nursing
27 facility operators, operating the facility as a leasehold, to
28 renew the 30-month bond and to provide proof of such renewal
29 to the agency annually at the time of application for license
30 renewal.
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1 6. Any failure of the nursing facility licensee
2 operator to acquire, maintain, renew annually, or provide
3 proof to the agency shall be grounds for the agency to deny
4 or, cancel, revoke, or suspend the facility license to operate
5 such facility and to take any further action, including, but
6 not limited to, enjoining the facility, asserting a moratorium
7 pursuant to ss. 408.801-408.819, or applying for a receiver,
8 deemed necessary to ensure compliance with this section and to
9 safeguard and protect the health, safety, and welfare of the
10 facility's residents. A lease agreement required as a
11 condition of bond financing or refinancing under s. 154.213 by
12 a health facilities authority or required under s. 159.30 by a
13 county or municipality is not a leasehold for purposes of this
14 paragraph and is not subject to the bond requirement of this
15 paragraph.
16 Section 57. Subsections (1) and (4) of section 400.18,
17 Florida Statutes, are amended to read:
18 400.18 Closing of nursing facility.--
19 (1) Whenever a licensee voluntarily discontinues
20 operation, and during the period when it is preparing for such
21 discontinuance, it shall inform the agency not less than 90
22 days prior to the discontinuance of operation. The licensee
23 also shall inform the resident or the next of kin, legal
24 representative, or agency acting on behalf of the resident of
25 the fact, and the proposed time, of such discontinuance of
26 operation and give at least 90 days' notice so that suitable
27 arrangements may be made for the transfer and care of the
28 resident. In the event any resident has no such person to
29 represent him or her, the licensee shall be responsible for
30 securing a suitable transfer of the resident before the
31 discontinuance of operation. The agency shall be responsible
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1 for arranging for the transfer of those residents requiring
2 transfer who are receiving assistance under the Medicaid
3 program.
4 (4) Immediately upon discontinuance of operation of a
5 facility, the licensee shall surrender the license therefor to
6 the agency, and the license shall be canceled.
7 Section 58. Subsections (1), (2), and (3) of section
8 400.19, Florida Statutes, are amended to read:
9 400.19 Right of entry and inspection.--
10 (1) In accordance with ss. 408.801-408.819, the agency
11 and any duly designated officer or employee thereof or a
12 member of the State Long-Term Care Ombudsman Council or the
13 local long-term care ombudsman council shall have the right to
14 enter upon and into the premises of any facility licensed
15 pursuant to this part, or any distinct nursing home unit of a
16 hospital licensed under chapter 395 or any freestanding
17 facility licensed under chapter 395 that provides extended
18 care or other long-term care services, at any reasonable time
19 in order to determine the state of compliance with the
20 provisions of this part and rules in force pursuant thereto.
21 The right of entry and inspection shall also extend to any
22 premises which the agency has reason to believe is being
23 operated or maintained as a facility without a license, but no
24 such entry or inspection of any premises shall be made without
25 the permission of the owner or person in charge thereof,
26 unless a warrant is first obtained from the circuit court
27 authorizing same. Any application for a facility license or
28 renewal thereof, made pursuant to this part, shall constitute
29 permission for and complete acquiescence in any entry or
30 inspection of the premises for which the license is sought, in
31 order to facilitate verification of the information submitted
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1 on or in connection with the application; to discover,
2 investigate, and determine the existence of abuse or neglect;
3 or to elicit, receive, respond to, and resolve complaints. The
4 agency shall, within 60 days after receipt of a complaint made
5 by a resident or resident's representative, complete its
6 investigation and provide to the complainant its findings and
7 resolution.
8 (2) The agency shall coordinate nursing home facility
9 licensing activities and responsibilities of any duly
10 designated officer or employee involved in nursing home
11 facility inspection to assure necessary, equitable, and
12 consistent supervision of inspection personnel without
13 unnecessary duplication of inspections, consultation services,
14 or complaint investigations. To facilitate such coordination,
15 all rules promulgated by the agency pursuant to this part
16 shall be distributed to nursing homes licensed under s.
17 400.062 30 days prior to implementation. This requirement
18 does not apply to emergency rules.
19 (3) The agency shall every 15 months conduct at least
20 one unannounced inspection to determine compliance by the
21 licensee with statutes, and with rules promulgated under the
22 provisions of those statutes, governing minimum standards of
23 construction, quality and adequacy of care, and rights of
24 residents. The survey shall be conducted every 6 months for
25 the next 2-year period if the facility has been cited for a
26 class I deficiency, has been cited for two or more class II
27 deficiencies arising from separate surveys or investigations
28 within a 60-day period, or has had three or more substantiated
29 complaints within a 6-month period, each resulting in at least
30 one class I or class II deficiency. In addition to any other
31 fees or fines in this part, the agency shall assess a fine for
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1 each facility that is subject to the 6-month survey cycle. The
2 fine for the 2-year period shall be $6,000, one-half to be
3 paid at the completion of each survey. The agency may adjust
4 this fine by the change in the Consumer Price Index, based on
5 the 12 months immediately preceding the increase, to cover the
6 cost of the additional surveys. The agency shall verify
7 through subsequent inspection that any deficiency identified
8 during the annual inspection is corrected. However, the
9 agency may verify the correction of a class III or class IV
10 deficiency unrelated to resident rights or resident care
11 without reinspecting the facility if adequate written
12 documentation has been received from the facility, which
13 provides assurance that the deficiency has been corrected. The
14 giving or causing to be given of advance notice of such
15 unannounced inspections by an employee of the agency to any
16 unauthorized person shall constitute cause for suspension of
17 not fewer than 5 working days according to the provisions of
18 chapter 110.
19 Section 59. Section 400.191, Florida Statutes, is
20 amended to read:
21 400.191 Availability, distribution, and posting of
22 reports and records.--
23 (1) The agency shall provide information to the public
24 about all of the licensed nursing home facilities operating in
25 the state. The agency shall, within 60 days after an annual
26 inspection visit or within 30 days after any interim visit to
27 a facility, send copies of the inspection reports to the local
28 long-term care ombudsman council, the agency's local office,
29 and a public library or the county seat for the county in
30 which the facility is located. The agency may provide
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1 electronic access to inspection reports as a substitute for
2 sending copies.
3 (2) The agency shall publish the Guide to Nursing
4 Homes in Florida provide additional information in
5 consumer-friendly printed and electronic formats to assist
6 consumers and their families in comparing and evaluating
7 nursing home facilities.
8 (a) The agency shall provide an Internet site which
9 shall include at least the following information either
10 directly or indirectly through a link to another established
11 site or sites of the agency's choosing:
12 1. A list by name and address of all nursing home
13 facilities in this state, including any prior name a facility
14 was known by during the previous 12-month period.
15 2. Whether such nursing home facilities are
16 proprietary or nonproprietary.
17 3. The current owner of the facility's license and the
18 year that that entity became the owner of the license.
19 4. The name of the owner or owners of each facility
20 and whether the facility is affiliated with a company or other
21 organization owning or managing more than one nursing facility
22 in this state.
23 5. The total number of beds in each facility and the
24 most recently available occupancy levels.
25 6. The number of private and semiprivate rooms in each
26 facility.
27 7. The religious affiliation, if any, of each
28 facility.
29 8. The languages spoken by the administrator and staff
30 of each facility.
31
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1 9. Whether or not each facility accepts Medicare or
2 Medicaid recipients or insurance, health maintenance
3 organization, Veterans Administration, CHAMPUS program, or
4 workers' compensation coverage.
5 10. Recreational and other programs available at each
6 facility.
7 11. Special care units or programs offered at each
8 facility.
9 12. Whether the facility is a part of a retirement
10 community that offers other services pursuant to part III,
11 part IV, or part V.
12 13. Survey and deficiency information contained on the
13 Online Survey Certification and Reporting (OSCAR) system of
14 the federal Centers for Medicare and Medicaid Services Health
15 Care Financing Administration, including recertification
16 annual survey, revisit, and complaint survey information, for
17 each facility for the past 30 45 months. For noncertified
18 nursing homes, state survey and deficiency information,
19 including licensure annual survey, revisit, and complaint
20 survey information for the past 30 45 months shall be
21 provided.
22 14. A summary of the Online Survey Certification and
23 Reporting (OSCAR) data for each facility over the past 30 45
24 months. Such summary may include a score, rating, or
25 comparison ranking with respect to other facilities based on
26 the number of citations received by the facility of
27 recertification annual, revisit, and complaint surveys; the
28 severity and scope of the citations; and the number of annual
29 recertification surveys the facility has had during the past
30 30 45 months. The score, rating, or comparison ranking may be
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1 presented in either numeric or symbolic form for the intended
2 consumer audience.
3 (b) The agency shall provide the following information
4 in printed form:
5 1. A list by name and address of all nursing home
6 facilities in this state.
7 2. Whether such nursing home facilities are
8 proprietary or nonproprietary.
9 3. The current owner or owners of the facility's
10 license and the year that entity became the owner of the
11 license.
12 4. The total number of beds, and of private and
13 semiprivate rooms, in each facility.
14 5. The religious affiliation, if any, of each
15 facility.
16 6. The name of the owner of each facility and whether
17 the facility is affiliated with a company or other
18 organization owning or managing more than one nursing facility
19 in this state.
20 7. The languages spoken by the administrator and staff
21 of each facility.
22 8. Whether or not each facility accepts Medicare or
23 Medicaid recipients or insurance, health maintenance
24 organization, Veterans Administration, CHAMPUS program, or
25 workers' compensation coverage.
26 9. Recreational programs, special care units, and
27 other programs available at each facility.
28 10. The Internet address for the site where more
29 detailed information can be seen.
30
31
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1 11. A statement advising consumers that each facility
2 will have its own policies and procedures related to
3 protecting resident property.
4 12. A summary of the Online Survey Certification and
5 Reporting (OSCAR) data for each facility over the past 30 45
6 months. Such summary may include a score, rating, or
7 comparison ranking with respect to other facilities based on
8 the number of citations received by the facility on
9 recertification annual, revisit, and complaint surveys; the
10 severity and scope of the citations; the number of citations;
11 and the number of annual recertification surveys the facility
12 has had during the past 30 45 months. The score, rating, or
13 comparison ranking may be presented in either numeric or
14 symbolic form for the intended consumer audience.
15 (c) For purposes of this subsection, references to the
16 Online Survey Certification and Reporting (OSCAR) system shall
17 refer to any future system that the Centers for Medicare and
18 Medicaid Services Health Care Financing Administration
19 develops to replace the current OSCAR system.
20 (d) The agency may provide the following additional
21 information on an Internet site or in printed form as the
22 information becomes available:
23 1. The licensure status history of each facility.
24 2. The rating history of each facility.
25 3. The regulatory history of each facility, which may
26 include federal sanctions, state sanctions, federal fines,
27 state fines, and other actions.
28 4. Whether the facility currently possesses the Gold
29 Seal designation awarded pursuant to s. 400.235.
30 5. Internet links to the Internet sites of the
31 facilities or their affiliates.
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1 (3) Each nursing home facility licensee shall maintain
2 as public information, available upon request, records of all
3 cost and inspection reports pertaining to that facility that
4 have been filed with, or issued by, any governmental agency.
5 Copies of such reports shall be retained in such records for
6 not less than 5 years from the date the reports are filed or
7 issued.
8 (a) The agency shall quarterly publish in the Guide to
9 Nursing Homes in Florida a "Nursing Home Guide Watch List" to
10 assist consumers in evaluating the quality of nursing home
11 care in Florida. The watch list must identify each facility
12 that met the criteria for a conditional licensure status on
13 any day within the quarter covered by the list and each
14 facility that was operating under bankruptcy protection on any
15 day within the quarter. The watch list must include, but is
16 not limited to, the facility's name, address, and ownership;
17 the county in which the facility operates; the license
18 expiration date; the number of licensed beds; a description of
19 the deficiency causing the facility to be placed on the list;
20 any corrective action taken; and the cumulative number of days
21 times the facility had a conditional license since the initial
22 publication of the has been on a watch list. The watch list
23 must include a brief description regarding how to choose a
24 nursing home, the categories of licensure, the agency's
25 inspection process, an explanation of terms used in the watch
26 list, and the addresses and phone numbers of the agency's
27 managed care and health quality assurance field area offices.
28 (b) Upon publication of each quarterly Guide to
29 Nursing Homes in Florida watch list, the agency must transmit
30 a copy of all pages listing the facility the watch list to
31
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1 each nursing home facility by mail and must make the watch
2 list available on the agency's Internet website.
3 (4) Any records of a nursing home facility determined
4 by the agency to be necessary and essential to establish
5 lawful compliance with any rules or standards shall be made
6 available to the agency on the premises of the facility and
7 submitted to the agency. Each facility must submit this
8 information electronically when electronic transmission to the
9 agency is available.
10 (5) Every nursing home facility licensee shall:
11 (a) Post, in a sufficient number of prominent
12 positions in the nursing home so as to be accessible to all
13 residents and to the general public:
14 1. A concise summary of the last inspection report
15 pertaining to the nursing home and issued by the agency, with
16 references to the page numbers of the full reports, noting any
17 deficiencies found by the agency and the actions taken by the
18 licensee to rectify such deficiencies and indicating in such
19 summaries where the full reports may be inspected in the
20 nursing home.
21 2. A copy of the most recent version of all pages
22 listing the facility in the Guide to Nursing Homes in Florida
23 the Florida Nursing Home Guide Watch List.
24 (b) Upon request, provide to any person who has
25 completed a written application with an intent to be admitted
26 to, or to any resident of, such nursing home, or to any
27 relative, spouse, or guardian of such person, a copy of the
28 last inspection report pertaining to the nursing home and
29 issued by the agency, provided the person requesting the
30 report agrees to pay a reasonable charge to cover copying
31 costs.
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1 (6) The agency may adopt rules as necessary to
2 administer this section.
3 Section 60. Section 400.20, Florida Statutes, is
4 amended to read:
5 400.20 Licensed nursing home administrator
6 required.--A No nursing home may not shall operate except
7 under the supervision of a licensed nursing home
8 administrator, and a no person may not shall be a nursing home
9 administrator unless he or she holds is the holder of a
10 current license as provided in chapter 468. A change of the
11 nursing home administrator must be reported to the agency
12 within 30 days.
13 Section 61. Subsection (4) of section 400.211, Florida
14 Statutes, is amended to read:
15 400.211 Persons employed as nursing assistants;
16 certification requirement.--
17 (4) When employed by a nursing home facility for a
18 12-month period or longer, a nursing assistant, to maintain
19 certification, shall submit to a performance review every 12
20 months and must receive regular inservice education based on
21 the outcome of such reviews. The inservice training must:
22 (a) Be sufficient to ensure the continuing competence
23 of nursing assistants and be in accordance with s. 464.203(7),
24 must be at least 18 hours per year, and may include hours
25 accrued under s. 464.203(8);
26 (b) Include, at a minimum:
27 1. Techniques for assisting with eating and proper
28 feeding;
29 2. Principles of adequate nutrition and hydration;
30
31
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1 3. Techniques for assisting and responding to the
2 cognitively impaired resident or the resident with difficult
3 behaviors;
4 4. Techniques for caring for the resident at the
5 end-of-life; and
6 5. Recognizing changes that place a resident at risk
7 for pressure ulcers and falls; and
8 (c) Address areas of weakness as determined in nursing
9 assistant performance reviews and may address the special
10 needs of residents as determined by the nursing home facility
11 staff.
12
13 Costs associated with this training may not be reimbursed from
14 additional Medicaid funding through interim rate adjustments.
15 Section 62. Subsections (2), (7), and (8) of section
16 400.23, Florida Statutes, are amended to read:
17 400.23 Rules; evaluation and deficiencies; licensure
18 status.--
19 (2) Pursuant to the intention of the Legislature, the
20 agency, in consultation with the Department of Health and the
21 Department of Elderly Affairs, shall adopt and enforce rules
22 to implement this part and ss. 408.801-408.819, which shall
23 include reasonable and fair criteria in relation to:
24 (a) The location of the facility and housing
25 conditions that will ensure the health, safety, and comfort of
26 residents, including an adequate call system. In making such
27 rules, the agency shall be guided by criteria recommended by
28 nationally recognized reputable professional groups and
29 associations with knowledge of such subject matters. The
30 agency shall update or revise such criteria as the need
31 arises. The agency may require alterations to a building if it
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1 determines that an existing condition constitutes a distinct
2 hazard to life, health, or safety. In performing any
3 inspections of facilities authorized by this part, the agency
4 may enforce the special-occupancy provisions of the Florida
5 Building Code and the Florida Fire Prevention Code which apply
6 to nursing homes. The agency is directed to provide assistance
7 to the Florida Building Commission in updating the
8 construction standards of the code relative to nursing homes.
9 (b) The number and qualifications of all personnel,
10 including management, medical, nursing, and other professional
11 personnel, and nursing assistants, orderlies, and support
12 personnel, having responsibility for any part of the care
13 given residents.
14 (c) All sanitary conditions within the facility and
15 its surroundings, including water supply, sewage disposal,
16 food handling, and general hygiene which will ensure the
17 health and comfort of residents.
18 (d) The equipment essential to the health and welfare
19 of the residents.
20 (e) A uniform accounting system.
21 (f) The care, treatment, and maintenance of residents
22 and measurement of the quality and adequacy thereof, based on
23 rules developed under this chapter and the Omnibus Budget
24 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
25 1987), Title IV (Medicare, Medicaid, and Other Health-Related
26 Programs), Subtitle C (Nursing Home Reform), as amended.
27 (g) The preparation and annual update of a
28 comprehensive emergency management plan. The agency shall
29 adopt rules establishing minimum criteria for the plan after
30 consultation with the Department of Community Affairs. At a
31 minimum, the rules must provide for plan components that
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1 address emergency evacuation transportation; adequate
2 sheltering arrangements; postdisaster activities, including
3 emergency power, food, and water; postdisaster transportation;
4 supplies; staffing; emergency equipment; individual
5 identification of residents and transfer of records; and
6 responding to family inquiries. The comprehensive emergency
7 management plan is subject to review and approval by the local
8 emergency management agency. During its review, the local
9 emergency management agency shall ensure that the following
10 agencies, at a minimum, are given the opportunity to review
11 the plan: the Department of Elderly Affairs, the Department
12 of Health, the Agency for Health Care Administration, and the
13 Department of Community Affairs. Also, appropriate volunteer
14 organizations must be given the opportunity to review the
15 plan. The local emergency management agency shall complete
16 its review within 60 days and either approve the plan or
17 advise the facility of necessary revisions.
18 (h) The availability, distribution, and posting of
19 reports and records pursuant to s. 400.191 and the Gold Seal
20 Program pursuant to s. 400.235.
21 (7) The agency shall, at least every 15 months,
22 evaluate all nursing home facilities and make a determination
23 as to the degree of compliance by each licensee with the
24 established rules adopted under this part as a basis for
25 assigning a licensure status to that facility. The agency
26 shall base its evaluation on the most recent inspection
27 report, taking into consideration findings from other official
28 reports, surveys, interviews, investigations, and inspections.
29 The agency shall assign a licensure status of standard or
30 conditional to each nursing home.
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1 (a) A standard licensure status means that a facility
2 has no class I or class II deficiencies and has corrected all
3 class III deficiencies within the time established by the
4 agency.
5 (b) A conditional licensure status means that a
6 facility, due to the presence of one or more class I or class
7 II deficiencies, or class III deficiencies not corrected
8 within the time established by the agency, is not in
9 substantial compliance at the time of the survey with criteria
10 established under this part or with rules adopted by the
11 agency. If the facility has no class I, class II, or class
12 III deficiencies at the time of the followup survey, a
13 standard licensure status may be assigned.
14 (c) In evaluating the overall quality of care and
15 services and determining whether the facility will receive a
16 conditional or standard license, the agency shall consider the
17 needs and limitations of residents in the facility and the
18 results of interviews and surveys of a representative sampling
19 of residents, families of residents, ombudsman council members
20 in the planning and service area in which the facility is
21 located, guardians of residents, and staff of the nursing home
22 facility.
23 (d) The current licensure status of each facility must
24 be indicated in bold print on the face of the license. A list
25 of the deficiencies of the facility shall be posted in a
26 prominent place that is in clear and unobstructed public view
27 at or near the place where residents are being admitted to
28 that facility. Licensees receiving a conditional licensure
29 status for a facility shall prepare, within 10 working days
30 after receiving notice of deficiencies, a plan for correction
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1 of all deficiencies and shall submit the plan to the agency
2 for approval.
3 (e) Each licensee shall post its license in a
4 prominent place that is in clear and unobstructed public view
5 at or near the place where residents are being admitted to the
6 facility.
7 (e)(f) The agency shall adopt rules that:
8 1. Establish uniform procedures for the evaluation of
9 facilities.
10 2. Provide criteria in the areas referenced in
11 paragraph (c).
12 3. Address other areas necessary for carrying out the
13 intent of this section.
14 (8) The agency shall adopt rules pursuant to this part
15 and ss. 408.801-408.819 to provide that, when the criteria
16 established under subsection (2) are not met, such
17 deficiencies shall be classified according to the nature and
18 the scope of the deficiency. The scope shall be cited as
19 isolated, patterned, or widespread. An isolated deficiency is
20 a deficiency affecting one or a very limited number of
21 residents, or involving one or a very limited number of staff,
22 or a situation that occurred only occasionally or in a very
23 limited number of locations. A patterned deficiency is a
24 deficiency where more than a very limited number of residents
25 are affected, or more than a very limited number of staff are
26 involved, or the situation has occurred in several locations,
27 or the same resident or residents have been affected by
28 repeated occurrences of the same deficient practice but the
29 effect of the deficient practice is not found to be pervasive
30 throughout the facility. A widespread deficiency is a
31 deficiency in which the problems causing the deficiency are
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1 pervasive in the facility or represent systemic failure that
2 has affected or has the potential to affect a large portion of
3 the facility's residents. The agency shall indicate the
4 classification on the face of the notice of deficiencies as
5 follows:
6 (a) A class I deficiency is a deficiency that the
7 agency determines presents a situation in which immediate
8 corrective action is necessary because the facility's
9 noncompliance has caused, or is likely to cause, serious
10 injury, harm, impairment, or death to a resident receiving
11 care in a facility. The condition or practice constituting a
12 class I violation shall be abated or eliminated immediately,
13 unless a fixed period of time, as determined by the agency, is
14 required for correction. A class I deficiency is subject to a
15 civil penalty of $10,000 for an isolated deficiency, $12,500
16 for a patterned deficiency, and $15,000 for a widespread
17 deficiency. The fine amount shall be doubled for each
18 deficiency if the facility was previously cited for one or
19 more class I or class II deficiencies during the last
20 licensure annual inspection or any inspection or complaint
21 investigation since the last licensure annual inspection. A
22 fine must be levied notwithstanding the correction of the
23 deficiency.
24 (b) A class II deficiency is a deficiency that the
25 agency determines has compromised the resident's ability to
26 maintain or reach his or her highest practicable physical,
27 mental, and psychosocial well-being, as defined by an accurate
28 and comprehensive resident assessment, plan of care, and
29 provision of services. A class II deficiency is subject to a
30 civil penalty of $2,500 for an isolated deficiency, $5,000 for
31 a patterned deficiency, and $7,500 for a widespread
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1 deficiency. The fine amount shall be doubled for each
2 deficiency if the facility was previously cited for one or
3 more class I or class II deficiencies during the last
4 licensure annual inspection or any inspection or complaint
5 investigation since the last licensure annual inspection. A
6 fine shall be levied notwithstanding the correction of the
7 deficiency.
8 (c) A class III deficiency is a deficiency that the
9 agency determines will result in no more than minimal
10 physical, mental, or psychosocial discomfort to the resident
11 or has the potential to compromise the resident's ability to
12 maintain or reach his or her highest practical physical,
13 mental, or psychosocial well-being, as defined by an accurate
14 and comprehensive resident assessment, plan of care, and
15 provision of services. A class III deficiency is subject to a
16 civil penalty of $1,000 for an isolated deficiency, $2,000 for
17 a patterned deficiency, and $3,000 for a widespread
18 deficiency. The fine amount shall be doubled for each
19 deficiency if the facility was previously cited for one or
20 more class I or class II deficiencies during the last
21 licensure annual inspection or any inspection or complaint
22 investigation since the last licensure annual inspection. A
23 citation for a class III deficiency must specify the time
24 within which the deficiency is required to be corrected. If a
25 class III deficiency is corrected within the time specified,
26 no civil penalty shall be imposed.
27 (d) A class IV deficiency is a deficiency that the
28 agency determines has the potential for causing no more than a
29 minor negative impact on the resident. If the class IV
30 deficiency is isolated, no plan of correction is required.
31
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1 Section 63. Subsections (1) and (2) of section
2 400.241, Florida Statutes, are repealed.
3 Section 64. Subsection (5) of section 400.402, Florida
4 Statutes, is repealed and present subsections (12), (14), and
5 (17) of that section are redesignated as subsections (11),
6 (13), and (16), respectively, and amended to read:
7 400.402 Definitions.--When used in this part, the
8 term:
9 (5) "Applicant" means an individual owner,
10 corporation, partnership, firm, association, or governmental
11 entity that applies for a license.
12 (11)(12) "Extended congregate care" means acts beyond
13 those authorized in subsection (16) (17) that may be performed
14 pursuant to part I of chapter 464 by persons licensed
15 thereunder while carrying out their professional duties, and
16 other supportive services which may be specified by rule. The
17 purpose of such services is to enable residents to age in
18 place in a residential environment despite mental or physical
19 limitations that might otherwise disqualify them from
20 residency in a facility licensed under this part.
21 (13)(14) "Limited nursing services" means acts that
22 may be performed pursuant to part I of chapter 464 by persons
23 licensed thereunder while carrying out their professional
24 duties but limited to those acts which the agency department
25 specifies by rule. Acts which may be specified by rule as
26 allowable limited nursing services shall be for persons who
27 meet the admission criteria established by the agency
28 department for assisted living facilities and shall not be
29 complex enough to require 24-hour nursing supervision and may
30 include such services as the application and care of routine
31 dressings, and care of casts, braces, and splints.
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1 (16)(17) "Personal services" means direct physical
2 assistance with or supervision of the activities of daily
3 living and the self-administration of medication and other
4 similar services which the agency department may define by
5 rule. "Personal services" shall not be construed to mean the
6 provision of medical, nursing, dental, or mental health
7 services.
8 Section 65. Section 400.407, Florida Statutes, is
9 amended to read:
10 400.407 License required; fee, display.--
11 (1) The requirements of ss. 408.801-408.819 apply to
12 the provision of services that necessitate licensure pursuant
13 this part and ss. 408.801-408.819 and to entities licensed by
14 or applying for such licensure from the Agency for Health Care
15 Administration pursuant to this part. A license issued by the
16 agency is required for an assisted living facility operating
17 in this state.
18 (2) Separate licenses shall be required for facilities
19 maintained in separate premises, even though operated under
20 the same management. A separate license shall not be required
21 for separate buildings on the same grounds.
22 (3) In addition to the requirements of s. 408.806,
23 each any license granted by the agency must state the maximum
24 resident capacity of the facility, the type of care for which
25 the license is granted, the date the license is issued, the
26 expiration date of the license, and any other information
27 deemed necessary by the agency. Licenses shall be issued for
28 one or more of the following categories of care: standard,
29 extended congregate care, limited nursing services, or limited
30 mental health.
31
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1 (a) A standard license shall be issued to facilities
2 providing one or more of the personal services identified in
3 s. 400.402. Such facilities may also employ or contract with a
4 person licensed under part I of chapter 464 to administer
5 medications and perform other tasks as specified in s.
6 400.4255.
7 (b) An extended congregate care license shall be
8 issued to facilities providing, directly or through contract,
9 services beyond those authorized in paragraph (a), including
10 acts performed pursuant to part I of chapter 464 by persons
11 licensed thereunder, and supportive services defined by rule
12 to persons who otherwise would be disqualified from continued
13 residence in a facility licensed under this part.
14 1. In order for extended congregate care services to
15 be provided in a facility licensed under this part, the agency
16 must first determine that all requirements established in law
17 and rule are met and must specifically designate, on the
18 facility's license, that such services may be provided and
19 whether the designation applies to all or part of a facility.
20 Such designation may be made at the time of initial licensure
21 or relicensure, or upon request in writing by a licensee under
22 this part pursuant to s. 408.806. Notification of approval or
23 denial of such request shall be made in accordance with ss.
24 408.801-408.819 within 90 days after receipt of such request
25 and all necessary documentation. Existing facilities
26 qualifying to provide extended congregate care services must
27 have maintained a standard license and may not have been
28 subject to administrative sanctions during the previous 2
29 years, or since initial licensure if the facility has been
30 licensed for less than 2 years, for any of the following
31 reasons:
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1 a. A class I or class II violation;
2 b. Three or more repeat or recurring class III
3 violations of identical or similar resident care standards as
4 specified in rule from which a pattern of noncompliance is
5 found by the agency;
6 c. Three or more class III violations that were not
7 corrected in accordance with the corrective action plan
8 approved by the agency;
9 d. Violation of resident care standards resulting in a
10 requirement to employ the services of a consultant pharmacist
11 or consultant dietitian;
12 e. Denial, suspension, or revocation of a license for
13 another facility under this part in which the applicant for an
14 extended congregate care license has at least 25 percent
15 ownership interest; or
16 f. Imposition of a moratorium on admissions or
17 initiation of injunctive proceedings.
18 2. Facilities that are licensed to provide extended
19 congregate care services shall maintain a written progress
20 report on each person who receives such services, which report
21 describes the type, amount, duration, scope, and outcome of
22 services that are rendered and the general status of the
23 resident's health. A registered nurse, or appropriate
24 designee, representing the agency shall visit such facilities
25 at least quarterly to monitor residents who are receiving
26 extended congregate care services and to determine if the
27 facility is in compliance with this part, ss. 408.801-408.819,
28 and with rules that relate to extended congregate care. One of
29 these visits may be in conjunction with the regular survey.
30 The monitoring visits may be provided through contractual
31 arrangements with appropriate community agencies. A
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1 registered nurse shall serve as part of the team that inspects
2 such facility. The agency may waive one of the required yearly
3 monitoring visits for a facility that has been licensed for at
4 least 24 months to provide extended congregate care services,
5 if, during the inspection, the registered nurse determines
6 that extended congregate care services are being provided
7 appropriately, and if the facility has no class I or class II
8 violations and no uncorrected class III violations. Before
9 such decision is made, the agency shall consult with the
10 long-term care ombudsman council for the area in which the
11 facility is located to determine if any complaints have been
12 made and substantiated about the quality of services or care.
13 The agency may not waive one of the required yearly monitoring
14 visits if complaints have been made and substantiated.
15 3. Facilities that are licensed to provide extended
16 congregate care services shall:
17 a. Demonstrate the capability to meet unanticipated
18 resident service needs.
19 b. Offer a physical environment that promotes a
20 homelike setting, provides for resident privacy, promotes
21 resident independence, and allows sufficient congregate space
22 as defined by rule.
23 c. Have sufficient staff available, taking into
24 account the physical plant and firesafety features of the
25 building, to assist with the evacuation of residents in an
26 emergency, as necessary.
27 d. Adopt and follow policies and procedures that
28 maximize resident independence, dignity, choice, and
29 decisionmaking to permit residents to age in place to the
30 extent possible, so that moves due to changes in functional
31 status are minimized or avoided.
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1 e. Allow residents or, if applicable, a resident's
2 representative, designee, surrogate, guardian, or attorney in
3 fact to make a variety of personal choices, participate in
4 developing service plans, and share responsibility in
5 decisionmaking.
6 f. Implement the concept of managed risk.
7 g. Provide, either directly or through contract, the
8 services of a person licensed pursuant to part I of chapter
9 464.
10 h. In addition to the training mandated in s. 400.452,
11 provide specialized training as defined by rule for facility
12 staff.
13 4. Facilities licensed to provide extended congregate
14 care services are exempt from the criteria for continued
15 residency as set forth in rules adopted under s. 400.441.
16 Facilities so licensed shall adopt their own requirements
17 within guidelines for continued residency set forth by the
18 department in rule. However, such facilities may not serve
19 residents who require 24-hour nursing supervision. Facilities
20 licensed to provide extended congregate care services shall
21 provide each resident with a written copy of facility policies
22 governing admission and retention.
23 5. The primary purpose of extended congregate care
24 services is to allow residents, as they become more impaired,
25 the option of remaining in a familiar setting from which they
26 would otherwise be disqualified for continued residency. A
27 facility licensed to provide extended congregate care services
28 may also admit an individual who exceeds the admission
29 criteria for a facility with a standard license, if the
30 individual is determined appropriate for admission to the
31 extended congregate care facility.
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1 6. Before admission of an individual to a facility
2 licensed to provide extended congregate care services, the
3 individual must undergo a medical examination as provided in
4 s. 400.426(4) and the facility must develop a preliminary
5 service plan for the individual.
6 7. When a facility can no longer provide or arrange
7 for services in accordance with the resident's service plan
8 and needs and the facility's policy, the facility shall make
9 arrangements for relocating the person in accordance with s.
10 400.428(1)(k).
11 8. Failure to provide extended congregate care
12 services may result in denial of extended congregate care
13 license renewal.
14 9. No later than January 1 of each year, the
15 department, in consultation with the agency, shall prepare and
16 submit to the Governor, the President of the Senate, the
17 Speaker of the House of Representatives, and the chairs of
18 appropriate legislative committees, a report on the status of,
19 and recommendations related to, extended congregate care
20 services. The status report must include, but need not be
21 limited to, the following information:
22 a. A description of the facilities licensed to provide
23 such services, including total number of beds licensed under
24 this part.
25 b. The number and characteristics of residents
26 receiving such services.
27 c. The types of services rendered that could not be
28 provided through a standard license.
29 d. An analysis of deficiencies cited during licensure
30 inspections.
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1 e. The number of residents who required extended
2 congregate care services at admission and the source of
3 admission.
4 f. Recommendations for statutory or regulatory
5 changes.
6 g. The availability of extended congregate care to
7 state clients residing in facilities licensed under this part
8 and in need of additional services, and recommendations for
9 appropriations to subsidize extended congregate care services
10 for such persons.
11 h. Such other information as the department considers
12 appropriate.
13 (c) A limited nursing services license shall be issued
14 to a facility that provides services beyond those authorized
15 in paragraph (a) and as specified in this paragraph.
16 1. In order for limited nursing services to be
17 provided in a facility licensed under this part, the agency
18 must first determine that all requirements established in law
19 and rule are met and must specifically designate, on the
20 facility's license, that such services may be provided. Such
21 designation may be made at the time of initial licensure or
22 relicensure, or upon request in writing by a licensee under
23 this part pursuant to s. 408.806. Notification of approval or
24 denial of such request shall be made in accordance with ss.
25 408.801-408.819 within 90 days after receipt of such request
26 and all necessary documentation. Existing facilities
27 qualifying to provide limited nursing services shall have
28 maintained a standard license and may not have been subject to
29 administrative sanctions that affect the health, safety, and
30 welfare of residents for the previous 2 years or since initial
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1 licensure if the facility has been licensed for less than 2
2 years.
3 2. Facilities that are licensed to provide limited
4 nursing services shall maintain a written progress report on
5 each person who receives such nursing services, which report
6 describes the type, amount, duration, scope, and outcome of
7 services that are rendered and the general status of the
8 resident's health. A registered nurse representing the agency
9 shall visit such facilities at least twice a year to monitor
10 residents who are receiving limited nursing services and to
11 determine if the facility is in compliance with applicable
12 provisions of this part and with related rules. The monitoring
13 visits may be provided through contractual arrangements with
14 appropriate community agencies. A registered nurse shall also
15 serve as part of the team that inspects such facility.
16 3. A person who receives limited nursing services
17 under this part must meet the admission criteria established
18 by the agency for assisted living facilities. When a resident
19 no longer meets the admission criteria for a facility licensed
20 under this part, arrangements for relocating the person shall
21 be made in accordance with s. 400.428(1)(k), unless the
22 facility is licensed to provide extended congregate care
23 services.
24 (4) In accordance with s. 408.805, an applicant or
25 licensee shall pay a fee for each license application
26 submitted under this part and ss. 408.801-408.819. The amount
27 of the fee shall be established by rule.
28 (a) The biennial license fee required of a facility is
29 $300 per license, with an additional fee of $50 per resident
30 based on the total licensed resident capacity of the facility,
31 except that no additional fee will be assessed for beds
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1 designated for recipients of optional state supplementation
2 payments provided for in s. 409.212. The total fee may not
3 exceed $10,000, no part of which shall be returned to the
4 facility. The agency shall adjust the per bed license fee and
5 the total licensure fee annually by not more than the change
6 in the consumer price index based on the 12 months immediately
7 preceding the increase.
8 (b) In addition to the total fee assessed under
9 paragraph (a), the agency shall require facilities that are
10 licensed to provide extended congregate care services under
11 this part to pay an additional fee per licensed facility. The
12 amount of the biennial fee shall be $400 per license, with an
13 additional fee of $10 per resident based on the total licensed
14 resident capacity of the facility. No part of this fee shall
15 be returned to the facility. The agency may adjust the per bed
16 license fee and the annual license fee once each year by not
17 more than the average rate of inflation for the 12 months
18 immediately preceding the increase.
19 (c) In addition to the total fee assessed under
20 paragraph (a), the agency shall require facilities that are
21 licensed to provide limited nursing services under this part
22 to pay an additional fee per licensed facility. The amount of
23 the biennial fee shall be $250 per license, with an additional
24 fee of $10 per resident based on the total licensed resident
25 capacity of the facility. No part of this fee shall be
26 returned to the facility. The agency may adjust the per bed
27 license fee and the biennial license fee once each year by not
28 more than the average rate of inflation for the 12 months
29 immediately preceding the increase.
30 (5) Counties or municipalities applying for licenses
31 under this part are exempt from the payment of license fees.
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1 (6) The license shall be displayed in a conspicuous
2 place inside the facility.
3 (7) A license shall be valid only in the possession of
4 the individual, firm, partnership, association, or corporation
5 to which it is issued and shall not be subject to sale,
6 assignment, or other transfer, voluntary or involuntary; nor
7 shall a license be valid for any premises other than that for
8 which originally issued.
9 (8) A fee may be charged to a facility requesting a
10 duplicate license. The fee shall not exceed the actual cost
11 of duplication and postage.
12 Section 66. Subsection (1) of section 400.4075,
13 Florida Statutes, is amended to read:
14 400.4075 Limited mental health license.--An assisted
15 living facility that serves three or more mental health
16 residents must obtain a limited mental health license.
17 (1) To obtain a limited mental health license, a
18 facility must hold a standard license as an assisted living
19 facility, must not have any current uncorrected deficiencies
20 or violations, and must ensure that, within 6 months after
21 receiving a limited mental health license, the facility
22 administrator and the staff of the facility who are in direct
23 contact with mental health residents must complete training of
24 no less than 6 hours related to their duties. Such designation
25 may be made at the time of initial licensure or relicensure,
26 or upon request in writing by a licensee under this part
27 pursuant to s. 408.806. Notification of approval or denial of
28 such request shall be made in accordance with ss.
29 408.801-408.819. The This training required by this subsection
30 shall will be provided by or approved by the Department of
31 Children and Family Services.
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1 Section 67. Section 400.408, Florida Statutes, is
2 amended to read:
3 400.408 Unlicensed facilities; referral of person for
4 residency to unlicensed facility; penalties; verification of
5 licensure status.--
6 (1)(a) It is unlawful to own, operate, or maintain an
7 assisted living facility without obtaining a license under
8 this part.
9 (b) Except as provided under paragraph (d), any person
10 who owns, operates, or maintains an unlicensed assisted living
11 facility commits a felony of the third degree, punishable as
12 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
13 continued operation is a separate offense.
14 (c) Any person found guilty of violating paragraph (a)
15 a second or subsequent time commits a felony of the second
16 degree, punishable as provided under s. 775.082, s. 775.083,
17 or s. 775.084. Each day of continued operation is a separate
18 offense.
19 (1)(d) Any person who owns, operates, or maintains an
20 unlicensed assisted living facility due to a change in this
21 part or a modification in department rule within 6 months
22 after the effective date of such change and who, within 10
23 working days after receiving notification from the agency,
24 fails to cease operation or apply for a license under this
25 part commits a felony of the third degree, punishable as
26 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
27 continued operation is a separate offense.
28 (e) Any facility that fails to cease operation after
29 agency notification may be fined for each day of noncompliance
30 pursuant to s. 400.419.
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1 (f) When a licensee has an interest in more than one
2 assisted living facility, and fails to license any one of
3 these facilities, the agency may revoke the license, impose a
4 moratorium, or impose a fine pursuant to s. 400.419, on any or
5 all of the licensed facilities until such time as the
6 unlicensed facility is licensed or ceases operation.
7 (g) If the agency determines that an owner is
8 operating or maintaining an assisted living facility without
9 obtaining a license and determines that a condition exists in
10 the facility that poses a threat to the health, safety, or
11 welfare of a resident of the facility, the owner is subject to
12 the same actions and fines imposed against a licensed facility
13 as specified in ss. 400.414 and 400.419.
14 (h) Any person aware of the operation of an unlicensed
15 assisted living facility must report that facility to the
16 agency. The agency shall provide to the department's elder
17 information and referral providers a list, by county, of
18 licensed assisted living facilities, to assist persons who are
19 considering an assisted living facility placement in locating
20 a licensed facility.
21 (2)(i) Each field office of the Agency for Health Care
22 Administration shall establish a local coordinating workgroup
23 which includes representatives of local law enforcement
24 agencies, state attorneys, local fire authorities, the
25 Department of Children and Family Services, the district
26 long-term care ombudsman council, and the district human
27 rights advocacy committee to assist in identifying the
28 operation of unlicensed facilities and to develop and
29 implement a plan to ensure effective enforcement of state laws
30 relating to such facilities. The workgroup shall report its
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1 findings, actions, and recommendations semiannually to the
2 Director of Health Facility Regulation of the agency.
3 (3)(2) It is unlawful to knowingly refer a person for
4 residency to an unlicensed assisted living facility; to an
5 assisted living facility the license of which is under denial
6 or has been suspended or revoked; or to an assisted living
7 facility that has a moratorium pursuant to s. 408.814 on
8 admissions. Any person who violates this subsection commits a
9 noncriminal violation, punishable by a fine not exceeding $500
10 as provided in s. 775.083.
11 (a) Any health care practitioner, as defined in s.
12 456.001, who is aware of the operation of an unlicensed
13 facility shall report that facility to the agency. Failure to
14 report a facility that the practitioner knows or has
15 reasonable cause to suspect is unlicensed shall be reported to
16 the practitioner's licensing board.
17 (b) Any hospital or community mental health center
18 licensed under chapter 395 or chapter 394 which knowingly
19 discharges a patient or client to an unlicensed facility is
20 subject to sanction by the agency.
21 (c) Any employee of the agency or department, or the
22 Department of Children and Family Services, who knowingly
23 refers a person for residency to an unlicensed facility; to a
24 facility the license of which is under denial or has been
25 suspended or revoked; or to a facility that has a moratorium
26 pursuant to s. 408.814 on admissions is subject to
27 disciplinary action by the agency or department, or the
28 Department of Children and Family Services.
29 (d) The employer of any person who is under contract
30 with the agency or department, or the Department of Children
31 and Family Services, and who knowingly refers a person for
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1 residency to an unlicensed facility; to a facility the license
2 of which is under denial or has been suspended or revoked; or
3 to a facility that has a moratorium pursuant to s. 408.814 on
4 admissions shall be fined and required to prepare a corrective
5 action plan designed to prevent such referrals.
6 (e) The agency shall provide the department and the
7 Department of Children and Family Services with a list of
8 licensed facilities within each county and shall update the
9 list at least quarterly.
10 (f) At least annually, the agency shall notify, in
11 appropriate trade publications, physicians licensed under
12 chapter 458 or chapter 459, hospitals licensed under chapter
13 395, nursing home facilities licensed under part II of this
14 chapter, and employees of the agency or the department, or the
15 Department of Children and Family Services, who are
16 responsible for referring persons for residency, that it is
17 unlawful to knowingly refer a person for residency to an
18 unlicensed assisted living facility and shall notify them of
19 the penalty for violating such prohibition. The department and
20 the Department of Children and Family Services shall, in turn,
21 notify service providers under contract to the respective
22 departments who have responsibility for resident referrals to
23 facilities. Further, the notice must direct each noticed
24 facility and individual to contact the appropriate agency
25 office in order to verify the licensure status of any facility
26 prior to referring any person for residency. Each notice must
27 include the name, telephone number, and mailing address of the
28 appropriate office to contact.
29 Section 68. Section 400.411, Florida Statutes, is
30 amended to read:
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1 400.411 Initial application for license; provisional
2 license.--
3 (1) Each applicant for licensure must comply with all
4 provisions of ss. 408.801-408.819 and the following:
5 Application for a license shall be made to the agency on forms
6 furnished by it and shall be accompanied by the appropriate
7 license fee.
8 (2) The applicant may be an individual owner, a
9 corporation, a partnership, a firm, an association, or a
10 governmental entity.
11 (3) The application must be signed by the applicant
12 under oath and must contain the following:
13 (a) The name, address, date of birth, and social
14 security number of the applicant and the name by which the
15 facility is to be known. If the applicant is a firm,
16 partnership, or association, the application shall contain the
17 name, address, date of birth, and social security number of
18 every member thereof. If the applicant is a corporation, the
19 application shall contain the corporation's name and address;
20 the name, address, date of birth, and social security number
21 of each of its directors and officers; and the name and
22 address of each person having at least a 5-percent ownership
23 interest in the corporation.
24 (b) The name and address of any professional service,
25 firm, association, partnership, or corporation that is to
26 provide goods, leases, or services to the facility if a
27 5-percent or greater ownership interest in the service, firm,
28 association, partnership, or corporation is owned by a person
29 whose name must be listed on the application under paragraph
30 (a).
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1 (c) The name and address of any long-term care
2 facility with which the applicant, administrator, or financial
3 officer has been affiliated through ownership or employment
4 within 5 years of the date of this license application; and a
5 signed affidavit disclosing any financial or ownership
6 interest that the applicant, or any person listed in paragraph
7 (a), holds or has held within the last 5 years in any facility
8 licensed under this part, or in any other entity licensed by
9 this state or another state to provide health or residential
10 care, which facility or entity closed or ceased to operate as
11 a result of financial problems, or has had a receiver
12 appointed or a license denied, suspended or revoked, or was
13 subject to a moratorium on admissions, or has had an
14 injunctive proceeding initiated against it.
15 (d) A description and explanation of any exclusions,
16 permanent suspensions, or terminations of the applicant from
17 the Medicare or Medicaid programs. Proof of compliance with
18 disclosure of ownership and control interest requirements of
19 the Medicaid or Medicare programs shall be accepted in lieu of
20 this submission.
21 (e) The names and addresses of persons of whom the
22 agency may inquire as to the character, reputation, and
23 financial responsibility of the owner and, if different from
24 the applicant, the administrator and financial officer.
25 (a)(f) Identify Identification of all other homes or
26 facilities, including the addresses and the license or
27 licenses under which they operate, if applicable, which are
28 currently operated by the applicant or administrator and which
29 provide housing, meals, and personal services to residents.
30 (b)(g) Provide the location of the facility for which
31 a license is sought and documentation, signed by the
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1 appropriate local government official, which states that the
2 applicant has met local zoning requirements.
3 (c)(h) Provide the name, address, date of birth,
4 social security number, education, and experience of the
5 administrator, if different from the applicant.
6 (4) The applicant shall furnish satisfactory proof of
7 financial ability to operate and conduct the facility in
8 accordance with the requirements of this part. A certificate
9 of authority, pursuant to chapter 651, may be provided as
10 proof of financial ability.
11 (5) If the applicant is a continuing care facility
12 certified under chapter 651, a copy of the facility's
13 certificate of authority must be provided.
14 (6) The applicant shall provide proof of liability
15 insurance as defined in s. 624.605.
16 (7) If the applicant is a community residential home,
17 the applicant must provide proof that it has met the
18 requirements specified in chapter 419.
19 (8) The applicant must provide the agency with proof
20 of legal right to occupy the property.
21 (2)(9) The applicant must furnish proof that the
22 facility has received a satisfactory firesafety inspection.
23 The local authority having jurisdiction or the State Fire
24 Marshal must conduct the inspection within 30 days after
25 written request by the applicant.
26 (3)(10) The applicant must furnish documentation of a
27 satisfactory sanitation inspection of the facility by the
28 county health department.
29 (11) The applicant must furnish proof of compliance
30 with level 2 background screening as required under s.
31 400.4174.
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1 (4)(12) A provisional license may be issued to an
2 applicant making initial application for licensure or making
3 application for a change of ownership. A provisional license
4 shall be limited in duration to a specific period of time not
5 to exceed 6 months, as determined by the agency.
6 (5)(13) A county or municipality may not issue an
7 occupational license that is being obtained for the purpose of
8 operating a facility regulated under this part without first
9 ascertaining that the applicant has been licensed to operate
10 such facility at the specified location or locations by the
11 agency. The agency shall furnish to local agencies
12 responsible for issuing occupational licenses sufficient
13 instruction for making such determinations.
14 Section 69. Section 400.412, Florida Statutes, is
15 amended to read:
16 400.412 Sale or transfer of ownership of a
17 facility.--It is the intent of the Legislature to protect the
18 rights of the residents of an assisted living facility when
19 the facility is sold or the ownership thereof is transferred.
20 Therefore, in addition to the requirements of ss.
21 408.801-408.819, whenever a facility is sold or the ownership
22 thereof is transferred, including leasing:
23 (1) The transferee shall make application to the
24 agency for a new license at least 60 days before the date of
25 transfer of ownership. The application must comply with the
26 provisions of s. 400.411.
27 (2)(a) The transferor shall notify the agency in
28 writing at least 60 days before the date of transfer of
29 ownership.
30
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1 (1)(b) The transferee new owner shall notify the
2 residents, in writing, of the change transfer of ownership
3 within 7 days after of his or her receipt of the new license.
4 (3) The transferor shall be responsible and liable
5 for:
6 (a) The lawful operation of the facility and the
7 welfare of the residents domiciled in the facility until the
8 date the transferee is licensed by the agency.
9 (b) Any and all penalties imposed against the facility
10 for violations occurring before the date of transfer of
11 ownership unless the penalty imposed is a moratorium on
12 admissions or denial of licensure. The moratorium on
13 admissions or denial of licensure remains in effect after the
14 transfer of ownership, unless the agency has approved the
15 transferee's corrective action plan or the conditions which
16 created the moratorium or denial have been corrected, and may
17 be grounds for denial of license to the transferee in
18 accordance with chapter 120.
19 (c) Any outstanding liability to the state, unless the
20 transferee has agreed, as a condition of sale or transfer, to
21 accept the outstanding liabilities and to guarantee payment
22 therefor; except that, if the transferee fails to meet these
23 obligations, the transferor shall remain liable for the
24 outstanding liability.
25 (2)(4) The transferor of a facility the license of
26 which is denied pending an administrative hearing shall, as a
27 part of the written change-of-ownership transfer-of-ownership
28 contract, advise the transferee that a plan of correction must
29 be submitted by the transferee and approved by the agency at
30 least 7 days before the change transfer of ownership and that
31 failure to correct the condition which resulted in the
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1 moratorium pursuant to s. 408.814 on admissions or denial of
2 licensure is grounds for denial of the transferee's license.
3 (5) The transferee must provide the agency with proof
4 of legal right to occupy the property before a license may be
5 issued. Proof may include, but is not limited to, copies of
6 warranty deeds, or copies of lease or rental agreements,
7 contracts for deeds, quitclaim deeds, or other such
8 documentation.
9 Section 70. Section 400.414, Florida Statutes, is
10 amended to read:
11 400.414 Denial or, revocation, or suspension of
12 license; moratorium; imposition of administrative fine;
13 grounds.--
14 (1) The agency may deny or, revoke, or suspend any
15 license issued under this part, impose a moratorium, or impose
16 an administrative fine in the manner provided in chapter 120,
17 for any of the following actions by an assisted living
18 facility, for the actions of any person subject to level 2
19 background screening under s. 400.4174, or for the actions of
20 any facility employee in violation of any provision of this
21 part, ss. 408.801-408.819, or applicable rule:
22 (a) An intentional or negligent act seriously
23 affecting the health, safety, or welfare of a resident of the
24 facility.
25 (b) The determination by the agency that the owner
26 lacks the financial ability to provide continuing adequate
27 care to residents.
28 (c) Misappropriation or conversion of the property of
29 a resident of the facility.
30 (d) Failure to follow the criteria and procedures
31 provided under part I of chapter 394 relating to the
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1 transportation, voluntary admission, and involuntary
2 examination of a facility resident.
3 (e) A citation of any of the following deficiencies as
4 defined in s. 400.419:
5 1. One or more cited class I deficiencies.
6 2. Three or more cited class II deficiencies.
7 3. Five or more cited class III deficiencies that have
8 been cited on a single survey and have not been corrected
9 within the times specified.
10 (f) A determination that a person subject to level 2
11 background screening under s. 400.4174(1) does not meet the
12 screening standards of s. 435.04 or that the facility is
13 retaining an employee subject to level 1 background screening
14 standards under s. 400.4174(2) who does not meet the screening
15 standards of s. 435.03 and for whom exemptions from
16 disqualification have not been provided by the agency.
17 (g) A determination that an employee, volunteer,
18 administrator, or owner, or person who otherwise has access to
19 the residents of a facility does not meet the criteria
20 specified in s. 435.03(2), and the owner or administrator has
21 not taken action to remove the person. Exemptions from
22 disqualification may be granted as set forth in s. 435.07. No
23 administrative action may be taken against the facility if the
24 person is granted an exemption.
25 (h) Violation of a moratorium.
26 (i) Failure of the license applicant, the licensee
27 during relicensure, or a licensee that holds a provisional
28 license to meet the minimum license requirements of this part,
29 or related rules, at the time of license application or
30 renewal.
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1 (j) A fraudulent statement or omission of any material
2 fact on an application for a license or any other document
3 required by the agency, including the submission of a license
4 application that conceals the fact that any board member,
5 officer, or person owning 5 percent or more of the facility
6 may not meet the background screening requirements of s.
7 400.4174, or that the applicant has been excluded, permanently
8 suspended, or terminated from the Medicaid or Medicare
9 programs.
10 (h)(k) An intentional or negligent life-threatening
11 act in violation of the uniform firesafety standards for
12 assisted living facilities or other firesafety standards that
13 threatens the health, safety, or welfare of a resident of a
14 facility, as communicated to the agency by the local authority
15 having jurisdiction or the State Fire Marshal.
16 (l) Exclusion, permanent suspension, or termination
17 from the Medicare or Medicaid programs.
18 (i)(m) Knowingly operating any unlicensed facility or
19 providing without a license any service that must be licensed
20 under this chapter.
21 (j)(n) Any act constituting a ground upon which
22 application for a license may be denied.
23
24 Administrative proceedings challenging agency action under
25 this subsection shall be reviewed on the basis of the facts
26 and conditions that resulted in the agency action.
27 (2) Upon notification by the local authority having
28 jurisdiction or by the State Fire Marshal, the agency may deny
29 or revoke the license of an assisted living facility that
30 fails to correct cited fire code violations that affect or
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1 threaten the health, safety, or welfare of a resident of a
2 facility.
3 (3) The agency may deny a license to any applicant
4 controlling interest as defined in s. 408.803 that or to any
5 officer or board member of an applicant who is a firm,
6 corporation, partnership, or association or who owns 5 percent
7 or more of the facility, if the applicant, officer, or board
8 member has or had a 25-percent or greater financial or
9 ownership interest in any other facility licensed under this
10 part, or in any entity licensed by this state or another state
11 to provide health or residential care, which facility or
12 entity during the 5 years prior to the application for a
13 license closed due to financial inability to operate; had a
14 receiver appointed or a license denied, suspended, or revoked;
15 was subject to a moratorium pursuant to s. 408.814 on
16 admissions; had an injunctive proceeding initiated against it;
17 or has an outstanding fine assessed under this chapter.
18 (4) The agency shall deny or revoke the license of an
19 assisted living facility that has two or more class I
20 violations that are similar or identical to violations
21 identified by the agency during a survey, inspection,
22 monitoring visit, or complaint investigation occurring within
23 the previous 2 years.
24 (5) An action taken by the agency to suspend, deny, or
25 revoke a facility's license under this part, in which the
26 agency claims that the facility owner or an employee of the
27 facility has threatened the health, safety, or welfare of a
28 resident of the facility be heard by the Division of
29 Administrative Hearings of the Department of Management
30 Services within 120 days after receipt of the facility's
31 request for a hearing, unless that time limitation is waived
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1 by both parties. The administrative law judge must render a
2 decision within 30 days after receipt of a proposed
3 recommended order.
4 (6) The agency shall provide to the Division of Hotels
5 and Restaurants of the Department of Business and Professional
6 Regulation, on a monthly basis, a list of those assisted
7 living facilities that have had their licenses denied,
8 suspended, or revoked or that are involved in an appellate
9 proceeding pursuant to s. 120.60 related to the denial,
10 suspension, or revocation of a license.
11 (7) Agency notification of a license suspension or
12 revocation, or denial of a license renewal, shall be posted
13 and visible to the public at the facility.
14 (8) The agency may issue a temporary license pending
15 final disposition of a proceeding involving the suspension or
16 revocation of an assisted living facility license.
17 Section 71. Section 400.417, Florida Statutes, is
18 amended to read:
19 400.417 Expiration of license; renewal; conditional
20 license.--
21 (1) Biennial licenses, unless sooner suspended or
22 revoked, shall expire 2 years from the date of issuance.
23 Limited nursing, extended congregate care, and limited mental
24 health licenses shall expire at the same time as the
25 facility's standard license, regardless of when issued. The
26 agency shall notify the facility at least 120 days prior to
27 expiration that a renewal license is necessary to continue
28 operation. The notification must be provided electronically or
29 by mail delivery. Ninety days prior to the expiration date, an
30 application for renewal shall be submitted to the agency. Fees
31 must be prorated. The failure to file a timely renewal
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1 application shall result in a late fee charged to the facility
2 in an amount equal to 50 percent of the current fee.
3 (2) A license shall be renewed in accordance with ss.
4 408.801-408.819 within 90 days upon the timely filing of an
5 application on forms furnished by the agency and the provision
6 of satisfactory proof of ability to operate and conduct the
7 facility in accordance with the requirements of this part and
8 adopted rules, including proof that the facility has received
9 a satisfactory firesafety inspection, conducted by the local
10 authority having jurisdiction or the State Fire Marshal,
11 within the preceding 12 months and an affidavit of compliance
12 with the background screening requirements of ss. s. 400.4174
13 and 408.809.
14 (3) In addition to the requirements of ss.
15 408.801-408.819, An applicant for renewal of a license who has
16 complied with the provisions of s. 400.411 with respect to
17 proof of financial ability to operate shall not be required to
18 provide further proof unless the facility or any other
19 facility owned or operated in whole or in part by the same
20 person has demonstrated financial instability as provided
21 under s. 400.447(2) or unless the agency suspects that the
22 facility is not financially stable as a result of the annual
23 survey or complaints from the public or a report from the
24 State Long-Term Care Ombudsman Council. each facility must
25 report to the agency any adverse court action concerning the
26 facility's financial viability, within 7 days after its
27 occurrence. The agency shall have access to books, records,
28 and any other financial documents maintained by the facility
29 to the extent necessary to determine the facility's financial
30 stability. A license for the operation of a facility shall not
31
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1 be renewed if the licensee has any outstanding fines assessed
2 pursuant to this part which are in final order status.
3 (4) A licensee against whom a revocation or suspension
4 proceeding is pending at the time of license renewal may be
5 issued a conditional license effective until final disposition
6 by the agency. If judicial relief is sought from the final
7 disposition, the court having jurisdiction may issue a
8 conditional license for the duration of the judicial
9 proceeding.
10 (4)(5) A conditional license may be issued to an
11 applicant for license renewal if the applicant fails to meet
12 all standards and requirements for licensure. A conditional
13 license issued under this subsection shall be limited in
14 duration to a specific period of time not to exceed 6 months,
15 as determined by the agency, and shall be accompanied by an
16 agency-approved plan of correction.
17 (5)(6) When an extended care or limited nursing
18 license is requested during a facility's biennial license
19 period, the fee shall be prorated in order to permit the
20 additional license to expire at the end of the biennial
21 license period. The fee shall be calculated as of the date the
22 additional license application is received by the agency.
23 (6)(7) The agency department may by rule establish
24 renewal procedures, identify forms, and specify documentation
25 necessary to administer this section and ss. 408.801-408.819.
26 Section 72. Section 400.415, Florida Statutes, is
27 repealed.
28 Section 73. Section 400.4174, Florida Statutes, is
29 amended to read:
30 400.4174 Background screening; exemptions.--
31
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1 (1)(a) Level 2 background screening must be conducted
2 on each of the following persons, who shall be considered
3 employees for the purposes of conducting screening under
4 chapter 435:
5 1. The facility owner if an individual, the
6 administrator, and the financial officer.
7 2. An officer or board member if the facility owner is
8 a firm, corporation, partnership, or association, or any
9 person owning 5 percent or more of the facility if the agency
10 has probable cause to believe that such person has been
11 convicted of any offense prohibited by s. 435.04. For each
12 officer, board member, or person owning 5 percent or more who
13 has been convicted of any such offense, the facility shall
14 submit to the agency a description and explanation of the
15 conviction at the time of license application. This
16 subparagraph does not apply to a board member of a
17 not-for-profit corporation or organization if the board member
18 serves solely in a voluntary capacity, does not regularly take
19 part in the day-to-day operational decisions of the
20 corporation or organization, receives no remuneration for his
21 or her services, and has no financial interest and has no
22 family members with a financial interest in the corporation or
23 organization, provided that the board member and facility
24 submit a statement affirming that the board member's
25 relationship to the facility satisfies the requirements of
26 this subparagraph.
27 (b) Proof of compliance with level 2 screening
28 standards which has been submitted within the previous 5 years
29 to meet any facility or professional licensure requirements of
30 the agency or the Department of Health satisfies the
31 requirements of this subsection, provided that such proof is
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1 accompanied, under penalty of perjury, by an affidavit of
2 compliance with the provisions of chapter 435. Proof of
3 compliance with the background screening requirements of the
4 Financial Services Commission and the Office of Insurance
5 Regulation for applicants for a certificate of authority to
6 operate a continuing care retirement community under chapter
7 651, submitted within the last 5 years, satisfies the
8 Department of Law Enforcement and Federal Bureau of
9 Investigation portions of a level 2 background check.
10 (c) The agency may grant a provisional license to a
11 facility applying for an initial license when each individual
12 required by this subsection to undergo screening has completed
13 the Department of Law Enforcement background checks, but has
14 not yet received results from the Federal Bureau of
15 Investigation, or when a request for an exemption from
16 disqualification has been submitted to the agency pursuant to
17 s. 435.07, but a response has not been issued.
18 (2) The owner or administrator of an assisted living
19 facility must conduct level 1 background screening, as set
20 forth in chapter 435, on all employees hired on or after
21 October 1, 1998, who perform personal services as defined in
22 s. 400.402(17). The agency may exempt an individual from
23 employment disqualification as set forth in chapter 435. Such
24 persons shall be considered as having met this requirement if:
25 (1)(a) Proof of compliance with level 1 screening
26 requirements obtained to meet any professional license
27 requirements in this state is provided and accompanied, under
28 penalty of perjury, by a copy of the person's current
29 professional license and an affidavit of current compliance
30 with the background screening requirements.
31
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1 (2)(b) The person required to be screened has been
2 continuously employed in the same type of occupation for which
3 the person is seeking employment without a breach in service
4 which exceeds 180 days, and proof of compliance with the level
5 1 screening requirement which is no more than 2 years old is
6 provided. Proof of compliance shall be provided directly from
7 one employer or contractor to another, and not from the person
8 screened. Upon request, a copy of screening results shall be
9 provided by the employer retaining documentation of the
10 screening to the person screened.
11 (3)(c) The person required to be screened is employed
12 by a corporation or business entity or related corporation or
13 business entity that owns, operates, or manages more than one
14 facility or agency licensed under this chapter, and for whom a
15 level 1 screening was conducted by the corporation or business
16 entity as a condition of initial or continued employment.
17 Section 74. Section 400.4176, Florida Statutes, is
18 amended to read:
19 400.4176 Notice of change of administrator.--If,
20 during the period for which a license is issued, the owner
21 changes administrators, the owner must notify the agency of
22 the change within 10 days and provide documentation within 90
23 days that the new administrator has completed the applicable
24 core educational requirements under s. 400.452. Background
25 screening shall be completed on any new administrator as
26 specified in s. 400.4174.
27 Section 75. Subsection (7) of section 400.4178,
28 Florida Statutes, is repealed.
29 Section 76. Section 400.418, Florida Statutes, is
30 amended to read:
31
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1 400.418 Disposition of fees and administrative
2 fines.--
3 (1) Income from license fees, inspection fees, late
4 fees, and administrative fines collected under this part
5 generated pursuant to ss. 400.407, 400.408, 400.417, 400.419,
6 and 400.431 shall be deposited in the Health Care Trust Fund
7 administered by the agency. Such funds shall be directed to
8 and used by the agency for the following purposes:
9 (1)(a) Up to 50 percent of the trust funds accrued
10 each fiscal year under this part may be used to offset the
11 expenses of receivership, pursuant to s. 400.422, if the court
12 determines that the income and assets of the facility are
13 insufficient to provide for adequate management and operation.
14 (2)(b) An amount of $5,000 of the trust funds accrued
15 each year under this part shall be allocated to pay for
16 inspection-related physical and mental health examinations
17 requested by the agency pursuant to s. 400.426 for residents
18 who are either recipients of supplemental security income or
19 have monthly incomes not in excess of the maximum combined
20 federal and state cash subsidies available to supplemental
21 security income recipients, as provided for in s. 409.212.
22 Such funds shall only be used where the resident is ineligible
23 for Medicaid.
24 (3)(c) Any trust funds accrued each year under this
25 part and not used for the purposes specified in paragraphs (a)
26 and (b) shall be used to offset the costs of the licensure
27 program, including the costs of conducting background
28 investigations, verifying information submitted, defraying the
29 costs of processing the names of applicants, and conducting
30 inspections and monitoring visits pursuant to this part and
31 ss. 408.801-408.819.
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1 (2) Income from fees generated pursuant to s.
2 400.441(5) shall be deposited in the Health Care Trust Fund
3 and used to offset the costs of printing and postage.
4 Section 77. Section 400.419, Florida Statutes, is
5 amended to read:
6 400.419 Violations; imposition of administrative
7 fines; grounds.--
8 (1) The agency shall impose an administrative fine in
9 the manner provided in chapter 120 for a violation of any
10 provision of this part, ss. 408.801-408.819, or applicable
11 rule any of the actions or violations as set forth within this
12 section by an assisted living facility, for the actions of any
13 person subject to level 2 background screening under s.
14 400.4174, for the actions of any facility employee, or for an
15 intentional or negligent act seriously affecting the health,
16 safety, or welfare of a resident of the facility.
17 (2) Each violation of this part and adopted rules
18 shall be classified according to the nature of the violation
19 and the gravity of its probable effect on facility residents.
20 The agency shall indicate the classification on the written
21 notice of the violation as follows:
22 (a) Class "I" violations are those conditions or
23 occurrences related to the operation and maintenance of a
24 facility or to the personal care of residents which the agency
25 determines present an imminent danger to the residents or
26 guests of the facility or a substantial probability that death
27 or serious physical or emotional harm would result therefrom.
28 The condition or practice constituting a class I violation
29 shall be abated or eliminated within 24 hours, unless a fixed
30 period, as determined by the agency, is required for
31 correction. The agency shall impose an administrative fine for
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1 a cited class I violation in an amount not less than $5,000
2 and not exceeding $10,000 for each violation. A fine may be
3 levied notwithstanding the correction of the violation.
4 (b) Class "II" violations are those conditions or
5 occurrences related to the operation and maintenance of a
6 facility or to the personal care of residents which the agency
7 determines directly threaten the physical or emotional health,
8 safety, or security of the facility residents, other than
9 class I violations. The agency shall impose an administrative
10 fine for a cited class II violation in an amount not less than
11 $1,000 and not exceeding $5,000 for each violation. A fine
12 shall be levied notwithstanding the correction of the
13 violation.
14 (c) Class "III" violations are those conditions or
15 occurrences related to the operation and maintenance of a
16 facility or to the personal care of residents which the agency
17 determines indirectly or potentially threaten the physical or
18 emotional health, safety, or security of facility residents,
19 other than class I or class II violations. The agency shall
20 impose an administrative fine for a cited class III violation
21 in an amount not less than $500 and not exceeding $1,000 for
22 each violation. A citation for a class III violation must
23 specify the time within which the violation is required to be
24 corrected. If a class III violation is corrected within the
25 time specified, no fine may be imposed, unless it is a
26 repeated offense.
27 (d) Class "IV" violations are those conditions or
28 occurrences related to the operation and maintenance of a
29 building or to required reports, forms, or documents that do
30 not have the potential of negatively affecting residents.
31 These violations are of a type that the agency determines do
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1 not threaten the health, safety, or security of residents of
2 the facility. The agency shall impose an administrative fine
3 for a cited class IV violation in an amount not less than $100
4 and not exceeding $200 for each violation. A citation for a
5 class IV violation must specify the time within which the
6 violation is required to be corrected. If a class IV violation
7 is corrected within the time specified, no fine shall be
8 imposed. Any class IV violation that is corrected during the
9 time an agency survey is being conducted will be identified as
10 an agency finding and not as a violation.
11 (3) In determining if a penalty is to be imposed and
12 in fixing the amount of the fine, the agency shall consider
13 the following factors:
14 (a) The gravity of the violation, including the
15 probability that death or serious physical or emotional harm
16 to a resident will result or has resulted, the severity of the
17 action or potential harm, and the extent to which the
18 provisions of the applicable laws or rules were violated.
19 (b) Actions taken by the owner or administrator to
20 correct violations.
21 (c) Any previous violations.
22 (d) The financial benefit to the facility of
23 committing or continuing the violation.
24 (e) The licensed capacity of the facility.
25 (4) Each day of continuing violation after the date
26 fixed for termination of the violation, as ordered by the
27 agency, constitutes an additional, separate, and distinct
28 violation.
29 (5) Any action taken to correct a violation shall be
30 documented in writing by the owner or administrator of the
31 facility and verified through followup visits by agency
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1 personnel. The agency may impose a fine and, in the case of an
2 owner-operated facility, revoke or deny a facility's license
3 when a facility administrator fraudulently misrepresents
4 action taken to correct a violation.
5 (6) For fines that are upheld following administrative
6 or judicial review, the violator shall pay the fine, plus
7 interest at the rate as specified in s. 55.03, for each day
8 beyond the date set by the agency for payment of the fine.
9 (7) Any unlicensed facility that continues to operate
10 after agency notification is subject to a $1,000 fine per day.
11 (8) Any licensed facility whose owner or administrator
12 concurrently operates an unlicensed facility shall be subject
13 to an administrative fine of $5,000 per day.
14 (9) Any facility whose owner fails to apply for a
15 change-of-ownership license in accordance with s. 400.412 and
16 operates the facility under the new ownership is subject to a
17 fine of $5,000.
18 (6)(10) In addition to any administrative fines
19 imposed, the agency may assess a survey fee, equal to the
20 lesser of one half of the facility's biennial license and bed
21 fee or $500, to cover the cost of conducting initial complaint
22 investigations that result in the finding of a violation that
23 was the subject of the complaint or monitoring visits
24 conducted under s. 400.428(3)(c) to verify the correction of
25 the violations.
26 (7)(11) The agency, as an alternative to or in
27 conjunction with an administrative action against a facility
28 for violations of this part and adopted rules, shall make a
29 reasonable attempt to discuss each violation and recommended
30 corrective action with the owner or administrator of the
31 facility, prior to written notification. The agency, instead
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1 of fixing a period within which the facility shall enter into
2 compliance with standards, may request a plan of corrective
3 action from the facility which demonstrates a good faith
4 effort to remedy each violation by a specific date, subject to
5 the approval of the agency.
6 (12) Administrative fines paid by any facility under
7 this section shall be deposited into the Health Care Trust
8 Fund and expended as provided in s. 400.418.
9 (8)(13) The agency shall develop and disseminate an
10 annual list of all facilities sanctioned or fined $5,000 or
11 more for violations of state standards, the number and class
12 of violations involved, the penalties imposed, and the current
13 status of cases. The list shall be disseminated, at no charge,
14 to the Department of Elderly Affairs, the Department of
15 Health, the Department of Children and Family Services, the
16 area agencies on aging, the Florida Statewide Advocacy
17 Council, and the state and local ombudsman councils. The
18 Department of Children and Family Services shall disseminate
19 the list to service providers under contract to the department
20 who are responsible for referring persons to a facility for
21 residency. The agency may charge a fee commensurate with the
22 cost of printing and postage to other interested parties
23 requesting a copy of this list.
24 Section 78. Subsections (2) and (3) of section 400.42,
25 Florida Statutes, are amended to read:
26 400.42 Certain solicitation prohibited; third-party
27 supplementation.--
28 (2) Solicitation of contributions of any kind in a
29 threatening, coercive, or unduly forceful manner by or on
30 behalf of an assisted living facility or facilities by any
31 agent, employee, owner, or representative of any assisted
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1 living facility or facilities is grounds for denial,
2 suspension, or revocation of the license of the assisted
3 living facility or facilities by or on behalf of which such
4 contributions were solicited.
5 (3) The admission or maintenance of assisted living
6 facility residents whose care is supported, in whole or in
7 part, by state funds may not be conditioned upon the receipt
8 of any manner of contribution or donation from any person. The
9 solicitation or receipt of contributions in violation of this
10 subsection is grounds for denial, suspension, or revocation of
11 license, as provided in s. 400.414, for any assisted living
12 facility by or on behalf of which such contributions were
13 solicited.
14 Section 79. Section 400.421, Florida Statutes, is
15 repealed.
16 Section 80. Subsection (10) of section 400.423,
17 Florida Statutes, is amended to read:
18 400.423 Internal risk management and quality assurance
19 program; adverse incidents and reporting requirements.--
20 (10) The agency Department of Elderly Affairs may
21 adopt rules necessary to administer this section.
22 Section 81. Subsection (8) of section 400.424, Florida
23 Statutes, is amended to read:
24 400.424 Contracts.--
25 (8) The agency department may by rule clarify terms,
26 establish procedures, clarify refund policies and contract
27 provisions, and specify documentation as necessary to
28 administer this section.
29 Section 82. Subsection (3) of section 400.4255,
30 Florida Statutes, is amended to read:
31 400.4255 Use of personnel; emergency care.--
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1 (3) Facility staff may withhold or withdraw
2 cardiopulmonary resuscitation if presented with an order not
3 to resuscitate executed pursuant to s. 401.45. The agency
4 department shall adopt rules providing for the implementation
5 of such orders. Facility staff and facilities shall not be
6 subject to criminal prosecution or civil liability, nor be
7 considered to have engaged in negligent or unprofessional
8 conduct, for withholding or withdrawing cardiopulmonary
9 resuscitation pursuant to such an order and applicable rules
10 adopted by the department. The absence of an order to
11 resuscitate executed pursuant to s. 401.45 does not preclude a
12 physician from withholding or withdrawing cardiopulmonary
13 resuscitation as otherwise permitted by law.
14 Section 83. Subsection (6) of section 400.4256,
15 Florida Statutes, is amended to read:
16 400.4256 Assistance with self-administration of
17 medication.--
18 (6) The agency department may by rule establish
19 facility procedures and interpret terms as necessary to
20 implement this section.
21 Section 84. Subsection (8) of section 400.427, Florida
22 Statutes, is amended to read:
23 400.427 Property and personal affairs of residents.--
24 (8) The agency department may by rule clarify terms
25 and specify procedures and documentation necessary to
26 administer the provisions of this section relating to the
27 proper management of residents' funds and personal property
28 and the execution of surety bonds.
29 Section 85. Subsection (4) of section 400.4275,
30 Florida Statutes, is amended to read:
31
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1 400.4275 Business practice; personnel records;
2 liability insurance.--The assisted living facility shall be
3 administered on a sound financial basis that is consistent
4 with good business practices.
5 (4) The agency department may by rule clarify terms,
6 establish requirements for financial records, accounting
7 procedures, personnel procedures, insurance coverage, and
8 reporting procedures, and specify documentation as necessary
9 to implement the requirements of this section.
10 Section 86. Subsections (1) and (5) of section
11 400.431, Florida Statutes, are amended to read:
12 400.431 Closing of facility; notice; penalty.--
13 (1) Whenever a facility voluntarily discontinues
14 operation, it shall inform the agency in writing at least 90
15 days prior to the discontinuance of operation. The facility
16 shall also inform each resident or the next of kin, legal
17 representative, or agency acting on each resident's behalf, of
18 the fact and the proposed time of such discontinuance,
19 following the notification requirements provided in s.
20 400.428(1)(k). In the event a resident has no person to
21 represent him or her, the facility shall be responsible for
22 referral to an appropriate social service agency for
23 placement.
24 (5) The agency may levy a fine in an amount no greater
25 than $5,000 upon each person or business entity that owns any
26 interest in a facility that terminates operation without
27 providing notice to the agency and the residents of the
28 facility at least 30 days before operation ceases. This fine
29 shall not be levied against any facility involuntarily closed
30 at the initiation of the agency. The agency shall use the
31 proceeds of the fines to operate the facility until all
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1 residents of the facility are relocated and shall deposit any
2 balance of the proceeds into the Health Care Trust Fund
3 established pursuant to s. 400.418.
4 Section 87. Section 400.434, Florida Statutes, is
5 amended to read:
6 400.434 Right of entry and inspection.--Any duly
7 designated officer or employee of the department, the
8 Department of Children and Family Services, the agency, the
9 state or local fire marshal, or a member of the state or local
10 long-term care ombudsman council, or the agency in accordance
11 with s. 408.811 shall have the right to enter unannounced upon
12 and into the premises of any facility licensed pursuant to
13 this part in order to determine the state of compliance with
14 the provisions of this part, ss. 408.801-408.819, and
15 applicable of rules or standards in force pursuant thereto.
16 The right of entry and inspection shall also extend to any
17 premises which the agency has reason to believe is being
18 operated or maintained as a facility without a license; but no
19 such entry or inspection of any premises may be made without
20 the permission of the owner or person in charge thereof,
21 unless a warrant is first obtained from the circuit court
22 authorizing such entry. The warrant requirement shall extend
23 only to a facility which the agency has reason to believe is
24 being operated or maintained as a facility without a license.
25 Any application for a license or renewal thereof made pursuant
26 to this part shall constitute permission for, and complete
27 acquiescence in, any entry or inspection of the premises for
28 which the license is sought, in order to facilitate
29 verification of the information submitted on or in connection
30 with the application; to discover, investigate, and determine
31 the existence of abuse or neglect; or to elicit, receive,
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1 respond to, and resolve complaints. Any current valid license
2 shall constitute unconditional permission for, and complete
3 acquiescence in, any entry or inspection of the premises by
4 authorized personnel. The agency shall retain the right of
5 entry and inspection of facilities that have had a license
6 revoked or suspended within the previous 24 months, to ensure
7 that the facility is not operating unlawfully. However, before
8 entering the facility, a statement of probable cause must be
9 filed with the director of the agency, who must approve or
10 disapprove the action within 48 hours. Probable cause shall
11 include, but is not limited to, evidence that the facility
12 holds itself out to the public as a provider of personal care
13 services or the receipt of a complaint by the long-term care
14 ombudsman council about the facility. Data collected by the
15 state or local long-term care ombudsman councils or the state
16 or local advocacy councils may be used by the agency in
17 investigations involving violations of regulatory standards.
18 Section 88. Subsection (1) of section 400.435, Florida
19 Statutes, is repealed.
20 Section 89. Section 400.441, Florida Statutes, is
21 amended to read:
22 400.441 Rules establishing standards.--
23 (1) It is the intent of the Legislature that rules
24 published and enforced pursuant to this section shall include
25 criteria by which a reasonable and consistent quality of
26 resident care and quality of life may be ensured and the
27 results of such resident care may be demonstrated. Such rules
28 shall also ensure a safe and sanitary environment that is
29 residential and noninstitutional in design or nature. It is
30 further intended that reasonable efforts be made to
31 accommodate the needs and preferences of residents to enhance
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1 the quality of life in a facility. In order to provide safe
2 and sanitary facilities and the highest quality of resident
3 care accommodating the needs and preferences of residents, the
4 agency department, in consultation with the department agency,
5 the Department of Children and Family Services, and the
6 Department of Health, shall adopt rules, policies, and
7 procedures to administer this part and ss. 408.801-408.819,
8 which must include reasonable and fair minimum standards in
9 relation to:
10 (a) The requirements for and maintenance of
11 facilities, not in conflict with the provisions of chapter
12 553, relating to plumbing, heating, cooling, lighting,
13 ventilation, living space, and other housing conditions, which
14 will ensure the health, safety, and comfort of residents and
15 protection from fire hazard, including adequate provisions for
16 fire alarm and other fire protection suitable to the size of
17 the structure. Uniform firesafety standards shall be
18 established and enforced by the State Fire Marshal in
19 cooperation with the agency, the department, and the
20 Department of Health.
21 1. Evacuation capability determination.--
22 a. The provisions of the National Fire Protection
23 Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
24 for determining the ability of the residents, with or without
25 staff assistance, to relocate from or within a licensed
26 facility to a point of safety as provided in the fire codes
27 adopted herein. An evacuation capability evaluation for
28 initial licensure shall be conducted within 6 months after the
29 date of licensure. For existing licensed facilities that are
30 not equipped with an automatic fire sprinkler system, the
31 administrator shall evaluate the evacuation capability of
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1 residents at least annually. The evacuation capability
2 evaluation for each facility not equipped with an automatic
3 fire sprinkler system shall be validated, without liability,
4 by the State Fire Marshal, by the local fire marshal, or by
5 the local authority having jurisdiction over firesafety,
6 before the license renewal date. If the State Fire Marshal,
7 local fire marshal, or local authority having jurisdiction
8 over firesafety has reason to believe that the evacuation
9 capability of a facility as reported by the administrator may
10 have changed, it may, with assistance from the facility
11 administrator, reevaluate the evacuation capability through
12 timed exiting drills. Translation of timed fire exiting drills
13 to evacuation capability may be determined:
14 (I) Three minutes or less: prompt.
15 (II) More than 3 minutes, but not more than 13
16 minutes: slow.
17 (III) More than 13 minutes: impractical.
18 b. The Office of the State Fire Marshal shall provide
19 or cause the provision of training and education on the proper
20 application of Chapter 5, NFPA 101A, 1995 edition, to its
21 employees, to staff of the Agency for Health Care
22 Administration who are responsible for regulating facilities
23 under this part, and to local governmental inspectors. The
24 Office of the State Fire Marshal shall provide or cause the
25 provision of this training within its existing budget, but may
26 charge a fee for this training to offset its costs. The
27 initial training must be delivered within 6 months after July
28 1, 1995, and as needed thereafter.
29 c. The Office of the State Fire Marshal, in
30 cooperation with provider associations, shall provide or cause
31 the provision of a training program designed to inform
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1 facility operators on how to properly review bid documents
2 relating to the installation of automatic fire sprinklers.
3 The Office of the State Fire Marshal shall provide or cause
4 the provision of this training within its existing budget, but
5 may charge a fee for this training to offset its costs. The
6 initial training must be delivered within 6 months after July
7 1, 1995, and as needed thereafter.
8 d. The administrator of a licensed facility shall sign
9 an affidavit verifying the number of residents occupying the
10 facility at the time of the evacuation capability evaluation.
11 2. Firesafety requirements.--
12 a. Except for the special applications provided
13 herein, effective January 1, 1996, the provisions of the
14 National Fire Protection Association, Life Safety Code, NFPA
15 101, 1994 edition, Chapter 22 for new facilities and Chapter
16 23 for existing facilities shall be the uniform fire code
17 applied by the State Fire Marshal for assisted living
18 facilities, pursuant to s. 633.022.
19 b. Any new facility, regardless of size, that applies
20 for a license on or after January 1, 1996, must be equipped
21 with an automatic fire sprinkler system. The exceptions as
22 provided in section 22-2.3.5.1, NFPA 101, 1994 edition, as
23 adopted herein, apply to any new facility housing eight or
24 fewer residents. On July 1, 1995, local governmental entities
25 responsible for the issuance of permits for construction shall
26 inform, without liability, any facility whose permit for
27 construction is obtained prior to January 1, 1996, of this
28 automatic fire sprinkler requirement. As used in this part,
29 the term "a new facility" does not mean an existing facility
30 that has undergone change of ownership.
31
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1 c. Notwithstanding any provision of s. 633.022 or of
2 the National Fire Protection Association, NFPA 101A, Chapter
3 5, 1995 edition, to the contrary, any existing facility
4 housing eight or fewer residents is not required to install an
5 automatic fire sprinkler system, nor to comply with any other
6 requirement in Chapter 23, NFPA 101, 1994 edition, that
7 exceeds the firesafety requirements of NFPA 101, 1988 edition,
8 that applies to this size facility, unless the facility has
9 been classified as impractical to evacuate. Any existing
10 facility housing eight or fewer residents that is classified
11 as impractical to evacuate must install an automatic fire
12 sprinkler system within the timeframes granted in this
13 section.
14 d. Any existing facility that is required to install
15 an automatic fire sprinkler system under this paragraph need
16 not meet other firesafety requirements of Chapter 23, NFPA
17 101, 1994 edition, which exceed the provisions of NFPA 101,
18 1988 edition. The mandate contained in this paragraph which
19 requires certain facilities to install an automatic fire
20 sprinkler system supersedes any other requirement.
21 e. This paragraph does not supersede the exceptions
22 granted in NFPA 101, 1988 edition or 1994 edition.
23 f. This paragraph does not exempt facilities from
24 other firesafety provisions adopted under s. 633.022 and local
25 building code requirements in effect before July 1, 1995.
26 g. A local government may charge fees only in an
27 amount not to exceed the actual expenses incurred by local
28 government relating to the installation and maintenance of an
29 automatic fire sprinkler system in an existing and properly
30 licensed assisted living facility structure as of January 1,
31 1996.
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1 h. If a licensed facility undergoes major
2 reconstruction or addition to an existing building on or after
3 January 1, 1996, the entire building must be equipped with an
4 automatic fire sprinkler system. Major reconstruction of a
5 building means repair or restoration that costs in excess of
6 50 percent of the value of the building as reported on the tax
7 rolls, excluding land, before reconstruction. Multiple
8 reconstruction projects within a 5-year period the total costs
9 of which exceed 50 percent of the initial value of the
10 building at the time the first reconstruction project was
11 permitted are to be considered as major reconstruction.
12 Application for a permit for an automatic fire sprinkler
13 system is required upon application for a permit for a
14 reconstruction project that creates costs that go over the
15 50-percent threshold.
16 i. Any facility licensed before January 1, 1996, that
17 is required to install an automatic fire sprinkler system
18 shall ensure that the installation is completed within the
19 following timeframes based upon evacuation capability of the
20 facility as determined under subparagraph 1.:
21 (I) Impractical evacuation capability, 24 months.
22 (II) Slow evacuation capability, 48 months.
23 (III) Prompt evacuation capability, 60 months.
24
25 The beginning date from which the deadline for the automatic
26 fire sprinkler installation requirement must be calculated is
27 upon receipt of written notice from the local fire official
28 that an automatic fire sprinkler system must be installed. The
29 local fire official shall send a copy of the document
30 indicating the requirement of a fire sprinkler system to the
31 Agency for Health Care Administration.
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1 j. It is recognized that the installation of an
2 automatic fire sprinkler system may create financial hardship
3 for some facilities. The appropriate local fire official
4 shall, without liability, grant two 1-year extensions to the
5 timeframes for installation established herein, if an
6 automatic fire sprinkler installation cost estimate and proof
7 of denial from two financial institutions for a construction
8 loan to install the automatic fire sprinkler system are
9 submitted. However, for any facility with a class I or class
10 II, or a history of uncorrected class III, firesafety
11 deficiencies, an extension must not be granted. The local
12 fire official shall send a copy of the document granting the
13 time extension to the Agency for Health Care Administration.
14 k. A facility owner whose facility is required to be
15 equipped with an automatic fire sprinkler system under Chapter
16 23, NFPA 101, 1994 edition, as adopted herein, must disclose
17 to any potential buyer of the facility that an installation of
18 an automatic fire sprinkler requirement exists. The sale of
19 the facility does not alter the timeframe for the installation
20 of the automatic fire sprinkler system.
21 l. Existing facilities required to install an
22 automatic fire sprinkler system as a result of
23 construction-type restrictions in Chapter 23, NFPA 101, 1994
24 edition, as adopted herein, or evacuation capability
25 requirements shall be notified by the local fire official in
26 writing of the automatic fire sprinkler requirement, as well
27 as the appropriate date for final compliance as provided in
28 this subparagraph. The local fire official shall send a copy
29 of the document to the Agency for Health Care Administration.
30 m. Except in cases of life-threatening fire hazards,
31 if an existing facility experiences a change in the evacuation
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1 capability, or if the local authority having jurisdiction
2 identifies a construction-type restriction, such that an
3 automatic fire sprinkler system is required, it shall be
4 afforded time for installation as provided in this
5 subparagraph.
6
7 Facilities that are fully sprinkled and in compliance with
8 other firesafety standards are not required to conduct more
9 than one of the required fire drills between the hours of 11
10 p.m. and 7 a.m., per year. In lieu of the remaining drills,
11 staff responsible for residents during such hours may be
12 required to participate in a mock drill that includes a review
13 of evacuation procedures. Such standards must be included or
14 referenced in the rules adopted by the State Fire Marshal.
15 Pursuant to s. 633.022(1)(b), the State Fire Marshal is the
16 final administrative authority for firesafety standards
17 established and enforced pursuant to this section. All
18 licensed facilities must have an annual fire inspection
19 conducted by the local fire marshal or authority having
20 jurisdiction.
21 (b) The preparation and annual update of a
22 comprehensive emergency management plan. Such standards must
23 be included in the rules adopted by the agency department
24 after consultation with the Department of Community Affairs.
25 At a minimum, the rules must provide for plan components that
26 address emergency evacuation transportation; adequate
27 sheltering arrangements; postdisaster activities, including
28 provision of emergency power, food, and water; postdisaster
29 transportation; supplies; staffing; emergency equipment;
30 individual identification of residents and transfer of
31 records; communication with families; and responses to family
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1 inquiries. The comprehensive emergency management plan is
2 subject to review and approval by the local emergency
3 management agency. During its review, the local emergency
4 management agency shall ensure that the following agencies, at
5 a minimum, are given the opportunity to review the plan: the
6 Department of Elderly Affairs, the Department of Health, the
7 Agency for Health Care Administration, and the Department of
8 Community Affairs. Also, appropriate volunteer organizations
9 must be given the opportunity to review the plan. The local
10 emergency management agency shall complete its review within
11 60 days and either approve the plan or advise the facility of
12 necessary revisions.
13 (c) The number, training, and qualifications of all
14 personnel having responsibility for the care of residents.
15 The rules must require adequate staff to provide for the
16 safety of all residents. Facilities licensed for 17 or more
17 residents are required to maintain an alert staff for 24 hours
18 per day.
19 (d) All sanitary conditions within the facility and
20 its surroundings which will ensure the health and comfort of
21 residents. The rules must clearly delineate the
22 responsibilities of the agency's licensure and survey staff,
23 the county health departments, and the local authority having
24 jurisdiction over fire safety and ensure that inspections are
25 not duplicative. The agency may collect fees for food service
26 inspections conducted by the county health departments and
27 transfer such fees to the Department of Health.
28 (e) License application and license renewal, transfer
29 of ownership, Proper management of resident funds and personal
30 property, surety bonds, resident contracts, refund policies,
31 financial ability to operate, and facility and staff records.
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1 (f) Inspections, complaint investigations,
2 moratoriums, classification of deficiencies, levying and
3 enforcement of penalties, and use of income from fees and
4 fines.
5 (g) The enforcement of the resident bill of rights
6 specified in s. 400.428.
7 (h) The care and maintenance of residents, which must
8 include, but is not limited to:
9 1. The supervision of residents;
10 2. The provision of personal services;
11 3. The provision of, or arrangement for, social and
12 leisure activities;
13 4. The arrangement for appointments and transportation
14 to appropriate medical, dental, nursing, or mental health
15 services, as needed by residents;
16 5. The management of medication;
17 6. The nutritional needs of residents;
18 7. Resident records; and
19 8. Internal risk management and quality assurance.
20 (i) Facilities holding a limited nursing, extended
21 congregate care, or limited mental health license.
22 (j) The establishment of specific criteria to define
23 appropriateness of resident admission and continued residency
24 in a facility holding a standard, limited nursing, extended
25 congregate care, and limited mental health license.
26 (k) The use of physical or chemical restraints. The
27 use of physical restraints is limited to half-bed rails as
28 prescribed and documented by the resident's physician with the
29 consent of the resident or, if applicable, the resident's
30 representative or designee or the resident's surrogate,
31 guardian, or attorney in fact. The use of chemical restraints
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1 is limited to prescribed dosages of medications authorized by
2 the resident's physician and must be consistent with the
3 resident's diagnosis. Residents who are receiving medications
4 that can serve as chemical restraints must be evaluated by
5 their physician at least annually to assess:
6 1. The continued need for the medication.
7 2. The level of the medication in the resident's
8 blood.
9 3. The need for adjustments in the prescription.
10 (2) In adopting any rules pursuant to this part, the
11 agency department, in conjunction with the department agency,
12 shall make distinct standards for facilities based upon
13 facility size; the types of care provided; the physical and
14 mental capabilities and needs of residents; the type,
15 frequency, and amount of services and care offered; and the
16 staffing characteristics of the facility. Rules developed
17 pursuant to this section shall not restrict the use of shared
18 staffing and shared programming in facilities that are part of
19 retirement communities that provide multiple levels of care
20 and otherwise meet the requirements of law and rule. Except
21 for uniform firesafety standards, the agency department shall
22 adopt by rule separate and distinct standards for facilities
23 with 16 or fewer beds and for facilities with 17 or more beds.
24 The standards for facilities with 16 or fewer beds shall be
25 appropriate for a noninstitutional residential environment,
26 provided that the structure is no more than two stories in
27 height and all persons who cannot exit the facility unassisted
28 in an emergency reside on the first floor. The agency
29 department, in conjunction with the department agency, may
30 make other distinctions among types of facilities as necessary
31 to enforce the provisions of this part. Where appropriate, the
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1 agency shall offer alternate solutions for complying with
2 established standards, based on distinctions made by the
3 department and the agency relative to the physical
4 characteristics of facilities and the types of care offered
5 therein.
6 (3) The department shall submit a copy of proposed
7 rules to the Speaker of the House of Representatives, the
8 President of the Senate, and appropriate committees of
9 substance for review and comment prior to the promulgation
10 thereof.
11 (a) Rules adopted promulgated by the agency department
12 shall encourage the development of homelike facilities which
13 promote the dignity, individuality, personal strengths, and
14 decisionmaking ability of residents.
15 (b) The agency, in consultation with the department,
16 may waive rules promulgated pursuant to this part in order to
17 demonstrate and evaluate innovative or cost-effective
18 congregate care alternatives which enable individuals to age
19 in place. Such waivers may be granted only in instances where
20 there is reasonable assurance that the health, safety, or
21 welfare of residents will not be endangered. To apply for a
22 waiver, the licensee shall submit to the agency a written
23 description of the concept to be demonstrated, including
24 goals, objectives, and anticipated benefits; the number and
25 types of residents who will be affected, if applicable; a
26 brief description of how the demonstration will be evaluated;
27 and any other information deemed appropriate by the agency.
28 Any facility granted a waiver shall submit a report of
29 findings to the agency and the department within 12 months.
30 At such time, the agency may renew or revoke the waiver or
31 pursue any regulatory or statutory changes necessary to allow
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1 other facilities to adopt the same practices. The agency
2 department may by rule clarify terms and establish waiver
3 application procedures, criteria for reviewing waiver
4 proposals, and procedures for reporting findings, as necessary
5 to implement this subsection.
6 (4) The agency may use an abbreviated biennial
7 standard licensure inspection that consists of a review of key
8 quality-of-care standards in lieu of a full inspection in
9 facilities which have a good record of past performance.
10 However, a full inspection shall be conducted in facilities
11 which have had a history of class I or class II violations,
12 uncorrected class III violations, confirmed ombudsman council
13 complaints, or confirmed licensure complaints, within the
14 previous licensure period immediately preceding the inspection
15 or when a potentially serious problem is identified during the
16 abbreviated inspection. The agency, in consultation with the
17 department, shall develop the key quality-of-care standards
18 with input from the State Long-Term Care Ombudsman Council and
19 representatives of provider groups for incorporation into its
20 rules. The agency department, in consultation with the
21 department agency, shall report annually to the Legislature
22 concerning its implementation of this subsection. The report
23 shall include, at a minimum, the key quality-of-care standards
24 which have been developed; the number of facilities identified
25 as being eligible for the abbreviated inspection; the number
26 of facilities which have received the abbreviated inspection
27 and, of those, the number that were converted to full
28 inspection; the number and type of subsequent complaints
29 received by the agency or department on facilities which have
30 had abbreviated inspections; any recommendations for
31 modification to this subsection; any plans by the agency to
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1 modify its implementation of this subsection; and any other
2 information which the agency department believes should be
3 reported.
4 (5) A fee shall be charged by the department to any
5 person requesting a copy of this part or rules promulgated
6 under this part. Such fees shall not exceed the actual cost
7 of duplication and postage.
8 Section 90. Subsection (4) of section 400.442, Florida
9 Statutes, is amended to read:
10 400.442 Pharmacy and dietary services.--
11 (4) The agency department may by rule establish
12 procedures and specify documentation as necessary to implement
13 this section.
14 Section 91. Subsection (3) of section 400.444, Florida
15 Statutes, is amended to read:
16 400.444 Construction and renovation; requirements.--
17 (3) The agency department may adopt rules to establish
18 procedures and specify the documentation necessary to
19 implement this section.
20 Section 92. Subsections (1), (2), and (3) of section
21 400.447 and section 400.451, Florida Statutes, are repealed.
22 Section 93. Subsections (1), (3), and (6) of section
23 400.452, Florida Statutes, as amended by section 3 of chapter
24 2003-405, Laws of Florida, are amended to read:
25 400.452 Staff training and educational programs; core
26 educational requirement.--
27 (1) Administrators and other assisted living facility
28 staff must meet minimum training and education requirements
29 established by the Department of Elderly Affairs or the agency
30 by rule. This training and education is intended to assist
31 facilities to appropriately respond to the needs of residents,
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1 to maintain resident care and facility standards, and to meet
2 licensure requirements.
3 (3) Effective January 1, 2004, a new facility
4 administrator must complete the required training and
5 education, including the competency test, within a reasonable
6 time after being employed as an administrator, as determined
7 by the department. Failure to do so is a violation of this
8 part and subjects the violator to an administrative fine as
9 prescribed in s. 400.419. Administrators licensed in
10 accordance with chapter 468, part II, are exempt from this
11 requirement. Other licensed professionals may be exempted, as
12 determined by the department by rule.
13 (6) Other facility staff shall participate in training
14 relevant to their job duties as specified by rule of the
15 department.
16 Section 94. Section 400.454, Florida Statutes, is
17 amended to read:
18 400.454 Collection of information; local subsidy.--
19 (1) To enable the agency department to collect the
20 information requested by the Legislature regarding the actual
21 cost of providing room, board, and personal care in
22 facilities, the agency may department is authorized to conduct
23 field visits and audits of facilities as may be necessary.
24 The owners of randomly sampled facilities shall submit such
25 reports, audits, and accountings of cost as required the
26 department may require by rule; provided that such reports,
27 audits, and accountings shall be the minimum necessary to
28 implement the provisions of this section. Any facility
29 selected to participate in the study shall cooperate with the
30 agency department by providing cost of operation information
31 to interviewers.
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1 (2) Local governments or organizations may contribute
2 to the cost of care of local facility residents by further
3 subsidizing the rate of state-authorized payment to such
4 facilities. Implementation of local subsidy shall require
5 agency departmental approval and shall not result in
6 reductions in the state supplement.
7 Section 95. Subsections (1) and (4) of section
8 400.464, Florida Statutes, are amended to read:
9 400.464 Home health agencies to be licensed;
10 expiration of license; exemptions; unlawful acts; penalties.--
11 (1) The requirements of ss. 408.801-408.819 apply to
12 the provision of services that necessitate licensure pursuant
13 to this part and ss. 408.801-408.819 and to entities licensed
14 or registered by or applying for such licensure or
15 registration from the Agency for Health Care Administration
16 pursuant to this part. Any home health agency must be licensed
17 by the agency to operate in this state. A license issued to a
18 home health agency, unless sooner suspended or revoked,
19 expires 1 year after its date of issuance.
20 (4)(a) An organization may not provide, offer, or
21 advertise home health services to the public unless the
22 organization has a valid license or is specifically exempted
23 under this part. An organization that offers or advertises to
24 the public any service for which licensure or registration is
25 required under this part must include in the advertisement the
26 license number or regulation number issued to the organization
27 by the agency. The agency shall assess a fine of not less
28 than $100 to any licensee or registrant who fails to include
29 the license or registration number when submitting the
30 advertisement for publication, broadcast, or printing. The
31 holder of a license issued under this part may not advertise
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1 or indicate to the public that it holds a home health agency
2 or nurse registry license other than the one it has been
3 issued.
4 (b) A person who violates paragraph (a) is subject to
5 an injunctive proceeding under s. 408.816 s. 400.515. A
6 violation of paragraph (a) or s. 408.812 is a deceptive and
7 unfair trade practice and constitutes a violation of the
8 Florida Deceptive and Unfair Trade Practices Act.
9 (c) A person who violates the provisions of paragraph
10 (a) commits a misdemeanor of the second degree, punishable as
11 provided in s. 775.082 or s. 775.083. Any person who commits
12 a second or subsequent violation commits a misdemeanor of the
13 first degree, punishable as provided in s. 775.082 or s.
14 775.083. Each day of continuing violation constitutes a
15 separate offense.
16 Section 96. Section 400.471, Florida Statutes, is
17 amended to read:
18 400.471 Application for license; fee; provisional
19 license; temporary permit.--
20 (1) Each applicant for licensure must comply with all
21 provisions of ss. 408.801-408.819. Application for an initial
22 license or for renewal of an existing license must be made
23 under oath to the agency on forms furnished by it and must be
24 accompanied by the appropriate license fee as provided in
25 subsection (8). The agency must take final action on an
26 initial licensure application within 60 days after receipt of
27 all required documentation.
28 (2) In addition to the requirements of ss.
29 408.801-408.819, the applicant must file with the application
30 satisfactory proof that the home health agency is in
31 compliance with this part and applicable rules, including:
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1 (a) A listing of services to be provided, either
2 directly by the applicant or through contractual arrangements
3 with existing providers; and
4 (b) The number and discipline of professional staff to
5 be employed.; an annually thereafter
6 (c) Proof of financial ability to operate.
7 (3) An applicant for initial licensure must
8 demonstrate financial ability to operate by submitting a
9 balance sheet and income and expense statement for the first 2
10 years of operation which provide evidence of having sufficient
11 assets, credit, and projected revenues to cover liabilities
12 and expenses. The applicant shall have demonstrated financial
13 ability to operate if the applicant's assets, credit, and
14 projected revenues meet or exceed projected liabilities and
15 expenses. All documents required under this subsection must
16 be prepared in accordance with generally accepted accounting
17 principles, and the financial statement must be signed by a
18 certified public accountant.
19 (4) Each applicant for licensure must comply with the
20 following requirements:
21 (a) Upon receipt of a completed, signed, and dated
22 application, the agency shall require background screening of
23 the applicant, in accordance with the level 2 standards for
24 screening set forth in chapter 435. As used in this
25 subsection, the term "applicant" means the administrator, or a
26 similarly titled person who is responsible for the day-to-day
27 operation of the licensed home health agency, and the
28 financial officer, or similarly titled individual who is
29 responsible for the financial operation of the licensed home
30 health agency.
31
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1 (b) The agency may require background screening for a
2 member of the board of directors of the licensee or an officer
3 or an individual owning 5 percent or more of the licensee if
4 the agency reasonably suspects that such individual has been
5 convicted of an offense prohibited under the level 2 standards
6 for screening set forth in chapter 435.
7 (c) Proof of compliance with the level 2 background
8 screening requirements of chapter 435 which has been submitted
9 within the previous 5 years in compliance with any other
10 health care or assisted living licensure requirements of this
11 state is acceptable in fulfillment of paragraph (a). Proof of
12 compliance with background screening which has been submitted
13 within the previous 5 years to fulfill the requirements of the
14 Financial Services Commission and the Office of Insurance
15 Regulation pursuant to chapter 651 as part of an application
16 for a certificate of authority to operate a continuing care
17 retirement community is acceptable in fulfillment of the
18 Department of Law Enforcement and Federal Bureau of
19 Investigation background check.
20 (d) A provisional license may be granted to an
21 applicant when each individual required by this section to
22 undergo background screening has met the standards for the
23 Department of Law Enforcement background check, but the agency
24 has not yet received background screening results from the
25 Federal Bureau of Investigation. A standard license may be
26 granted to the licensee upon the agency's receipt of a report
27 of the results of the Federal Bureau of Investigation
28 background screening for each individual required by this
29 section to undergo background screening which confirms that
30 all standards have been met, or upon the granting of a
31 disqualification exemption by the agency as set forth in
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1 chapter 435. Any other person who is required to undergo level
2 2 background screening may serve in his or her capacity
3 pending the agency's receipt of the report from the Federal
4 Bureau of Investigation. However, the person may not continue
5 to serve if the report indicates any violation of background
6 screening standards and a disqualification exemption has not
7 been requested of and granted by the agency as set forth in
8 chapter 435.
9 (e) Each applicant must submit to the agency, with its
10 application, a description and explanation of any exclusions,
11 permanent suspensions, or terminations of the licensee or
12 potential licensee from the Medicare or Medicaid programs.
13 Proof of compliance with the requirements for disclosure of
14 ownership and control interest under the Medicaid or Medicare
15 programs may be accepted in lieu of this submission.
16 (f) Each applicant must submit to the agency a
17 description and explanation of any conviction of an offense
18 prohibited under the level 2 standards of chapter 435 by a
19 member of the board of directors of the applicant, its
20 officers, or any individual owning 5 percent or more of the
21 applicant. This requirement does not apply to a director of a
22 not-for-profit corporation or organization if the director
23 serves solely in a voluntary capacity for the corporation or
24 organization, does not regularly take part in the day-to-day
25 operational decisions of the corporation or organization,
26 receives no remuneration for his or her services on the
27 corporation or organization's board of directors, and has no
28 financial interest and has no family members with a financial
29 interest in the corporation or organization, provided that the
30 director and the not-for-profit corporation or organization
31 include in the application a statement affirming that the
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1 director's relationship to the corporation satisfies the
2 requirements of this paragraph.
3 (g) A license may not be granted to an applicant if
4 the applicant, administrator, or financial officer has been
5 found guilty of, regardless of adjudication, or has entered a
6 plea of nolo contendere or guilty to, any offense prohibited
7 under the level 2 standards for screening set forth in chapter
8 435, unless an exemption from disqualification has been
9 granted by the agency as set forth in chapter 435.
10 (h) The agency may deny or revoke licensure if the
11 applicant:
12 1. Has falsely represented a material fact in the
13 application required by paragraph (e) or paragraph (f), or has
14 omitted any material fact from the application required by
15 paragraph (e) or paragraph (f); or
16 2. Has been or is currently excluded, suspended,
17 terminated from, or has involuntarily withdrawn from
18 participation in this state's Medicaid program, or the
19 Medicaid program of any other state, or from participation in
20 the Medicare program or any other governmental or private
21 health care or health insurance program.
22 (i) An application for license renewal must contain
23 the information required under paragraphs (e) and (f).
24 (3)(5) In addition to the requirements of s. 408.810,
25 the home health agency must also obtain and maintain the
26 following insurance coverages in an amount of not less than
27 $250,000 per claim, and the home health agency must submit
28 proof of coverage with an initial application for licensure
29 and with each annual application for license renewal:
30 (a) Malpractice insurance as defined in s.
31 624.605(1)(k); and
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1 (b) Liability insurance as defined in s.
2 624.605(1)(b).
3 (6) Ninety days before the expiration date, an
4 application for renewal must be submitted to the agency under
5 oath on forms furnished by it, and a license must be renewed
6 if the applicant has met the requirements established under
7 this part and applicable rules. The home health agency must
8 file with the application satisfactory proof that it is in
9 compliance with this part and applicable rules. If there is
10 evidence of financial instability, the home health agency must
11 submit satisfactory proof of its financial ability to comply
12 with the requirements of this part.
13 (7) When transferring the ownership of a home health
14 agency, the transferee must submit an application for a
15 license at least 60 days before the effective date of the
16 transfer. If the home health agency is being leased, a copy
17 of the lease agreement must be filed with the application.
18 (4)(8) In accordance with s. 408.805, an applicant or
19 licensee shall pay a fee for each license application
20 submitted under this part and ss. 408.801-408.819. The fee
21 shall be established by rule and shall be set at The license
22 fee and annual renewal fee required of a home health agency
23 are nonrefundable. The agency shall set the fees in an amount
24 that is sufficient to cover the agency's its costs in carrying
25 out its responsibilities under this part, but may not to
26 exceed $2,000 per biennium $1,000. However, state, county, or
27 municipal governments applying for licenses under this part
28 are exempt from the payment of license fees. All fees
29 collected under this part must be deposited in the Health Care
30 Trust Fund for the administration of this part.
31
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1 (9) The license must be displayed in a conspicuous
2 place in the administrative office of the home health agency
3 and is valid only while in the possession of the person to
4 which it is issued. The license may not be sold, assigned, or
5 otherwise transferred, voluntarily or involuntarily, and is
6 valid only for the home health agency and location for which
7 originally issued.
8 (10) A home health agency against whom a revocation or
9 suspension proceeding is pending at the time of license
10 renewal may be issued a provisional license effective until
11 final disposition by the agency of such proceedings. If
12 judicial relief is sought from the final disposition, the
13 court that has jurisdiction may issue a temporary permit for
14 the duration of the judicial proceeding.
15 (5)(11) The agency may not issue a license designated
16 as certified to a home health agency that fails to satisfy the
17 requirements of a Medicare certification survey from the
18 agency.
19 (12) The agency may not issue a license to a home
20 health agency that has any unpaid fines assessed under this
21 part.
22 Section 97. Section 400.474, Florida Statutes, is
23 amended to read:
24 400.474 Denial or, suspension, revocation of license;
25 injunction; grounds; penalties.--
26 (1) The agency may deny, revoke, or suspend a license,
27 or impose an administrative fine in the manner provided in
28 chapter 120, or initiate injunctive proceedings under s.
29 408.816 for the violation of any provision of this part, ss.
30 408.801-408.819, or applicable rules s. 400.515.
31
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1 (2) Any of the following actions by a home health
2 agency or its employee is grounds for disciplinary action by
3 the agency:
4 (a) Violation of this part, ss. 408.801-408.819, or of
5 applicable rules.
6 (b) An intentional, reckless, or negligent act that
7 materially affects the health or safety of a patient.
8 (c) Knowingly providing home health services in an
9 unlicensed assisted living facility or unlicensed adult
10 family-care home, unless the home health agency or employee
11 reports the unlicensed facility or home to the agency within
12 72 hours after providing the services.
13 (3) The agency may impose the following penalties for
14 operating without a license upon an applicant or owner who has
15 in the past operated, or who currently operates, a licensed
16 home health agency.
17 (a) If a home health agency that is found to be
18 operating without a license wishes to apply for a license, the
19 home health agency may submit an application only after the
20 agency has verified that the home health agency no longer
21 operates an unlicensed home health agency.
22 (b) Any person, partnership, or corporation that
23 violates paragraph (a) and that previously operated a licensed
24 home health agency or concurrently operates both a licensed
25 home health agency and an unlicensed home health agency
26 commits a felony of the third degree punishable as provided in
27 s. 775.082, s. 775.083, or s. 775.084. If an owner has an
28 interest in more than one home health agency and fails to
29 license any one of those home health agencies, the agency must
30 issue a cease and desist order for the activities of the
31 unlicensed home health agency and impose a moratorium on any
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1 or all of the licensed related home health agencies until the
2 unlicensed home health agency is licensed.
3 (3)(c) If any home health agency is found to be
4 operating without a license meets the criteria in paragraph
5 (a) or paragraph (b) and that home health agency has received
6 any government reimbursement for services provided by an
7 unlicensed home health agency, the agency shall make a fraud
8 referral to the appropriate government reimbursement program.
9 (4) The agency may deny, revoke, or suspend the
10 license of a home health agency, or may impose on a home
11 health agency administrative fines not to exceed the aggregate
12 sum of $5,000 if:
13 (a) The agency is unable to obtain entry to the home
14 health agency to conduct a licensure survey, complaint
15 investigation, surveillance visit, or monitoring visit.
16 (b) An applicant or a licensed home health agency has
17 falsely represented a material fact in the application, or has
18 omitted from the application any material fact, including, but
19 not limited to, the fact that the controlling or ownership
20 interest is held by any officer, director, agent, manager,
21 employee, affiliated person, partner, or shareholder who is
22 not eligible to participate.
23 (c) An applicant, owner, or person who has a 5 percent
24 or greater interest in a licensed entity:
25 1. Has been previously found by any licensing,
26 certifying, or professional standards board or agency to have
27 violated the standards or conditions that relate to home
28 health-related licensure or certification, or to the quality
29 of home health-related services provided; or
30 2. Has been or is currently excluded, suspended,
31 terminated from, or has involuntarily withdrawn from,
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1 participation in the Medicaid program of this state or any
2 other state, the Medicare program, or any other governmental
3 health care or health insurance program.
4 Section 98. Subsection (1) and paragraphs (a) and (b)
5 of subsection (2) of section 400.484, Florida Statutes, are
6 amended to read:
7 400.484 Right of inspection; deficiencies; fines.--
8 (1) In accordance with s. 408.811, Any duly authorized
9 officer or employee of the agency may make such inspections
10 and investigations as are necessary in order to determine the
11 state of compliance with this part and with applicable rules.
12 The right of inspection extends to any business that the
13 agency has reason to believe is being operated as a home
14 health agency without a license, but such inspection of any
15 such business may not be made without the permission of the
16 owner or person in charge unless a warrant is first obtained
17 from a circuit court. Any application for a license issued
18 under this part or for license renewal constitutes permission
19 for an appropriate inspection to verify the information
20 submitted on or in connection with the application.
21 (2) The agency shall impose fines for various classes
22 of deficiencies in accordance with the following schedule:
23 (a) A class I deficiency is any act, omission, or
24 practice that results in a patient's death, disablement, or
25 permanent injury, or places a patient at imminent risk of
26 death, disablement, or permanent injury. Upon finding a class
27 I deficiency, the agency may impose an administrative fine in
28 the amount of $5,000 for each occurrence and each day that the
29 deficiency exists. In addition, the agency may immediately
30 revoke the license, or impose a moratorium pursuant to s.
31
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1 408.814 on the admission of new patients, until the factors
2 causing the deficiency have been corrected.
3 (b) A class II deficiency is any act, omission, or
4 practice that has a direct adverse effect on the health,
5 safety, or security of a patient. Upon finding a class II
6 deficiency, the agency may impose an administrative fine in
7 the amount of $1,000 for each occurrence and each day that the
8 deficiency exists. In addition, the agency may suspend the
9 license, or impose a moratorium pursuant to s. 408.814 on the
10 admission of new patients, until the deficiency has been
11 corrected.
12 Section 99. Section 400.494, Florida Statutes, is
13 amended to read:
14 400.494 Information about patients confidential.--
15 (1) Information about patients received by persons
16 employed by, or providing services to, a home health agency or
17 received by the licensing agency through reports or inspection
18 shall be confidential and exempt from the provisions of s.
19 119.07(1) and may shall not be disclosed to any person other
20 than the patient without the written consent of that patient
21 or the patient's guardian.
22 (2) This section does not apply to information
23 lawfully requested by the Medicaid Fraud Control Unit of the
24 Office of the Attorney General or requested under s. 408.811
25 Department of Legal Affairs.
26 Section 100. Section 400.495, Florida Statutes, is
27 amended to read:
28 400.495 Notice of toll-free telephone number for
29 central abuse hotline.--In addition to the requirements of s.
30 408.810(5), On or before the first day home health services
31 are provided to a patient, any home health agency or nurse
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1 registry licensed under this part must inform the patient and
2 his or her immediate family, if appropriate, of the right to
3 report abusive, neglectful, or exploitative practices. The
4 statewide toll-free telephone number for the central abuse
5 hotline must be provided to patients in a manner that is
6 clearly legible and must include the words: "To report abuse,
7 neglect, or exploitation, please call toll-free ...(phone
8 number)...." the Agency for Health Care Administration shall
9 adopt rules that provide for 90 days' advance notice of a
10 change in the toll-free telephone number and that outline due
11 process procedures, as provided under chapter 120, for home
12 health agency personnel and nurse registry personnel who are
13 reported to the central abuse hotline. Home health agencies
14 and nurse registries shall establish appropriate policies and
15 procedures for providing such notice to patients.
16 Section 101. Section 400.497, Florida Statutes, is
17 amended to read:
18 400.497 Rules establishing minimum standards.--The
19 agency shall adopt, publish, and enforce rules to implement
20 ss. 408.801-408.819, this part, including, as applicable, ss.
21 400.506 and 400.509, which must provide reasonable and fair
22 minimum standards relating to:
23 (1) The home health aide competency test and home
24 health aide training. The agency shall create the home health
25 aide competency test and establish the curriculum and
26 instructor qualifications for home health aide training.
27 Licensed home health agencies may provide this training and
28 shall furnish documentation of such training to other licensed
29 home health agencies upon request. Successful passage of the
30 competency test by home health aides may be substituted for
31
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1 the training required under this section and any rule adopted
2 pursuant thereto.
3 (2) Shared staffing. The agency shall allow shared
4 staffing if the home health agency is part of a retirement
5 community that provides multiple levels of care, is located on
6 one campus, is licensed under this chapter, and otherwise
7 meets the requirements of law and rule.
8 (3) The criteria for the frequency of onsite licensure
9 surveys.
10 (4) Licensure application and renewal.
11 (5) The requirements for onsite and electronic
12 accessibility of supervisory personnel of home health
13 agencies.
14 (6) Information to be included in patients' records.
15 (7) Geographic service areas.
16 (8) Preparation of a comprehensive emergency
17 management plan pursuant to s. 400.492.
18 (a) The Agency for Health Care Administration shall
19 adopt rules establishing minimum criteria for the plan and
20 plan updates, with the concurrence of the Department of Health
21 and in consultation with the Department of Community Affairs.
22 (b) The rules must address the requirements in s.
23 400.492. In addition, the rules shall provide for the
24 maintenance of patient-specific medication lists that can
25 accompany patients who are transported from their homes.
26 (c) The plan is subject to review and approval by the
27 county health department. During its review, the county health
28 department shall ensure that the following agencies, at a
29 minimum, are given the opportunity to review the plan:
30 1. The local emergency management agency.
31 2. The Agency for Health Care Administration.
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1 3. The local chapter of the American Red Cross or
2 other lead sheltering agency.
3 4. The district office of the Department of Children
4 and Family Services.
5
6 The county health department shall complete its review within
7 60 days after receipt of the plan and shall either approve the
8 plan or advise the home health agency of necessary revisions.
9 (d) For any home health agency that operates in more
10 than one county, the Department of Health shall review the
11 plan, after consulting with all of the county health
12 departments, the agency, and all the local chapters of the
13 American Red Cross or other lead sheltering agencies in the
14 areas of operation for that particular home health agency. The
15 Department of Health shall complete its review within 90 days
16 after receipt of the plan and shall either approve the plan or
17 advise the home health agency of necessary revisions. The
18 Department of Health shall make every effort to avoid imposing
19 differing requirements based on differences between counties
20 on the home health agency.
21 (e) The requirements in this subsection do not apply
22 to:
23 1. A facility that is certified under chapter 651 and
24 has a licensed home health agency used exclusively by
25 residents of the facility; or
26 2. A retirement community that consists of residential
27 units for independent living and either a licensed nursing
28 home or an assisted living facility, and has a licensed home
29 health agency used exclusively by the residents of the
30 retirement community, provided the comprehensive emergency
31 management plan for the facility or retirement community
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1 provides for continuous care of all residents with special
2 needs during an emergency.
3 Section 102. Section 400.506, Florida Statutes, is
4 amended to read:
5 400.506 Licensure of nurse registries; requirements;
6 penalties.--
7 (1) A nurse registry is exempt from the licensing
8 requirements of a home health agency but must be licensed as a
9 nurse registry. The requirements of ss. 408.801-408.819 apply
10 to the provision of services that necessitate licensure
11 pursuant to ss. 400.506-400.518 and ss. 408.801-408.819 and to
12 entities licensed by or applying for such licensed from the
13 Agency for Health Care Administration pursuant to ss.
14 400.506-400.518. Each operational site of the nurse registry
15 must be licensed, unless there is more than one site within a
16 county. If there is more than one site within a county, only
17 one license per county is required. Each operational site
18 must be listed on the license.
19 (2) Each applicant for licensure must comply with all
20 provisions of ss. 408.801-408.819, with the exception of s.
21 408.810(6) and (10). the following requirements:
22 (a) Upon receipt of a completed, signed, and dated
23 application, the agency shall require background screening, in
24 accordance with the level 2 standards for screening set forth
25 in chapter 435, of the managing employee, or other similarly
26 titled individual who is responsible for the daily operation
27 of the nurse registry, and of the financial officer, or other
28 similarly titled individual who is responsible for the
29 financial operation of the registry, including billings for
30 patient care and services. The applicant shall comply with
31
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1 the procedures for level 2 background screening as set forth
2 in chapter 435.
3 (b) The agency may require background screening of any
4 other individual who is an applicant if the agency has
5 probable cause to believe that he or she has been convicted of
6 a crime or has committed any other offense prohibited under
7 the level 2 standards for screening set forth in chapter 435.
8 (c) Proof of compliance with the level 2 background
9 screening requirements of chapter 435 which has been submitted
10 within the previous 5 years in compliance with any other
11 health care or assisted living licensure requirements of this
12 state is acceptable in fulfillment of the requirements of
13 paragraph (a).
14 (d) A provisional license may be granted to an
15 applicant when each individual required by this section to
16 undergo background screening has met the standards for the
17 Department of Law Enforcement background check but the agency
18 has not yet received background screening results from the
19 Federal Bureau of Investigation. A standard license may be
20 granted to the applicant upon the agency's receipt of a report
21 of the results of the Federal Bureau of Investigation
22 background screening for each individual required by this
23 section to undergo background screening which confirms that
24 all standards have been met, or upon the granting of a
25 disqualification exemption by the agency as set forth in
26 chapter 435. Any other person who is required to undergo level
27 2 background screening may serve in his or her capacity
28 pending the agency's receipt of the report from the Federal
29 Bureau of Investigation. However, the person may not continue
30 to serve if the report indicates any violation of background
31 screening standards and a disqualification exemption has not
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1 been requested of and granted by the agency as set forth in
2 chapter 435.
3 (e) Each applicant must submit to the agency, with its
4 application, a description and explanation of any exclusions,
5 permanent suspensions, or terminations of the applicant from
6 the Medicare or Medicaid programs. Proof of compliance with
7 the requirements for disclosure of ownership and control
8 interests under the Medicaid or Medicare programs may be
9 accepted in lieu of this submission.
10 (f) Each applicant must submit to the agency a
11 description and explanation of any conviction of an offense
12 prohibited under the level 2 standards of chapter 435 by a
13 member of the board of directors of the applicant, its
14 officers, or any individual owning 5 percent or more of the
15 applicant. This requirement does not apply to a director of a
16 not-for-profit corporation or organization if the director
17 serves solely in a voluntary capacity for the corporation or
18 organization, does not regularly take part in the day-to-day
19 operational decisions of the corporation or organization,
20 receives no remuneration for his or her services on the
21 corporation or organization's board of directors, and has no
22 financial interest and has no family members with a financial
23 interest in the corporation or organization, provided that the
24 director and the not-for-profit corporation or organization
25 include in the application a statement affirming that the
26 director's relationship to the corporation satisfies the
27 requirements of this paragraph.
28 (g) A license may not be granted to an applicant if
29 the applicant or managing employee has been found guilty of,
30 regardless of adjudication, or has entered a plea of nolo
31 contendere or guilty to, any offense prohibited under the
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1 level 2 standards for screening set forth in chapter 435,
2 unless an exemption from disqualification has been granted by
3 the agency as set forth in chapter 435.
4 (h) The agency may deny or revoke the license if any
5 applicant:
6 1. Has falsely represented a material fact in the
7 application required by paragraph (e) or paragraph (f), or has
8 omitted any material fact from the application required by
9 paragraph (e) or paragraph (f); or
10 2. Has had prior action taken against the applicant
11 under the Medicaid or Medicare program as set forth in
12 paragraph (e).
13 (i) An application for license renewal must contain
14 the information required under paragraphs (e) and (f).
15 (3) In accordance with s. 408.805, an applicant or
16 licensee shall pay a fee for each license application
17 submitted under ss. 400.508-400.518 and ss. 408.801-408.819.
18 The amount of the fee shall be established by rule and may not
19 exceed $2,000 per biennium. Application for license must be
20 made to the Agency for Health Care Administration on forms
21 furnished by it and must be accompanied by the appropriate
22 licensure fee, as established by rule and not to exceed the
23 cost of regulation under this part. The licensure fee for
24 nurse registries may not exceed $1,000 and must be deposited
25 in the Health Care Trust Fund.
26 (4) The Agency for Health Care Administration may
27 deny, revoke, or suspend a license or impose an administrative
28 fine in the manner provided in chapter 120 against a nurse
29 registry that:
30 (a) Fails to comply with this section or applicable
31 rules.
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1 (b) Commits an intentional, reckless, or negligent act
2 that materially affects the health or safety of a person
3 receiving services.
4 (5) A license issued for the operation of a nurse
5 registry, unless sooner suspended or revoked, expires 1 year
6 after its date of issuance. Sixty days before the expiration
7 date, an application for renewal must be submitted to the
8 Agency for Health Care Administration on forms furnished by
9 it. The Agency for Health Care Administration shall renew the
10 license if the applicant has met the requirements of this
11 section and applicable rules. A nurse registry against which
12 a revocation or suspension proceeding is pending at the time
13 of license renewal may be issued a conditional license
14 effective until final disposition by the Agency for Health
15 Care Administration of such proceedings. If judicial relief is
16 sought from the final disposition, the court having
17 jurisdiction may issue a conditional license for the duration
18 of the judicial proceeding.
19 (6) The Agency for Health Care Administration may
20 institute injunctive proceedings under s. 400.515.
21 (4)(7) A person that offers or advertises to the
22 public that it provides any service for which licensure is
23 required under this section must include in such advertisement
24 the license number issued to it by the Agency for Health Care
25 Administration.
26 (8) It is unlawful for a person to offer or advertise
27 to the public services as defined by rule without obtaining a
28 valid license from the Agency for Health Care Administration.
29 It is unlawful for any holder of a license to advertise or
30 hold out to the public that he or she holds a license for
31 other than that for which he or she actually holds a license.
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1 A person who violates this subsection is subject to injunctive
2 proceedings under s. 400.515.
3 (9) Any duly authorized officer or employee of the
4 Agency for Health Care Administration may make such
5 inspections and investigations as are necessary to respond to
6 complaints or to determine the state of compliance with this
7 section and applicable rules.
8 (a) If, in responding to a complaint, an agent or
9 employee of the Agency for Health Care Administration has
10 reason to believe that a crime has been committed, he or she
11 shall notify the appropriate law enforcement agency.
12 (b) If, in responding to a complaint, an agent or
13 employee of the Agency for Health Care Administration has
14 reason to believe that abuse, neglect, or exploitation has
15 occurred, according to the definitions in chapter 415, he or
16 she shall file a report under chapter 415.
17 (5)(10)(a) A nurse registry may refer for contract in
18 private residences registered nurses and licensed practical
19 nurses registered and licensed under part I of chapter 464,
20 certified nursing assistants certified under part II of
21 chapter 464, home health aides who present documented proof of
22 successful completion of the training required by rule of the
23 agency, and companions or homemakers for the purposes of
24 providing those services authorized under s. 400.509(1). Each
25 person referred by a nurse registry must provide current
26 documentation that he or she is free from communicable
27 diseases.
28 (b) A certified nursing assistant or home health aide
29 may be referred for a contract to provide care to a patient in
30 his or her home only if that patient is under a physician's
31 care. A certified nursing assistant or home health aide
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1 referred for contract in a private residence shall be limited
2 to assisting a patient with bathing, dressing, toileting,
3 grooming, eating, physical transfer, and those normal daily
4 routines the patient could perform for himself or herself were
5 he or she physically capable. A certified nursing assistant
6 or home health aide may not provide medical or other health
7 care services that require specialized training and that may
8 be performed only by licensed health care professionals. The
9 nurse registry shall obtain the name and address of the
10 attending physician and send written notification to the
11 physician within 48 hours after a contract is concluded that a
12 certified nursing assistant or home health aide will be
13 providing care for that patient.
14 (c) A registered nurse shall make monthly visits to
15 the patient's home to assess the patient's condition and
16 quality of care being provided by the certified nursing
17 assistant or home health aide. Any condition which in the
18 professional judgment of the nurse requires further medical
19 attention shall be reported to the attending physician and the
20 nurse registry. The assessment shall become a part of the
21 patient's file with the nurse registry and may be reviewed by
22 the agency during their survey procedure.
23 (6)(11) A person who is referred by a nurse registry
24 for contract in private residences and who is not a nurse
25 licensed under part I of chapter 464 may perform only those
26 services or care to clients that the person has been certified
27 to perform or trained to perform as required by law or rules
28 of the Agency for Health Care Administration or the Department
29 of Business and Professional Regulation. Providing services
30 beyond the scope authorized under this subsection constitutes
31 the unauthorized practice of medicine or a violation of the
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1 Nurse Practice Act and is punishable as provided under chapter
2 458, chapter 459, or part I of chapter 464.
3 (7)(12) Each nurse registry must require every
4 applicant for contract to complete an application form
5 providing the following information:
6 (a) The name, address, date of birth, and social
7 security number of the applicant.
8 (b) The educational background and employment history
9 of the applicant.
10 (c) The number and date of the applicable license or
11 certification.
12 (d) When appropriate, information concerning the
13 renewal of the applicable license, registration, or
14 certification.
15 (8)(13) Each nurse registry must comply with the
16 procedures set forth in s. 400.512 for maintaining records of
17 the employment history of all persons referred for contract
18 and is subject to the standards and conditions set forth in
19 that section. However, an initial screening may not be
20 required for persons who have been continuously registered
21 with the nurse registry since September 30, 1990.
22 (9)(14) The nurse registry must maintain the
23 application on file, and that file must be open to the
24 inspection of the Agency for Health Care Administration. The
25 nurse registry must maintain on file the name and address of
26 the client to whom the nurse or other nurse registry personnel
27 is sent for contract and the amount of the fee received by the
28 nurse registry. A nurse registry must maintain the file that
29 includes the application and other applicable documentation
30 for 3 years after the date of the last file entry of
31 client-related information.
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1 (10)(15) Nurse registries shall assist persons who
2 would need assistance and sheltering during evacuations
3 because of physical, mental, or sensory disabilities in
4 registering with the appropriate local emergency management
5 agency pursuant to s. 252.355.
6 (11)(16) Each nurse registry shall prepare and
7 maintain a comprehensive emergency management plan that is
8 consistent with the criteria in this subsection and with the
9 local special needs plan. The plan shall be updated annually.
10 The plan shall specify how the nurse registry shall facilitate
11 the provision of continuous care by persons referred for
12 contract to persons who are registered pursuant to s. 252.355
13 during an emergency that interrupts the provision of care or
14 services in private residencies.
15 (a) All persons referred for contract who care for
16 persons registered pursuant to s. 252.355 must include in the
17 patient record a description of how care will be continued
18 during a disaster or emergency that interrupts the provision
19 of care in the patient's home. It shall be the responsibility
20 of the person referred for contract to ensure that continuous
21 care is provided.
22 (b) Each nurse registry shall maintain a current
23 prioritized list of patients in private residences who are
24 registered pursuant to s. 252.355 and are under the care of
25 persons referred for contract and who need continued services
26 during an emergency. This list shall indicate, for each
27 patient, if the client is to be transported to a special needs
28 shelter and if the patient is receiving skilled nursing
29 services. Nurse registries shall make this list available to
30 county health departments and to local emergency management
31 agencies upon request.
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1 (c) Each person referred for contract who is caring
2 for a patient who is registered pursuant to s. 252.355 shall
3 provide a list of the patient's medication and equipment needs
4 to the nurse registry. Each person referred for contract shall
5 make this information available to county health departments
6 and to local emergency management agencies upon request.
7 (d) Each person referred for contract shall not be
8 required to continue to provide care to patients in emergency
9 situations that are beyond the person's control and that make
10 it impossible to provide services, such as when roads are
11 impassable or when patients do not go to the location
12 specified in their patient records.
13 (e) The comprehensive emergency management plan
14 required by this subsection is subject to review and approval
15 by the county health department. During its review, the county
16 health department shall ensure that, at a minimum, the local
17 emergency management agency, the Agency for Health Care
18 Administration, and the local chapter of the American Red
19 Cross or other lead sheltering agency are given the
20 opportunity to review the plan. The county health department
21 shall complete its review within 60 days after receipt of the
22 plan and shall either approve the plan or advise the nurse
23 registry of necessary revisions.
24 (f) The Agency for Health Care Administration shall
25 adopt rules establishing minimum criteria for the
26 comprehensive emergency management plan and plan updates
27 required by this subsection, with the concurrence of the
28 Department of Health and in consultation with the Department
29 of Community Affairs.
30
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1 (12)(17) All persons referred for contract in private
2 residences by a nurse registry must comply with the following
3 requirements for a plan of treatment:
4 (a) When, in accordance with the privileges and
5 restrictions imposed upon a nurse under part I of chapter 464,
6 the delivery of care to a patient is under the direction or
7 supervision of a physician or when a physician is responsible
8 for the medical care of the patient, a medical plan of
9 treatment must be established for each patient receiving care
10 or treatment provided by a licensed nurse in the home. The
11 original medical plan of treatment must be timely signed by
12 the physician and reviewed by him or her in consultation with
13 the licensed nurse at least every 2 months. Any additional
14 order or change in orders must be obtained from the physician
15 and reduced to writing and timely signed by the physician.
16 The delivery of care under a medical plan of treatment must be
17 substantiated by the appropriate nursing notes or
18 documentation made by the nurse in compliance with nursing
19 practices established under part I of chapter 464.
20 (b) Whenever a medical plan of treatment is
21 established for a patient, the initial medical plan of
22 treatment, any amendment to the plan, additional order or
23 change in orders, and copy of nursing notes must be filed in
24 the office of the nurse registry.
25 (13)(18) The nurse registry must comply with the
26 notice requirements of s. 400.495, relating to abuse
27 reporting.
28 (14)(19) In addition to any other penalties imposed
29 pursuant to this section or part, the agency may assess costs
30 related to an investigation that results in a successful
31 prosecution, excluding costs associated with an attorney's
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1 time. If the agency imposes such an assessment and the
2 assessment is not paid, and if challenged is not the subject
3 of a pending appeal, prior to the renewal of the license, the
4 license shall not be issued until the assessment is paid or
5 arrangements for payment of the assessment are made.
6 (15)(20) The Agency for Health Care Administration
7 shall adopt rules to implement this section and ss.
8 408.801-408.819.
9 Section 103. Section 400.509, Florida Statutes, is
10 amended to read:
11 400.509 Registration of particular service providers
12 exempt from licensure; certificate of registration; regulation
13 of registrants.--
14 (1) Any organization that provides companion services
15 or homemaker services and does not provide a home health
16 service to a person is exempt from licensure under this part.
17 However, any organization that provides companion services or
18 homemaker services must register with the agency.
19 (2) The requirements of ss. 408.801-408.819 apply to
20 the provision of services that necessitate registration or
21 licensure pursuant to ss. 400.509-400.512 and ss.
22 408.801-408.819 and to entities registered by or applying for
23 such registration from the Agency for Health Care
24 Administration pursuant to ss. 400.509-400.512. Each applicant
25 for registration must comply with all provisions of ss.
26 408.801-408.819, with the exception of s. 408.810(6)-(10).
27 Registration consists of annually filing with the agency,
28 under oath, on forms provided by it, the following
29 information:
30
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1 (a) If the registrant is a firm or partnership, the
2 name, address, date of birth, and social security number of
3 every member.
4 (b) If the registrant is a corporation or association,
5 its name and address; the name, address, date of birth, and
6 social security number of each of its directors and officers;
7 and the name and address of each person having at least a 5
8 percent interest in the corporation or association.
9 (c) The name, address, date of birth, and social
10 security number of each person employed by or under contract
11 with the organization.
12 (3) In accordance with s. 408.805, an applicant or
13 registrant shall pay a fee for each registration issued under
14 this part and ss. 408.801-408.819. The amount of the fee shall
15 be $50 per biennium. The agency shall charge a registration
16 fee of $25 to be submitted with the information required under
17 subsection (2).
18 (4) Each applicant for registration must comply with
19 the following requirements:
20 (a) Upon receipt of a completed, signed, and dated
21 application, the agency shall require background screening, in
22 accordance with the level 1 standards for screening set forth
23 in chapter 435, of every individual who will have contact with
24 the client. The agency shall require background screening of
25 the managing employee or other similarly titled individual who
26 is responsible for the operation of the entity, and of the
27 financial officer or other similarly titled individual who is
28 responsible for the financial operation of the entity,
29 including billings for client services in accordance with the
30 level 2 standards for background screening as set forth in
31 chapter 435.
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1 (b) The agency may require background screening of any
2 other individual who is affiliated with the applicant if the
3 agency has a reasonable basis for believing that he or she has
4 been convicted of a crime or has committed any other offense
5 prohibited under the level 2 standards for screening set forth
6 in chapter 435.
7 (c) Proof of compliance with the level 2 background
8 screening requirements of chapter 435 which has been submitted
9 within the previous 5 years in compliance with any other
10 health care or assisted living licensure requirements of this
11 state is acceptable in fulfillment of paragraph (a).
12 (d) A provisional registration may be granted to an
13 applicant when each individual required by this section to
14 undergo background screening has met the standards for the
15 abuse-registry background check through the agency and the
16 Department of Law Enforcement background check, but the agency
17 has not yet received background screening results from the
18 Federal Bureau of Investigation. A standard registration may
19 be granted to the applicant upon the agency's receipt of a
20 report of the results of the Federal Bureau of Investigation
21 background screening for each individual required by this
22 section to undergo background screening which confirms that
23 all standards have been met, or upon the granting of a
24 disqualification exemption by the agency as set forth in
25 chapter 435. Any other person who is required to undergo
26 level 2 background screening may serve in his or her capacity
27 pending the agency's receipt of the report from the Federal
28 Bureau of Investigation. However, the person may not continue
29 to serve if the report indicates any violation of background
30 screening standards and if a disqualification exemption has
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1 not been requested of and granted by the agency as set forth
2 in chapter 435.
3 (e) Each applicant must submit to the agency, with its
4 application, a description and explanation of any exclusions,
5 permanent suspensions, or terminations of the applicant from
6 the Medicare or Medicaid programs. Proof of compliance with
7 the requirements for disclosure of ownership and control
8 interests under the Medicaid or Medicare programs may be
9 accepted in lieu of this submission.
10 (f) Each applicant must submit to the agency a
11 description and explanation of any conviction of an offense
12 prohibited under the level 2 standards of chapter 435 which
13 was committed by a member of the board of directors of the
14 applicant, its officers, or any individual owning 5 percent or
15 more of the applicant. This requirement does not apply to a
16 director of a not-for-profit corporation or organization who
17 serves solely in a voluntary capacity for the corporation or
18 organization, does not regularly take part in the day-to-day
19 operational decisions of the corporation or organization,
20 receives no remuneration for his or her services on the
21 corporation's or organization's board of directors, and has no
22 financial interest and no family members having a financial
23 interest in the corporation or organization, if the director
24 and the not-for-profit corporation or organization include in
25 the application a statement affirming that the director's
26 relationship to the corporation satisfies the requirements of
27 this paragraph.
28 (g) A registration may not be granted to an applicant
29 if the applicant or managing employee has been found guilty
30 of, regardless of adjudication, or has entered a plea of nolo
31 contendere or guilty to, any offense prohibited under the
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1 level 2 standards for screening set forth in chapter 435,
2 unless an exemption from disqualification has been granted by
3 the agency as set forth in chapter 435.
4 (h) The agency may deny or revoke the registration of
5 any applicant who:
6 1. Has falsely represented a material fact in the
7 application required by paragraph (e) or paragraph (f), or has
8 omitted any material fact from the application required by
9 paragraph (e) or paragraph (f); or
10 2. Has had prior action taken against the applicant
11 under the Medicaid or Medicare program as set forth in
12 paragraph (e).
13 (i) An application for licensure renewal must contain
14 the information required under paragraphs (e) and (f).
15 (4)(5) Each registrant must obtain the employment or
16 contract history of persons who are employed by or under
17 contract with the organization and who will have contact at
18 any time with patients or clients in their homes by:
19 (a) Requiring such persons to submit an employment or
20 contractual history to the registrant; and
21 (b) Verifying the employment or contractual history,
22 unless through diligent efforts such verification is not
23 possible. The agency shall prescribe by rule the minimum
24 requirements for establishing that diligent efforts have been
25 made.
26
27 There is no monetary liability on the part of, and no cause of
28 action for damages arises against, a former employer of a
29 prospective employee of or prospective independent contractor
30 with a registrant who reasonably and in good faith
31 communicates his or her honest opinions about the former
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1 employee's or contractor's job performance. This subsection
2 does not affect the official immunity of an officer or
3 employee of a public corporation.
4 (6) On or before the first day on which services are
5 provided to a patient or client, any registrant under this
6 part must inform the patient or client and his or her
7 immediate family, if appropriate, of the right to report
8 abusive, neglectful, or exploitative practices. The statewide
9 toll-free telephone number for the central abuse hotline must
10 be provided to patients or clients in a manner that is clearly
11 legible and must include the words: "To report abuse, neglect,
12 or exploitation, please call toll-free ...(phone number)...."
13 Registrants must establish appropriate policies and procedures
14 for providing such notice to patients or clients.
15 (7) The provisions of s. 400.512 regarding screening
16 apply to any person or business entity registered under this
17 section on or after October 1, 1994.
18 (8) Upon verification that all requirements for
19 registration have been met, the Agency for Health Care
20 Administration shall issue a certificate of registration valid
21 for no more than 1 year.
22 (9) The Agency for Health Care Administration may
23 deny, suspend, or revoke the registration of a person that:
24 (a) Fails to comply with this section or applicable
25 rules.
26 (b) Commits an intentional, reckless, or negligent act
27 that materially affects the health or safety of a person
28 receiving services.
29 (10) The Agency for Health Care Administration may
30 institute injunctive proceedings under s. 400.515.
31
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1 (5)(11) A person that offers or advertises to the
2 public a service for which registration is required must
3 include in its advertisement the registration number issued by
4 the Agency for Health Care Administration.
5 (12) It is unlawful for a person to offer or advertise
6 to the public services, as defined by rule, without obtaining
7 a certificate of registration from the Agency for Health Care
8 Administration. It is unlawful for any holder of a
9 certificate of registration to advertise or hold out to the
10 public that he or she holds a certificate of registration for
11 other than that for which he or she actually holds a
12 certificate of registration. Any person who violates this
13 subsection is subject to injunctive proceedings under s.
14 400.515.
15 (13) Any duly authorized officer or employee of the
16 Agency for Health Care Administration has the right to make
17 such inspections and investigations as are necessary in order
18 to respond to complaints or to determine the state of
19 compliance with this section and applicable rules.
20 (a) If, in responding to a complaint, an officer or
21 employee of the Agency for Health Care Administration has
22 reason to believe that a crime has been committed, he or she
23 shall notify the appropriate law enforcement agency.
24 (b) If, in responding to a complaint, an officer or
25 employee of the Agency for Health Care Administration has
26 reason to believe that abuse, neglect, or exploitation has
27 occurred, according to the definitions in chapter 415, he or
28 she shall file a report under chapter 415.
29 (6)(14) In addition to any other penalties imposed
30 pursuant to this section or part, the agency may assess costs
31 related to an investigation that results in a successful
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1 prosecution, excluding costs associated with an attorney's
2 time. If the agency imposes such an assessment and the
3 assessment is not paid, and if challenged is not the subject
4 of a pending appeal, prior to the renewal of the registration,
5 the registration shall not be issued until the assessment is
6 paid or arrangements for payment of the assessment are made.
7 (7)(15) The Agency for Health Care Administration
8 shall adopt rules to administer this section and ss.
9 408.801-408.819.
10 Section 104. Subsections (2) and (7) of section
11 400.512, Florida Statutes, are amended to read:
12 400.512 Screening of home health agency personnel;
13 nurse registry personnel; and companions and homemakers.--The
14 agency shall require employment or contractor screening as
15 provided in chapter 435, using the level 1 standards for
16 screening set forth in that chapter, for home health agency
17 personnel; persons referred for employment by nurse
18 registries; and persons employed by companion or homemaker
19 services registered under s. 400.509.
20 (2) The administrator of each home health agency, the
21 managing employee of each nurse registry, and the managing
22 employee of each companion or homemaker service registered
23 under s. 400.509 must sign an affidavit annually, under
24 penalty of perjury, stating that all personnel hired,
25 contracted with, or registered on or after October 1, 1994,
26 who enter the home of a patient or client in their service
27 capacity have been screened and that its remaining personnel
28 have worked for the home health agency or registrant
29 continuously since before October 1, 1994.
30
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1 (7)(a) It is a misdemeanor of the first degree,
2 punishable under s. 775.082 or s. 775.083, for any person
3 willfully, knowingly, or intentionally to:
4 1. Fail, by false statement, misrepresentation,
5 impersonation, or other fraudulent means, to disclose in any
6 application for voluntary or paid employment a material fact
7 used in making a determination as to such person's
8 qualifications to be an employee under this section;
9 2. Operate or attempt to operate an entity licensed or
10 registered under this part with persons who do not meet the
11 minimum standards for good moral character as contained in
12 this section; or
13 2.3. Use information from the criminal records
14 obtained under this section for any purpose other than
15 screening that person for employment as specified in this
16 section or release such information to any other person for
17 any purpose other than screening for employment under this
18 section.
19 (b) It is a felony of the third degree, punishable
20 under s. 775.082, s. 775.083, or s. 775.084, for any person
21 willfully, knowingly, or intentionally to use information from
22 the juvenile records of a person obtained under this section
23 for any purpose other than screening for employment under this
24 section.
25 Section 105. Section 400.515, Florida Statutes, is
26 repealed.
27 Section 106. Subsections (6) and (7) of section
28 400.551, Florida Statutes, are amended to read:
29 400.551 Definitions.--As used in this part, the term:
30 (6) "Operator" means the licensee or person having
31 general administrative charge of an adult day care center.
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1 (7) "Owner" means the licensee owner of an adult day
2 care center.
3 Section 107. Section 400.554, Florida Statutes, is
4 amended to read:
5 400.554 License requirement; fee; exemption;
6 display.--
7 (1) The requirements of ss. 408.801-408.819 apply to
8 the provision of services that necessitate licensure pursuant
9 to this part and ss. 408.801-408.819 and to entities licensed
10 by or applying for such licensure from the Agency for Health
11 Care Administration pursuant to this part. It is unlawful to
12 operate an adult day care center without first obtaining from
13 the agency a license authorizing such operation. The agency
14 is responsible for licensing adult day care centers in
15 accordance with this part.
16 (2) Separate licenses are required for centers
17 operated on separate premises, even though operated under the
18 same management. Separate licenses are not required for
19 separate buildings on the same premises.
20 (3) In accordance with s. 408.805, an applicant or
21 licensee shall pay a fee for each license application
22 submitted under this part and ss. 408.801-408.819. The amount
23 of the fee shall be established by rule and The biennial
24 license fee required of a center shall be determined by the
25 department, but may not exceed $150 per biennium.
26 (4) County-operated or municipally operated centers
27 applying for licensure under this part are exempt from the
28 payment of license fees.
29 (5) The license for a center shall be displayed in a
30 conspicuous place inside the center.
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1 (6) A license is valid only in the possession of the
2 individual, firm, partnership, association, or corporation to
3 which it is issued and is not subject to sale, assignment, or
4 other transfer, voluntary or involuntary; nor is a license
5 valid for any premises other than the premises for which
6 originally issued.
7 Section 108. Section 400.555, Florida Statutes, is
8 amended to read:
9 400.555 Application for license.--
10 (1) An application for a license to operate an adult
11 day care center must be made to the agency on forms furnished
12 by the agency and must be accompanied by the appropriate
13 license fee unless the applicant is exempt from payment of the
14 fee as provided in s. 400.554(4).
15 (2) In addition to all provisions of ss.
16 408-801-408.819, the applicant for licensure must furnish:
17 (a) a description of the physical and mental
18 capabilities and needs of the participants to be served and
19 the availability, frequency, and intensity of basic services
20 and of supportive and optional services to be provided.;
21 (b) Satisfactory proof of financial ability to operate
22 and conduct the center in accordance with the requirements of
23 this part, which must include, in the case of an initial
24 application, a 1-year operating plan and proof of a 3-month
25 operating reserve fund; and
26 (c) Proof of adequate liability insurance coverage.
27 (d) Proof of compliance with level 2 background
28 screening as required under s. 400.5572.
29 (e) A description and explanation of any exclusions,
30 permanent suspensions, or terminations of the application from
31 the Medicare or Medicaid programs. Proof of compliance with
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1 disclosure of ownership and control interest requirements of
2 the Medicare or Medicaid programs shall be accepted in lieu of
3 this submission.
4 Section 109. Section 400.556, Florida Statutes, is
5 amended to read:
6 400.556 Denial or, suspension, revocation of license;
7 administrative fines; investigations and inspections.--
8 (1) The agency may deny, revoke, or suspend a license
9 under this part, impose a moratorium, or may impose an
10 administrative fine against the owner of an adult day care
11 center or its operator or employee in the manner provided in
12 chapter 120 for a violation of any provision of this part, ss.
13 408.801-408.819, or applicable rules.
14 (2) Each of the following actions by the owner of an
15 adult day care center or by its operator or employee is a
16 ground for action by the agency against the owner of the
17 center or its operator or employee:
18 (a) An intentional or negligent act materially
19 affecting the health or safety of center participants.
20 (b) A violation of this part or of any standard or
21 rule under this part.
22 (b)(c) A failure of persons subject to level 2
23 background screening under s. 400.4174(1) to meet the
24 screening standards of s. 435.04, or the retention by the
25 center of an employee subject to level 1 background screening
26 standards under s. 400.4174(2) who does not meet the screening
27 standards of s. 435.03 and for whom exemptions from
28 disqualification have not been provided by the agency.
29 (c)(d) Failure to follow the criteria and procedures
30 provided under part I of chapter 394 relating to the
31
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1 transportation, voluntary admission, and involuntary
2 examination of center participants.
3 (d)(e) Multiple or repeated violations of this part or
4 of any standard or rule adopted under this part or ss.
5 408.801-408.819.
6 (f) Exclusion, permanent suspension, or termination of
7 the owner, if an individual, officer, or board member of the
8 adult day care center, if the owner is a firm, corporation,
9 partnership, or association, or any person owning 5 percent or
10 more of the center, from the Medicare or Medicaid program.
11 (3) The agency is responsible for all investigations
12 and inspections conducted pursuant to this part.
13 Section 110. Section 400.5565, Florida Statutes, is
14 amended to read:
15 400.5565 Administrative fines; interest.--
16 (1)(a) If the agency determines that an adult day care
17 center is not operated in compliance with this part, ss.
18 408.801-408.819, or applicable with rules adopted under this
19 part, the agency, notwithstanding any other administrative
20 action it takes, shall make a reasonable attempt to discuss
21 with the owner each violation and recommended corrective
22 action prior to providing the owner with written notification.
23 The agency may request the submission of a corrective action
24 plan for the center which demonstrates a good faith effort to
25 remedy each violation by a specific date, subject to the
26 approval of the agency.
27 (b) The owner of a center or its operator or employee
28 found in violation of this part, ss. 408.801-408.819, or
29 applicable of rules adopted under this part may be fined by
30 the agency. A fine may not exceed $500 for each violation.
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1 In no event, however, may such fines in the aggregate exceed
2 $5,000.
3 (c) The failure to correct a violation by the date set
4 by the agency, or the failure to comply with an approved
5 corrective action plan, is a separate violation for each day
6 such failure continues, unless the agency approves an
7 extension to a specific date.
8 (d) If the owner of a center or its operator or
9 employee appeals an agency action under this section and the
10 fine is upheld, the violator shall pay the fine, plus interest
11 at the legal rate specified in s. 687.01 for each day that the
12 fine remains unpaid after the date set by the agency for
13 payment of the fine.
14 (2) In determining whether to impose a fine and in
15 fixing the amount of any fine, the agency shall consider the
16 following factors:
17 (a) The gravity of the violation, including the
18 probability that death or serious physical or emotional harm
19 to a participant will result or has resulted, the severity of
20 the actual or potential harm, and the extent to which the
21 provisions of the applicable statutes or rules were violated.
22 (b) Actions taken by the owner or operator to correct
23 violations.
24 (c) Any previous violations.
25 (d) The financial benefit to the center of committing
26 or continuing the violation.
27 Section 111. Section 400.557, Florida Statutes, is
28 amended to read:
29 400.557 Expiration of license; renewal; Conditional
30 license or permit.--
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1 (1) A license issued for the operation of an adult day
2 care center, unless sooner suspended or revoked, expires 2
3 years after the date of issuance. The agency shall notify a
4 licensee at least 120 days before the expiration date that
5 license renewal is required to continue operation. The
6 notification must be provided electronically or by mail
7 delivery. At least 90 days prior to the expiration date, an
8 application for renewal must be submitted to the agency. A
9 license shall be renewed, upon the filing of an application on
10 forms furnished by the agency, if the applicant has first met
11 the requirements of this part and of the rules adopted under
12 this part. The applicant must file with the application
13 satisfactory proof of financial ability to operate the center
14 in accordance with the requirements of this part and in
15 accordance with the needs of the participants to be served and
16 an affidavit of compliance with the background screening
17 requirements of s. 400.5572.
18 (2) A licensee against whom a revocation or suspension
19 proceeding is pending at the time for license renewal may be
20 issued a conditional license effective until final disposition
21 by the agency of the proceeding. If judicial relief is sought
22 from the final disposition, the court having jurisdiction may
23 issue a conditional permit effective for the duration of the
24 judicial proceeding.
25 (3) The agency may issue a conditional license to an
26 applicant for license renewal or change of ownership if the
27 applicant fails to meet all standards and requirements for
28 licensure. A conditional license issued under this subsection
29 must be limited to a specific period not exceeding 6 months,
30 as determined by the agency, and must be accompanied by an
31 approved plan of correction.
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1 Section 112. Section 400.5572, Florida Statutes, is
2 amended to read:
3 400.5572 Background screening.--
4 (1)(a) Level 2 background screening must be conducted
5 on each of the following persons, who shall be considered
6 employees for the purposes of conducting screening under
7 chapter 435:
8 1. The adult day care center owner if an individual,
9 the operator, and the financial officer.
10 2. An officer or board member if the owner of the
11 adult day care center is a firm, corporation, partnership, or
12 association, or any person owning 5 percent or more of the
13 facility, if the agency has probable cause to believe that
14 such person has been convicted of any offense prohibited by s.
15 435.04. For each officer, board member, or person owning 5
16 percent or more who has been convicted of any such offense,
17 the facility shall submit to the agency a description and
18 explanation of the conviction at the time of license
19 application. This subparagraph does not apply to a board
20 member of a not-for-profit corporation or organization if the
21 board member serves solely in a voluntary capacity, does not
22 regularly take part in the day-to-day operational decisions of
23 the corporation or organization, receives no remuneration for
24 his or her services, and has no financial interest and has no
25 family members with a financial interest in the corporation or
26 organization, provided that the board member and facility
27 submit a statement affirming that the board member's
28 relationship to the facility satisfies the requirements of
29 this subparagraph.
30 (b) Proof of compliance with level 2 screening
31 standards which has been submitted within the previous 5 years
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1 to meet any facility or professional licensure requirements of
2 the agency or the Department of Health satisfies the
3 requirements of this subsection.
4 (c) The agency may grant a provisional license to an
5 adult day care center applying for an initial license when
6 each individual required by this subsection to undergo
7 screening has completed the Department of Law Enforcement
8 background check, but has not yet received results from the
9 Federal Bureau of Investigation, or when a request for an
10 exemption from disqualification has been submitted to the
11 agency pursuant to s. 435.07, but a response has not been
12 issued.
13 (2) The owner or administrator of an adult day care
14 center must conduct level 1 background screening as set forth
15 in chapter 435 on all employees hired on or after October 1,
16 1998, who provide basic services or supportive and optional
17 services to the participants. Such persons satisfy this
18 requirement if:
19 (1)(a) Proof of compliance with level 1 screening
20 requirements obtained to meet any professional license
21 requirements in this state is provided and accompanied, under
22 penalty of perjury, by a copy of the person's current
23 professional license and an affidavit of current compliance
24 with the background screening requirements.
25 (2)(b) The person required to be screened has been
26 continuously employed, without a breach in service that
27 exceeds 180 days, in the same type of occupation for which the
28 person is seeking employment and provides proof of compliance
29 with the level 1 screening requirement which is no more than 2
30 years old. Proof of compliance must be provided directly from
31 one employer or contractor to another, and not from the person
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1 screened. Upon request, a copy of screening results shall be
2 provided to the person screened by the employer retaining
3 documentation of the screening.
4 (3)(c) The person required to be screened is employed
5 by a corporation or business entity or related corporation or
6 business entity that owns, operates, or manages more than one
7 facility or agency licensed under this chapter, and for whom a
8 level 1 screening was conducted by the corporation or business
9 entity as a condition of initial or continued employment.
10 Section 113. Sections 400.5575 and 400.558, Florida
11 Statutes, are repealed.
12 Section 114. Section 400.559, Florida Statutes, is
13 amended to read:
14 400.559 Closing or change of owner or operator of
15 center.--
16 (1) Before operation of an adult day care center may
17 be voluntarily discontinued, the operator must, inform the
18 agency in writing at least 60 days prior to the discontinuance
19 of operation. The operator must also, at such time, inform
20 each participant of the fact and the proposed date of such
21 discontinuance.
22 (2) Immediately upon discontinuance of the operation
23 of a center, the owner or operator shall surrender the license
24 for the center to the agency, and the license shall be
25 canceled by the agency.
26 (3) If a center has a change of ownership, the new
27 owner shall apply to the agency for a new license at least 60
28 days before the date of the change of ownership.
29 (4) If a center has a change of operator, the new
30 operator shall notify the agency in writing within 30 days
31 after the change of operator.
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1 Section 115. Section 400.56, Florida Statutes, is
2 amended to read:
3 400.56 Right of entry and inspection.--In accordance
4 with s. 408.811, Any duly designated officer or employee of
5 the agency or department has the right to enter the premises
6 of any adult day care center licensed pursuant to this part,
7 at any reasonable time, in order to determine the state of
8 compliance with this part, ss. 408.801-408.819, and applicable
9 the rules or standards in force pursuant to this part. The
10 right of entry and inspection also extends to any premises
11 that the agency has reason to believe are being operated as a
12 center without a license, but no entry or inspection of any
13 unlicensed premises may be made without the permission of the
14 owner or operator unless a warrant is first obtained from the
15 circuit court authorizing entry or inspection. Any
16 application for a center license or license renewal made
17 pursuant to this part constitutes permission for, and complete
18 acquiescence in, any entry or inspection of the premises for
19 which the license is sought in order to facilitate
20 verification of the information submitted on or in connection
21 with the application.
22 Section 116. Section 400.562, Florida Statutes, is
23 amended to read:
24 400.562 Rules establishing standards.--
25 (1) The agency Department of Elderly Affairs, in
26 conjunction with the Department of Elderly Affairs agency,
27 shall adopt rules to implement the provisions of this part and
28 ss. 408.801-408.819. The rules must include reasonable and
29 fair standards. Any conflict between these standards and those
30 that may be set forth in local, county, or municipal
31
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1 ordinances shall be resolved in favor of those having
2 statewide effect. Such standards must relate to:
3 (a) The maintenance of adult day care centers with
4 respect to plumbing, heating, lighting, ventilation, and other
5 building conditions, including adequate meeting space, to
6 ensure the health, safety, and comfort of participants and
7 protection from fire hazard. Such standards may not conflict
8 with chapter 553 and must be based upon the size of the
9 structure and the number of participants.
10 (b) The number and qualifications of all personnel
11 employed by adult day care centers who have responsibilities
12 for the care of participants.
13 (c) All sanitary conditions within adult day care
14 centers and their surroundings, including water supply, sewage
15 disposal, food handling, and general hygiene, and maintenance
16 of sanitary conditions, to ensure the health and comfort of
17 participants.
18 (d) Basic services provided by adult day care centers.
19 (e) Supportive and optional services provided by adult
20 day care centers.
21 (f) Data and information relative to participants and
22 programs of adult day care centers, including, but not limited
23 to, the physical and mental capabilities and needs of the
24 participants, the availability, frequency, and intensity of
25 basic services and of supportive and optional services
26 provided, the frequency of participation, the distances
27 traveled by participants, the hours of operation, the number
28 of referrals to other centers or elsewhere, and the incidence
29 of illness.
30 (g) Components of a comprehensive emergency management
31 plan, developed in consultation with the Department of Health,
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1 the Department of Elderly Affairs Agency for Health Care
2 Administration, and the Department of Community Affairs.
3 (2) Pursuant to s. 119.07, the agency may charge a fee
4 for furnishing a copy of this part, or of the rules adopted
5 under this part, to any person upon request for the copy.
6 (2)(3) Pursuant to this part, s. 408.811, and
7 applicable rules adopted by the department, the agency may
8 conduct an abbreviated biennial inspection of key
9 quality-of-care standards, in lieu of a full inspection, of a
10 center that has a record of good performance. However, the
11 agency must conduct a full inspection of a center that has had
12 one or more confirmed complaints within the licensure period
13 immediately preceding the inspection or which has a serious
14 problem identified during the abbreviated inspection. The
15 agency shall by rule develop the key quality-of-care
16 standards, taking into consideration the comments and
17 recommendations of the Department of Elderly Affairs and of
18 provider groups. These standards shall be included in rules
19 adopted by the Department of Elderly Affairs.
20 Section 117. Section 400.564, Florida Statutes, is
21 repealed.
22 Section 118. Section 400.602, Florida Statutes, is
23 amended to read:
24 400.602 Licensure required; prohibited acts;
25 exemptions; display, transferability of license.--
26 (1)(a) The requirements of ss. 408.801-408.819 apply
27 to the provision of services that necessitate licensure
28 pursuant to this part and ss. 408.801-408.819 and to entities
29 licensed by or applying for such licensure from the Agency for
30 Health Care Administration pursuant to this part. It is
31
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1 unlawful to operate or maintain a hospice without first
2 obtaining a license from the agency.
3 (b) It is unlawful for Any person or legal entity not
4 licensed as a hospice under this part may not to use the word
5 "hospice" in its name, or to offer or advertise hospice
6 services or hospice-like services in such a way as to mislead
7 a person to believe that the offeror is a hospice licensed
8 under this part.
9 (2) Services provided by a hospital, nursing home, or
10 other health care facility, health care provider, or
11 caregiver, or under the Community Care for the Elderly Act, do
12 not constitute a hospice unless the facility, provider, or
13 caregiver establishes a separate and distinct administrative
14 program to provide home, residential, and homelike inpatient
15 hospice services.
16 (3)(a) A separately licensed hospice may not use a
17 name which is substantially the same as the name of another
18 hospice licensed under this part.
19 (b) A licensed hospice which intends to change its
20 name or address must notify the agency at least 60 days before
21 making the change.
22 (4) The license shall be displayed in a conspicuous
23 place inside the hospice program office; shall be valid only
24 in the possession of the person or public agency to which it
25 is issued; shall not be subject to sale, assignment, or other
26 transfer, voluntary or involuntary; and shall not be valid for
27 any hospice other than the hospice for which originally
28 issued.
29 (4)(5) Notwithstanding s. 400.601(3), any hospice
30 operating in corporate form exclusively as a hospice,
31 incorporated on or before July 1, 1978, may be transferred to
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1 a for-profit or not-for-profit entity, and may transfer the
2 license to that entity.
3 (5)(6) Notwithstanding s. 400.601(3), at any time
4 after July 1, 1995, any entity entitled to licensure under
5 subsection (4) (5) may obtain a license for up to two
6 additional hospices in accordance with the other requirements
7 of this part and upon receipt of any certificate of need that
8 may be required under the provisions of ss. 408.031-408.045.
9 Section 119. Section 400.605, Florida Statutes, is
10 amended to read:
11 400.605 Administration; forms; fees; rules;
12 inspections; fines.--
13 (1) The agency department, in consultation with the
14 department agency, shall by rule establish minimum standards
15 and procedures for a hospice pursuant to this part and ss.
16 408.801-408.819. The rules must include:
17 (a) License application procedures and requirements.
18 (a)(b) The qualifications of professional and
19 ancillary personnel to ensure the provision of appropriate and
20 adequate hospice care.
21 (b)(c) Standards and procedures for the administrative
22 management of a hospice.
23 (c)(d) Standards for hospice services that ensure the
24 provision of quality patient care.
25 (d)(e) Components of a patient plan of care.
26 (e)(f) Procedures relating to the implementation of
27 advanced directives and do-not-resuscitate orders.
28 (f)(g) Procedures for maintaining and ensuring
29 confidentiality of patient records.
30 (g)(h) Standards for hospice care provided in
31 freestanding inpatient facilities that are not otherwise
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1 licensed medical facilities and in residential care facilities
2 such as nursing homes, assisted living facilities, adult
3 family care homes, and hospice residential units and
4 facilities.
5 (h)(i) Physical plant standards for hospice
6 residential and inpatient facilities and units.
7 (i)(j) Components of a comprehensive emergency
8 management plan, developed in consultation with the Department
9 of Health, the Department of Elderly Affairs, and the
10 Department of Community Affairs.
11 (j)(k) Standards and procedures relating to the
12 establishment and activities of a quality assurance and
13 utilization review committee.
14 (k)(l) Components and procedures relating to the
15 collection of patient demographic data and other information
16 on the provision of hospice care in this state.
17 (2) In accordance with s. 408.805, an applicant or
18 licensee shall pay a fee for each license application
19 submitted under this part and ss. 408.801-408.819. The amount
20 of the fee shall be established by rule and may not exceed
21 $1,200 per biennium. The agency shall:
22 (a) Prepare and furnish all forms necessary under the
23 provisions of this part in relation to applications for
24 licensure or licensure renewals.
25 (b) Collect from the applicant at the time of filing
26 an application for a license or at the time of renewal of a
27 license a fee which must be reasonably calculated to cover the
28 cost of regulation under this part, but may not exceed $600
29 per program. All fees collected under this part shall be
30 deposited in the Health Care Trust Fund for the administration
31 of this part.
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1 (c) Issue hospice licenses to all applicants which
2 meet the provisions of this part and applicable rules.
3 (3)(d) In accordance with s. 408.811, the agency shall
4 conduct annual licensure inspections of all licensees, except
5 that licensure inspections may be conducted biennially for
6 hospices having a 3-year record of substantial compliance. The
7 agency shall
8 (e) conduct such inspections and investigations as are
9 necessary in order to determine the state of compliance with
10 the provisions of this part, ss. 408.801-408.819, and
11 applicable adopted rules. The right of inspection also
12 extends to any program that the agency has reason to believe
13 is offering or advertising itself as a hospice without a
14 license, but no inspection may be made without the permission
15 of the owner or person in charge thereof unless a warrant is
16 first obtained from a circuit court authorizing such
17 inspection. An application for a license or license renewal
18 made pursuant to this part constitutes permission for an
19 inspection of the hospice for which the license is sought in
20 order to facilitate verification of the information submitted
21 on or in connection with the application.
22 (4)(f) In accordance with ss. 408.801-408.819, the
23 agency may impose an administrative fine for any violation of
24 the provisions of this part, ss. 408.801-408.819, or
25 applicable rules.
26 Section 120. Section 400.606, Florida Statutes, is
27 amended to read:
28 400.606 License; application; renewal; conditional
29 license or permit; certificate of need.--
30 (1) A license application must be filed on a form
31 provided by the agency and must be accompanied by the
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1 appropriate license fee as well as satisfactory proof that the
2 hospice is in compliance with this part and any rules adopted
3 by the department and proof of financial ability to operate
4 and conduct the hospice in accordance with the requirements of
5 this part. The initial application and change-of-ownership
6 application must be accompanied by a plan for the delivery of
7 home, residential, and homelike inpatient hospice services to
8 terminally ill persons and their families. Such plan must
9 contain, but need not be limited to:
10 (a) The estimated average number of terminally ill
11 persons to be served monthly.
12 (b) The geographic area in which hospice services will
13 be available.
14 (c) A listing of services which are or will be
15 provided, either directly by the applicant or through
16 contractual arrangements with existing providers.
17 (d) Provisions for the implementation of hospice home
18 care within 3 months after licensure.
19 (e) Provisions for the implementation of hospice
20 homelike inpatient care within 12 months after licensure.
21 (f) The number and disciplines of professional staff
22 to be employed.
23 (g) The name and qualifications of any existing or
24 potential contractee.
25 (h) A plan for attracting and training volunteers.
26 (i) The projected annual operating cost of the
27 hospice.
28 (j) A statement of financial resources and personnel
29 available to the applicant to deliver hospice care.
30
31
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1 If the applicant is licensed to operate an existing health
2 care provider, the application must be accompanied by a copy
3 of the most recent profit-loss statement and, if applicable,
4 the most recent licensure inspection report.
5 (2) Each applicant must submit to the agency with its
6 application a description and explanation of any exclusions,
7 permanent suspensions, or terminations from the Medicaid or
8 Medicare programs of the owner, if an individual; of any
9 officer or board member of the hospice, if the owner is a
10 firm, corporation, partnership, or association; or of any
11 person owning 5 percent or more of the hospice. Proof of
12 compliance with disclosure of ownership and control interest
13 requirements of the Medicaid or Medicare programs may be
14 accepted in lieu of this submission.
15 (2)(3) A license issued for the operation of a
16 hospice, unless sooner suspended or revoked, shall expire
17 automatically 1 year from the date of issuance. Sixty days
18 prior to the expiration date, a hospice wishing to renew its
19 license shall submit an application for renewal to the agency
20 on forms furnished by the agency. The agency shall renew the
21 license if the applicant has first met the requirements
22 established under this part and all applicable rules and has
23 provided the information described under this section in
24 addition to the application. However, The application for
25 license renewal shall be accompanied by an update of the plan
26 for delivery of hospice care only if information contained in
27 the plan submitted pursuant to subsection (1) is no longer
28 applicable.
29 (4) A hospice against which a revocation or suspension
30 proceeding is pending at the time of license renewal may be
31 issued a conditional license by the agency effective until
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1 final disposition of such proceeding. If judicial relief is
2 sought from the final agency action, the court having
3 jurisdiction may issue a conditional permit for the duration
4 of the judicial proceeding.
5 (3)(5) The agency shall not issue a license to a
6 hospice that fails to receive a certificate of need under the
7 provisions of ss. 408.031-408.045. A licensed hospice is a
8 health care facility as that term is used in s. 408.039(5) and
9 is entitled to initiate or intervene in an administrative
10 hearing.
11 (4)(6) A freestanding hospice facility that is
12 primarily engaged in providing inpatient and related services
13 and that is not otherwise licensed as a health care facility
14 shall be required to obtain a certificate of need. However, a
15 freestanding hospice facility with six or fewer beds shall not
16 be required to comply with institutional standards such as,
17 but not limited to, standards requiring sprinkler systems,
18 emergency electrical systems, or special lavatory devices.
19 Section 121. Section 400.6065, Florida Statutes, is
20 amended to read:
21 400.6065 Background screening.--
22 (1) Upon receipt of a completed application under s.
23 400.606, the agency shall require level 2 background screening
24 on each of the following persons, who shall be considered
25 employees for the purposes of conducting screening under
26 chapter 435:
27 (a) The hospice administrator and financial officer.
28 (b) An officer or board member if the hospice is a
29 firm, corporation, partnership, or association, or any person
30 owning 5 percent or more of the hospice if the agency has
31 probable cause to believe that such officer, board member, or
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1 owner has been convicted of any offense prohibited by s.
2 435.04. For each officer, board member, or person owning 5
3 percent or more who has been convicted of any such offense,
4 the hospice shall submit to the agency a description and
5 explanation of the conviction at the time of license
6 application. This paragraph does not apply to a board member
7 of a not-for-profit corporation or organization if the board
8 member serves solely in a voluntary capacity, does not
9 regularly take part in the day-to-day operational decisions of
10 the corporation or organization, receives no remuneration for
11 his or her services, and has no financial interest and has no
12 family members with a financial interest in the corporation or
13 organization, provided that the board member and the
14 corporation or organization submit a statement affirming that
15 the board member's relationship to the corporation or
16 organization satisfies the requirements of this paragraph.
17 (2) Proof of compliance with level 2 screening
18 standards which has been submitted within the previous 5 years
19 to meet any facility or professional licensure requirements of
20 the agency or the Department of Health satisfies the
21 requirements of this section.
22 (3) The agency may grant a provisional license to a
23 hospice applying for an initial license when each individual
24 required by this section to undergo screening has completed
25 the Department of Law Enforcement background check, but has
26 not yet received results from the Federal Bureau of
27 Investigation.
28 (1)(4) The agency shall require employment or
29 contractor screening as provided in chapter 435, using the
30 level 1 standards for screening set forth in that chapter, for
31 hospice personnel.
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1 (2)(5) The agency may grant exemptions from
2 disqualification from employment under this section as
3 provided in s. 435.07.
4 (6) The administration of each hospice must sign an
5 affidavit annually, under penalty of perjury, stating that all
6 personnel employed or contracted with on or after October 1,
7 1998, who provide hospice services in a facility, or who enter
8 the home of a patient in their service capacity, have been
9 screened.
10 (3)(7) Proof of compliance with the screening
11 requirements of chapter 435 shall be accepted in lieu of the
12 requirements of this section if the person has been
13 continuously employed or registered without a breach in
14 service that exceeds 180 days, the proof of compliance is not
15 more than 2 years old, and the person has been screened, at
16 the discretion of the hospice.
17 (4)(8)(a) It is a misdemeanor of the first degree,
18 punishable under s. 775.082 or s. 775.083, for any person
19 willfully, knowingly, or intentionally to:
20 1. Fail, by false statement, misrepresentation,
21 impersonation, or other fraudulent means, to disclose in any
22 application for voluntary or paid employment a material fact
23 used in making a determination as to such person's
24 qualifications to be employed or contracted with under this
25 section;
26 2. Operate or attempt to operate an entity licensed
27 under this part with persons who do not meet the minimum
28 standards for good moral character as contained in this
29 section; or
30 2.3. Use information from the criminal records
31 obtained under this section for any purpose other than
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1 screening as specified in this section, or release such
2 information to any other person for any purpose other than
3 screening under this section.
4 (b) It is a felony of the third degree, punishable
5 under s. 775.082, s. 775.083, or s. 775.084, for any person
6 willfully, knowingly, or intentionally to use information from
7 the juvenile records of a person obtained under this section
8 for any purpose other than screening for employment under this
9 section.
10 Section 122. Section 400.607, Florida Statutes, is
11 amended to read:
12 400.607 Denial, suspension, or revocation of license;
13 imposition of administrative fine; grounds; injunctions.--
14 (1) The agency may deny or, revoke, or suspend a
15 license, impose a moratorium, or impose an administrative
16 fine, which may not exceed $5,000 per violation, for the
17 violation of any provision of this part, ss. 408.801-408.819,
18 or applicable rules in the manner provided in chapter 120.
19 (2) Any of the following actions by a licensed hospice
20 or any of its employees shall be grounds for action by the
21 agency against a hospice:
22 (a) A violation of the provisions of this part or
23 applicable rules.
24 (b) An intentional or negligent act materially
25 affecting the health or safety of a patient.
26 (3) The agency may deny or revoke a license upon a
27 determination that:
28 (a) Persons subject to level 2 background screening
29 under s.